High number of CCHF cases in Afghanistan: an assessment conducted

Afghanistan has experienced an unusual increase in cases and deaths from Crimean- Congo Hemorrhagic Fever [CCHF] during 2017 with Herat province being the most affected. Up to date, a total of 242 cases including 42 deaths [CFR: 17.35%] have been reported in 27 out of 34 provinces. WHO organized a technical mission in February 2018 to support activities for improving prevention and control efforts

[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

Nosocomial outbreak of CCHF in Pakistan

During the last few weeks, at-least eleven [11] laboratory-confirmed cases of Crimean Congo haemorrhagic fever [CCHF] were reported from Pakistan of which two died. One of the deceased was a medical doctor working in a hospital in Manshera district under the KPK province. The clinical exposure of this medical doctor to the disease remains unknown. Additionally, four female doctors and four other health care staff [Three nurses and a ward attendant] working at a hospital in Rawalpindi contracted the disease and tested positive for CCHF while they were attending patients of CCHF in the same hospital

CCHF in Afghanistan

On 11 August 2008, a suspected case of haemorrhagic fever was admitted at the regional hospital of Herat province in Afghanistan. The case, a married woman of 33 years, was admitted with high fever, headache, vomiting and epistaxis. The patient was, later, laboratory confirmed as suffering from Crimean Congo haemorrhagic fever [CCHF]. The family of the patient has cows, goats and sheep in their house, and the patient had a history of slaughtering sheep and coming in contact with blood and meat of the slaughtered sheep. The patient has recovered and no more cases were reported from the area

CCHF in Afghanistan: outbreak contained

The outbreak of Crimien-Congo haemorrhagic fever [CCHF] reported earlier from Herat province of Afghanistan [Weekly Epi Monitor, issue no: 34, dated 24 August 2008], has been successfully contained. Since 28th of August 2008, no new case has been reported from Herat province or elsewhere in Afghanistan. So far, a total of 19 cases of CCHF have been officially reported by the Ministry of Public Health in Afghanistan including 3 deaths [CFR: 15.7%]. Six of these reported cases have been laboratory confirmed. No human to human transmission of cases was reported during this period. However, only one health care worker providing care to the CCHF patients in the hospitals was reported to have infected with the disease