The National Health Institute (NIH) of Pakistan has issued an advisory on the Crimean-Congo Hemorrhagic Fever (CCHF), also known as the Congo virus, in the wake of Eid-ul-Adha 2022 as the said disease holds a high-risk of spreading through human-animal interaction.
Furthermore, the health body has urged everyone to be vigilant about the situation and take all precautionary measures to curb the spread of the transmission of Congo virus. It is pertinent to mention that Balochistan remains the most affected province with more cases of Congo virus, however, cases of the disease have been reported from across the country.
In 2022, there are a total of four confirmed cases that have been reported in the country (one each from Punjab and Sindh). The Congo virus is easily transmissible to people through tick bites or through contact with infected animal blood or tissues during and immediately after slaughter.
The CCHF can also be transmitted from an infected person to another person through contact with infectious blood, secretions or bodily fluids. It bears mentioning that symptoms of the Congo virus mimic signs and symptoms of Dengue Hemorrhagic Fever (DHF).
“Considering its transmission dynamics (human-to-human) and high mortality, it is imperative to exclude CCHF through a careful epidemiological history/ clinical examination of the patient while strictly observing the prescribed hospital infection control measures,” says NIH Pakistan.
In a suspected case, a person will have a sudden onset of fever over 38C° or more for more than three days and less than 10 days with hemorrhagic symptoms and animal contact history from a CCHF endemic area. Meanwhile, a probable case will include a person with a history of 10 days of febrile illness with above mentioned clinical presentation and epidemiological link to CCHF endemic areas.
However, a confirmed case of the Congo virus is only possible through lab tests of CCHF (PCR and serology).
The incubation period of the Congo virus in a person infected by tick bite is 1-3 days, with a maximum of 9 days, while incubation period following contact with infected blood or tissues is usually 5-6 days, with a maximum of 13 days.
Therefore, the NIH has advised everyone to follow preventative measures to restrict the spread of the disease as no vaccines are available.
The following preventative measures are to be followed for tick-to-human transmission while visiting high-risk areas:
- Wear protective clothing (long sleeves, long trousers);
- Wear light-colored clothing to allow easy detection of ticks on the clothes;
- Regularly examine clothing and skin for ticks; if found, remove them safely;
- Use approved acaricides on clothing;
- Use approved insect repellent on the skin. Insect repellents are the most effective in warding off ticks in human populations;
- Avoid visiting areas where ticks are abundant and seasons when they are most active.
The following measures will help reduce animal to human transmission:
- Wear gloves and other protective clothing while handling animals or their tissues in endemic areas, notably during slaughtering, butchering and culling procedures in slaughterhouses or at home;
- Quarantine animals (possibly 30 days) before they enter slaughterhouses or routinely treat animals with acaricides prior to slaughter;
- Inject ivermectin to animals with ticks, 24-30 days before slaughter.
The following measures will help reduce human-to-human transmission:
- Avoid close physical contact with CCHF-infected people;
- Wear gloves and protective equipment when taking care of ill people;
- Wash hands with soap regularly after caring for or visiting ill people;
- Observe safe burial practices by avoiding contact with mucus membranes & body fluids of the deceased patient and use of appropriate PPEs while touching the deceased person.