Reasonable Rascal
03-01-03, 02:56
CRIMEAN-CONGO HEMORRHAGIC FEVER - PAKISTAN: SUSPECTED
**************************************
A ProMED-mail post
Date: Fri 28 Feb 2003
From: Rashid A. Chotani <rchotani@jhsph.edu>
Source: Dawn newspaper online, Fri 29 Feb 2003 [edited]
<http://www.dawn.com/2003/02/26/local15.htm>
Pakistan: Suspected Crimean-Congo Hemorrhagic Fever Deaths in Rawalpindi
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2 brothers suspected to be suffering from Crimean-Congo Hemorrhagic Fever (CCHF) died on Tue 25 Feb 2003 at the Holy Family Hospital. These deaths occurred 5 days after a similar incident was reported from Rawalpindi General Hospital. [Tragically] the dates coincided with the first anniversaries of the deaths of 2 women, including a lady doctor, who died of CCHF a year ago at the same hospital. The victims (3 and 5 years of age) had come to the hospital on Tuesday at 2 am with high-grade fever and epistaxis from Gawalmandi, a [densely] populated locality of the city.
Gawalmandi is mostly inhabited by lower-middle-class families and has highly unhygienic environs. The area is administratively controlled by the cantonment board. One of the boys died a few hours after arriving at the hospital, while the other expired at around 10 am.
7 "close contacts", excluding the immediate relatives of the victims, have been identified and isolated. The exact number of people under surveillance is 16. The paediatric emergency ward and intensive care unit, where the 2 boys were kept for treatment, have been sealed and disinfected. Blood samples of both the victims have been collected by National Institute of Health, Islamabad and will be sent to South Africa for analysis. The confirmation or otherwise of the disease can only be done after the report from South Africa is received, and till then, these cases will continue to be treated as suspected.
The 2 children had cared for and played with livestock prior to Eid-ul-Adha (a Muslim holiday signifying sacrifice), and animals are sacrificed for 3 days. The holiday lasted from 12 to 14 Feb 2003. Thus, these children were in close contact with the animals prior to the holiday and probably were exposed to the tick _Hyalomma mirginatum_. The incubation period is around 2 to 7 days but has been reported to be as long as 12 days. In humans, the disease appears suddenly with symptoms similar to those of influenza, followed by a rash. Hemorrhage does not occur in all cases and can be more severe in some, beginning on or about the fourth day and continuing for about 2 weeks. The outbreak aggregate human case-fatality rate is around 30 percent.
In Pakistan, CCHF virus was first isolated in 1970 from ticks from the Changa Manga forest, Lahore district, and from Hunza, Gilgit Agency. The first reported case and the first nosocomial human case appeared in 1976, when a laparotomy was performed on a patient with abdominal pain, haematemesis, and melena. Since the first recognition of human cases, there have been many outbreaks, of which only 2 have been reported in the form of [referenced] publications.
Nosocomial outbreaks in Pakistan continue despite dissemination of information on preventive measures among medical staff. These outbreaks follow a pattern. The index case always dies, succumbing to severe haemorrhagic complications, and then exposed health care workers develop the disease and often, the complications.
A mouse-brain vaccine is available in Europe and Russia, but it is not known whether it is effective or safe in humans. Intravenous ribavirin has been established as an effective antiviral therapy. Also oral ribavirin has been shown to be effective in patients with less severe disease. The most [effective] preventive measures are the use of repellents such as diethyltoluamide and permethrin.
--
Rashid A. Chotani, MD, MPH
Department of Emergency Medicine
Department of International Health
Center for International Emergency Disaster & Refugee Studies
Director, Global Infectious Disease Surveillance & Alert System
The Johns Hopkins School of Medicine & Public Health
<rchotani@jhsph.edu>
[Crimean-Congo hemorrhagic fever virus (CCHFV), a member of the genus _Nairovirus_ of the family _Bunyaviridae_ of segmented genome negative-sense RNA viruses, is the cause of a zoonotic disease that for many years was recognized only in Central Asia and eastern Europe. CCHFV is known now to be present throughout Asia, the Middle East and Africa. In recent years CCHFV-associated disease has been particularly prevalent in countries bordering the Persian Gulf, where traditional sheep slaughtering and butchering practices continue. The virus is maintained by a cycle involving transovarial and transstadial transmission in _Hyaloma_ spp. and related ticks. The larval and nymphal ticks become infected during feeding on small mammals and birds, and the adults during feeding on wild and domestic ruminants. Infection of wild and domestic ruminants results in abundant production of CCHFV. Remarkably, there is no evidence of clinical disease in animals other than humans, where the outcome can be a severe hemorrhagic fever. - Mod.CP]
**************************************
A ProMED-mail post
Date: Fri 28 Feb 2003
From: Rashid A. Chotani <rchotani@jhsph.edu>
Source: Dawn newspaper online, Fri 29 Feb 2003 [edited]
<http://www.dawn.com/2003/02/26/local15.htm>
Pakistan: Suspected Crimean-Congo Hemorrhagic Fever Deaths in Rawalpindi
--------------------------------------------------
2 brothers suspected to be suffering from Crimean-Congo Hemorrhagic Fever (CCHF) died on Tue 25 Feb 2003 at the Holy Family Hospital. These deaths occurred 5 days after a similar incident was reported from Rawalpindi General Hospital. [Tragically] the dates coincided with the first anniversaries of the deaths of 2 women, including a lady doctor, who died of CCHF a year ago at the same hospital. The victims (3 and 5 years of age) had come to the hospital on Tuesday at 2 am with high-grade fever and epistaxis from Gawalmandi, a [densely] populated locality of the city.
Gawalmandi is mostly inhabited by lower-middle-class families and has highly unhygienic environs. The area is administratively controlled by the cantonment board. One of the boys died a few hours after arriving at the hospital, while the other expired at around 10 am.
7 "close contacts", excluding the immediate relatives of the victims, have been identified and isolated. The exact number of people under surveillance is 16. The paediatric emergency ward and intensive care unit, where the 2 boys were kept for treatment, have been sealed and disinfected. Blood samples of both the victims have been collected by National Institute of Health, Islamabad and will be sent to South Africa for analysis. The confirmation or otherwise of the disease can only be done after the report from South Africa is received, and till then, these cases will continue to be treated as suspected.
The 2 children had cared for and played with livestock prior to Eid-ul-Adha (a Muslim holiday signifying sacrifice), and animals are sacrificed for 3 days. The holiday lasted from 12 to 14 Feb 2003. Thus, these children were in close contact with the animals prior to the holiday and probably were exposed to the tick _Hyalomma mirginatum_. The incubation period is around 2 to 7 days but has been reported to be as long as 12 days. In humans, the disease appears suddenly with symptoms similar to those of influenza, followed by a rash. Hemorrhage does not occur in all cases and can be more severe in some, beginning on or about the fourth day and continuing for about 2 weeks. The outbreak aggregate human case-fatality rate is around 30 percent.
In Pakistan, CCHF virus was first isolated in 1970 from ticks from the Changa Manga forest, Lahore district, and from Hunza, Gilgit Agency. The first reported case and the first nosocomial human case appeared in 1976, when a laparotomy was performed on a patient with abdominal pain, haematemesis, and melena. Since the first recognition of human cases, there have been many outbreaks, of which only 2 have been reported in the form of [referenced] publications.
Nosocomial outbreaks in Pakistan continue despite dissemination of information on preventive measures among medical staff. These outbreaks follow a pattern. The index case always dies, succumbing to severe haemorrhagic complications, and then exposed health care workers develop the disease and often, the complications.
A mouse-brain vaccine is available in Europe and Russia, but it is not known whether it is effective or safe in humans. Intravenous ribavirin has been established as an effective antiviral therapy. Also oral ribavirin has been shown to be effective in patients with less severe disease. The most [effective] preventive measures are the use of repellents such as diethyltoluamide and permethrin.
--
Rashid A. Chotani, MD, MPH
Department of Emergency Medicine
Department of International Health
Center for International Emergency Disaster & Refugee Studies
Director, Global Infectious Disease Surveillance & Alert System
The Johns Hopkins School of Medicine & Public Health
<rchotani@jhsph.edu>
[Crimean-Congo hemorrhagic fever virus (CCHFV), a member of the genus _Nairovirus_ of the family _Bunyaviridae_ of segmented genome negative-sense RNA viruses, is the cause of a zoonotic disease that for many years was recognized only in Central Asia and eastern Europe. CCHFV is known now to be present throughout Asia, the Middle East and Africa. In recent years CCHFV-associated disease has been particularly prevalent in countries bordering the Persian Gulf, where traditional sheep slaughtering and butchering practices continue. The virus is maintained by a cycle involving transovarial and transstadial transmission in _Hyaloma_ spp. and related ticks. The larval and nymphal ticks become infected during feeding on small mammals and birds, and the adults during feeding on wild and domestic ruminants. Infection of wild and domestic ruminants results in abundant production of CCHFV. Remarkably, there is no evidence of clinical disease in animals other than humans, where the outcome can be a severe hemorrhagic fever. - Mod.CP]