Healthcare providers, animal handlers need to take extra care
Deaths of two confirmed patients of Crimean-Congo Hemorrhagic Fever (CCHF) involving Punjab province in last 10 days convinced health professionals to stress on the need of strict preventive measures while fearing an outbreak of the deadly infection in the country.
Dr. Sagheer Ahmed, a general surgeon at Victoria Hospital, Bahawalpur, died of the infection at Aga Khan Hospital in Karachi on Saturday while the other patient, a female medical student tested positive for CCHF and died at Victoria Hospital Bahawalpur some 10 days back. Dr. Sagheer contracted infection during management of the female patient at the Victoria Hospital.
The appearance of confirmed cases of CCHF in Bahawalpur calls for serious attention from all stakeholders including experts from health department and livestock department, said Additional District Health Officer Dr. Muhammad Najeeb Durrani while talking to ‘The News’ on Sunday.
He added that the CCHF has an infrequent incidental appearance in Pakistan and it can appear anywhere but at the most risks are animal handlers and the health care providers. “The most important thing is to create awareness among high risk groups and general public to avoid losses.”
Studies reveal that the CCHF is caused by Nairovirus of the Bunyaviridae family and can be transmitted to humans by the bite of Hyalomma tick that is mostly found on the skin of animals including goat, sheep or cattle. The CCHF is also caused by direct contact with the blood of an infected animal or human. Exposure to blood or tissue of the infected animal during or post slaughtering and direct contact with blood or secretions of infected person may also cause transmission.
Dr. Durrani said that CCHF is caused by the bite of an infected tick and when an infected tick having virus bites an animal, the animal usually goat, sheep or cattle gets infected by developing fever having virus in its blood. At that point in time the virus is circulating in the blood of that animal and when it is slaughtered, the person slaughtering the animal gets infected or the animal handler coming in close contact with the infected animal contracts infection, he said.
He explained that the person slaughtering the animal or living in close contact with the infected animal develops fever. As the Congo fever virus circulates in his blood, his platelets get depleted resulting in haemorrhages, he said.
After infection of the first human, comes the most deadly feature as the Index case is usually only one but disease starts human to human transmission, that is the most deadly feature of the infection, said Dr. Durrani.
He explained that in most of the cases, patient's attendant or health care provider gets the virus inadvertently mostly on his hands and takes to ingest by touching his own mouth, eyes or nose. “The virus in this secondary infection starts multiplying itself in the new host rapidly and this mode of transmission is called nasocomial transmission.”
He said after appearance of a case, every person attending the patient is at risk. What is needed is to establish and develop Infection Control Protocols in all healthcare settings, he said.
He added that everyone must understand that the only measure to stop the spread of disease is barrier nursing and basic bio-safety measures. The suspected persons including attendants and health care providers should be monitored for developing fever and if they develop fever, they must be admitted to hospitals in isolation for test and immediate response, he said.
He added that a laboratory meeting all international bio safety levels is needed to test the CCHF virus and in Pakistan, only NIH enjoys this BSL-3 status. The required blood samples from the suspected patients must be taken by a trained lab attendant and transported to laboratory in a highly safe triple packing in a carrier reserved for transporting highly contagious material with label, he said.
He said the disease is endemic in Balochistan and in regions having borders with Afghanistan such as Loralai, Qila Abdullah, Chaman and Zhob however its cases have also been reported from Karachi, Mirpur AJK, Peshawar, Multan, Attock, Hazara division and Rawalpindi.
He said health departments and hospitals should create awareness among its employees, particularly the health care providers to know the importance of barrier nursing and bio safety protocols.
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