IMA releases white paper on Crimean-Congo Haemorrhagic Fever

The Indian Medical Association (IMA) today sought to inform the public about preventive measures to counter Crimean-Congo Haemorrhagic Fever (CCHF) after tests confirmed that a patient who recently died at AIIMS here had contracted the disease.

PTI| Last Updated: Jan 23, 2015, 21:00 PM IST

New Delhi: The Indian Medical Association (IMA) today sought to inform the public about preventive measures to counter Crimean-Congo Haemorrhagic Fever (CCHF) after tests confirmed that a patient who recently died at AIIMS here had contracted the disease.

The white paper compiled by Dr KK Aggarwal, the IMA Secretary General, explains what the disease is and what preventive measures should be taken to check it. The advisory came after tests at National Institute of Virology (NIV) at Pune confirmed that the patient, who was referred to AIIMS from a hospital in Jodhpur, had succumbed to CCHF.

As per the white paper, CCHF is a severe, potentially fatal disease in humans caused by tick-borne virus (Nairovirus) and mainly occurs in Africa, Asia, Eastern Europe and Middle East.

CCHF was first confirmed in a nosocomial (originating in a hospital) outbreak in 2011 in Gujarat. Another outbreak occurred in July, 2013, in Karyana village of Amreli district in Gujarat, IMA said.

"There is no vaccine available for either people or animals. Preventions that one can take include reducing the risk of human-to-human transmission in the community, avoiding close physical contact with CCHF-infected people, wearing gloves and protective equipment while taking care of ill people, washing hands regularly after caring or visiting ill people," stated the white paper.

Health workers caring for patients with suspected or confirmed CCHF, or those handling specimens from them, should implement standard infection-control precautions. These include basic hand hygiene, use of personal protective equipment, safe injection practices and safe burial practices.

Transmission of CCHF in humans occurs through tick bites, contact with a patient with CCHF during the acute stage of infection or contact with blood or tissue from infected livestock.

"Human-to-human transmission can occur resulting from close contact with the blood, secretions organs or other bodily fluids of infected persons. The four distinct phases of the disease are incubation, pre-haemorrhagic, haemorrhagic and convalescence," it added.

The incubation period that follows a tick bite is usually

short and lasts for between three to seven days. The pre- hemorrhagic period is characterised by the sudden onset of fever, headache, myalgia, and dizziness. Additional symptoms of diarrhoea, nausea and vomiting are also seen in some cases.

"Nearly three days later, haemorrhagic manifestations from petechiae, large haematomas and frank bleeding (vaginal, gastrointestinal, nose, urinary, and respiratory tracts) usually follows.

"The convalescence period begins in survivors about 10 to 20 days after onset of the illness," the white paper says.

The disease is diagnosed by ELISA and immunofluorescence assays from about seven days after its onset.

Treatment of CCHF is mainly supportive. Ribavirin is effective, to be given for 10 days (30 mg/kg as an initial loading dose, then 15 mg/kg every six hours for four days, and then 7.5 mg/kg every eight hours for six days).

Meanwhile, the report said that a study on Vector Borne and Zoonotic diseases looked at the prevalence of CCHFV among bovine, sheep and goat populations from 15 districts of Gujarat and found antibodies in all the 15 districts surveyed; with positivity of 12.09 per cent in bovine, 41.21 per cent in sheep and 33.62 per cent in goats.

"Anti-CCHF virus (CCHFV) immunoglobulin G(IgG) antibodies were detected in domestic animals from the adjoining villages of the affected area, indicating a considerable amount of positivity against domestic animals," the white paper said.