CRIMEAN-Congo hemorrhagic fever (CCHF), a deadly tick-borne viral hemorrhagic fever, is endemic in certain parts of Africa, Russia, Central Asia, and Pakistan. Its severe complications and highly infectious nature make it akin to the Asian Ebola virus. In Pakistan, CCHF is predominantly found in the rural province of Baluchistan, where most cases originate. The first case of CCHF in Pakistan was reported in 1976. Between 1976 and 2010, there were 14 cases, but the virus has since become more prevalent. As of June 2023, six deaths have been reported, highlighting the persistent threat of CCHF in Pakistan.
CCHF is an emerging zoonotic disease with no specific treatment or vaccine, making its management challenging. The incidence of CCHF has been rising rapidly, particularly in the World Health Organization-Eastern Mediterranean Region (WHO-EMR), where Pakistan ranks fourth in reported cases. Health officials in Pakistan are particularly concerned about the spread of the virus ahead of the Muslim festival of Eid ul-Adha, when the handling of livestock significantly increases.
During Eid ul-Adha, hundreds of thousands of goats, cows, and sheep are transported and prepared for slaughter. This increase in animal handling and fresh meat processing heightens the risk of humans contracting CCHF. The virus causes no symptoms in livestock but can be transmitted to humans through tick bites or contact with infected animal blood or tissues during and immediately after slaughter. CCHF, endemic in parts of Africa, the Balkans, the Middle East, and Asia, has a fatality rate of up to 40%. Spread through ticks and contact with infected fluids, it poses high risks for livestock workers. The Pakistan Agricultural Research Council advises precautions: avoiding tick-infested animals, proper disposal of offal, wearing protective clothing, and using tick repellent. CCHF, first identified in 1944 and 1969, presents symptoms 1-9 days after a tick bite or 5-6 days after contact with infected tissues. Treatment focuses on supportive care and preventing secondary infections.
Preventive measures are crucial to controlling the spread of CCHF. People should avoid animals with ticks, select only tick-free animals for sacrifice, and apply anti-tick sprays before bringing animals to markets. Handling ticks with bare hands should be avoided, and offal should be properly disposed of, either by burying or by municipal services. Wearing full-sleeved, brightly colored clothing and using tick repellent before visiting animal markets can help identify and repel ticks. Reducing unnecessary visits to animal markets and opting for domestic animals for sacrificial purposes can also lower the risk. Post-slaughter, thorough cleaning with disinfectants is essential.
Pakistan faces numerous communicable and non-communicable diseases, with CCHF being one of the most fatal. Rapid climate change due to industrial, occupational, and agricultural activities is considered a major factor in the emergence and re-emergence of CCHF in Pakistan. The country experiences biannual peaks of the disease between March-May and August-October. To combat this, the government should enhance vertical programs for zoonotic disease control, improve coordination between health departments, and collaborate with international organizations such as the World Organization for Animal Health (OIE). By implementing these measures, Pakistan can better manage and mitigate the impact of CCHF.
— The writer is retired officer of Sindh Govt.
