PRO/AH/EDR> Crimean-Congo hem. fever – Asia (21): Pakistan (KP) fatal


A ProMED-mail post
ProMED-mail is a program of the
International Society for Infectious Diseases

Date: Sun 6 Aug 2023
Source: Dawn [edited]

With Crimean-Congo haemorrhagic fever infecting 14 people and killing
4 in Khyber Pakhtunkhwa during the last one and a half months, health
experts have called for preventive measures against the tick-borne

The cases of Congo fever have been reported after Eidul Azha at the
end of June [2023], according to a health department report.

It said 2 people killed by the infection were Afghan nationals, while
the other 2 belonged to Khyber tribal and Charsadda districts.

The report said 3 of the confirmed Congo fever cases were Afghan
nationals, while 5 were residents of Peshawar district, 2 of Lakki
Marwat district and one of Charsadda, Khyber and Kohat districts

The experts said the disease was spread by ticks from animals to
humans or from humans to humans, so the people went down with it due
to contact with sacrificial animals at cattle markets ahead of and
during Eid days.

Former medical specialist at the Lady Reading Hospital Prof Khalid
Mahmood told Dawn that healthcare personnel were at risk from the CCHF
during the provision of care to patients, so “standard precautions and
patient isolation” were essential for the prevention of the disease.

He said no specific treatment was available for the potentially deadly
disease, so its prevention was of paramount importance.

“Isolation of patients and supportive management are the mainstay of
treatment,” he said.

Prof Khalid said the Congo fever was usually transmitted by ticks but
it could also spread through contact with viraemiac animal tissues
during and immediately post-slaughter of animals.

He said the main preventive measure included the avoidance of tick
bites and exposure to tick infested animals as well as the use of
personal protective equipment during risky environments and its
control in animals by using insecticides in livestock. The expert said
goats, sheep and hares served as the main hosts for the virus.

He said the disease’s spread was common immediately after the Eidul
Azha festival was over and that the virus was transmitted from
infected people to others by contact with infected blood or body

“Animals originating from endemic areas may be treated with pesticides
2 weeks before the slaughter to inhibit possible tick infestation,” he

Prof Khalid said gloves and PPE should be used by the people handling
animals in endemic areas, while the outer side of the hide should
never touch the surface of animal body and internal organs.

He added that butchers should not handle the hide without gloves.

“The waste and blood of animals should not be disposed of into streams
and watercourses, but methods such as rendering, landfill and
composting should be adopted to prevent the spread of the Congo
fever,” he said.

The medical expert said antiviral drugs like Ribavirin had been tried
both for prevention and treatment with no strong evidence in favour of
its use.

He said patients generally had high fever and bleeding episodes and
might get secondary infections.

“Vaccination of the exposed population in future and eradication of
the tick population from the animals may lead to significant reduction
in the disease burden in the endemic areas,” he said.

Former medical specialist at the LRH Prof Syed Amjad Taqweem, who
currently works at the Health Net Hospital, Hayatabad, told Dawn that
laboratory tests used to diagnose CCHF included reverse
transcriptase-PCR, immunofluorescence assay, antibody (IgG, IgM) and
antigen-capture Elisa, and virus isolation.

He said suspected patients of CCHF were primarily diagnosed by RT-PCR,
which provided the highest detection sensitivity to active infection
at the earliest.

Prof Taqweem recommended better awareness of the viral disease among
the people as well as those handling animals.

“Suspected patients should be tested immediately and if they turn out
to be confirmed cases, they should be isolated immediately,” he said.

He said the Congo fever was directly related to animal handling.
“Ticks live in hot and humid environments, so animal migration takes
place for Eidul Azha transmitting the infection to human beings. It is
dangerous because of the high death rate,” he said.

[Byline: Ashfaq Yusufzai]

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