Monday, November 06, 2023

Pakistan: CCHF Dispatches From Balochis­tan

Directorate of Public Relations Balochistan


Yesterday, when I wrote about the death of a young doctor from CCHFand the infection of at least 4 other HCWs - in the western province of Balochistan, I was hard pressed to find any mention of the outbreak on official government websites.  

Over the past 24 hours, that has changed, with government officials taking to social media to warn about the outbreak.  

The most detailed report I've found comes from the Facebook page of the Directorate of Public Relations Balochistan.  I've posted the translated statement below:

A High-level meeting chaired by Caretaker Chief Minister Balochistan Mir Ali Mardan Khan Domki on the situation of Congo virus

Health Emergency imposed in Balochistan, Caretaker Chief Minister Mir Ali Mardan Khan Domki
44 cases of Congo virus have been reported in Balochistan, Caretaker Chief Minister Mir Ali Mardan Khan Domki

Two more health care workers of the Department of Health affected by Congo virus are being transported to Karachi by air ambulance today, Caretaker Chief Minister Balochistan

In contact with the Sindh government. Arrangements for treatment have been completed in other standard private hospitals including Agha Khan Hospital, Caretaker Chief Minister Balochistan
Standard treatment of all the victims is being done at the expense of the Balochistan Government, Caretaker Chief Minister Balochistan

The Livestock Department should immediately start disinfectant spraying in cattle markets across the province. Chief Minister Balochistan instructs.

All Divisional Commissioners, DHOs and Livestock Officers should keep a close eye on the situation, directing Caretaker Chief Minister Balochistan

Private altar houses banned for two weeks in Quetta under section 144, decision in the meeting

Individual private altars will be banned for two weeks, Balochistan Government

Animals can be slaughtered in altars located away from the population, decision

Balochistan government declared Dr. Shukrullah Jan as a martyr and announced the provision of all benefits to the bereaved, decision in the meeting.

The government also approved the provision of funds required for RBC and extension of contract employees of public health laboratories, decision in the meeting

According to preliminary evidence, the virus spread from a patient belonging to Harnai in Civil Hospital, briefing by the Health Department to the Caretaker Chief Minister.

This patient was brought to Civil Hospital Quetta on October 22, briefing

Congo virus report of this patient came positive on October 25, briefing

Through the trace and track process, 112 people samples including doctors, medical staff, admitted patients and their attendants of Civil Hospital have been obtained. Briefing by Abdullah Khan, Secretary Health Department Balochistan

The affected ward of Civil Hospital is sealed while other departments were disinfected under special measures, Health Secretary Abdullah Khan

The situation is under control, further spread of Congo virus has been prevented, Balochistan Health Department

 Sporadic cases of Crimean Congo Hemorrhagic Fever are not uncommon in Pakistan. Three weeks ago (before this latest outbreak) one local media outlet reported that - in the first ten months of 2023 - Balochistan had recorded 41 CCHF infections, and 15 deaths. 

Since we are lacking case line lists, and media reports don't tell us when recent cases were detected, it is difficult to determine how many new cases there really are.  I've seen media reports of 7 or 8 HCWs (doctors, nurses, and paramedics) infected, making the number mentioned above (44) a bit perplexing.

The one other official document I've been able to find (see below) was issued by the health department on Saturday, which orders that all CCHF patients be transferred to the isolation unit at the Fatima Jinnah Institute of Chest Diseases in Quetta.

Hopefully we'll get a more detailed report, either from local officials - or the WHO - in the days ahead. In the meantime, a sampling of some of the other messaging coming from local officials in Balochistan. 

Although nosocomial (and less often, household) human-to-human spread of the virus have frequently been reported, community spread is primarily through infected ticks or contact with infected animals. 

The WHO's fact sheet on CCHF includes:

23 May 2022

Key facts
  • The Crimean-Congo haemorrhagic fever (CCHF) virus causes severe viral haemorrhagic fever outbreaks.
  • CCHF outbreaks have a case fatality rate of up to 40%.
  • The virus is primarily transmitted to people from ticks and livestock animals. Human-to-human transmission can occur resulting from close contact with the blood, secretions, organs or other bodily fluids of infected persons.
  • CCHF is endemic in Africa, the Balkans, the Middle East and Asia, in countries south of the 50th parallel north.
  • There is no vaccine available for either people or animals.

Crimean-Congo haemorrhagic fever (CCHF) is a widespread disease caused by a tick-borne virus (Nairovirus) of the Bunyaviridae family. The CCHF virus causes severe viral haemorrhagic fever outbreaks, with a case fatality rate of 10–40%.

CCHF is endemic in Africa, the Balkans, the Middle East and Asian countries south of the 50th parallel north – the geographical limit of the principal tick vector.
The Crimean-Congo haemorrhagic fever virus in animals and ticks

The hosts of the CCHF virus include a wide range of wild and domestic animals such as cattle, sheep and goats. Many birds are resistant to infection, but ostriches are susceptible and may show a high prevalence of infection in endemic areas, where they have been at the origin of human cases. For example, a former outbreak occurred at an ostrich abattoir in South Africa. There is no apparent disease in these animals.

Animals become infected by the bite of infected ticks and the virus remains in their bloodstream for about one week after infection, allowing the tick-animal-tick cycle to continue when another tick bites. Although a number of tick genera are capable of becoming infected with CCHF virus, ticks of the genus Hyalomma are the principal vector.

The CCHF virus is transmitted to people either by tick bites or through contact with infected animal blood or tissues during and immediately after slaughter. The majority of cases have occurred in people involved in the livestock industry, such as agricultural workers, slaughterhouse workers and veterinarians.

Human-to-human transmission can occur resulting from close contact with the blood, secretions, organs or other bodily fluids of infected persons. Hospital-acquired infections can also occur due to improper sterilization of medical equipment, reuse of needles and contamination of medical supplies.
        (Continue . . . .)

I'll update this story if new details emerge.  In the meantime you'll find ongoing coverage in this FluTrackers thread.