Asad Mustafa Karim and Prof. Dr. Sang Hee Lee |
Human beings have been combating viruses since long, even before our species had even evolved into its modern form. Pakistan, lying in Asia, is faced with a quadruple burden of communicable and non-communicable diseases. There are many health-related issues in Pakistan like infectious diseases; high maternal, neonatal, and child mortality and morbidity; the high magnitude of death, disease, and disability posed by non-communicable diseases; and injuries and violence.
The CCHF virus, a zoonotic agent, causes fatal infection in humans with a mortality rate up to 50%.
Within this context, Crimean-Congo Hemorrhagic Fever (CCHF) is one of the diseases that need utmost attention. Crimean-Congo Hemorrhagic Fever Virus (CCHFV) is one of the most widespread, deadly vector-borne arboviruses described in Asia, Africa, southeastern Europe, and the Middle East.
What is CCHFV?
CCHF was first diagnosed during World War II, in the Crimean region of Russia, and the virus was first isolated from the Democratic Republic of Congo in 1969. CCHFV is a highly virulent pathogen that has caused 10,000 human infections globally. The CCHF virus, a zoonotic agent, belongs to the family Bunyaviridae and causes fatal infection in humans with a mortality rate up to 50%. Individuals can be infected by CCHF virus through the bites of Hyalomma ticks found on hairy animals, handling potentially infectious body fluids of the infected patients, or contacting the tissues and blood from viremic livestock.
According to a research carried out in 2016, 86 of the 483 suspected cases positive for CCHFV and 35 (41%) patients died. Baluchistan had the highest number of positive cases (44%) as compared to other provinces.
After the dengue viruses, CCHF virus is the second most outspread virus of all medically important arboviruses. Exceptional permissive climatic conditions for Hyalomma genus ticks might have contributed to the explosive spread of CCHF virus in Pakistan. The widespread geographical expansion of CCHF virus, its ability to cause mild, febrile and severe human illness with higher mortality rates, and fears about its intentional introduction as an emerging pathogen or bioterrorism agent make the virus a significant fatal human pathogen. Therefore, there is a need for thorough surveillance of CCHF in all provinces of Pakistan so that the objective of controlling and preventing CCHF can be achieved.
In 2016, we prospectively tested serum samples of patients by CCHFV-specific IgG using ELISA kits. Of these 483 suspected cases, 86 were positive for CCHFV and 35 (41%) patients died. Baluchistan had the highest number of positive cases (44%) as compared to other provinces.
We hypothesized that the virus, most likely, is being transported by the imported animals from Afghanistan or Iran. To verify this hypothesis, we did ELISAs on samples from 21 randomly selected transported animals from Afghanistan and Iran and found that 62% of them were CCHFV positive. Therefore, we suggest border control regulations must be enforced because the movement of animals and people from Afghanistan into Pakistan without any monitoring or health checks has overwhelmed the local public health system.
In the next 10–15 years, Eid-ul-Adha will occur in summer when CCHF is more prevalent, suggesting a dire need to implement policies on the slaughter of sacrificial animals to prevent a potential health catastrophe.
It is a very common perception in Pakistan that the Congo hemorrhagic fever prevails only during the season of Eid-ul-Adha – an annual religious festival where about 8 million animals (sheep, goats, cows, and camels) are sacrificed. This, however, is not true because the breeding of virus is totally dependent on temperature.
Climatic change is thought to be a primary cause of spreading infectious diseases. In Pakistan temperature starts to rise in the month of April, consequently increasing the tick activity. Generally, CCHF cases start surfacing from the month of April in Pakistan. As the temperature increases, tick activity also increases and till the arrival of Eid-ul-Adha temperature gives a high probability of sporadic outbreaks of CCHF. In the next 10–15 years, Eid-ul-Adha will occur in summer when CCHF is more prevalent, suggesting a dire need to implement policies on the slaughter of sacrificial animals to prevent a potential health catastrophe.
No Definite Treatment, Yet
There is no specific treatment for CCHF and no medicine is in clinical trial phases for this deadly virus. CCHF is diagnosed via ELISA Kits, antigen detection, and most importantly with polymerase chain reaction (PCR). Ribavirin is considered as an effective agent against CCHF, although definitive studies are not available to support this claim.
Treatment should include an adequate attention to fluid balance and rectification of any electrolyte abnormalities present. Therefore, the public, farmers, animal handlers, and health-care workers need to be educated about health hazards posed by CCHF virus. In addition, use of acaricides on domestic or imported animals and other sacrificial animals is one of the best control strategies to combat CCHF outbreaks.
Asad Mustafa Karim is a Pakistani national, who is a currently a Ph.D. student of clinical microbiology in South Korea. He is working on different research projects from 4 years. He has co-authored 10 research articles in distinguished journals. His research interests include Epidemiology of infectious diseases, Mechanisms of antimicrobial resistance in clinical microorganisms, and Biochemistry of ESBLs. This research was published in “The Lancet Infectious Diseases”.