Eidul Azha falls every year and is one of the leading festivals for Muslims – and celebrated with pomp and show around the world. During this festival, Muslims sacrifice animals. Pakistan will be observing Eidul Azha in the third week of July 2021. The celebrations of this festival during the Covid 19 pandemic are rather challenging because of the record rise in cases in Pakistan. Again, this festival is linked with epidemics of the Crimean Congo Haemorrhagic Fever (CCHF) in Eurasian countries (Pakistan included), resulting in considerable morbidity and mortality.
CCHF is an emerging tick-borne zoonotic viral disease caused by the genus Nairovirus of the Bunyaviridae family. The CCHF virus is responsible for acute and severe haemorrhagic fever. The symptoms include but are not limited to headache, high-grade fever, backache, joint pain, upper abdominal pain, and vomiting. Most human infections develop through the bite of vector ticks, direct contact with raw meat, the blood of livestock or an infected human. Nosocomial infections are also a common source of infection.
The CCHF virus was isolated from numerous tick species, but members of the genus Hyalomma are principal vectors. Its primary hosts are domestic animals, such as cattle, sheep and goats, while high-risk occupations involve animal handlers, veterinary and medical staff attending infected animals and humans.
Since the initial disclosure of CCHF in humans in 1976, sporadic cases have continued to emerge all over Pakistan. From January 2015 to December 2020, the country registered 290 laboratory-confirmed cases of CCHF. A study published in 2019 validated my concerns that CCHF cases would increase in the months following Eidul Azha, which was celebrated in the second week of August that year. The study revealed that 60 percent of CCHF cases recorded from different areas of Pakistan in 2019 were reported in August and September. Keeping in mind the previous upsurging trend of CCHF cases because of Eidul Azha, this year National Institute of Health (NIH) Islamabad issued a red alert preempting an upsurge.
During Eidul Azha, the threat multiplies manifold because of the large-scale transfer of animals for sale from tick-infested rural to urban localities. None/few health checks on the animals and lack of awareness and sensitivity among the public while dealing with sacrificial animals also complicates the issue. Slaughtering of animals by non-professional butchers and that too in open areas with no protective measures leads to the spread of CCHF and other diseases. Last but not least is the lack of appropriate and efficient disposal of blood and carcasses which results in increasing the transmission of the CCHF virus during Eidul Azha because of more frequent animal-to-animal, animal-to-human, and human-to-human contact.
Despite efforts by the government of Pakistan, the upsurge of CCHF remains unrestrained due to the above-discussed factors. I suggest that the government should establish coordination and closer integration among concerned government departments to deal with CCHF. Prevention and control measures are recommended right from the entrance of animals in urban areas to disposal after slaughtering. It needs to start with animal dipping/ direct spraying of animals with arachnicides at each point of entry for tick control. To minimise the risk of CCHF spread, a veterinarian should perform a thorough animal health check before granting entry.
To protect citizens from this infection, local authorities should plan to restrict the free movement of animals once entered and must be kept in a defined market area. Relevant institutes have to pay special emphasis on carrying out awareness campaigns before and during Eid so that the public is aware of the potential dangers. It is of utmost importance to protect the high-risk groups (which includes butchers, shepherds, veterinary doctors, medical doctors, and technicians) by educating and encouraging them to use personal protection equipment (PPE). Use of insect repellents needs to be normalised during Eid days and we must inspect clothing and skin for ticks after dealing with animals.
One crucial aspect is the training of personnel involved in animal slaughter. We should instruct them to follow precautionary measures to avoid direct exposure to animal blood and body fluids during slaughtering. The government has an obligation to enforce laws that make animal slaughter in open areas a felony and ensure that it is carried out in abattoirs. The livestock department has to check the hygiene conditions of existing abattoirs before Eid and ensure no access points are available for birds, rodents and other insects to penetrate.
Proper disposal of blood and remnants of slaughtered animals is an extremely important step in all this process. It should not be disposed of into watercourses or in the open air and adopt safe methods (rendering, landfill, composting and anaerobic digestion). Healthcare workers need to be more careful when attending suspected or confirmed CCHF patients and practise standard infection control precautions. Hospitals and laboratories handling CCHF patients and samples should be ordered to guarantee strict biosafety in their premises to avoid infection spread.
The unavailability of an effective CCHF vaccine for humans and the limited success of vector control actions makes CCHF a high priority area for public health policymakers. The government of Pakistan should dedicate ample resources to prevent and control CCHF. I recommend that local authorities in each district take measures to control vectors and reduce exposure to the virus via contact with the blood or meat of sacrificed animals. Informative drives need to be launched in the most intelligible way, utilising social media platforms, short movies on television, ads on television, radio, hoardings, magazines, and newspapers before and during Eidul Azha.
An immediate plan implementing a surveillance strategy, standard preventive measures, early detection, proper treatment, and timely response is the need of the hour. Without such a plan, the sudden outbreak of CCHF while Covid-19 is already pressuring the country’s healthcare system may pose a serious threat to human lives in Pakistan.
The writer holds a doctorate in Preventive Veterinary Science and works at the Chinese Academy of Agricultural Sciences in Beijing.
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