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Congo fever rears its head again in Pakistan
JIPH-643; No. of Pages 2
ARTICLE IN PRESS
Journal of Infection and Public Health (2016) xxx, xxx—xxx
LETTER TO THE EDITOR Congo fever rears its head again in Pakistan KEYWORDS
Congo fever; Death; Public health; Pakistan Bahawalpur, Pakistan has become the site of high alert for the Pakistan’s Ministry of National Health Services (NHS), with three recent cases of CrimeanCongo Hemorrhagic Fever (CCHF) being reported within the past fifteen days in patients hailing from this region. It was reported that the index patient was a female nursing student, hailing from Lodhran, who had been operated upon at Bahawalpur Victoria Hospital and had expired a day later. Later, the operating senior surgeon was admitted with symptoms of high grade fever, sore throat and diarrhea and was shifted to a private hospital in Karachi, Sindh where his blood samples tested positive for Congo virus [1]. A junior doctor who had assisted during the surgery was also rushed to the hospital with similar symptoms and diagnosed with CCHF [1]. The senior surgeon expired soon after, accounting for the second death due to this deadly virus, within fifteen days. In 2015, two deaths due to Congo fever were reported in Karachi, while four patients recovered from the viral infection. According to the World Health Organization, CCHF is caused by tick-borne virus (Nairovirus) of the Bunyaviridae family and leads to severe viral hemorrhagic fever outbreaks, with a case fatality rate of 10—40%. This disease is endemic in Africa, the Middle East, the Balkans and certain Asian countries including Pakistan [2]. The virus is principally transmitted from ticks and livestock animals and human-to-human transmission results from close contact with the blood, organs, secretions or other bodily fluids of infected persons [3]. Nosocomial infections can result from
improper sterilization or contamination of medical equipment or reuse of needles [2]. Currently there is no commercial vaccine available for humans or animals. This recent outbreak must serve as a wakeup call for health authorities over the ineffectiveness of infection control measures currently in use in the country’s already overburdened health facilities. Exposed health care personnel are at risk of developing Congo fever and its associated complications, which may lead to an epidemic in densely populated urban centers [4]. An executive member of the Medical Microbiology and Infectious Diseases Society of Pakistan has called attention to the urgent need for bio-safety measures at hospitals which should include infection control training such as basic hand hygiene and safe injection practices for all health workers and physicians, isolation rooms for suspected patients, availability of protective equipment, proper hospital waste management and sterilization techniques for surgical instruments used in such cases. Simultaneously, there is an equally pressing need to spread awareness via easily available sources such as television, internet and newspapers amongst health care personnel, slaughterhouse workers, veterinarians and the public regarding the mode of spread of this disease and the common preventive measures that can be utilized against it [5].
Funding None.
Conflicts of interest statement We declare that we have no conflicts of interest.
Ethical approval Not required.
http://dx.doi.org/10.1016/j.jiph.2016.09.011 1876-0341/© 2016 Published by Elsevier Limited on behalf of King Saud Bin Abdulaziz University for Health Sciences.
Please cite this article in press as: Fatima H, et al. Congo fever rears its head again in Pakistan. J Infect Public Health (2016), http://dx.doi.org/10.1016/j.jiph.2016.09.011
JIPH-643; No. of Pages 2
ARTICLE IN PRESS
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LETTER TO THE EDITOR
References [1] Junaidi I. An ‘alert’ NIH waits for Congo fever samples; 2016 http://www.dawn.com/news/1274398 [accessed 29.08.16]. [2] Crimean-Congo haemorrhagic fever; 2013 http://www.who. int/mediacentre/factsheets/fs208/en/ [accessed 29.08.16]. [3] Gozel MG, Bakir M, Oztop AY, Engin A, Dokmetas I, Elaldi N. Investigation of Crimean-Congo hemorrhagic fever virus transmission from patients to relatives: a prospective contact tracing study. Am J Trop Med Hyg 2014;90:160—2. [4] Begum F, Wisseman CL, Casals J. Tick-borne viruses of west Pakistan IV, Viruses similar to, or identical with, crimean hemorrhagic fever (Congo-Semunya), Wad Medani and Pak Argas 461 isolated from ticks of the Changa Manga forest, Lahore district, and of Hunza, Gilgit agency, W. Pakistan. Am J Epidemiol 1970;92:197—202.
[5] Lakhani A, Mahmood H, Laeeq A, Mansoor S, Lodhi S, Majid S, et al. Viral hemorrhagic fever in Pakistan: awareness among health care personnel. J Pak Med Assoc 2002;52:214—7.
Huda Fatima Tooba Fatima Qadir Saba Ahmed ∗ Ariba Moin Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan ∗ Corresponding
author. E-mail address: [email protected] (S. Ahmed) 29 August 2016
Available online at www.sciencedirect.com
ScienceDirect
Please cite this article in press as: Fatima H, et al. Congo fever rears its head again in Pakistan. J Infect Public Health (2016), http://dx.doi.org/10.1016/j.jiph.2016.09.011
ARTICLE IN PRESS
Journal of Infection and Public Health (2016) xxx, xxx—xxx
LETTER TO THE EDITOR Congo fever rears its head again in Pakistan KEYWORDS
Congo fever; Death; Public health; Pakistan Bahawalpur, Pakistan has become the site of high alert for the Pakistan’s Ministry of National Health Services (NHS), with three recent cases of CrimeanCongo Hemorrhagic Fever (CCHF) being reported within the past fifteen days in patients hailing from this region. It was reported that the index patient was a female nursing student, hailing from Lodhran, who had been operated upon at Bahawalpur Victoria Hospital and had expired a day later. Later, the operating senior surgeon was admitted with symptoms of high grade fever, sore throat and diarrhea and was shifted to a private hospital in Karachi, Sindh where his blood samples tested positive for Congo virus [1]. A junior doctor who had assisted during the surgery was also rushed to the hospital with similar symptoms and diagnosed with CCHF [1]. The senior surgeon expired soon after, accounting for the second death due to this deadly virus, within fifteen days. In 2015, two deaths due to Congo fever were reported in Karachi, while four patients recovered from the viral infection. According to the World Health Organization, CCHF is caused by tick-borne virus (Nairovirus) of the Bunyaviridae family and leads to severe viral hemorrhagic fever outbreaks, with a case fatality rate of 10—40%. This disease is endemic in Africa, the Middle East, the Balkans and certain Asian countries including Pakistan [2]. The virus is principally transmitted from ticks and livestock animals and human-to-human transmission results from close contact with the blood, organs, secretions or other bodily fluids of infected persons [3]. Nosocomial infections can result from
improper sterilization or contamination of medical equipment or reuse of needles [2]. Currently there is no commercial vaccine available for humans or animals. This recent outbreak must serve as a wakeup call for health authorities over the ineffectiveness of infection control measures currently in use in the country’s already overburdened health facilities. Exposed health care personnel are at risk of developing Congo fever and its associated complications, which may lead to an epidemic in densely populated urban centers [4]. An executive member of the Medical Microbiology and Infectious Diseases Society of Pakistan has called attention to the urgent need for bio-safety measures at hospitals which should include infection control training such as basic hand hygiene and safe injection practices for all health workers and physicians, isolation rooms for suspected patients, availability of protective equipment, proper hospital waste management and sterilization techniques for surgical instruments used in such cases. Simultaneously, there is an equally pressing need to spread awareness via easily available sources such as television, internet and newspapers amongst health care personnel, slaughterhouse workers, veterinarians and the public regarding the mode of spread of this disease and the common preventive measures that can be utilized against it [5].
Funding None.
Conflicts of interest statement We declare that we have no conflicts of interest.
Ethical approval Not required.
http://dx.doi.org/10.1016/j.jiph.2016.09.011 1876-0341/© 2016 Published by Elsevier Limited on behalf of King Saud Bin Abdulaziz University for Health Sciences.
Please cite this article in press as: Fatima H, et al. Congo fever rears its head again in Pakistan. J Infect Public Health (2016), http://dx.doi.org/10.1016/j.jiph.2016.09.011
JIPH-643; No. of Pages 2
ARTICLE IN PRESS
2
LETTER TO THE EDITOR
References [1] Junaidi I. An ‘alert’ NIH waits for Congo fever samples; 2016 http://www.dawn.com/news/1274398 [accessed 29.08.16]. [2] Crimean-Congo haemorrhagic fever; 2013 http://www.who. int/mediacentre/factsheets/fs208/en/ [accessed 29.08.16]. [3] Gozel MG, Bakir M, Oztop AY, Engin A, Dokmetas I, Elaldi N. Investigation of Crimean-Congo hemorrhagic fever virus transmission from patients to relatives: a prospective contact tracing study. Am J Trop Med Hyg 2014;90:160—2. [4] Begum F, Wisseman CL, Casals J. Tick-borne viruses of west Pakistan IV, Viruses similar to, or identical with, crimean hemorrhagic fever (Congo-Semunya), Wad Medani and Pak Argas 461 isolated from ticks of the Changa Manga forest, Lahore district, and of Hunza, Gilgit agency, W. Pakistan. Am J Epidemiol 1970;92:197—202.
[5] Lakhani A, Mahmood H, Laeeq A, Mansoor S, Lodhi S, Majid S, et al. Viral hemorrhagic fever in Pakistan: awareness among health care personnel. J Pak Med Assoc 2002;52:214—7.
Huda Fatima Tooba Fatima Qadir Saba Ahmed ∗ Ariba Moin Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan ∗ Corresponding
author. E-mail address: [email protected] (S. Ahmed) 29 August 2016
Available online at www.sciencedirect.com
ScienceDirect
Please cite this article in press as: Fatima H, et al. Congo fever rears its head again in Pakistan. J Infect Public Health (2016), http://dx.doi.org/10.1016/j.jiph.2016.09.011