Crimean congo hemorrhagic fever

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  • 1. S H A K E R A S A D I Q G I L L Crimean-congo hemorrhagic fever
  • 2. Definition  An acute disease caused by arbovirus that can be transmitted to humans by ticks.  First described by 1944 in crimean peninsula  Viral etiology was confirmed in 1945
  • 3. Etiology  CCHF belongs to family Bunyaviridae genus Nairovirus (from Nairobi sheep disease virus)
  • 4. Occurrence  Human CCHF is known to occur in 38 countries including  Iraq  Afghanistan  Pakistan
  • 5.  In areas of endemicity infection with CCHF found in human and domestic animals more frequently in cattle than in sheep and goats.
  • 6. Risk of Exposure  Animal herders, livestock workers, and slaughterhouse workers in endemic areas are at risk of CCHF.  Healthcare workers in endemic areas handling blood and body fluids.  Individuals and international travellers with contact to livestock in endemic regions may also be exposed.
  • 7. Reservoir of infection  Hedgehogs  Horses  Mouse like rodents act as reservoir
  • 8. Hedgehogs
  • 9. Vectors  Ticks act as reservoir  CCHF has been isolated from more than 30 species of ticks including predominately Hyalomma but also Ixodes species
  • 10. Ticks
  • 11.  Human infection occur in rural areas with livestock, slaughter houses and dairy cattle as the source of epidemic  In Afghanistan and UAE camels introduce the CCHF virus
  • 12. Transmission  Contact with ticks  Infected livestock  Tick sucking on a cow bruised with hand, virus can be transmitted  Slaughtering of animals  Castration  Branding of animals
  • 13.  Support in birth  Nosocomial infections are frequent  Occur in patient care takers  Aerosol transmission  Used as biological weapon for bioterrorism
  • 14. Clinical manifestations  Incubation period after tick bite is 1-3 days  Depending upon the dose IP may up to 9 days following nosocomial exposure to viremic blood,tissues and excreta  Fever  Shivering  Maliase
  • 15.  Irritability  Head-limb and backaches.  Anorexia  Abdominal pain and nausea  Vomiting is common  Fever last for 5-12 days but biphasic courses are seen
  • 16.  Skin on face and neck is red and swollen  Conjunctiva and mucous membranes are congested and edematous  Petechial bleeding on the skin of entire body  Bleeding on mucosal membranes  Urogenital bleeding  Case fatality is 30 -50 days
  • 17.  Patients die with hemorrhagic shock and secondary infections.
  • 18. Diagnosis  Diagnostic tests should be performed in BSL 4  PCR  RT-PCR  Testing for virus specific IgM antibodies  ELISA  Serum neutralization
  • 19. Differential diagnosis  Typhoid fever  Malaria  Yellow fever  Dengue
  • 20. Therapy  Treatment for CCHF is primarily supportive.  Care should include careful attention to fluid balance and correction of electrolyte abnormalities, oxygenation and appropriate treatment of secondary infections.  Intensive care should be given with protective clothing's  Vital function must be controlled
  • 21.  Packed red cells, platelets, clotting factors and albumin are required for the treatment of hemorrhagic shock.  Ribavirin blocks viral replication can be used.  Transport of patient with hemorrhagic fever to the hospital in isolation quarters is not recommended.  In critical stage the patients be attended by experienced personal.
  • 22. Prophylaxis  Inactivated virus vaccine from mouse brain was prepared in Russia  No modern vaccine is available  Use gloves and protective clothing while handling infected patients and cattle  Nosocomial infections should be prevented  Safe handing of infected material
  • 23.  Specimen should be inactivated before removal from isolation ward  Addition of detergent will reduce the virus titer  The most dangerous manipulation is running specimen in the centrifuge  Infected needles and knives should be avoided
  • 24.  Agricultural workers and others working with animals should use insect repellent on exposed skin and clothing.  Insect repellents containing DEET (N, N-diethyl-m- toluamide) are the most effective in warding off ticks.
  • 25. Reducing the risk of tick-to-human transmission WHO recommendations  wear protective clothing (long sleeves, long trousers);  wear light coloured clothing to allow easy detection of ticks on the clothes;  use approved acaricides (chemicals intended to kill ticks) on clothing;
  • 26.  use approved repellent on the skin and clothing;  regularly examine clothing and skin for ticks; if found, remove them safely;  seek to eliminate or control tick infestations on animals or in stables and barns; and  avoid areas where ticks are abundant and seasons when they are most active.
  • 27. Reducing the risk of animal-to-human transmission  wear gloves and other protective clothing while handling animals or their tissues in endemic areas, notably during slaughtering, butchering and culling procedures in slaughterhouses or at home;  quarantine animals before they enter slaughterhouses or routinely treat animals with pesticides two weeks prior to slaughter.
  • 28. Reducing the risk of human-to-human transmission in the community:  avoid close physical contact with CCHF-infected people;  wear gloves and protective equipment when taking care of ill people;  wash hands regularly after caring for or visiting ill people.
  • 29. CCHF in Pakistan  From 1 January to 9 June 2013, a total of 16 suspected cases of Crimean-Congo haemorrhagic fever (CCHF), including six deaths (case–fatality rate 37.5%) were reported from Pakistan.  So far, 7 of these reported cases have been laboratory-confirmed.  In 2012, the country faced a similar outbreak of CCHF with 61 suspected cases, including 17 deaths (case–fatality rate 27.8%) reported from the disease.
  • 30.  The majority of the cases were reported from the province of Balochistan, Sindh, Khyber Pakhtunkhwa and Punjab.  Crimean-Congo haemorrhagic fever is endemic in Pakistan and cases are reported sporadically since 2000.
  • 31. Suspected cases of CCHF reported in Pakistan 2000-2010 Year Case Death Case fatality 2000-2002 191 59 26.2 2003-2006 328 42 12.8 2010 29 3 4.9 2012 61 17 27.8
  • 32. End