With the presence of CCHF virus confirmed in adjoining Pakistan, China and Afghanistan – countries that India has had trade ties with for years – scientists have long suspected the presence of the virus here.

With the presence of CCHF virus confirmed in adjoining Pakistan, China and Afghanistan – countries that India has had trade ties with for years – scientists have long suspected the presence of the virus here.

CONGO FEVER

Recently lots of talk has been there about congo fever in India. We are going to highlight some facts about congo fever.

Crimean-Congo haemorrhagic fever (CCHF) is a widespread disease caused by a tick-borne virus (Nairovirus) of the Bunyaviridae family. The CCHF virus causes severe viral haemorrhagic fever outbreaks.CCHF is endemic in Africa, the Balkans, the Middle East and Asian countries, now prominent in India. Recently several cases have been found in Gujarat, rajasthan and other states of India.

Is it new to India?

With the presence of CCHF virus confirmed in adjoining Pakistan, China and Afghanistan – countries that India has had trade ties with for years – scientists have long suspected the presence of the virus here.

In 1976, the Indian Journal of Medical Research published a study that tested 643 human samples and found nine, from Kerala and Pondicherry, to be positive with the CCHF virus-specific antibody. The study also found positive cases among livestock from different southern states and Maharashtra. Cases with haemorrhagic manifestations among hospital staff were reported from Ahmedabad in the 2011 incident.

It was speculated that there could be more cases in the state. Further research found suspected cases of infected livestock in villages around Bengal.

The Indian Council of Medical Research confirmed that nine people have tested positive for Crimean-Congo Haemorrhagic Fever in Gujarat, The Indian Express reported. However, the head of Epidemiology and Communicable Diseases division at ICMR, RR Gangakhedkar, called this “a small outbreak”. “Of 78 samples tested from Gujarat in August this year, virologists have been able to confirm the presence of the virus in nine samples,” Gangakhedkar told The Indian Express. “Moreover, out of the two samples sent from Rajasthan one has tested positive.”

Gujarat Health Department officials said four patients have so far succumbed to the fever in the state.“The last patient died on September 3, but we received news on her sample testing positive for CCHF late Wednesday night,” doctor Dinkar Raval said. An alert has been issued in Western Rajasthan as border areas in Pakistan and in Gujarat have reported increased Congo fever cases, The Times of India reported.

Transmission

The CCHF virus is transmitted to people either by tick bites or through contact with infected animal blood or tissues during and immediately after slaughter. The majority Of cases are found in agricultural workers, slaughterhouse workers and veterinarians. It can be transmitted due to close contact with the blood, secretions, organs or other bodily fluids of infected persons. Hospital-acquired infections can also occur due to improper sterilization of medical equipment, reuse of needles and contamination of medical supplies.

Signs and symptoms

The length of the incubation period depends on the mode of acquisition of the virus. Following infection by a tick bite, the incubation period is usually one to three days, with a maximum of nine days. The incubation period following contact with infected blood or tissues is usually five to six days, with a documented maximum of 13 days.

Onset of symptoms is sudden, with fever, muscle ache, dizziness, neck pain and stiffness, backache, headache, sore eyes and photophobia (sensitivity to light). There may be nausea, vomiting, diarrhoea, abdominal pain and sore throat early on, followed by sharp mood swings and confusion. After two to four days, the agitation may be replaced by sleepiness, depression and the abdominal pain may localize to the upper right quadrant, with detectable liver enlargement.

The mortality rate from CCHF is approximately 30%, with death occurring in the second week of illness. In patients who recover, improvement generally begins on the ninth or tenth day after the onset of illness.

TREATMENT

In particular, patients need to pay attention to the fluid and electrolyte balance. The WHO also recommends “ventilation support for enough oxygenation, mild sedation and hemodynamic support depending upon the situation at the early stages of the disease in early stage of the disease presentation”. Delay in the diagnosis and supportive care decreases the efficacy of treatment and can greatly aggravate the disease with fatal consequences. The antiviral drug ribavirin has been used to treat CCHF infection with apparent benefit and both oral and intravenous formulations seem to be effective, says the WHO.

PREVENTIVE MEASURES.

Reducing the risk of tick-to-human transmission:
- wear protective clothing (long sleeves, long trousers)
- wear light coloured clothing to allow easy detection of ticks on the clothes
- use approved repellent on the skin and clothing
- regularly examine clothing and skin for ticks
- avoid areas where ticks are abundant and seasons when they are most active.
Reducing the risk of animal-to-human transmission:
- wear gloves and other protective clothing while handling animals or their tissues during slaughtering in slaughterhouses or at home
- quarantine animals before they enter slaughterhouses or routinely treat animals with pesticides two weeks prior to slaughter.
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.