KARACHI: In what should serve as a wake-up call for health authorities that have repeatedly ignored alarm over lack of infection control measures at health facilities, a surgeon recently admitted to a private hospital in the city from Punjab after being infected with Crimean-Congo Hemorrhagic Fever (CCHF) died on Saturday.

Dr Sagheer Sameejah, a senior surgeon of surgical ward No 4 at the Bahawal Victoria Hospital (BVH) in Bahawalpur, was recently admitted to the Agha Khan University Hospital in the city.

It’s the second death from the CCHF in the country in the last 15 days. Earlier one patient died in Karachi and the other in Bahawalpur. A patient whose lab reports have tested positive for Congo virus is under treatment at the AKUH.

The infection, according to sources, has spread apparently at the BVH due to lack of bio-safety measures during treatment of a Congo virus patient.

While details of the first Congo virus patient, a female nurse student operated upon at the BVH, are still awaited, the health department of Sindh has shared some details of the suspected Congo virus patients, all doctors of the BVH, who were admitted to the AKUH.

“Dr Sagheer was admitted to the AKUH with Dr Owais and Dr Alam two days ago. Dr Sagheer’s blood samples had been found positive for Congo virus,” said focal person of provincial health department Dr Syed Zafar Mehdi.

According to him, the surgeon and his colleagues had operated a Congo virus patient over two weeks ago at the BVH. Dr Owais was still under treatment at the intensive care unit of the AKUH, he said.

The first Congo virus patient, Ms Nadia hailing from Lodhran, died on July 17, according to media reports.

The AKUH sources added that the Congo virus infection had been confirmed in two patients, of whom one died on Saturday. The third patient had been discharged after its lab reports came negative.

Two patients died of Congo virus in Karachi last year while four persons suffering from the same disease recovered.

Wake-up call

Expressing serious concern over the news emerging from the case, Dr Altaf Ahmed, executive member of the Medical Microbiology and Infectious Diseases Society of Pakistan, said it’s time health authorities both at the national and provincial levels start according due importance to bio-safety measures at health facilities.

According to him, it’s not the first time that a doctor had died of the CCHF and similar cases had occurred in the past, causing little concern at the government level.

“Most hospitals in Pakistan don’t have isolation rooms. There is no infection control policy or training in place for healthcare workers,” he said, adding that a few organisations with limited resources were involved in educating and imparting training on infection control in the country.

The issue of hospital waste management, he said, was also compromised.

“Hospital’s sterilisation units are working without following standards of cleaning and sterilisation of surgical instruments,” he said.

According to the World Health Organisation website, CCHF is a widespread disease caused by a tick-borne virus (Nairovirus) of the Bunyaviridae family. The CCHF virus causes severe viral haemorrhagic fever outbreaks, with a case fatality rate of 10 per cent to 40pc.

“The virus is primarily transmitted to people from ticks and livestock animals. Human-to-human transmission can occur resulting from close contact with the blood, secretions, organs or other bodily fluids of infected persons.

“CCHF is endemic in Africa, the Balkans, the Middle East and Asia, in countries south of the 50th parallel north. There is no vaccine available for either people or animals,” the website says.

The hosts of the CCHF virus include a wide range of wild and domestic animals such as cattle, sheep and goats.

Animals become infected by the bite of infected ticks and the virus remains in their bloodstream for about one week after infection, allowing the tick-animal-tick cycle to continue till another tick bites the animal. Although a number of tick genera are capable of becoming infected with CCHF virus, ticks of the genus Hyalomma are the principal vector.

Hospital-acquired infections can also occur due to improper sterilisation of medical equipment, reuse of needles and contamination of medical supplies.

“The virus doesn’t cause any disease in animals but they become its carrier once they are infected. The CCHF virus is transmitted to people either by tick bites or through contact with infected animal blood or tissues. The majority of cases have occurred in people involved in the livestock industry, such as agricultural workers, slaughterhouse workers and veterinarians,” said Dr Nasrullah Panhwar, a senior veterinary surgeon.

Drive against Congo virus

Meanwhile, health officials in Bahawalpur said that Dr Sagheer’s body will be shifted to his ancestral home in Kahror Pucca in Lodhran district.

Eight employees of the BVH, including a professor, Dr Gulzar Malik, have been quarantined in a special ward established at the hospital while a number of others are under observation.

A campaign to prevent the spread of Congo virus has been launched by the district and as many as 150 mobile teams of livestock and dairy development department have been constituted to carry out vaccination.

The livestock sector of the Cholistan Development Authority, Bahawalpur, has been directed to activate its drive for animal vaccination in the desert of Cholistan.

Published in Dawn, July 31st, 2016