Crimean Congo Haemorrhagic Fever (CCHF) is an infectious disease caused by Nairovirus and is considered to be a tropically neglected disease. It is endemic in poor resource countries like Pakistan. Emergency Health Care Professionals (HCPs) are at the greatest risk of contracting this disease. This viral hemorrhagic fever is primarily spread by Hyalomma tick bites or through contact with infected animals. CCHF virus is seroprevalent in Central Africa, the Middle East, and Asian Countries such as Pakistan. Its long-lasting and severe mechanism of infection as well as its ability to become epidemic along with its preventive and diagnostic difficulties pose a serious health risk to public health systems. The fatality rate is also high (10-40%).
In Pakistan, the continued circulation of CCHFV is due to a number of factors that include, bordering with CCHF endemic areas like Iran and Afghanistan, favorable climatic conditions for vector multiplication, and lack of disease knowledge among the rural community that depends on agriculture and livestock. The time period between January 2014 and May 2020, saw a continued rise in CCHFV cases in Pakistan, with about 356 confirmed CCHF patients and a mortality rate of 25% reported by the National Institute of Health, Islamabad. Among these patients, the highest numbers were reported from Balochistan (38%), followed by Punjab (23%), KPK (19%), Sindh (14%), and the lowest from Islamabad (6%). CCHF seroprevalence was reported to be 2.7% with the greatest occurrence in rural areas.
In 1976, during the laparotomy of a CCHF patient, nosocomial CCHFV transmission was reported with 11 secondary cases due to hospital-led transmission that resulted in 3 deaths. Presently, several deaths and nosocomial transmissions in HCPs have taken place in multiple areas of Pakistan including Quetta, Rawalpindi, Abbottabad, and Bahawalpur, probably due to negligence of precautionary measures and the highly contagious nature of CCHF. All HCPs and associated authorities that are involved in CCHF management should be educated well and take strict precautions to prevent transmission of the disease.
As of now, two major authorities provide CCHF diagnostic services in Pakistan, namely the National Institute of Health (NIH), Islamabad, and Aga Khan University Hospital, Karachi. NIH is serving as the country’s principal referral laboratory that receives thousands of samples each day for the diagnosis of multiple infectious diseases circulating in Pakistan, including CCHF. Despite the fact that molecular assays such as real-time PCR are used for the detection of CCHFV in suspected samples, details on the genotypic diversity of viruses circulating in Pakistan are limited.
Conclusion
CCHF is increasingly becoming a serious health issue in Pakistan. The virus which was only found in specific regions of the country is now recorded in all parts of Pakistan, reasons being livestock trade and nomadic population movement. Furthermore, as animal trade and farming continue to grow, CCHF cases in Pakistan may rise in the near future. Thus, upgradation in surveillance systems and continuous monitoring are required to control CCHF in Pakistan. Similarly, the role of the Animal Quarantine Department (AQD) and the National Veterinary Laboratory will be critical in the future in order to control transboundary zoonotic diseases like CCHF.
The National Institute of Health, Islamabad, advises supportive care for the management of CCHF symptoms along with the use of antimicrobial ribavirin against CCHF infection. At present, no licensed and safe vaccine is available for human use.
References
– Ahmed, A., Saqlain, M., Tanveer, M. et al. Knowledge, attitude and perceptions about Crimean Congo Haemorrhagic Fever (CCHF) among occupationally high-risk healthcare professionals of Pakistan. BMC Infect Dis 21, 35 (2021). https://doi.org/10.1186/s12879-020-05714-z
– Umair M, Khurshid A, Alam MM, Akhtar R, Salman M, Ikram A (2020) Genetic diversity and phylogenetic analysis of Crimean-Congo Hemorrhagic Fever viruses circulating in Pakistan during 2019. PLoS Negl Trop Dis 14(6): e0008238. https://doi.org/10.1371/journal.pntd.0008238