Peshawar: With Eid-ul-Azha (Feast of Sacrifice) just around the bend, large scale cross-border transportation of cattle ahead of the religious festival is likely to increase the threat of Congo hemorrhagic fever, health authorities warn.
For days now, health professionals have been stressing timely and adequate steps to contain the Congo virus by setting up quarantine centers for sacrificial animals which are mainly brought from Afghanistan.
“Due to lack of facilities in hospitals to treat Congo fever and the risk of contracting the virus while interacting with patients, doctors and paramedics feel hesitant to visit such patients,” Dr Niaz Ali, registrar of isolation ward in the Hayatabad Medical Complex Peshawar, told News Lens.
The provincial health department have set up isolation wards in three major hospitals of Peshawar – the Lady Reading Hospital, the Khyber Teaching Hospital and the Hayatabad Medical Complex – where suspected patients of the disease will be admitted to prevent the virus from spreading to other patients and hospital staff.
The symptoms of the Crimean Congo Hemorrhagic (CCHF) can be sudden, says the US based Center for Disease Control (CDC) fact sheet on the disease available on center’s website. Initial signs and symptoms include headache, high fever, back pain, joint pain, stomach pain, and vomiting. These can be accompanied by other common symptoms such as blood-shot eyes, a flushed face, raw throat, and petechiae (red or purple spots) on the palate. Symptoms may also include jaundice, and in severe cases, changes in mood and sensory perception.
According to the CDC fact sheet, as the illness progresses, large areas of severe bruising, severe nosebleeds, and uncontrolled bleeding at injection sites can be seen, beginning on about the fourth day of illness and lasting for about two weeks.
“Majority of CCHF patients come from Afghanistan, however, staff of ward and patients do not understand languages of each other which is a big hurdle in treatment” said Dr. Ali.
On detection of symptoms of Congo virus, patients are kept in isolation.
According to Dr. Ali, 20 patients infected with Congo virus have been treated in Hayatabad Medical Complex. They were kept in isolation from other patients due to the highly contagious nature of the disease.
“Once a Congo fever patient vomited blood during the course of treatment, infecting the staff member with the virus and creating an alarming situation in the hospital,” Dr. Ali recalled.
He suggested that authorities need to take immediate precautionary measures and make it mandatory for Afghan sheep to cross a pond filled with water that contains virus-killing medicine.
Muhammad Ishtiaq, a cattle trader from the Khyber Agency in the tribal areas bordering Afghanistan, said sheep, cows and other cattle were exported to Afghanistan from Pakistan via the Torkhum border. A large number of lambs, he said, came in from Afghanistan, Pakistan’s neighbour to the east, before Eid-ul-Azha.
Ishtiaq said Afghan lambs that may carry the infectious tick that spread the Congo virus are sold to local businessmen and cattle traders in Khyber Agency, from where they find their way into the neighbouring Khyber Paskhtunkhwa province.
Congo virus infected patients require special attention and care in the course of treatment. However, hospital staff is generally reluctant to stay close to patients due to its viral effects. Of the 20 patients treated at Hayatabad Medical Complex this year, three patients died at the hospital. Now the authorities have reserved three private rooms to quarantine Congo infected patients.
“The CCHF, carrying a high mortality rate of 30 to 50 percent, poses a serious public health threat in Pakistan especially before, during and after Eid-ul-Azha because of large scale movement of cattle resulting in increased contact with humans,” said Dr. Attaullah at the Hayatabad Medical Complex.“Accordingly, an alert is being issued to adopt required measures in different district headquarters hospitals.”
“All 20 patients treated here at HMC had traveled from Afghanistan to Peshawar for the sole purpose of treatment,” said Dr. Attaullah. “Not a single patients from Pakistan has reported at HMC so far.”
Laiq Zada, Director Administration at the Lady Reading Hospital, said the medical staff used to to keep Congo fever patients in medical wards with other patients that put everyone in the ward at risk. However, since the establishment of isolation ward, the hospital can now keep patients in quarantine.
“Due to the spike in incident of Congo fever in the province, the Provincial government decided to establish isolation wards in three major hospitals at provincial capital,” said Laiq Zada.
Mehmood Jan, who traveled to Peshawar from Laghman in Afghanistan with his sister for treatment said, “my sister Haseena is infected with Congo virus and we have spend 30,000 rupees ($300) on her treatment so far.”
“We know nothing about how my sister got infected with Congo virus but she looks after sheep at the house,” said Jan.
According to health experts, crushing an infected tick could also result in infection. Infection may rarely occur if people breathe in the virus passed out in the infected animal’s excreta. People who work in close contact with livestock such as those working in the agriculture sector, slaughterhouses and veterinary hospitals are at a higher risk of the disease.
“Once a person contracts the virus, the infection spreads to other people if they come in contact with the patient’s infected blood or body fluids,” said Dr. Zeeshan of HMC.
Infection could also spread in hospitals during injections and surgical procedures which is why hospital staff that treat patients with CCHF are at a higher risk of contracting the virus.
Dr. Zeeshan said CCHF virus was the second most widespread arbovirus of medical importance after Dengue virus. Arbovirus are transmitted by arthropod vectors- the word arbovirus is an acronym (ARthropod-BOrne virus).
While the mortality rate from CCHF between 30 percent to 50 percent, with death occurring in the second week of illness, patients who recover show improvement on the ninth or tenth day after the onset of illness.
Dr. Zeeshan stressed the need for an awareness campaign about the mode of transmission of arbovirus from animals to humans as thousands of people earned their livelihood through dairy and livestock farming. He said people needed to be informed about precautions they could take to protect them from disease.
“People should avoid purchasing animals suffering from flu and other illnesses at the cattle markets,” he said.
Dr. Muhammad Zafar, an official of the Livestock Department KP, said the department had directed regional officers to combat Congo virus. “Our staff has been spraying sacrificial animals at selling points and animals market to prevent the spread of Congo tick on the eve of EID where people will come in contact with cattle.”