Maqsood Ahmad | Department of Allied Health Sciences, UHS, Lahore &
Muhammad Saeed | Department Of Pathology, PIC, Lahore
Since the existence of human on this earth, is encountering different types of challenges from nature. In medical, sometime it appears as bird flu, sometimes as dengue hemorrhagic fever and also as Ebola virus but this time very lethal challenge is arising in shape of Crimean-Congo Hemorrhagic Fever (CCHF).
CCHF is widespread tick-borne viral disease that is endemic in Africa, Balkans, Middle East and now also in Asia. Therefore it is also called “African Countries Disease”. This disease was diagnosed in 1944 in Crimea, so named as Crimean-Congo Hemorrhagic Fever. This zoonotic disease virus is member of Bunyaviridae family of RNA viruses. While clinical disease is rare in infected animals, with mortality rate of 10-40%.
This is not new in Pakistan; seven patients were expired in 2002 including one lady doctor and four children. Last year 56 cases of CCHF were declared in Baluchistan, from which 13 patients were passed away. Daily Naway-e-Waqat reported that recently in Bahawalpur (Lodhraan) sixty-two suspected cases of CCHF were found. After further investigations in National Institute of Health, Islamabad fifty-two was declared negative. Two staff nurses are also suffering with CCHF. Few days ago a doctor from same area expired with this disease. This dilemma has rushed a wave of fear in health care providers and establishment as well.
Transmission
This disease is caused by Hyalomma tick. CCHF virus is transmitted to people either by tick bites, through infected animal blood or tissues during after slaughter. Majority of cases have occurred in people involved in livestock industry.
Human-to-human transmission can occur from close contact with infected blood, organs or other bodily fluids. Hospital-acquired infections also occur due to improper sterilization of medical equipment, reuse of needles.
Signs and symptoms
Duration of incubation period (IP) depends on mode of acquisition of virus. Following infection by tick bite, IP is usually one to three days, with maximum of nine days. IP following contact with infected blood or tissues is usually five to six days, documented maximum of 13 days.
Symptoms appear sudden with fever, myalgia, dizziness, neck pain and stiffness, backache, headache, sore eyes and photophobia, nausea, vomiting, diarrhea, abdominal pain and sore throat, followed by sharp mood swings and confusion. After two to four days, agitation is replaced by sleepiness, depression and lassitude with detectable hepatomegaly.
Other clinical signs include tachycardia, lymphadenopathy and a petechial rash on mouth, throat, and skin. This converts into larger rashes and hemorrhagic phenomena. Severely ill patients may experience rapid kidney deterioration, sudden liver failure or pulmonary failure after fifth day of illness.
The mortality rate from CCHF is approximately 30%, with death occurring in second week of illness. In patients who recover, improvement generally begins on 09-10 days of disease.
Diagnosis
CCHF virus can be diagnosed by following laboratory techniques;
- Enzyme-Linked Immunosorbent Assay (ELISA)
- Serum Neutralization;
- Reverse Transcriptase Polymerase Chain reaction (RT-PCR) Assay
- Virus isolation by cell culture.
RT-PCR is most sensitive technique with highest specificity and lowest sensitivity. All samples should be treated as highly as highly infectious material. If samples have been inactivated with virucides, gamma rays, formaldehyde, heat they can be manipulated in a basic biosafety environment.
Treatment
Commonly symptomatic treatment is advised. Anti-viral drug like ribavirin is also effective.
Prevention and Control:
Control in animal and tick:
To minimize incidence of CCHF is really tough task. But we can prevent it by proper sanitation and using insecticides in livestock.
Still vaccines are not available for use in animals.
Control in human:
Mouse brain-derived vaccine was prepared against CCHF, but not any valuable results were found.
In absence of treatment, vaccine, only way for saving society is prevention of CCHF by public awareness campaigns, educating people by risk factors.
Public health advice should focus on several aspects:
Use full body and light colored clothes, approved acaricides and repllent on clothing and skin respectively, regular examine of clothes and animals for ticks, gloves and other protective clothes in livestock setting, use of pesticeides regularly, avoid contact with infected people, wear PPE while taking care of infected people and wash hands before and after caring the victimized. Before and during slaughter process animal must be examined by veterinary doctors to ensure medical fitness of animal.
Controlling infection in health-care settings:
All the people suspected/confirmed for CCHF, medical laboratory specimens for CCHF analysis must be handled by trained staff as highly infectious. As a precautionary measure, health-care providers caring for patients immediately outside the CCHF outbreak area should also implement standard infection control precautions.
Recommendations for infection control while providing care to patients with suspected or confirmed CCHF should follow guidelines developed by World health organization.
