Pakistan

Pakistan For Specific Travellers:
Crimean-Congo Hemorrhagic Fever

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Pakistan has confirmed recent cases of Crimean-Congo Hemorrhagic Fever (CCHF) in Balochistan, Sindh, Khyber Pakhtunkhwa, and Punjab. CCHF is endemic in Pakistan.

Source: ProMED-mail.

Last updated: November 13, 2019.

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Description

Crimean-Congo Hemorrhagic Fever is an infection caused by Crimean-Congo Hemorrhagic Fever Virus (CCHFV), a Nairovirus belonging to the Bunyaviridae family. It is a zoonosis – an animal disease that can spread to humans – primarily affecting wild animals and domestic livestock. Humans become ill with CCHF when they are bitten by infected ticks or when coming into contact with infected animal blood or tissues.

Risk

The virus is typically found in Southern and Eastern Europe, Central Asia, Africa, Southeast Asia, and the Middle East. Travellers undertaking outdoor activities such as camping or hiking, especially during the peak transmission season from Spring to Fall, are at greater risk. Crimean-Congo Hemorrhagic Fever is an occupational disease among healthcare practitioners, agricultural workers, abattoir employees, and veterinarians.

Serological evidence suggests the presence of Nairovirus causing CCHF in Armenia, Azerbaijan, Bangladesh, Benin, Bosnia & Herzegovina, Botswana, Burkina Faso, Cameroon, Central African Republic, Republic of Congo, Cote d'Ivoire, Croatia, Egypt, Ethiopia, Gabon, Gambia, Georgia, Greece, Guinea, Guinea-Bissau, Hungary, India, Iraq, Kenya, Macedonia, Madagascar, Moldova, Namibia, Nigeria, Oman, Romania, Saudi Arabia, Senegal, South Sudan, Sudan, Syria, Tanzania, Turkmenistan, Uganda, Ukraine, and Zimbabwe.

Symptoms

Usually symptoms appear 1 to 9 days after the tick bite. If coming in direct contact with infected animal blood or tissues, symptoms usually appear after 5 or 6 days. Initial symptoms include a sudden high fever, aching muscles, abdominal, back and joint pain, headache, vomiting, diarrhea, dizziness, sore eyes and throat, and red spots on the palate (roof of the mouth). Other symptoms may include jaundice, mood swings, confusion, aggression, and sensitivity to light. The infection progresses to hemorrhaging (bruising, nosebleeds, blood in the urine and feces, and bleeding from the gums) which usually starts 2 to 4 days after the initial symptoms and lasts approximately two weeks. Crimean-Congo Hemorrhagic Fever may be fatal. Treatment includes supportive care of symptoms and eliminating secondary infections.

Prevention

Travellers who hike, camp, or undertake outdoor activities in wooded regions of endemic areas should take measures to prevent tick bites.

  • Use a repellent containing 20%-30% DEET or 20% Picaridin. Re-apply according to manufacturer's directions.
  • Wear neutral-coloured (beige, light grey) and breathable garments, including long-sleeved shirts and pants. Tuck pants into socks.
  • If available, apply a permethrin spray or solution to clothing and gear.
  • When hiking in wooded areas, stay in the middle of the trail and avoid tall grasses and shrubs.
  • Use a tarp when sitting on the ground.
  • Carefully examine your body, clothing, gear, and pets for ticks before entering a dwelling.
  • Promptly remove ticks using tweezers by grasping the tick's head and mouth parts as much as possible and by pulling perpendicular from the skin. See How to: Tick Edition for videos on removing ticks correctly.
  • Thoroughly disinfect the bite site with soap and water or disinfectant. If travelling in an endemic area, save the tick in a zip-lock bag or container for up to 10 days (refrigerate live ticks; keep dead ticks in the freezer). Write down the date and location of your contact with the tick. Your healthcare practitioner may advise you to submit the tick for testing.
  • If you develop symptoms of a tick-borne disease, contact your healthcare practitioner immediately.
  • Apply sunscreen first followed by the repellent (preferably 20 minutes later.)
  • More details on insect bite prevention.
  • Avoid coming into contact with the blood or tissues of animals. Healthcare practitioners should take appropriate infection control measures to prevent infection.

There is no effective commercially available vaccine or preventive medication against Crimean-Congo Hemorrhagic Fever.

Crimean-Congo Hemorrhagic Fever Virus images, life cycle, and distribution maps:

Infection Landscapes


Information last updated: November 13, 2019.



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