NIH issues pre-Eid advisory for prevention of Congo fever

Islamabad:In view of the extensive movement of sacrificial animals ahead of Eidul Azha, the National Institute of Health (NIH) has issued an advisory

alerting different stakeholders including human and animal healthcare authorities to take timely steps for prevention and control of Crimean Congo Hemorrhagic Fever (CCHF) during the next few months.

The movement of animals significantly enhances the risk of CCHF disease transmission due to increased human-animal interaction. CCHF is caused by a tick -borne virus with the case fatality rate ranging from 10- 40%. Ticks serve as both the reservoir and vector for the virus. Numerous wild and domestic animals, such as cattle, buffaloes, goats and sheep are silent carriers of this virus and the adult ticks get infected by feeding on these animals.

CCHF cases have been reported from almost all geographical regions of Pakistan. Since 2015, a total of 643 laboratory confirmed cases have been reported to NIH across Pakistan with a mortality rate of around 25 per cent. Over these years, more than 70 per cent of the cases (460) were reported from Balochistan, followed by Sindh and Punjab.

In animals, transient fever is the only sign which often goes unnoticed. In humans, the onset is sudden with initial symptoms of fever, headache, back pain, joint pain and vomiting. As the illness progresses, large areas of severe bruising, bleeding from nose and gums, and injection sites may be observed beginning on about the fourth day of illness and lasting for about two weeks.

Healthcare workers along with animal herders, veterinarians, para-veterinary staff, livestock workers, agriculture workers, animal merchants, butchers and slaughterhouse workers are at higher risk of CCHF. Apart from them the close contacts caring the patients and persons involved in burial practices are also at risk of getting infection.

General supportive care with treatment of symptoms is the main approach to managing CCHF. The antiviral drug Ribavirin (oral and IV) has been used to treat CCHF infection with apparent benefit. There is currently no vaccine available for human and the only way to reduce infection is by raising awareness.

In advising the general public, NIH has called for reducing the risk of infestation from tick-to-human by wearing protective light-coloured clothing (long sleeves, long trousers) during visits to the animal market/’mandi’ to allow easy detection of ticks and their removal. The risk of infection transmission from animal-to-humans can be controlled by monitoring sacrificial animals at entry points/markets and making sure that every animal is treated with approved acaricides body sprays at least a week ahead of scheduled slaughtering. Wearing gloves and other protective clothing while handling animals or their tissues, notably during slaughtering, butchering and culling procedures in slaughterhouses or at home is also important.

According to the advisory, the risk of human-to-human transmission can be avoided by avoiding close contact with suspected patients, wearing gloves and protective equipment when taking care, and washing hands frequently after caring or visiting ill people. Safe burial practices include spraying the dead body with 1:10 liquid bleach solution, wrapping the body in a winding sheet sprayed with bleach solution, placing the body in a plastic bag sealed with adhesive tape, disinfecting the transport vehicle, and burning all clothing of the deceased.

Health-care workers caring for suspected patients or handling their specimens should exercise standard plus contact infection control precautions. Physicians should exercise high degree of suspicion while examining patients with likely symptoms. Lab tests for CCHF should only be recommended to those who fulfill criteria of suspected case definition available at NIH website (www.nih.org.pk). Sample from suspected CCHF case should be collected by trained phlebotomist with full preventive measures using appropriate personal protective equipment, the advisory adds.