NCDC Newsletter
(Quarterly Newsletter from National Centre for Disease Control (N
Volume 4, Issue 1 January- March, 2015
http://nicd.nic.in/writereaddata/linkimages/Newsltr0320156655589079.pdf
...
Crimean Congo haemorrhagic fever: Need to remain alert
Crimean Congo haemorrhagic fever (CCHF) is an emerging public health problem in India. It is an
acute, highly-contagious and life-threatening disease caused by a Nairovirus of the Bunyaviridae
family. The first outbreak in India was reported in 2011 from Gujarat killing four people including a
doctor and a nurse who were either involved in the treatment or were the close contacts of patient.
Subsequently, every year outbreaks of CCHF have been reported from different districts of Gujarat ,
Recently, outbreaks of CCHF have also been reported from Jodhpur, Rajasthan and Muradabad .(Uttar Pradesh (Table 1)
...
Recent Outbreaks
Multi-disciplinary teams of the National Centre for Disease Control assisted State Governments
of Rajasthan and UP to investigate recent outbreaks of CCHF along with the State
.Departments of Health and Animal Husbandry
In Jodhpur, Rajasthan, in January 2015, four CCHF cases were reported and all these were male nurses
of ICU of a private hospital. Dates of onset of all four cases were within a span
of one & two days. A retrospective review of clinical records of all the cases admitted in
ICU within fifteen days duration before onset of first case, revealed that there was only
one case compatible with clinical symptoms of CCHF. This case was earlier diagnosed by
the doctors of the private hospital as a case of hepatic-encephalopathy and died in the
hospital while undergoing treatment for the same. Clinico-epidemiological, environmental
and entomological examination strengthened the possibility of this case being the index case
for this CCHF outbreak. Some key findings of the investigation pointing to the diagnosis were
as follows: case patient was a cattle grazer by occupation, spending most of his time with the
cattle; cattle in the village of this case were ;(found to be heavily infested with ticks (Fig. 1
case patient was involved in distribution of free fodder from a location near the animal enclosure
at outskirt of village leading to increase in the possibility of exposure to animal ticks
Fig 1.) Therefore, close contact with tickinfested animals and handling of haystacks)
without use of protective clothing by the index patient were some prominent risk factors
identified as likely route of transmission for the present episode of CCHF.
During the same month, 57 year old female patient resident of village Kanth in district
Muradabad, UP developed fever and weakness and was treated by a local medical practitioner
and a private hospital. When she deteriorated ,further and developed bleeding manifestations
she was shifted to a private tertiary care hospital in Noida, UP where she was investigated
for haemorrhagic fever. Peripheral smear ,for malaria, serology for typhoid, dengue
leptospirosis and rickettsial diseases were negative. She was diagnosed as a case of CCHF
after her blood sample was tested positive at NCDC, Delhi. Since then, she was isolated in
ICU and given Ribavirin but did not improve and expired in hospital ICU. All infection control
practices, PPE and waste management were followed appropriately.
Investigations revealed that the patient owned a buffalo and a cow calf and was closely involved
in taking care of these animals (feeding, bathing and cleaning the surroundings) and
milking them. The animal shed was located in the courtyard of the house (Fig 2). The
feed was stacked in the shed and court yard. Out of two domestic animals, one had been
sold in the open market by the family of the index case. Entomological examination of the
remaining animal and surroundings revealed tick infestation. The ticks and animal blood sera
collected from the house and the neighborhood were sent to the Institute of High Security
Animal Diseases, Bhopal. So-far results for 15 tik sample have come out negative. Results
for animal blood sera are awaited. Contact tracing and IEC was carried out. Local hospital
was strengthened to manage any such cases. State Animal Husbandry department has been
requested to carry out tick control measures.
...
http://nicd.nic.in/writereaddata/linkimages/Newsltr0320156655589079.pdf
