Detains on the nosocomial outbreak of CCHF (Crimean Congo Hemorrhagic Fever) in western Pakistan (see previous posts here, and here) remain scant - with messaging from local officials primarily focused on reassuring the public and providing prevention advice - but yesterday another HCW death was reported by the health department; that of a 35 y.o. paramedic.
Most of what we `know' comes from local media sources (see ongoing coverage in this FluTrackers thread), but reports are often lacking in detail, and sometimes contradictory.
A quote from a media report yesterday speaks to this vagueness.
Officials in the health department said around 17 patients had been brought to Karachi from Quetta a few days back, of whom two persons, including a doctor, expired during treatment at a private hospital while some of them were discharged after they recovered.
Other media reports speak of 4 deaths this week, not two.
The most recent update (Nov 10th) posted on the Facebook page of the Health Department, Balochistan provides the following (translated) narrative, which unfortunately provides no numbers, or trends, for this outbreak.
Caretaker Health Minister Balochistan Dr. Amir Muhammad Jogizai, Secretary Health Balochistan Abdullah Khan and Chief Planning Officer Ghulam Rasool Zahri visited doctors, pharmacists, staff nurses and paramedics under treatment affected by Congo virus at Agha Khan Hospital Karachi.Caretaker Health Minister Balochistan Dr. Amir Muhammad Jogizai and Secretary Health Balochistan Abdullah Khan also met with doctors of Agha Khan Hospital Karachi who treated Congo affected doctors and medical staff.The administration issued instructions to Agha Khan Hospital Karachi not to leave any stone unturned in providing medical facilities to the doctors and medical staff affected by Congo. Caretaker Health Minister Balochistan Dr. Amir Muhammad JogizaiMedical staff of Agha Khan Hospital Karachi is taking better care of patients infected with the virus. Regards, Health Minister, BalochistanAll affected patients are being treated completely on government expenses at Agha Khan Hospital Karachi. Caretaker Health Minister Balochistan Dr. Amir Muhammad JogizaiCaretaker Health Minister Balochistan and Secretary Health Balochistan also prayed for the recovery of Congo affected doctors and medical staffGod willing, very soon the doctors and medical staff affected by Congo will recover and be with their families. Secretary Health Balochistan Abdullah KhanIn the meeting, young doctors demanded the Caretaker Health Minister Balochistan that all the doctors who are present to take care of Congo-affected doctors and medical staff should be tested for PCR at Agha Khan Hospital Karachi at the expense of the Balochistan Government.Caretaker Health Minister Balochistan promised to conduct PCR test of these doctors at Agha Khan Hospital Karachi at the expense of Balochistan Government.Health emergency is in effect throughout the province. Effective measures have been taken to prevent the spread of Congo virus. Secretary Health BalochistanThe Health Department is fully active to control the epidemic of Congo virus. Congo virus will be eradicated soon from Balochistan. Secretary Health Balochistan Abdullah Khan
Slightly more informative, the local health department posted the following update yesterday as a graphic on Twitter/X. Since it is difficult to read, I've extracted the text passages and posted them below the graphic.
The only solid data provided is 17 positive cases have been identified to date, and 3 deaths had occurred (as of Nov 9th).
SITUATION REPORT CRIMEAN CONGO HEMORRHAGIC FEVER
CCHF is endemic in Balochistan and confirmed cases have been sporadically reported from around 20 districts since 2000. The clinical data recorded have shown cases mostly reported from the rural and bordering areas with Afghanistan, where animal herding is a common source of domestic economy. Low prevalence of preventive measures due to lack of awareness on the mode of transmission and correct animal herding have resulting in sporadic outbreaks The risk of transmission increases during Eid-Ul-Adha: when the cattle are transferred to densely populate urban area for business purposes. Similarly, the risk of human to human transmission at household level and hospital acquired infections are reported variably. The contributing factors include lack of community awareness and sub- optimal infection prevention and control measure in the health facilities
SITUATION Summary of Crimean-Congo Hemorrhagic Fever (CCHF) Outbreak in Balochistan, Pakistan
EPIDEMIOLOGY & ACTIONS
On 3 November, a Healthcare acquired CCHF infection was reported from the medical ICU at Sandeman Provincial Hospital Quetta, affecting 17 people so far as a whole and resulting in the death of 3.
Out of 230 so far tested samples, 17 were laboratory positiveACTIVITIES PERFORMED ON 8 NOVEMBER08 samples are being analyzed by PHL Lab today, wherein 01 got positive 02 positive cases tested cases traced and isolated in Fatima Jinnah Hospital Investigation of both the positive cases, contact tracing done and quarantined A second wave of call started today to the suspected cases to confirm for any symptoms, however no family reported any symptomsADVISORYThe CCHF outbreak in Balochistan is a serious public health concern: Department of Health is taking steps to contain the outbreak. Now as per the results it is necessary that the public shall adopt precautionary measures. Moreover, in case anyone develops the symptoms then he/she should visit FJC&G Hospital for screening.PARTNERS SUPPORT
- WHO has provided 50000 masks for hospitals
- NIH team has arrived along with lab kitsfor support of the investigation team
- UNICEF has provided 30000 gloves, 300 face shields, 300 hand sanitizers, and 1500 face masks
- Jhpiego conducted a training session Infection Prevention & Control (IPC) for healthcare providers at BMC hospital
Earlier this year The Lancet reported on a large, nosocomial outbreak of CCHF in Afghanistan (see The largest reported outbreak of CCHF in hospital settings: lessons from Kandahar, Afghanistan) where - out of 48 suspected cases - 14 tested positive in less than a week.
The authors warned `. . . that case numbers of Crimean–Congo haemorrhagic fever will increase drastically in health-care settings if infection prevention and control measures are not respected.'
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 two weeks ago the ECDC reported on the detection of CCHF in ticks in Southern France.
In 2019, in CDC: The 8 Zoonotic Diseases Of Most Concern In The United States, we looked at a joint CDC, USDA, DOI report on the top (n=56) zoonotic diseases of national concern for the United States.
CCHF was ranked #15, well ahead of Nipah (#20), MERS-CoV (#27) and Monkeypox (#29). While CCHF is not a problem here in the United States today, that could change over time.
Thus far, 7 genotypes have been described, and we've seen evidence of reassortment (see EID Journal Fatal Case of Crimean-Congo Hemorrhagic Fever Caused by Reassortant Virus, Spain, 2018), meaning that what we say about CCHF today may not hold true tomorrow.
While not currently in the same league as novel flu or emerging coronaviruses, CCHF is capable of sparking significant, and deadly, localized epidemics.
Which is why we keep a close watch on outbreaks such as we are seeing right now in Pakistan.
