Crimean Congo hemorrhagic infection is a neglected viral
infection in Pakistan .
Our general public is oblivious of this infection. According to World Health
Organization cases are reported throughout the year in endemic Pakistan . From
2012-2014, 200 cases were reported with 45 deaths (WHO, EMRO, Surveillance,
forecasting and response, Crimean-Congo haemorrhagic fever in Pakistan , 2015).
Last year more than 24 deaths were reported (PRO/AH/EDR, Crimean-Congo hem.
fever - Pakistan
(19), 20151106.3770944, Nov., 2015). The first case of 2016 was reported in
March and till now more than seven cases have been reported from our region. A
new case has emerged from Rawalpindi
area last week. The patient was a butcher by profession. This toll will rise
since this infection rate increases from June to October. This may be due to
the increased number of cattle reared for Eid ul Azha during this time period.
Hard ticks (pissu),
especially Hyalomma ticks, act as
both reservoir and vector of this virus. These ticks infest cattle, sheep,
camels, goats or hares, and from here human can make contact with this virus.
Virus is essentially spread through tick bite while human to human transmission
is rare. Humans can get this virus through infected blood or body fluids of
infected patients. Although the transmission routes of this virus are not many
yet it is an important infection to control because of high death rate during
an epidemic season. Death rates can increase from 9-50%. With no vaccine
available for humans or animals, treatment is basically of supportive nature
where fluid balance is critical to maintain. Ribavirin can be used alongside controlling
any secondary infections.
Hard Ticks. Their four morphological stages; (left to right) larva, nymph, adult male and female. Beat 'em!
Taken from: http://itg.author-e.eu/Generated/pubx/173/ectoparasites/ticks.htm
Documented
spread of CCHF has also occurred in hospitals due to improper sterilization of
medical equipment, reuse of injection needles, and contamination of medical
supplies. This point brings to distressing news for me. In last week of July,
Dr. Saghir Sameja died after he contacted CCHV from a patient while operating
on her. Another doctor, Dr. Omar also contacted this virus. Their patient, the
nurse, was said to be a wife of a cattle trader. The doctors might have caught
this virus while they came in contact with the infected blood of the patient.
There is an
interesting history in naming of this virus. Russian authorities deployed their
soldiers to harvest crops instead of the peasants in Crimea
in 1944. Here some 200 Russian soldiers contacted the “Crimean Hemorrhagic Fever”
named after the place due to tick bites while staying in open fields. After
many failed attempts, this virus was isolated in a renowned Russian
virologist’s lab in 1967. While almost a decade ago a virus was isolated from a
child in Democratic Republic of Congo in 1956 and hence named Congo Virus. Now
the virus from 1967 was sent to Rockefeller Foundation Virus Laboratory (RFVL)
in New York and was found close to Congo virus. So
the naming of this virus started in 1969 by The International Committee on
Taxonomy of Viruses [ICTV] and proposed the name "Congo-Crimean
hemorrhagic fever virus", but the Russians kept insisting on
"Crimean-Congo hemorrhagic fever virus". After a long diplomatic
standstill, and against all principles of scientific nomenclature based on
priority of publication and of virus isolation, the “Crimean-Congo hemorrhagic
fever virus” was finally adopted as the official name in 1973 (PRO/AH,
Crimean-Congo hem. fever: background, 20150309.3217736, 2015).
There is a lack
of knowledge and practices to keep animals safe from getting infested by ticks.
Because sacrificial animals are traded between countries hence the chance of
spread of this infection among countries is very likely. There should be
stricter practices to treat animals at entry points both at inter and
intra-country levels. Medical practitioners require more training and
protection to remain safe. With a growing population, this country requires
preplanning and intensive surveillance to control any epidemic that may become
a burden on economy as well as on people. Advisor to CM Punjab on Health,
Khawaja Salman Rafique has constituted a team to look into this matter. Let us
see what measures will be taken to control any further spread of this virus.
PRECAUTIONS:
Here are few points that should be
followed by general public.
- Wear full clothes while going to animal markets for purchase of cattle.
- Try not to use baggy clothes while coming in contact with the animals.
- Keep looking for any ticks around you.
- Use tick repellents like DEET, Autan or permithrin before handling cattle or going to open grassy places.
- Also use these repellents while going on hiking etc and try not to walk on long grass.
- Cattle must be treated with tick repellents to control any spread of ticks.
- This may seem gruesome but it is important to treat the body of dead patient with diluted bleach. Also, thick gloves must be used in washing the body so as to minimize any body fluid contact with the persons handling it.
- Any contact with the body fluid of suspected patients must be avoided.
- And our medical practitioners need extra care while handling any suspected patient of hemorrhagic fever.
Hopefully this virus will not
spread and our Eid ul Azha time period will remain safe from it!
