Dr Abdul Razak Shaikh
CRIMEAN-Congo hemorrhagic fever (CCHF), a tick-borne viral hemorrhagic fever, is endemic to certain parts of Africa, Russia, Central Asia and Pakistan. Due to its deadly complications and highly infectious nature, CCHF virus can be considered the Asian Ebola virus. In Pakistan, CCHF is endemic in the province of rural Balochistan and most cases reported in the country originate from this area. In 1976 the first case of Congo Fever virus was surfaced in Pakistan. During 1976-2010 there were 14 cases reported. Since then, this deadly CCHF virus is increasing. Six cases were also reported in Karachi this year. There is no specific treatment or vaccine against CCHF and it is an emerging zoonotic disease in many countries. Recently, the incidence of CCHF is increasing rapidly in the countries of the World Health Organization-Eastern Mediterranean Region (WHO-EMR). Pakistan is as number 4 in the overall CCHF ranking cases in WHO-EMR. Health officials in Pakistan have urged people to beware of livestock bearing ticks that spread a deadly fever, ahead of the Muslim festival of sacrifice. The government has issued annual safety guidelines as hundreds of thousands of goats cows and sheep are being transported and readied for slaughter during the Eid ul-Adha festival.
The increase in the handling of animals and fresh meat during the festival raises the risk of humans catching a tick-borne viral disease called Crimean-Congo hemorrhagic fever (CCHF). The CCHF viral disease causes no symptoms in livestock, but spreads to people from ticks or through contact with infected animal blood or tissues during and immediately after slaughter. According to the World Health organization, it is endemic in Africa, the Balkans, the Middle East and Asian countries where the ticks are found. The disease is fatal in up to 40 percent of cases. The disease can also spread between humans from close contact with the blood, secretions, organs or other bodily fluids. Guidelines issued by the Pakistan Agricultural Research Council say, livestock farmers, abattoir workers, butchers, veterinary and para-veterinary staff is at particularly high risk of acquiring the disease. Suggested precautions include keeping away from animals with ticks, disposing of offal properly and ensuring limbs are fully covered when going to markets. Wearing brightly coloured clothes can also mean ticks are easily spotted. Tick repellent should also be used, and slaughter areas thoroughly disinfected. The guidelines also say meat should not be handled with bare hands, children should be kept away from animals and only professional butchers should be used for slaughter. Across the border in Afghanistan, health officials have said they have seen a rise in CCHF cases recently as the drought has forced farmers to move livestock from rural parts of the north and west to other parts of the country. The first six months of this year, saw 125 cases and 18 deaths in Afghanistan. CCHF was first described in Crimea among soldiers and agricultural workers in 1944, and in 1969 it was recognized that the virus causing the disease was identical to a virus isolated from a child in Congo in 1956.
Usually, symptoms appear in one to nine days after the tick bite. If coming in direct contact with infected animal blood or tissues, symptoms usually appear after five or six days. Initial symptoms include a sudden high fever, aching muscles, abdominal, back and joint pain, headache, vomiting, diarrhea, dizziness, sore eyes and throat, and red spots on the palate (roof of the mouth). Other symptoms may include jaundice, mood swings, confusion, aggression and sensitivity to light. The infection progresses to hemorrhaging (bruising, nosebleeds, blood in the urine and feces, and bleeding from the gums) which usually starts two to four days after the initial symptoms and lasts approximately two weeks. Crimean-Congo Hemorrhagic Fever may be fatal. Treatment includes supportive care of symptoms and eliminating secondary infections. We can prevent ourselves from this deadly virus by getting measures. Keep away from the animals having ticks. Only select tick-free animals for sacrificial purposes. And apply anti-tick sprays on animals before bringing them to the animal market. Do not handle or try to pick ticks with bare hands from animals. The offal and leftover of animals must be disposed-of properly. Like burying and handing over offal to municipal corporation staff. When going to animal markets, always wear full sleeve and bright colour clothes. It is easy to identify ticks on bright colours and use tick repellent before visiting animal markets. Avoid unnecessary visit to the animal market and it is better to have domestic animals for sacrificial purposes. Do not handle meat with bare hands. And keep children away from animals. After animal slaughtering, wash the area thoroughly using disinfectants
Pakistan is being hit by communicable and non-communicable diseases over time. Among these, tick-borne viral disease, Crimean-Congo hemorrhagic fever (CCHF) is one of the most fatal infections. Rapid climate change aroused by industrial, occupational, and agricultural activities to support the ever-growing human population has been considered the single most causative basis for emergence or re-emergence of CCHF in Pakistan, where it has biannual peaks between the months of March-May and August-October. We suggest that the Government of Pakistan should focus its efforts on vertical programs for the control of zoonotic diseases, coordination and closer integration of health departments, collaboration with intergovernmental organizations such as the World Organization for Animal Health (OIE), implementation and monitoring of policies for effective surveillance, fostering of collaboration among infectious disease researchers, informative campaigns that target the general public or animal handlers in the weeks before the festival, and vector control programs. Moreover, collaborative efforts among endemic countries will further strengthen the CCHF virus control programme. WHO is working with partners to support CCHF surveillance, diagnostic capacity, and outbreak response activities in Europe, the Middle East, Asia, and Africa.
— The writer is retired officer of Sindh Govt.
Dr Abdul Razak Shaikh