Re-Emergence of Congo Virus in Pakistan: Call for Preparedness

Abstract

Crimean-congo hemorrhagic fever (CCHF) once again re-emerged in Pakistan. In July 2016, 2 CCHF cases were reported from Lodhran and Bahawalpur districts of Pakistan. Later on the CCHF virus was also reported from other region of the country including Balochistan, Karachi and Khyber Pakhtunkhwa. Up to 22 August 2016, a total of 20 deaths were reported of which 12 from Balochistan, 5 from Karachi, 2 from Bahawalpur and 1 from Khyber Pakhtunkhwa. Precautions measurements and awareness is necessary to protect the normal individuals away from this fatal disease. The media, health department and government need to play their active role to stop the spread of CCHF in the country.

Introduction

Crimean-congo hemorrhagic fever (CCHF) is a tick born viral zoonotic disease. The virus belongs to genus Nairovirus andfamily Bunyaviridae Hoogstraal, 1979Nichol, 2001. After dengue, CCHFV is the second most widespread arbovirus Ergönül, 2006. In 1960, CCHFV was isolated from ticks in Changa-Manga forest near Lahore Begum et al., 1970. In Pakistan the CCHF is endemic, the first case was reported from Rawalpindi in 1976 Alam et al., 2013. The disease was reported from different region of the world i.e. Africa, Southeastern Europe, Middle East and Asia. A significant increase in the CCHFV incidence was observed in the last decade especially in the South-eastern Europe Bente et al., 2013.

In 1944, the first case of CCHF was reported from former Soviet Union Casals et al., 1970Leshchinskaya, 1965. After that, many outbreaks have been reported from different countries including United Arab Emirates Suleiman et al., 1980, Iraq and Pakistan Al-Tikriti et al., 1981, Kuwait Al-Nakib et al., 1984, Bulgaria and Saudi Arabia Scrimgeour, 1995. In the last few years, many CCHF outbreaks were reported from Pakistan and also from the neighboring countries including Afghanistan, India and IranAthar et al., 2005Izadi et al., 2006. Izadi et al. (2006) reported 248 cases of CCHF in Iran, of which 169 were from Sistan-va-Baluchestan province which has the border with Baluchestan-province of Pakistan.

In July 2016, two CCHF cases were reported from Lodhran and Bahawalpur districts of Pakistan The Express Tribune, 2016. 01 August. In the recent cases the CCHF virus transferred dramatically. A student nurse was admitted to hospital having abdominal pain. After the surgery CCHF virus was detected. Later on the patient was died. The surgeon who operated the infected individual got sick, and later CCHF was diagnosed and treatment was started but he didnot recover. The staff that treated this surgeon also got some symptoms of CCHF. The authorities realized the situation and medical emergency was imposed. WHO team also visited the places and collected the samples to verify the CCHF.

Till August 22, 2016, a total of 20 deaths have been reported from P akistan. Hig h number of deaths were reported from Balochistan sharing bord er with Iran and Afghanistan, followed by Karachi as shown in Figure 1 Outbreak News Tod ay, 2016. 22 August.

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Figure 1.

The latest death shows traveling history of the virus from Afghanistan to Pakistan. A lady from Afghanistan was admitted for treatment at Fatima Jinnah TB Sanatorium Hospital in Quetta, which was died later on The Nation, 201 6. 22 August..

The previous data shows that, from the neighboring countries of Pakistan many outbreaks of CCHF were reported. There is no proper check in and check out system on Pak-Afghan and Pak-Iran boarders. The CCHF is a zoonotic born disease, therefore due to lack of proper monitoring of animal especially sacrificial animals during Eid-ul-Ad ha (Annual sacrificial celebration of Muslims) imported and exported among these countries. The preventive measurement for CCHF is not easy, acaricides is use to control and reduce the spread of causative agents. Protective clothing and gloves should be used while handling animals to reduce the risk of transmission of virus from animal to human.

After the diagnosis of Crimean-congo, isolation of patient is very important. The doctors and paramedics staff has to wear special dress with gloves, glasses and special gown. Congovirus spread through secretions of patients so we should not get in contact with its blood, urine, feaces or other secretions. All the utensils, bed sheets, syringes and pillow of patient should be properly disposed off otherwise that will be source of spread of virus. Area where Congo suspected must be sprayed with proper anti ticks spray. If the doctors or paramedics get by chance contact with patients they should immediately get anti viral rebavirin tablets. For treatment of CCHF, Ribavirin along with hematological support is recommended.

Conclusion

Precautions and awareness is necessary t o protect the healthy individuals away from this fatal disease. If the local communities are not informed and trained adequately, it may cause more fatalities. The media, health department and government need to play their role to stop the spread of CCHF in the country.