PAKISTAN: Viral fever strikes again in Baluchistan

Islamabad, 29 November (IRIN) - The World Health Organisation (WHO) has
urged health workers in Pakistan to be vigilant amid repeat outbreaks of a
highly contagious disease resembling the deadly Ebola virus.

Acting WHO representative for Pakistan Dr Faizullah Kakar told IRIN on
Tuesday that up to three cases of the deadly Crimean-Congo Haemorrhagic
Fever (CCHF) were reported in Karachi, in southwestern Baluchistan
Province last week. This followed an outbreak in September when the
disease claimed nine lives, including those of two health workers, in
Loralai, also in Baluchistan. A total of 16 cases were then reported
there, and others in the provincial capital Quetta.

On Friday last, Kakar conducted a workshop in Loralai to educate hospital
staff there following a similar workshop in Quetta in-mid November. "There
is panic, which is not good. In Quetta, people are very concerned. The
important thing now, however, is that we raise awareness of the disease.
We need to inform the public and educate doctors and hospital
administrators," he told IRIN.

The WHO representative said that an assessment of the effects of drought
on disease which he conducted in Baluchistan in June had warned of the
potential for a disease outbreak. Despite alerting the Government to his
findings, no proactive measures but only "reactive" ones were taken, Kakar
said. The WHO was now spearheading a drive to raise awareness of the
disease throughout Pakistan, and was educating hospital workers and
community leaders on early warning practices, he added.

The first confirmed occurrence of the disease in Pakistan was in 1978. The
name Crimean-Congo Haemorrhagic Fever derives from its original detection
in the Crimea in 1944 and subsequent occurrence in the Congo in 1956. It
is of the same family of acute haemorrhagic fevers as the Ebola virus
found in Africa, and which has claimed 149 lives so far during an ongoing
outbreak in Uganda.

CCHF is carried by ticks and is transferred to humans in one of three
ways: from a single tick bite, or, through simply penetration of the skin
to the blood system if a tick is crushed; through contact with blood from
a butchered animal infected with the virus; or through bodily fluids:
urine, saliva, tears and potentially even milk.

"We are telling doctors who treat patients to cover their eyes with
goggles as even sneezes from infected patients can spread the disease,"
Kakar said of the WHO. The agency was also urging health workers to be
especially vigilant in tracking symptoms: extreme headache, diarrhoea and
pain, followed by bleeding from the nose, rectum and blood patches on the
skin, he said. Early symptoms were very similar to that of malaria and
typhoid, and there had been some reports of misdiagnosis, he added. With
no laboratory testing facilities in Pakistan, blood samples are being sent
to South Africa or to the Centre for Disease Control in Atlanta, USA, for
diagnosis.

The incubation period for CCHF is short: two to seven days from a tick
bite to contraction. However, the disease was treatable if detected early
enough. A drug called Ribavirin had shown positive results if prescribed
at the outset, and two infected doctors from the Aga Khan Hospital in
Quetta had recovered after treatment, according to the WHO.

Kakar's predictions in June of a potential CCHF outbreak stemmed from his
research finding that drought exacerbated disease events, leading to one
theory that the tick population that carried the virus thrived in drought
conditions. In Baluchistan, where the drought was severe, people had left
their homes in the mountains and moved to urban areas to look for water.
Many were poor and living in tents with their animals, which may have been
carrying the specific tick-carrying species, he said.

These shepherds were among the targets of a widespread education campaign
by WHO. In Baluchistan, farmers were encouraged to treat animals with
insecticide to kill the ticks in a bid to stem the spread of the virus.
Mullahs were taught precautions to be taken in dealing with suspected
victims, in the hope that the information it would filter through
communities. WHO and the Centre for Disease Control had produced a book on
how to diagnose, control and treat the disease, which they circulated to
hospitals in Pakistan.

WHO, in collaboration with the government, has set up an early warning
system in Pakistan to monitor 18 specific viruses. A reporting structure
has been established for health workers to notify WHO and district health
officers on detecting any of these diseases, including CCHF.

"In the long run, we want to know more about the disease: how it spreads,
the habits of the population that increase the chances of getting the
disease, which tick population in Baluchistan carries this, as there are
so many species of ticks."

With the onset of winter, Kakar predicted more cases of CCHF. "We are not
worried there will be a big outbreak. It is a self-limiting disease, not
one that spreads rapidly. It is extremely deadly, but I think we can
contain it. Education is the key."