An outbreak of Crimean-Congo Hemorrhagic Fever recurs in Gujarat?

Dr KK Aggarwal and Dr Adit Desai

Ahmedabad, Aug 28 (PTI) Three women from Gujarat have fallen victims to Congo Fever in one week while as many new cases have come to light, the state government said on Wednesday. Of the three, two women from Surendranagar district died earlier this week while another woman succumbed to the infection late on Tuesday night, said deputy Chief Minister Nitin Patel in Gandhinagar. The latest deceased hailed from Bhavnagar district. "A total of three women have died due to Congo fever, which spreads through ticks in humans. Three new cases were also reported till now. Among the three, a woman is currently undergoing treatment at civil hospital in Ahmedabad while two male patients are admitted to SVP hospital," he said. Health Commissioner Jayanti Ravi said since cattle-rearers are more susceptible to the Crimean-Congo Hemorrhagic Fever (CCHF) virus, which is responsible for the infection, preventive measures are being taken.  Ahmedabad, TNN | Aug 29, 2019: Deputy CM and state health minister Nitin Patel confirmed that the three deaths in the state were due to CCHF virus. “A total 17 people including two from Halvad in Morbi district have tested positive for the virus while 11 samples tested negative. The health administration is taking all measures to control further spread of the disease,” Patel said. In Ahmedabad, three medical personnel treating Congo fever patients from Surendranagar at SVP Hospital have tested negative.

CCHF was first described in the Crimea (former USSR) in 1944 and given the name Crimean hemorrhagic fever.

In India, the first confirmed case of CCHF was reported during a nosocomial (Infections caught in hospitals) outbreak in Ahmadabad, Gujarat, in January 2011. During 2012–2015, several outbreaks and cases of CCHF transmitted by ticks via livestock and several nosocomial infections were reported in the states of Gujarat and Rajasthan (National Health Portal of India).

Crimean-Congo hemorrhagic fever: A quick recap

Crimean-Congo hemorrhagic fever (CCHF) is a zoonotic disease and is endemic in parts of Africa, the Middle East, Asia and southeastern Europe. It has been listed as a WHO Priority disease, which means “diseases that pose a public health risk because of their epidemic potential and for which there are no, or insufficient, countermeasures”.

·         Etiology: It is a viral hemorrhagic fever caused by the CCHF virus.

·         Transmission:  The CCHF virus is transmitted via ticks or direct contact with blood/body fluids or tissues of infected animals; nosocomial transmission can also occur. Transmission of the virus usually occurs between May and September; ticks survive most readily in relatively warm, dry habitats.

·         High risk groups: Persons in rural endemic areas working in animal husbandry

·         Incubation period: 1-3 days following tick bite; 3-7 days after contact with blood and body fluids.

·         Clinical features: Sudden onset of fever, headache, malaise, myalgia, sore throat, dizziness, conjunctivitis, photophobia, abdominal pain, nausea, vomiting. In severe cases, hemorrhagic manifestations (petechiae, ecchymoses, epistaxis and gum bleeding) occur.

o    Suspect CCHF in patients with fever and bleeding with relevant geographic and epidemiologic risk factors.

·         Biochemistry: Thrombocytopenia, leukopenia, hyperbilirubinemia with elevated transaminases, prolongation of prothrombin time and partial thromboplastin time.

·         Diagnostic tests: Serology (IgM and IgG antibodies, which appear 5 days from symptom onset); reverse-transcriptase polymerase chain reaction (RT-PCR) (which detects CCHFV RNA)

·         Management: Supportive care; fluid and electrolytes, antipyretic (paracetamol), avoid ibuprofen and aspirin. Severe cases may need mechanical ventilation, hemodialysis, vasopressor and inotropic agents.

o    Observe infection control precautions (including standard, contact and droplet precautions) i.e. use of personal protective equipment (an impervious gown, gloves, mask, and eye/face protection); respiratory protection (N95 mask or FFP3 respirator); shoe covers; dispose off all sharps and needles in hard containers and at the point of use.

o    Platelet transfusion to maintain platelet count >50,000/mm3 if bleeding occurs and for patients with platelet count <20,000/mm3 in the absence of bleeding 

o     Patients with suspected or confirmed CCHF should be treated in isolation rooms 

·         Prognosis: Symptoms usually resolve in 7-10 days in nonsevere cases. Mortality rate is 2-80%.

·         Post-exposure management: Monitor the person for clinical manifestations of CCHF for 2 weeks. Measure body temperature every day and do complete blood count (CBC) every week; no quarantine is required

·         Prevention: Avoid tick bites and contact with bodily fluids of infected animals; there is no vaccine for CCHF.

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Past National President IMA