Ebola virus disease in DRC: need for enhanced preparedness and readlness measures in EMR

The World Health Organization [WHO] was notified, on 11 May 2017, by the Ministry of Health [MoH] of the Democratic Republic of Congo [DRC] of a laboratory-confirmed case of Ebola virus disease [EVD]. Since 22 April 2017, 9 suspected cases including 3 deaths [CFR: 33.3%] were reported in the northern part of the country. The current situation calls for stepping up preparedness and readiness measures in the countries of the Eastern Mediterranean Region of WHO to prevent any importation of cases

Awareness and practices regarding crimean-congo haemorrhagic fever among animal handlers in peri-urban karachi and rural areas of Sindh

Objective: To assess the awareness and practices among animal handlers regarding Crimean-Congo haemorrhagic fever and compare the awareness and practices among different groups of animal handlers in Sindh, Pakistan

Methods: Cross-sectional study conducted among 150 animal handlers with the response rate of 93%, including sellers, butchers, transporters, caretakers and veterinary doctors in peri-urban Karachi and rural areas of Sindh. Quota sampling technique was adopted to select the study population. The duration of the study was three months from August 2016 to October 2016; this period includes selling of animals of sacrifice for Eid-ul-Azha in temporary established markets. Data was entered into Epidata 3.1 and analysed using SPSS version 23

Results: A total of 150 participants enrolled in the study. The mean age of the study participants was 35 +/- 7.5 years. Among the subjects, 48% were uneducated. Overall, 52% of the participants were aware about the Crimean-Congo fever. The hygiene practice among animal handlers was found to be washing; 40.7%, bathing; 27.3% and tick removal; 11.3%. The awareness of Crimean-Congo fever among animal caretakers was 50%, animal sellers; 43.3%, transporters; 36.7% and butchers; 30% [p<0.001]

Conclusion: The awareness among animal handlers was on the lower side among animal sellers, transporters, butchers and animal care taker and there is a need to improve the awareness level among these groups regarding practices, hygiene of the animal as well as handling procedures

unusual case of crimean congo hemorrhagic fever: prolonged bleeding with successful recovery

Crimean Congo Hemorrhagic Fever [CCHF] is a tick-borne viral disease with a major reservoir in both domestic and wild animals. In Pakistan, it is endemic largely in rural areas and most cases occur in spring and autumn. Recently, cases are being reported throughout the year, including winter months, with some even from urban areas. Death from CCHF is most likely to occur during the hemorrhagic phase. We report a case presenting from an urban locality in December. Clinical presentation was characterized by a prolonged hemorrhagic phase and a delayed normalization of platelet counts

case of brucellosis mimicking Crimean-Congo hemorrhagic fever

Brucellosis is a zoonotic disease caused by Brucella spp. that is transmitted to humans by the ingestion of unpasteurized milk and other dairy products from infected animals or through close contact with secretions. Crimean-Congo hemorrhagic fever [CCHF] is a tick-borne disease caused by a virus that is transmitted to humans by ixoid tick bites, contact with blood and tissue of infected animals or contact with infected humans. The symptoms of brucellosis are non-specific; it can mimic other diseases. In this paper, we present a case of brucellosis that was initially evaluated as CCHF. We emphasize that brucellosis should be considered in the differential diagnosis of CCHF, especially in endemic countries

CCHF In the EMR: Call for strategic actions for control

A recent sub-regional meeting held from 7-9 December in Muscat, Oman on Cri-mean Congo haemorrhagic fever [CCHF] concluded with a clarion call for developing effective strategies for its control in the Eastern Mediterranean Region of WHO

CCHF remains entrenched in Pakistan

In 2013, Pakistan has probably seen one of the worst outbreaks from Crimean- Congo haemorrhagic fever [CCHF]. As of December 2013, a total of 100 cases were reported across the country including 20 deaths [CFR: 20%]. 64 of these cases have been laboratory-confirmed

CCHF in Pakistan

In recent time, there has been a seasonal spike in the number of human infections with Crimean-Congo Haemorrhagic Fever [CCHF] virus in Pakistan. Between epidemiological week 8 and week 29 of this year, the health authorities in Pakistan reported a total of 40 cases of CCHF to WHO. There were 11 related deaths [CFR: 27.5%] and 22 of the cases were laboratory-confirmed. WHO is working closely with the health authorities to control this upsurge

Crimean-Congo Hemorrhagic Fever in Pakistan, 2014

In 2014, Pakistan reported 128 suspected cases of Crimean-Congo hemorrhagic fever [CCHF]. Among these cases, 52 were laboratory confirmed cases. There were 36 related deaths [CFR 28%]. The first CCHF reported cases were during week 8 in this year, and up to week 42 there were weekly cases reported from different Provinces in Pakistan

Crimean-Congo haemorrhagic fever in Pakistan

Since January 2014, Pakistan has reported a cumulative total of 154 cases of Crimean-Congo hemorrhagic fever [CCHF] including 40 related deaths [CFR 26%]. Of these reported cases, a total of 69 cases were laboratory confirmed. Suspected cases of CCHF were first reported during epidemiological week number eight. Subsequently, at least one case has been reported every week from different parts of the country

Crimean-Congo haemorrhagic fever [CCHF] in Pakistan

Crimean-Congo haemorrhagic fever [CCHF] continues to spread in Pakistan with new infections being reported in areas that are not known foci for the disease. In 2012, a total of 60 cases of CCHF including 16 deaths were reported in the country, while 3 new cases including 1 death have so far been reported in 2013 from Pakistan

CCHF continues to claim lives in Pakistan

Since it was first reported in the weekly epidemiological monitor- vol-6, issue-13, dated 31 March 2013, Crimean-Congo haemorrhagic fever [CCHF] continues to claim more lives in Pakistan with new infections reported almost every week. A total of 77 suspected cases including 15 deaths [CFR:19.4%] were reported from the country between 01 January to 29 September 2013. Of these reported cases, 48 were laboratory confirmed

Close contact precautions could prevent an outbreak of Crimean-Congo hemorrhagic fever: a case series report from southern part of Tehran

Between the end of June and the middle of July 2011, an outbreak of CCHF occurred in southern part of Tehran, Iran. This study reports clinical, laboratory findings and outcome of six cases, who were all consanguine. Index case who was livestock-worker died with hemorrhagic manifestations; thereafter his pregnant wife, three brothers, mother-in-law and his pregnant sister-in-law were admitted and except for the latter, ribavirin was administered. The brother with close contact with body fluids and blood of index case, died with hemorrhage. Low platelet, high aminotransferases and elevated PT, PTT were detected in this case. Skin manifestations were present in five cases. Only in one case RT-PCR and IgM serology were reported as positive for CCHF virus by reference laboratory. In endemic areas, high index of suspicion should be kept in mind in successfully finding and treating cases in early phase of the disease

[Study of the epidemiological status of Crimean-Congo Hemorrhagic fever disease in Qom province, 2011, Iran]

Crimean-Congo Hemorrhagic fever [CCHF] is an acute viral febrile hemorrhagic disease that is common between human and animal. This study was performed with the aim of determining epidemiological status of CCHF in Qom province. This descriptive study was done on patients with clinical signs or with an epidemiological history of CCHF, who were referred to hospitals, health centers, and private clinics during 2011. Then, based on guideline of the National Technical Committee of the Ministry of Health, patients were classified into three groups of suspected, probable and confirmed. The data were analyzed by frequency table, chi-square test, and Fisher's exact test. p<0.05 considered as significant. Twelve out of 38 patients, after diagnosis were placed in the suspected to CCHF group, went under follow-up and treatment. Among them, 5 cases [41.67%] were confirmed, 2 cases [16.67%] were probable, and 5 cases [41.67%] were suspected [only had some symptoms]. The majority of patients were male [91.76%] with the age range of 15-30 [83.34%], and resident in urban areas [75%]. 58.34% of the whole patients were farmers, students, or butchers. 83.34% of patients reported a history of contact with animals, and the mortality rate of confirmed cases was 20%. According to the results of this study, training of people at risk, and doing safety measures, such as keeping fresh meat in the refrigerator for 24 hours and using gloves while household cleaning fresh meat are necessary

case of Crimean-Congo hemorrhagic fever in Oman

In the summer of June 2011, the first case of Crimean-Congo hemorrhagic fever [CCHF] was observed in Oman since the last fifteen years. The first blood sample using reverse transcriptase polymerase chain reaction [PCR] test were sent looking for CCHF, tick-borne encephalitis, dengue, Japanese encephalitis, Chikungunya and West Nile. All resulted as negative. The repeated serology for CCHF came strongly positive after five days from the initial negative test, and accordingly patient started on ribavirin and he responded to it. His condition improved dramatically

Severe Fever with Thrombocytopenia Syndrome Virus, Crimean-Congo Haemorrhagic Fever Virus, and Migratory Birds

Severe Fever with Thrombocytopenia Syndrome (SFTS) and Crimean-Congo Haemorrhagic Fever (CCHF) are tick-borne diseases belonging to the family Bunyaviridae. Since SFTS was first reported in China in 2009, the virus was isolated and confirmed in 2011, with additional reports of SFTSV expanding its geographic range from China to South Korea and Japan. CCHFV has the widest geographic distribution of any tick-borne virus, encompassing around 30 countries from eastern China through Asia, the Middle East, and southeastern Europe to Africa. During the past decade, CCHFV has emerged in new areas of Europe, Africa, the Middle East, and Asia and has increased in endemic areas. Migratory birds are considered to play a role in dispersing CCHFV vectors, and the virus. This review summarises SFTSV and CCHFV, highlighting the role of migratory birds in the transmission of tick-borne disease.

[ co- infection of crime Congo hemorrhagic fever and brucellosis: a case report]

Crimean-Congo Hemorrhagic fever [CCHF] is a viral disease transmitted to ruminants or human by the bite of mature tick vectors. It can be transmitted through contact with the infectious blood or viraemic tissues during slaughter and hospital contacts. 80% of the cases are sub clinical and the rest of them are presenting with an acute febrile and occasionally hemorrhagic disease. The mortality rate of the fulminate form of the disease is equal to 20% to 50%. The hemorrhage is usually in the form of hematoma, melena, nose, conjunctiva, uterine or subcutaneous bleeding. CCHF complications are: encephalitis, optic neuropathy, hepatitis, renal failure and myocardial necrosis. In this article, we've discussed a CCHF patient who presented with high fever, myalgia, headache, nausea, vomiting, abdominal pain, diffuse cutaneous and gingival hemorrhage during the course of the disease while the patient was hospitalized. Profound jaundice, petechia and global ecchymosis were considerable. Lab data showed at the beginning of hospitalization that the number of liver enzymes was increased up to 8-10 times. The number of placates were lower than 150000 ml. Moreover, during the first three days there was a decrease in the number of white blood cells and PTT was abnormal. [AST] was higher than 100 units per litre. The results of serologic examination of IgM- ELISA virus for CCHF on day 5 and IgG-ELISA on day 10-which were carried out in pasture Institute-were reported to be positive. According to the patient's history and clinical symptoms, he was also suspicious for Brucellosis and the lab data demonstrated that he is also infected with Brucella. [Wright=1.320, 2ME=1.160] The patient was a 22 year old man, sheep farmer, residing in the GhalehKamkar area of Qom City

[Crimean -Congo Hemorrhagic Fever]

Crimean-Congo Hemorrhagic Fever [CCHF] is an acute viral hemorrhagic disease which is transmitted to humans by the bite of the Hyalomma tick or by direct contact with blood of an infected animal or human. CCHF was first recognized in the Crimean peninsula in the mid-1940s, and the same virus was isolated from a patient in Democratic Republic of Congo, in 1956. Person-to-person transmission of CCHF virus occurs through direct exposure to blood or other secretions; in addition, nosocomial transmission is well-documented with case fatality rates ranging from 30 70%. Tick bite is one of the most important risk factors for CCHF acquisition and Hyalomma tick is its main reservoir in the nature, but many domestic animals including cattle, sheep, goats, hare, buffalo, and even ostrich can be infected by this virus. Disease in animals is subclinical and they are infected only for one week. During the viremia phase, direct exposure to blood or other secretions can infect human. Hyalomma ticks favor dry climates and arid-type vegetation, and are abundant in European countries bordering the Mediterranean Sea; numerous animals may act as CCHF virus hosts. In recent years, a number of cases have been reported from Africa, Eastern Europe and Asia. Healthcare workers are also at risk of infection through unprotected contact with infected blood and other body fluids. Incubation phase is about 3 to 4 days after tick bite and 3-14 days when the patient is exposed to infected blood and other body fluids. Typical CCHF progresses rapidly with high fever, malaise, severe headache, myalgia, and gastrointestinal symptoms like abdominal pain and nausea. CCHF is confirmed either by detection of specific immunoglobulin M antibodies or a four-fold increase of immunoglobulin G titers using enzyme-linked immunoassays, indirect immunofluorescent assays, or through RT-PCR. Supportive therapy is an essential part of the case management. Intensive monitoring of fluid volume and blood component replacement is recommended. Oral ribavirin is the therapy of choice in the clinical practice. If the patient meets the criteria for probable CCHF, treatment with ribavirin protocol needs to be started immediately. Interferon and Immunoglobulin have significant antiviral activity in vitro against CCHF. Recently, we face many cases of CCHF in several provinces of Iran. The aim of this article is to review clinical manifestations, treatment and prevention of this disease

CCHF In Pakistan

The Crimien-Congo haemorrhagic fever [CCHF] has been reported from Pakistan in recent time. A total of 8 cases of CCHF including 3 deaths were reported which have the date of onset between 5 to 28 April 2012. While all these 8 cases were identified in all 4 provinces of Pakistan, they were all linked to Balochistan, a known endemic focus of CCHF

CCHF in multiple countries

In recent time, Crimean-Congo haemorrhagic fever [CCHF] has been reported from three countries in the region. These include Pakistan, Afghanistan and Iran [Islamic Republic of]. While nosocomial transmissions have been reported in healthcare workers both in Pakistan and Iran, no such transmission has yet been reported in Afghanistan. However, such healthcare associated transmissions of CCHF was reported in healthcare workers in Afghanistan in the past