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Crimean-Congo Hemorrhagic Fever and America's War on Terrorism
CCHF outbreaks west of Kabul and along the Afghan border
(Affected regions in red)
Update March 2002 41 deaths from "a form of hemorrhagic fever" have been reported in eastern Afghanistan. The outbreak is in the village of Tajwara, 210 miles west of Kabul, the capital. The disease has not yet been confirmed by laboratory diagnostics, but Crimean-Congo is the likely suspect, given the "black leg" syndrome present. Elsewhere, three CCHF deaths have been reported from a hospital in Rawalpindi, Pakistan, located near Islamabad. These cases originated in the Pakistani-Kashmir border area. While the disease is usually vectored through ticks, not only is direct animal-to-person contagion during colder months possible, person-to-person spread has been documented.
Protecting troops from infectious diseases is a major concern in their deployment to foreign locations. In 1995, there was an unconfirmed report of one military death caused by hantavirus pulmonary syndrome in Bosnia, soon after allied forces began operations. By mid-Spring 1996, there was a full-blown epidemic in the country, prompting Herculean efforts at rodent eradication.
With respect to United States ground operations in Afghanistan, it is to be remembered that there are several important diseases that are endemic in Afghanistan. Among these is Crimean-Congo Hemorrhagic Fever (CCHF). In the autumn of 2001 there were outbreaks along the country's western border with Iran and its southwestern border with Pakistan. In Quetta, Pakistan 75 cases, including 18 deaths, were reported. According to the World Health Organization's report of 5 October 2001, all cases orginated within Pakistan, with no Afghani refugees involved. Due, however, to the absence of public health reporting from Afghanistan, it cannot be said unequivocably that there was no outbreak on the other side of the border. Indeed, it is likely that there was.
The Iranian epidemic includes southeastern provinces along Afghanistan's western border. 100 human cases have been reported throughout Iran believed to be caused by illegal movement of animals across the borders with Afghanistan and Iraq. In an attempt to prevent cross-border spread of the disease, Iran has set up 40 border quarantine bases and 100 mobile bases that can be moved wherever necessary. In addition, 39 hospitals have been upgraded to meet the threat. While winter weather will soon slow the propagation of the CCHF tick vectors, the temperature in southwestern Afghanistan reached 80 degrees F on October 21, indicating that the necessary hard freeze is perhaps weeks away.
The first insertion of U.S. special operations troops was in the southern part of Afghanistan. It is currently believed that other forces will be introduced into the northern mountains where Osama bin Laden and his troops are believed to be hiding. If, however, intelligence indicates movement by the Al Quaeda group. into western and southwestern parts of the country, special operations will be conducted accordingly.
CCHF is a viral disease of both animals and humans transmitted through the bite of at least 29 species of ticks, through exposure to infected animals or their carcasses, and through exposure to the blood and bodily secretions of infected persons. In humans, it appears suddenly with symptoms similar to those of influenza, followed by a rash. Hemorrhage, which does not occur in all cases and can be more severe in some and less in others, begins on or about the fourth day and continues for about two weeks. The human fatality rate is, in the aggregate of all outbreaks, 30%.
A mouse-brain vaccine is available in Europe and Russia, but it is not known if it is effective and safe in humans. Thus, the most likely preventive measures are the use of repellents such as diethyltoluamide (Deet, Autan) and permethrin, which, when used in conjunction, have been deemed through research suspect agents in the cases of illness suffered by Allied troops in the Gulf War.
In animals, the disease takes the form of mild fever and viremia in sheep, cattle and small mammals such as hares. The most widespread form of prevention and control is the use of anti-tick solutions into which animals are literally dipped – a practice that can cause extreme trauma and must be repeated regularly to be effective. The causal agent is a Nairovirus of the Bunyaviridae family. Active disease occurs in many parts of the eastern hemisphere: southern China, southeastern Europe (in particular, the Caucasian countries), India, the Near East and throughout Africa. Antibodies, indicating immunity achieved through past mild infection, have been found widely. The name of the disease indicates the chronology of the first detections of the disease.