Islamabad: The Office of the District Health Officer Islamabad has issued an advisory for the prevention and control of Crimean-Congo Hemorrhagic Fever (CCHF) after reports of the death of a doctor by the infection in Quetta who was among the 11 healthcare providers infected after an outbreak of CCHF at a Sandeman hospital in Balochistan Province.
The advisory issued by the DHO Islamabad Dr. Muhammad Zaeem Zia states that cases of CCHF have been reported in Balochistan province recently and the number of individuals displaying symptoms of this condition is on a notable upswing. In light of this surge in CCHF cases, it is crucial for our community to adhere to the preventive measures, endorsed by public health experts, to effectively curb the transmission of this condition.
Dr. Zaeem expressed to ‘The News’ that the advisory has been issued for information and there must not be any panic. All we need to do is learn about CCHF and learn what its symptoms are and how to avoid these. The DHO office under the Ministry of NHSRC believes information is an important tool to be spread among people to avoid any panic, he said.
He explains that the CCHF outbreaks constitute a threat to public health services as the virus can lead to epidemics, has a high case-fatality ratio (10–40%), potentially results in hospital and health facility outbreaks, and is difficult to prevent and treat. Crimean-Congo hemorrhagic fever is found in Eastern Europe, the Mediterranean, Parts of Asia, Africa, the Middle East, and the Indian subcontinent. In Pakistan, CCHF was first reported in 1976, with sporadic cases occurring since then.
Talking of transmission, he said the Ixodid (hard) ticks, especially those of the genus, Hyalomma, are both a reservoir and a vector for the CCHF virus. Numerous wild and domestic animals, such as cattle, goats, sheep and hares, serve as amplifying hosts for the virus. Animals become infected by the bite of infected ticks and the virus remains in their bloodstream for about one week after infection, allowing the tick-animal-tick cycle to continue when another tick bites.
The CCHF virus is transmitted to people either by tick bites or through contact with infected animal blood or tissues during and immediately after slaughter. The majority of cases have occurred in people involved in the livestock industry, such as agricultural workers, slaughterhouse workers and veterinarians.
Human-to-human transmission can occur resulting from close contact with the blood, secretions, organs or other bodily fluids of infected persons. Hospital-acquired infections can also occur due to improper sterilization of medical equipment, reuse of needles and contamination of medical supplies, states the advisory.
The advisory explains that the onset of symptoms is sudden, with fever, muscle aches, dizziness, neck pain and stiffness, backache, headache, sore eyes and photophobia. There may be nausea, vomiting, diarrhoea, abdominal pain and sore throat early on, followed by sharp mood swings and confusion. After two to four days, the agitation may be replaced by sleepiness, depression and lassitude, and the abdominal pain may localize to the upper right quadrant, with detectable hepatomegaly (liver enlargement). As the illness progresses, large areas of severe bruising, severe nosebleeds, and uncontrolled bleeding at injection sites can be seen, beginning on about the fourth day of illness and lasting for about two weeks.
There is usually evidence of hepatitis, and severely ill patients may experience rapid kidney deterioration, sudden liver failure or pulmonary failure after the fifth day of the illness. The mortality rate from CCHF is approximately 30%, with death occurring in the second week of illness. In patients who recover, improvement generally begins on the ninth or tenth day after the onset of illness.
On prevention and control, the advisory states that agricultural workers and others working with animals should use insect repellent on exposed skin and clothing. Insect repellents containing DEET (N, N-diethyl-m-toluamide) are the most effective in warding off ticks. Wearing gloves and other protective clothing is recommended.
It is important for healthcare workers to use proper infection control precautions to prevent occupational exposure. In the absence of a vaccine, the only way to reduce infection in people is by raising awareness of the risk factors and educating people about the measures they can take to reduce exposure to the virus. To reduce the risk of human-to-human transmission, the advisory states that individuals should avoid close physical contact with CCHF-infected people, wear gloves and protective equipment while taking care of ill people and wash hands regularly after caring for or visiting ill people.
To control infection in healthcare settings, healthcare workers should implement standard infection control precautions. These include basic hand hygiene, use of personal protective equipment, safe injection practices, and safe burial practices. Samples taken from suspected CCHF patients should be handled by trained staff working in suitably equipped laboratories.
Dr. Zaeem concluded that it is of utmost importance that we raise awareness and implement these guidelines to prevent the further spread of CCHF within our community. We must remain vigilant and take all necessary precautions to protect ourselves and our loved ones, he said.