Sunday, November 05, 2023

Pakistan: Doctor Dies During Outbreak of CCHF In Balochistan



Although details on the outbreak remain murky, in the past few hours the Ministry of National Health Services, Pakistan, has confirmed the death of one of the attending doctors from CCHF (Crimean-Congo Hemorrhagic Fever) in Western Pakistan.  

Media reports indicate as many as 4 more doctors may be infected (see FluTrackers thread), although some twitter feeds are reporting an even larger number.

Aside from statements of condolences from the Ministry of Health, and local officials, very little information on this outbreak has been posted on the local Health Department's webpage, facebook page, or twitter account. 

Most of what we `know' comes from media reports and twitter feeds.  One such report (h/t Treyfish on FluTrackers) also describes a second, as yet unidentified outbreak, in the local government hospital.

Five doctors among 8 new cases of Congo virus in Quetta

Outbreak of unknown pathogens spread in ICU of government hospital in Quetta
| NOOR UL ARIFEENNov 04, 2023

Eight more cases of Congo virus have been reported in Quetta, out of which five are doctors.

On the other hand, an outbreak of unknown pathogens has spread in the intensive care unit of a government hospital in the Balochistan capital.

According to a spokesperson for the Balochistan Health Department Integrated Health Monitoring and Emergency Response Unit, sixteen medical staff members have been affected due to the outbreak of the pathogens in the ICU of the Civil Sandeman Hospital in Quetta. Those affected are being treated after being shifted to a separate ward.

According to the spokesman, the symptoms of the pathogen include the sudden onset of severe pain in the body. A high fever with stiffness and chills are also among its symptoms.

In addition, mild respiratory symptoms, decreased platelet count, and lymphopenia are also among its symptoms.

According to the spokesman, the pathogen is highly contagious, and teams from the health directorate are working to control the situation, and samples are being tested in labs to identify the pathogens.

All arrangements for prevention and testing have been made.


The primary vector for CCHF are ticks - but human-to-human transmission has also been reported - particular in hospital environments.  The following review, published in 2020, found that H-2-H transmission usually occurs in hospitals, and healthcare workers (HCWs) are mainly affected.

Nosocomial infections caused by Crimean-Congo haemorrhagic fever virus
K Tsergouli 1, T Karampatakis 2, A-B Haidich 3, S Metallidis 4, A Papa 2
Affiliations expandPMID: 31821852
DOI: 10.1016/j.jhin.2019.12.001


A review on nosocomial CCHFV infections was performed to elucidate the routes and circumstances of CCHFV transmission in hospital settings. From 1953 to 2016, 158 published cases of CCHFV nosocomial infection in 20 countries in Africa, Asia and Europe were found. Almost all cases were symptomatic (92.4%), with an overall CFR of 32.4%. The majority of cases occurred in hospital clinics (92.0%) and 10 cases (8.0%) occurred in laboratories. Most cases occurred among HCWs (86.1%), followed by visitors (12.7%) and hospitalized patients (1.3%). Nursing staff (44.9%) and doctors (32.3%) were the most affected HCWs, followed by laboratory staff (6.3%)

The primary transmission route was percutaneous contact (34.3%). Cutaneous contact accounted for 22.2% of cases, followed by exposure to aerosols (proximity) (18.2%), indirect contact (17.2%) and exposure to patient environment (8.1%). CCHFV can cause nosocomial infections with a high CFR.

Although Pakistan recorded its first case of CCHF nearly 50 years ago, in recent years it has seen increasing activity from this (primarily) tickborne disease.  Earlier this year, the following cautionary commentary was published.

Crimean-Congo hemorrhagic fever outbreak in Pakistan, 2022: A warning bell amidst unprecedented floods and COVID 19 pandemic

Shehroze Tabassum, Aroma Naeem, Maleeka Zamurad Khan, Nimra Mumtaz, Saima Gill, Laya Ohadi
First published: 12 January 2023

Crimean-Congo hemorrhagic fever (CCHF) is an infection caused by a tick-borne virus (genus: Nairovirus, family: Bunyaviridae). The most important vector for CCHF is the ixodid tick. Along with tick bite, direct contact with the virus-affected animal is responsible for its spread. Pakistan witnessed its first case of CCHF in 1976 and has been a major victim of CCHF for years, but spikes in cases are seen after Eid-ul-Adha, an Islamic festival involving the sacrifice of cattle. The disease, in particular, is common among butchers, veterinarians, and livestock workers.

          (Continue . . . )

CCHF is currently concentrated primarily in Africa, Asia, the Middle East and Balkans, but with an increasingly warmer climate, may expand its range in the years ahead.  Just this past week the ECDC reported on the detection of CCHF in ticks in Southern France.

Hopefully we'll get more details on the Balochistan CCHF outbreak, and the secondary outbreak in Quetta, in the days ahead.

Stay tuned.