• CCHF virus can transmit to people by tick bite or through contact with infected animal blood, doctors say
• Children advised to stay away from sacrificial animals

KARACHI: Health experts have warned citizens of the tick-borne Congo fever threat ahead of Eidul Azha, advising them to observe caution in purchase, care, handling and slaughter of sacrificial animals.

The Crimean Congo Hemorrhagic Fever (CCHF) causes severe viral hemorrhagic fever outbreaks and its mortality rate could be as high as 60 to 89 per cent. There is no vaccine available for the disease.

According to experts, the CCHF virus is primarily transmitted to people either by tick bites or through contact with infected animal blood or tissues during and immediately after slaughter.

Human-to-human transmission can occur resulting from close contact with the blood, secretions, organs or other bodily fluids of infected persons.

“Animal handling is the most important risk factor. Often, people including butchers don’t even notice a tick’s bite and get worried only after they fall sick within four to seven days of the infection and develop high fever,” said Dr Rafiq Khanani, the president of the Infectious Diseases Society of Pakistan.

He said that initial symptoms include muscle ache, backache, headache, abdominal pain and diarrhoea.

According to him, the illness can damage the walls of tiny blood vessels, making them leak, and can hamper the blood’s ability to clot.

“Its clinical signs include internal bleeding, especially of the gums that may cause skin discoloration. Patients should report to hospitals as soon as possible,” he said, adding that healthcare providers were at high risk and they must follow the protocol for patient examination and management.

Recalling the history of the CCHF in Pakistan, Dr Khanani said the first case in Pakistan was reported in 1976 when a surgeon along with three healthcare providers died following an infection from a patient.

“Last year, a major CCHF outbreak occurred at a Quetta hospital, killing at least three people including a doctor and making more than a dozen ill. This indicates we need to strictly enforce infection control practices at hospitals,” he said.

In addition, he emphasised, special measures needed to be in place at the time of Eidul Azha when trade and movement of animals increased manifold.

Every year, Dr Khanani said, several CCHF cases were reported in the country during this time of the year, resulting in loss of precious lives. Many deaths occurred in remote areas and remained undocumented.

“These lives could have been saved if we develop a protocol for keeping and transporting animals and managing livestock markets, handling of animals and their slaughter. And, at the same time, create awareness on the disease and sources of transmission,” he added.

The experts advise people to wear protective light-coloured clothing (long sleeves, long trousers) while handling animals and use approved repellent on the skin and clothing. Children should not be allowed close contact with animals.

Few diagnostic facilities

The experts regretted that despite being a CCHF-endemic country, Pakistan has limited diagnostic facilities for the viral infection.

No government hospital in Sindh, at least, is equipped with these facilities, they added.

“Only one private hospital in Karachi has the facility for CCHF test. It’s costly and not everyone can afford it. The other option is to send the blood sample to the National Institute of Health in Islamabad, which means that the test result would take at least three to five days to come,” shared a senior doctor associated with a government hospital.

He added that skinning and subsequent tanning of the hides were also risk factors for the CCHF infection.

“A majority of the victims we have seen so far were butchers who have least information about the illness and report at hospitals when the disease has reached an advanced stage, making their chances of survival slim,” he said.

The experts also pointed to lack of implementation of the guidelines released by the federal and provincial governments every year ahead of the Eid, highlighting that there was absolutely no implementation of the CCHF advisory at any level except that hospitals notified the disease.

Published in Dawn, June 16th, 2024