Viral fever strikes again in Baluchistan

The World Health Organisation (WHO) has urged health workers in Pakistan to be vigilant amid repeat outbreaks of a highly contagious disease resembling the deadly Ebola virus. Acting WHO representative for Pakistan Dr Faizullah Kakar told IRIN on Tuesday that up to three cases of the deadly Crimean-Congo Haemorrhagic Fever (CCHF) were reported in Karachi, in southwestern Baluchistan Province last week. This followed an outbreak in September when the disease claimed nine lives, including those of two health workers, in Loralai, also in Baluchistan. A total of 16 cases were then reported there, and others in the provincial capital Quetta. On Friday last, Kakar conducted a workshop in Loralai to educate hospital staff there following a similar workshop in Quetta in-mid November. “There is panic, which is not good. In Quetta, people are very concerned. The important thing now, however, is that we raise awareness of the disease. We need to inform the public and educate doctors and hospital administrators,” he told IRIN. The WHO representative said that an assessment of the effects of drought on disease which he conducted in Baluchistan in June had warned of the potential for a disease outbreak. Despite alerting the Government to his findings, no proactive measures but only “reactive” ones were taken, Kakar said. The WHO was now spearheading a drive to raise awareness of the disease throughout Pakistan, and was educating hospital workers and community leaders on early warning practices, he added. The first confirmed occurrence of the disease in Pakistan was in 1978. The name Crimean-Congo Haemorrhagic Fever derives from its original detection in the Crimea in 1944 and subsequent occurrence in the Congo in 1956. It is of the same family of acute haemorrhagic fevers as the Ebola virus found in Africa, and which has claimed 149 lives so far during an ongoing outbreak in Uganda. CCHF is carried by ticks and is transferred to humans in one of three ways: from a single tick bite, or, through simply penetration of the skin to the blood system if a tick is crushed; through contact with blood from a butchered animal infected with the virus; or through bodily fluids: urine, saliva, tears and potentially even milk. “We are telling doctors who treat patients to cover their eyes with goggles as even sneezes from infected patients can spread the disease,” Kakar said of the WHO. The agency was also urging health workers to be especially vigilant in tracking symptoms: extreme headache, diarrhoea and pain, followed by bleeding from the nose, rectum and blood patches on the skin, he said. Early symptoms were very similar to that of malaria and typhoid, and there had been some reports of misdiagnosis, he added. With no laboratory testing facilities in Pakistan, blood samples are being sent to South Africa or to the Centre for Disease Control in Atlanta, USA, for diagnosis. The incubation period for CCHF is short: two to seven days from a tick bite to contraction. However, the disease was treatable if detected early enough. A drug called Ribavirin had shown positive results if prescribed at the outset, and two infected doctors from the Aga Khan Hospital in Quetta had recovered after treatment, according to the WHO. Kakar’s predictions in June of a potential CCHF outbreak stemmed from his research finding that drought exacerbated disease events, leading to one theory that the tick population that carried the virus thrived in drought conditions. In Baluchistan, where the drought was severe, people had left their homes in the mountains and moved to urban areas to look for water. Many were poor and living in tents with their animals, which may have been carrying the specific tick-carrying species, he said. These shepherds were among the targets of a widespread education campaign by WHO. In Baluchistan, farmers were encouraged to treat animals with insecticide to kill the ticks in a bid to stem the spread of the virus. Mullahs were taught precautions to be taken in dealing with suspected victims, in the hope that the information it would filter through communities. WHO and the Centre for Disease Control had produced a book on how to diagnose, control and treat the disease, which they circulated to hospitals in Pakistan. WHO, in collaboration with the government, has set up an early warning system in Pakistan to monitor 18 specific viruses. A reporting structure has been established for health workers to notify WHO and district health officers on detecting any of these diseases, including CCHF. “In the long run, we want to know more about the disease: how it spreads, the habits of the population that increase the chances of getting the disease, which tick population in Baluchistan carries this, as there are so many species of ticks.” With the onset of winter, Kakar predicted more cases of CCHF. “We are not worried there will be a big outbreak. It is a self-limiting disease, not one that spreads rapidly. It is extremely deadly, but I think we can contain it. Education is the key.”