CRIMEAN-CONGO HEMORRHAGIC FEVER - PAKISTAN (02): (KARACHI)

CCHF as Bioweapon; http://www.millennium-ark.net/News_Files/NBC/Bio.Bugs.Congo.html


CRIMEAN-CONGO HEMORRHAGIC FEVER - PAKISTAN (02): (KARACHI)


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A ProMED-mail post



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International Society for Infectious Diseases





Date: Thu 16 Sep 2010

Source: Dawn, local news [edited]







Another Congo fever case reported in 2 weeks

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A young tannery worker who was admitted to the city government-run

Abbasi Shaheed Hospital (ASH) for the treatment of dengue fever has

tested positive for viral Crimean-Congo haemorrhagic fever (CCHF)

virus infection as well. It was the 2nd such case of CCHF reported

from the city hospitals during the short span of 2 weeks, said

medical circles, adding that the 1st patient had been discharged from

a private hospital after his recovery.



Reports about 2 deaths from CCHF in July [2010] and the preceding

months this year set alarm bells ringing and the city and health

practitioners and relevant authorities have stressed the need [to

undertake] urgent preventive measures.



The medical superintendent of the ASH, Dr Hamid Zaheer, told the Dawn

[newspaper] on Wednesday [15 Sep 2010] that a 23-year-old patient, a

resident of Sector 9/E, Orangi Town, [had been] brought to the

hospital with pain, high-grade fever and respiratory problems. "As I

have been told by doctors, the patients bled 2 days back, following

which in addition to initial tests and symptomatic treatment, some

serological tests were conducted and it was known by Tuesday [14 Sep

2010] that the patient had tested positive both for dengue fever

[virus] and CCHF [virus] infections. Initially he was kept in the

intensive care unit, but now [he is being treated] in an isolation

ward of the hospital, while the doctors and paramedics have also been

asked to observe the appropriate protocol while [treating] the

patients in question," Dr Zaheer stated.



Of the 5 patients tested positive for the viral disease [CCHF} since

March [2010], 2 have survived, while one is under treatment at the

ASH.



The death of a patient, in his mid-thirties, a resident of Bismillah

Colony, Landhi, was confirmed by the Indus Hospital, Korangi, in July

[2010]. This patient was a butcher by profession -- said to be one of

the most vulnerable jobs to contract the highly infectious disease.

The occupation of the other patient who died from CCHF in May was not

known.



Some of the experts after knowing about the CCHF [cases] in July had

highlighted the need to undertake a retrospective study of CCHF

patients, [to determine] their occupations and their contact with

other people during the period of incubation of the virus, and to

determine the sensitivity of lab results and [communication of] a

timely update by the hospitals on the cases to the health authorities.



The deputy medical superintendent of the ASH, Dr Javed Akhtar, said

that the [23-year-old patient currently being treated], a worker at

tannery, was admitted to the hospital on Sat 11 Sep 2010 and was kept

in the Medical-III [ward] initially and then was transferred to the

medical intensive care unit (ICU) in view of his deteriorating

condition.



The laboratory of the Aga Khan University Hospital (AKUH) informed

the hospital on Tue 14 Sep 2010 of positive test results for dengue

fever virus infection and CCHF virus infection, and as a result the

patient was transferred to an isolation ward.



Relatives of of the patient had also been debarred from meeting him,

the doctor said, adding that the patient was being provided with

blood platelets, which had critically decreased. Replying to a

question, Dr Akhtar said that the AKUH laboratory handed over the

formal serology test report to the ASH on Wednesday [15 Sep 2010] for

this patient, who is now being given all possible care and is now in

a stable condition and conscious.



The head of the infections control committee of the AKUH, Dr Bushra

Jamil, told Dawn that the AKUH lab had tested 2 samples positive in

recent days for CCHF -- one pertained to a patient admitted to the

AKUH and discharged after recovery a week ago, and the other the

sample received from the ASH.



An expert said that the doctors and paramedics [known] to have come

into contact with these patient during treatment, and relatives of

the patients, also needed to be kept under observation as a

preventive measure. It is worth noting that a few years back a doctor

handling a patient suffering from CCHF later died of the same

disease. [Nosocomial transmission of infection in hospitals in

Pakistan has been recorded previously. In 2002, a female doctor

contracted CCHF virus infection from a patient and died. 2 doctors

involved in her treatment also contracted infection; both survived

(see: ProMED-mail post - Crimean-Congo hemorrhagic fever - Pakistan

(02) 20020313.3735).]



Previously, in 1974, a physician died in Rawalpindi General Hospital

as a result of CCHFV infection contracted from patients. - Mod.CP]



[Byline: Mukhtar Alam]



--

Communicated by:

ProMED-mail





[The geographical distribution of CCHF virus, like that of its tick

vectors (_Hyalomma_ spp.), is widespread. Evidence of CCHF virus has

been found in Africa, Asia, the Middle East and Eastern Europe.

Health care workers in endemic areas should be aware of the illness

and the correct infection control procedures to protect themselves

and their patients from the risk of nosocomial (hospital-acquired)

infection.



Humans who become infected with CCHF acquire the virus from contact

with blood or other infected tissues from livestock, or they may

become infected directly from a tick bite. The majority of cases have

occurred in those involved with the livestock industry, such as

agricultural workers, slaughterhouse workers and veterinarians.

Following infection via tick bite, the incubation period is usually

one to 3 days, with a maximum of 9 days.



The incubation period following contact with infected blood or

tissues is usually 5 to 6 days. Onset of symptoms is sudden, with

fever, myalgia (aching muscles), dizziness, neck pain and stiffness,

backache, headache, sore eyes and photophobia (sensitivity to light).

There may be nausea, vomiting and sore throat early on, which may be

accompanied by diarrhoea and generalised abdominal pain. Details of

the subsequent course of the illness can be found at:

.



The mortality rate from CCHF is approximately 30 percent, with death

occurring in the 2nd week of illness. In those patients who recover,

improvement generally begins on the 9th or 10th day after the onset

of illness.



Of the 5 CCHF patients treated in the city of Karachi in recent

months, 2 (a butcher and a tannery worker) have worked with livestock

or livestock products. The case of the 23-year-old tannery worker

described in the above report is exceptional in that the patient has

tested positive for 2 unrelated hemorrhagic fever viruses -- dengue

fever virus (a flavivirus) and CCHF virus (a bunyavirus). Further

information on the course, treatment and outcome of the tannery

worker's illness are matters of general interest and would be

welcomed.



The HealthMap/ProMED-mail interactive map of Pakistan, showing the

location of the city of Karachi can be accessed at:

. - Mod.CP]



[see also:

Crimean-Congo hem. fever - Pakistan ex Afghanistan: RFI 20100629.2161

2009

----

Crimean-Congo hem. fever - Pakistan (03): differential 20091012.3527

Crimean-Congo hem. fever - Pakistan (02): ex Saudi Arabia, susp. 20091011.3516

Crimean-Congo hem. fever - Pakistan (Abottabad): RFI 20090927.3377

2008

----

Crimean-Congo hem. fever - Pakistan (03): (PB), susp. 20081121.3678

Crimean-Congo hem. fever - Pakistan (02): (PB), susp. 20081117.3630

Crimean-Congo hem. fever - Pakistan: (BA) 20081027.3392]

...................arn/lm/cp/ejp/lm

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