Nosocomial CCHF Cluster In Punjab, Pakistan - NOT

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Re: Nosocomial CCHF Cluster In Punjab, Pakistan

Re: Nosocomial CCHF Cluster In Punjab, Pakistan

The numbers do not quite add up here, but the situation seems to be getting much worse. The reporter may be getting the suspected CCHF and Dengue counts confused.

Of note is that the number of HCW affected in this article is given as three, not the 7-9 earlier. If there are 32 patients in the isolation ward, it is unlikely that 27 would have tested positive for CCHF, 5 for Dengue, and 21 people would have dengue tests pending.

http://tribune.com.pk/story/59853/5-more-suspected-in-holy-family/

5 more suspected in Holy Family

RAWALPINDI: Five more patients suspected of Crimean-Congo Hemorrhagic Fever (CCHF) were brought to Holy Family Hospital Rawalpindi on Thursday evening. The suspected patients include two women and three men.

Talking to the Express Tribune, Abdul Waheed, a staff member of the hospital’s isolation ward said the patients’ blood samples will be sent to the National Institute of Health (NIH) to be tested for Congo Fever virus on Friday.

He said 27 out of the 32 patients admitted to the ward had tested positive for the virus.

He said that blood samples of the three female staff members of the hospital who had earlier tested positive for CCHF, and were treated, have been sent to NIH again for verification. Their results are due on Friday, he added.

Dr Saima Naz, also a senior staff member of the hospital’s isolation ward said that five patients in the ward have tested positive of dengue fever, while blood samples of the remaining 21 patients suspected of dengue have been sent to NIH.

Majority of these patients belong to Chakwal and include two children, said Naz. She said strict measures were being taken in all hospital wards to prevent the disease from spreading.

Published in The Express Tribune, October 8th, 2010.

 

[alert]

Re: Nosocomial CCHF Cluster In Punjab, Pakistan - may be spreading

Re: Nosocomial CCHF Cluster In Punjab, Pakistan - may be spreading

http://www.promedmail.org/pls/apex/..._BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,85223

Archive Number 20101008.3660
Published Date 08-OCT-2010
Subject PRO/AH/EDR> Crimean-Congo hem. fever - Pakistan (06): (PB)


CRIMEAN-CONGO HEMORRHAGIC FEVER - PAKISTAN (06): (PUNJAB)
*********************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Fri 8 Oct 2010
Source: The Express Tribune [edited]
<http://tribune.com.pk/story/59853/5-more-suspected-in-holy-family/>


5 more suspected in Holy Family
-------------------------------
Another 5 patients suspected of having contracted Crimean-Congo
hemorrhagic fever (CCHF) were brought to Holy Family Hospital (HFH)
in Rawalpindi on Thursday evening (7 Oct 2010). The suspected
patients include 2 women and 3 men.

Talking to the Express Tribune, Abdul Waheed, a staff member of the
hospital's isolation ward said these patients' blood samples will be
sent to the National Institute of Health (NIH) to be tested for CCHF
virus on Friday [8 Oct 2010]. He said 27 out of the 32 patients
admitted to the ward had tested positive for the virus.

He said that blood samples of the 3 female staff members of the
hospital who had earlier tested positive for CCHF, and were treated,
have been sent to the NIH again for verification [presumably to
ensure that they are now free of virus? - Mod.CP]. Their results are
due on Friday [8 Oct 2010], he added.

Dr Saima Naz, also a senior staff member of the hospital's isolation
ward said that 5 patients in the ward have tested positive of dengue
fever, while blood samples of the remaining 21 patients suspected of
dengue have been sent to NIH. The majority of these patients belong
to Chakwal and include 2 children, said Naz. She said strict measures
were being taken in all hospital wards to prevent the disease from spreading.

--

[Cases of CCHF in Punjab province continue to accumulate, but there
has been little information so far about the source (or sources) of
the outbreak. In total, 27 of the 32 CCHF cases have been confirmed
by laboratory tests, and 5 of 26 cases of suspected dengue fever have
been confirmed. It is unclear from this press report whether the CCHF
and dengue fever patients are housed in the same or different
isolation wards. Clarification would be appreciated.

 

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Re: Nosocomial CCHF Cluster In Punjab, Pakistan - may be spreading

Re: Nosocomial CCHF Cluster In Punjab, Pakistan - may be spreading

http://www.dawn.com/wps/wcm/connect...abad/more-dengue-fever-patients-reach-hfh-900

More ?dengue fever? patients reach HFH By A Reporter
Saturday, 09 Oct, 2010 MEDIA GALLERY
Manish?s couture calling RAWALPINDI, Oct 8: Holy Family Hospital (HFH) on Friday admitted six more suspected patients of dengue fever.

However, the hospital discharged 12 patients of dengue fever and seven confirmed patients of Crimean-Congo Haemorrhagic Fever (CCHF) after declaring them out of danger.

Talking to this reporter, Dr Javed Hayyat, in charge Infection Control Committee at Holy Family Hospital, said six patients had arrived in the hospital with symptoms of dengue fever and were shifted to quarantine.

In reply to a query about CCHF patients, he said four female doctors and three staff nurses, who had been kept under treatment for the last two weeks, were cleared of Crimean-Congo Haemorrhagic Fever.

He said only two patients of Crimean-Congo Haemorrhagic Fever were admitted to the hospital, adding that they were immediately given Ribazol.

 

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Re: Nosocomial CCHF Cluster In Punjab, Pakistan - may be spreading

Re: Nosocomial CCHF Cluster In Punjab, Pakistan - may be spreading

The counts are all over the place.

http://www.thenews.com.pk/09-10-2010/islamabad/9077.htm

10 confirmed dengue fever cases reach HFH



Muhammad Qasim
Rawalpindi
The Holy Family Hospital (HFH) received another 30 suspects of dengue fever during last two days taking the total number of suspects to 112 from 82. On the other hand, the total number of suspects of Crimean-Congo Hemorrhagic Fever (CCHF) reported so far at the hospital has reached to 20.
The HFH administration informed ‘The News’ on Friday that of 112 suspected cases of dengue fever reported in this season at HFH, 15 have been confirmed positive by the National Institute of Health, Islamabad, for the infection, while of 20 suspected cases of the CCHF, 12 have been confirmed positive. ‘The News’ has learnt that the HFH received one suspected case of CCHF within past 48 hours whose blood sample has been sent to the NIH for confirmatory tests. “Within past two days, the NIH confirmed 10 cases of dengue fever positive taking the total number of positive cases to 15,” said Incharge Infection Control Committee at HFH Dr Javed Hayat while talking to ‘The News’ Friday.
He said that at present, a total of 45 patients including confirmed and suspected cases of dengue fever are undergoing treatment at the hospital. The HFH administration claimed that over 60 suspected patients of dengue fever have already been declared negative for the infection by the NIH. The hospital administration is waiting for confirmation reports in over 35 suspected cases of dengue fever.
Dr Javed claimed that so far not a single patient of dengue fever died at the hospital; however, he admitted that a confirmed patient of CCHF and another suspected case of CCHF died at the hospital within past two weeks. The HFH administration claimed that all patients including confirmed and suspected ones of dengue fever are being kept in strict isolation at the hospital. Dengue fever, a viral infection, is caused by the bite of a female mosquito namely Aedes Aegypti.
Meanwhile, a total of 12 cases of CCHF have been confirmed positive at HFH within past three weeks including nine health officials including four lady doctors, three nurses and two ward boys. The health officials who have been undergoing treatment at the HFH in isolation were infected by the CCHF virus while treating two confirmed cases of the CCHF at the hospital. It is important that a confirmed patient of CCHF Tofeeq, aged 30, who was brought to the hospital from Pindigheb on September 20 died of the infection at HFH on September 24 while a suspected case of CCHF, Tahira, aged 42, died at HFH in the night between September 29 and 30.
Earlier, a confirmed patient of CCHF, Rasheeda Begum, aged 35, moved to Shifa International Hospital on September 16 after staying for two days at HFH. It is important that the CCHF belongs to Ebola hemorrhagic fever family that is zoonotic, a disease that animals cause to humans. Of all the disease-causing human viruses, these are the only ones for which the animal host and the virus life cycle could not be known around the globe yet.
Scientists are unaware whether sheep, goats, and cattle serve as hosts or if other mammals, birds, reptiles, or even mosquitoes or ticks are involved in the life cycle of the virus family. The mortality rate of like hemorrhagic fevers range from 50 to 90 per cent. Persons with the infection of this virus family experience headache, high-grade fever, muscle pain, vomiting, along with internal and external bleeding. The CCHF is caused by nairovirus of the bunyaviridae family transmitted to humans by the bite of hyalomma tick or by direct contact with blood of an infected animal or human. The case fatality rate ranges from 2% to 50%.
The CCHF was first described in Crimea in 1944 and identified in 1956 in Congo. “Within past two days, the HFH received another suspected case of CCHF who is undergoing treatment at the hospital,” said Dr Javed and added that blood sample of the suspected case has been sent to NIH for confirmatory reports. Of the nine infected health officials, he said that that a few of them are being discharged from the hospital as they have been given 30 grams of oral ribavarine required for treatment.
Studies however reveal that intravenous (IV) ribavarine is the most effective and only recommended medicine for prevention and treatment of patients exposed to the CCHF which is almost unavailable in markets in Pakistan.

 

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Re: Nosocomial CCHF Cluster In Punjab, Pakistan - may be spreading

Re: Nosocomial CCHF Cluster In Punjab, Pakistan - may be spreading

http://tribune.com.pk/story/60367/this-eid%E2%80%A6be-wary-of-congo-and-animals/

RAWALPINDI:

snip

Talking to The Express Tribune, Dr Javed Hayat, Incharge Infection Control Committee at Holy Family Hospital (HFH) said this year about 20 patients suspected of Congo fever virus were brought to the hospital. Out of these 10 tested positive. One of the 10, Taufeeq Ahmad, a resident of Pindi Gheb, lost his life due to the illness.

“Those that tested positive are Rasheeda from Attock, three doctors of the hospital, two staff members, one student and two ward boys,” he added.

“The nine surviving Congo positive patients are currently admitted in the hospital and their condition is stable,” he maintained.

Similarly, 12 cases have been identified in Rawalpindi district, including two in Attock, two in Rawalpindi city and eight in Chakwal. Health officials also expressed concern over the increase in Dengue cases in the Chakwal region, which remained unaffected by the disease last year.

snip - the information below pertains to dengue testing, not CCHF testing

He added that BBHR had set up its own laboratory to get swift results of blood samples. “It takes five to six days get test results from the National Institute of Health (NIH), but with this facility, we will be able to provide results in three days,” he said.

Officials said they were taking all necessary steps to curtail the spread of the disease. “We are trying to educate the people about preventive measures. We are also conducting regular fumigations in different localities,” said Dr Randhawa.

Published in The Express Tribune, October 9th, 2010.

 

[alert]

Re: Nosocomial CCHF Cluster In Punjab, Pakistan - may be spreading

Re: Nosocomial CCHF Cluster In Punjab, Pakistan - may be spreading

This is one of the important reasons why ProMED exists - to refute errors in the common press. Thank you very much, ProMED.

http://www.promedmail.org/pls/apex/..._BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,85235

Archive Number 20101009.3670
Published Date 09-OCT-2010
Subject PRO/AH/EDR> Crimean-Congo hem. fever - Pakistan (07): revised data, WHO


CRIMEAN-CONGO HEMORRHAGIC FEVER - PAKISTAN (07): REVISED DATA, WORLD
HEALTH ORGANISATION
****************************************************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Sat 9 Oct 2010
From: Dr S. R. Kakar [edited]
<kakarr@pak.emro.who.int>


Re: CCHF in Pakistan
--------------------
Dear colleagues,

To set the record straight [with regard to the incidence of
Crimean-Congo hemorrhagic fever (CCHF) in Pakistan], one must have a
report directly from the NIH or WHO in Islamabad. I really cannot
understand how hospital staff can report to journalists and their
information is so skewed. In the past 2 months, there are only *3*
confirmed cases of CCHF outside of Baluchistan as noted below. We
will look into the 5 new suspected cases at HFH [Holy Family
Hospital, Rawalpindi], but there have not been 27 confirmed CCHF
cases from HFH at any time. NIH [The National Institute of Health] is
the only lab with CCHF reagents and these are procured from CDC
[Centers for Disease Control and Prevention] Atlanta.

It may be noted that due to the October convergence of seasonality
peaks of 3 different fever diseases, falciparum malaria, dengue fever
(DF and DHF), and Crimean-Congo hemorrhagic fever, the Pakistan
Disease Early Warning System (DEWS) is receiving high number of fever
disease alerts in addition to the Acute Watery Diarrhoea (AWD) alerts.

Crimean-Congo Hemorrhagic Fever (CCHF)
--------------------------------------
In Pakistan, the incidence of CCHF peaks in June and October but
cases occur throughout the year. Since 15 Sep 2010, 3 cases of CCHF
have been confirmed outside the endemic area of Baluchistan and 2 have died.

1. Medical doctor (38-year-old male) from Mansehra, working in
Abbotabad and Besham, all districts of Khyber Pakhtunkhwa [formerly
North West Frontier province], died on 23 Sep 2010 in Abbotabad of
brain hemorrhage, confirmed CCHF positive. Exposure to virus is not
known. 14 relatives and contacts (some having fever) have tested
negative to CCHF and Dengue fever. The doctor has been named for a
citation from the Ministry of Health for sacrificing his life in the
line of duty.

2. 30-year-old male from Kahuta Tehsil, Rawalpindi District, Punjab,
hospitalized at Holy Family Hospital (HFH), died on 28 Sep 2010.
Exposure to virus is not known.

3. 35-year-old female from Attock, Punjab, hospitalized at HFH and
transferred to Shifa, Islamabad, surviving, discharged 23 Sep 2010.
Onset of fever 8 Sep 2010. Presumed exposure as keeper of buffalo and
cows in the home. District Health Office took initiative to monitor
the family for fever for 14 days and no family members became ill.
Further, they treated the family livestock appropriately with acaricide.

In addition, 4 female doctors, 3 nurses and a ward boy who work at
HFH have tested positive for CCHF. They had some type of exposure to
the 2 above cases (#2 and #3) but no clear-cut exposure to blood, and
none have had high fever or low platelets, so we are requesting
review of this result [by a] virologist. Nevertheless, the NIH sent a
team who discussed infection control with the chiefs of services and
they are taking it seriously.

Quetta [the capital of Baluchistan province] has experienced the
usual outbreaks of CCHF this year [2010] peaking in June and
September but we have so far not been able to get a report from them.
We expect that, similar to every year since 2000, they have
experienced more than 50 cases with less than 10 percent deaths. They
have promised a full report tomorrow.

Response:
---------
Guidelines for CCHF management have been distributed both to Ministry
and Health Cluster stakeholders and are posted on both NIH and WHOPAK websites.

Specific measures to reduce the risk of transmission from ticks will
be undertaken by Ministry of Agriculture and Livestock with FAO
support while measures to prevent nosocomial infection will be
promoted by the Ministry of Health.

General supportive therapy is the mainstay of patient management in
CCHF. Intensive monitoring to guide volume and blood component
replacement is required. The antiviral drug ribavirin has been used
in treatment of established CCHF infection with apparent benefit.
Both oral and intravenous formulations seem to be effective.

When patients with CCHF are admitted to hospital, there is a risk of
nosocomial spread of infection. In the past, serious outbreaks have
occurred in this way and it is imperative that adequate infection
control measures be observed to prevent this disastrous outcome.

Patients with suspected or confirmed CCHF should be isolated and
cared for using barrier nursing techniques. Specimens of blood or
tissues taken for diagnostic purposes should be collected and handled
using universal precautions. Sharps (needles and other penetrating
surgical instruments) and body wastes should be safely disposed of
using appropriate decontamination procedures.

Health care workers are at risk of acquiring infection from sharps
injuries during surgical procedures and, in the past, infection has
been transmitted to surgeons operating on patients to determine the
cause of the abdominal symptoms in the early stages of (at that
moment undiagnosed) infection. Health care workers who have had
contact with tissue or blood from patients with suspected or
confirmed CCHF should be followed up with daily temperature and
symptom monitoring for at least 14 days after the putative exposure.

There is no safe and effective vaccine widely available for human
use. The tick vectors are numerous and widespread and tick control
with acaricides (chemicals intended to kill ticks) is only a
realistic option for well-managed livestock production facilities.

Persons living in endemic areas should use personal protective
measures that include avoidance of areas where tick vectors are
abundant and, when they are active (spring to autumn); regular
examination of clothing and skin for ticks, and their removal; and
use of repellents.

Persons who work with livestock or other animals in the endemic areas
can take practical measures to protect themselves. These include the
use of repellents on the skin (e.g., DEET) and clothing (e.g.,
permethrin) and wearing gloves or other protective clothing to
prevent skin contact with infected tissue or blood.

Notably in Pakistan most of the population are directly exposed to
livestock during Eid ul Adha, which falls in mid-November this year.
A media campaign will be undertaken to inform people how to protect
themselves from CCHF infection.

--
Dr S. R. Kakar,
Senior Epidemiologist,
World Health Organization,
Islamabad
Program Manager for the Disease Early Warning System
<kakarr@pak.emro.who.int>

[ProMED-mail is indebted to Dr. Kakar for sending us this statement
regarding the current incidence of CCHF in Pakistan which refutes
some erroneous information published in the Pakistani press and
relayed previously in good faith by ProMED-mail.

Apart from numerous presumptive seasonal cases in Baluchistan (not
mentioned in the national press or in ProMED-mail), there have only
been 3 confirmed cases elsewhere in Pakistan. These are described in
detail above, together with the nosocomial infections reported to
have occurred in the Holy Family Hospital Rawpindi (and about which
there is some uncertainty).

The HealthMap/ProMED-mail interactive map of Pakistan can be accessed at:
<http://healthmap.org/r/00tj>. - Mod.CP]

 

[alert]

Re: Nosocomial CCHF Cluster In Punjab, Pakistan - may be spreading

Re: Nosocomial CCHF Cluster In Punjab, Pakistan - may be spreading

The three confirmed cases in the above post are:

1. The doctor in Abbottabad, who according to this post died on Sep. 23.

http://www.flutrackers.com/forum/showthread.php?p=373049

2. The 30-year-old male, Taufeeq/Toseef in HFH above. Died Sep. 28.

3. The 35-year-old female, Rasheeda/Rashida, recovered and discharged Sep. 23.

Something mildly unusual may have happened with the HCW in this thread who treated cases #2 and #3, as they have tested positive, but have not experienced any symptoms, and are now well beyond the incubation period. One post in this thread indicates they were given 30 grams of ribavirin, which seems like a mega-dose and may have prevented illness (although that has never been reported anywhere in the world before). It is also possible that the original positive tests were contaminated, especially in light of the fact that none of the individuals had direct contact with blood.

In addition, there seem to be reports of a 42F, "Tahira", from the same village as cases #2 and #3, who died the night of September 29, and who will remain permanently in the "suspected" column as it seems no samples were taken from here.

The articles in this thread come from various sources, so it is unlikely we are receiving bad information from confused reporters. It seems likely that someone within Holy Family Hospital itself is releasing errant information for whatever reason.

 

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Re: Nosocomial CCHF Cluster In Punjab, Pakistan - may be spreading

Re: Nosocomial CCHF Cluster In Punjab, Pakistan - may be spreading

Same hospital. I have no way to know whether the hospital is overwhelmed with dengue patients (100 from that one village?), but that would explain some of the confused information.

The ProMED post indicates that the NIH and WHO will be looking into the situation at that hospital, so that may help clarify what is really going on.

http://www.onepakistan.com/news/local/67303-dengue-virus-kills-three-in-district-chakwal.html

Home | Local | Dengue virus kills three in district Chakwal
Dengue virus kills three in district Chakwal
By PPI 5 hours 40 minutes ago
Font size:
CHAKWAL: At least three persons become victims of Dengue virus in different areas of district Chakwal on Saturday. The outbreak of Dengue virus has created panic among the area people after deaths of the said persons.

Those died due to dengue include, Rana Taj Muhammad, Tassadaq Hussain a barber and a woman. More than 100 patients of only village Dhudial were sent to Holy Family Hospital Rawalpindi and now there was no space available for more patients at the Hospital. Meanwhile, District Health Office Chakwal in a press release issued Saturday claimed that spray teams have been dispatched to the affected areas and complete efforts would be made to control the situation. The Health Department has also advised the patients to use paracetamoul and drink water excessively to maintain the storage of water in the body. The Health Department was confident that situation would be under control very soon.

 

[alert]

Re: Nosocomial CCHF Cluster In Punjab, Pakistan - may be spreading

Re: Nosocomial CCHF Cluster In Punjab, Pakistan - may be spreading

The red statement contradicts the ProMED post above, and may very well be intentionally false. Alternative, HFH might be counting confirmed cases #2 and #3in the ProMED post, although neither is still in that hospital.

http://www.dawn.com/wps/wcm/connect...itals-receive-more-dengue,-congo-patients-000

Hospitals receive more ‘dengue, Congo’ patients By A Reporter
Sunday, 10 Oct, 2010

RAWALPINDI, Oct 9: More suspected patients of Crimean-Congo Haemorrhagic Fever (CCHF) and dengue fever were brought to hospitals in Rawalpindi on Saturday.

Seven suspected patients of CCHF and 11 suspected patients of dengue fever were brought to the District Headquarters (DHQ) Hospital, Benazir Bhutto Hospital (BBH) and the Holy Family Hospital (HFH) in the city.

According to data collected from the hospitals, three suspected CCHF patients were admitted in the DHQ, three in BBH and one more suspected patient was admitted in the HFH. The HFH received eight more suspected dengue fever patients. However, the doctors discharged 17 suspected patients from the HFH as their dengue serology were declared negative.

Dr Javed Hayyat, in-charge Infection Control Committee at HFH, told Dawn that 26 suspected and three confirmed patients of dengue fever were admitted in the hospital. He said three patients – two confirmed and one suspected of CCHF – were admitted.

BBH Medical Superintendent Dr Asif Qadir Mir said three suspected patients of CCHF were brought to the hospital, which already has three dengue fever suspected patients. He said the suspected patients were shifted in an isolated ward and their blood samples have been sent to the National Institute of Health (NIH).

DHQ Medical Superintendent Dr Sher Ali Khan said three suspected patients of CCHF and one suspected patient of dengue fever were admitted in the hospital. He said the patients belonged to Rawalpindi city and adjoining areas. Rawalpindi Medical College (RMC) Principal Dr Afzal Farooqi said the allied hospitals in the garrison city were geared up to deal with the increasing number patients of dengue fever and CCHF. He said the hospitals have allocated separate wards to deal with such patients and arranged sufficient stocks of medicines to deal with emergency.

 

[alert]

Re: Nosocomial CCHF Cluster In Punjab, Pakistan - may be spreading

Re: Nosocomial CCHF Cluster In Punjab, Pakistan - may be spreading

Presumably, these are the last two of the HCW. It appears that HFH now does not have any suspected or confirmed CCHF patients, which now agrees with the NIH letter.

http://www.dawn.com/wps/wcm/connect...islamabad/15-dengue-suspects-hospitalised-800

15 dengue suspects hospitalised By A Reporter
Friday, 08 Oct, 2010 FOUR LIONS
Crows, sheep and the terrorists RAWALPINDI, Oct 7: Fifteen more suspected dengue patients were on Thursday admitted to Holy Family and Benazir Bhutto hospitals. However, the HFH discharged two confirmed Crimean-Congo Haemorrhagic Fever (CCHF) patients declaring them out of danger.

Doctors said 11 more suspected patients were brought to HFH and four suspected patients admitted to BBH. However, the District Headquarters (DHQ) Hospital turned down the request of HFH administration to accommodate some suspected patients of dengue fever citing shortage of beds.

The arrival of 11 more suspected dengue patients at HFH brought the tally to 37 during the last two weeks.

Dr Javed Hayat of the HFH told this reporter that reports of 10 more patients already admitted to the hospital had been received confirming that they were infected with dengue virus. ?HFH has admitted a total of 15 confirmed dengue fever patients and 36 suspected patients.?

When contacted, Benazir Bhutto Hospital Medical Superintendent Dr Asif Qadir Mir said the four suspected dengue fever patients brought to the hospital were put on quarantine and their blood samples would be collected soon.

?We have purchased a new kit to diagnose dengue fever virus. The BBH would not send blood samples to the National Institute of Health for dengue serology and check the samples on its own premises,? he added.

 

[alert]

Re: Nosocomial CCHF Cluster In Punjab, Pakistan - may be spreading

Re: Nosocomial CCHF Cluster In Punjab, Pakistan - may be spreading

Apparently, a lot of the illness at Chakwal was malaria, not CCHF.

http://www.onepakistan.com/news/local/67605-dengue-fever-under-control-in-chakwal.html

Dengue fever under control in Chakwal
By PPI 6 hours 18 minutes ago
Font size:
CHAKWAL, Six cases of Dengue fever was tested positive in Cahkwal and due to second round of spray of chemicals the dengue virus is controlled considerably.

However simple fever gripped the whole District and most of the patients were caught with Malaria and other fever. Those tested positive of Dengue fever are Muhammad Usman son of Muhammad Rafique resident of village Dhudial, Iftikhar Ahmad son of Ghulam Sarwar resident of Chakwal, Adeeba daughter of Amir Khan resident of village Dhudial, Rozina wife of Farhat Hussain resident of village Dhudial and Muhamamd Sadiq son of Shamim resident of village Dhudial as these five were tested at Holy Family Hospital at Rawalpindi while Farzana resident of village Dhudial case was sent to the Laboratory by the local Health Department and it was tested positive. EDO Health Doctor Arshad Ali Sabir told on Monday that the second round of chemical spray as the affected 17 union councils have been started and due to this effort Dengue virus is controlled considerably; however he told that the affect the Dengue virus would remain for one month. He further told that 11 cases of Dengue were found at Rawalpindi and 19 at Islamabad. He claimed that the situation in Chakwal District was well under control and there was no need of any harassment among the people as there was no danger of any death due to dengue fever.

 

[alert]

Re: Nosocomial CCHF Cluster In Punjab, Pakistan - may be spreading

Re: Nosocomial CCHF Cluster In Punjab, Pakistan - may be spreading

http://www.dawn.com/wps/wcm/connect...cal/islamabad/more-dengue-patients-arrive-200

RAWALPINDI, Oct 11: City hospitals continued to receive suspected dengue patients on Monday.

Eight more suspected dengue patients were brought to Benazir Bhutto Hospital (BBH). ?We have 16 suspected patients of dengue fever in the hospital, from Rawalpindi, Chakwal and Attock,? said Dr Suhail Chaudhry.

He said these patients have been shifted to a separate ward.

He said blood samples of the patients have been sent to the National Institute of Health (NIH) for dengue serology.

Dr Chaudhry said the hospital would also receive NIH report on Wednesday about the three patients of Crimean-Congo Haemorrhagic Fever (CCHF) in the hospital.

?Now we have 29 suspected and 15 confirmed patients of dengue fever,? said Dr Javed Hayyat, incharge Infection Control Committee at HFH.

 

[alert]

Re: Nosocomial CCHF Cluster In Punjab, Pakistan - may be spreading

Re: Nosocomial CCHF Cluster In Punjab, Pakistan - may be spreading

http://www.dawn.com/wps/wcm/connect...ocal/deadly-congo-fever-cases-on-the-rise-200

Deadly Congo fever cases on the rise By Faiza Ilyas
Tuesday, 12 Oct, 2010 HERALD EXCLUSIVE
Part II of an interview with Asif Ali Zardari KARACHI, Oct 11: Kashif, a 32-year-old resident of Orangi Town, looks at his recent recovery from deadly Congo hemorrhagic fever as nothing short of a miracle. ?It was, probably, the most troubled period of my life,? he remarks while recalling his ordeal.

Kashif, father of two daughters, initially had a high fever with shivering a month ago. Taking it as a minor illness, he did not consult a doctor and took some tablets on his own to reduce the temperature. Feeling better the next morning, he took a bath and decided to go to Zainab Market where he worked as a salesman at a leather goods shop.

While on his way, he felt slight shivering and fever again. Feeling uneasy, he went to a government hospital and had a check-up. He didn?t feel better despite taking prescribed medicines.

The next day, he was admitted to a private hospital where he was given a blood transfusion. After remaining under treatment for two days, he was discharged from the hospital when he showed signs of improvement. His condition, however, deteriorated a day later at home.

Kashif started vomiting blood and also having rectal bleeding.

His family rushed him to the same private hospital, but he couldn?t be admitted there because no bed was vacant. Then, he was taken to the government-run Abbasi Shaheed Hospital and by that time he had gone into a semi-conscious state.

?I was kept in the intensive care unit for six days while I was completely unconscious for at least two days,? he recollects the events.

Apart from the severe adverse effects on his health, the debilitating illness cost him dearly. His family spent around Rs125,000 on his treatment.

?I need to pay the entire amount which my family borrowed to meet my medical expenses. Right now, this is the biggest concern of my life. My boss, however, is kind enough that he hasn?t fired me for the long leave as I am still at home, resting on medical advice,? he says.

At the hospital, Kashif was kept in an isolation unit and administered anti-viral drugs, besides being transfused large quantities of blood platelets, according to Dr Javed Akhter, his physician and deputy medical superintendent of the hospital.

?Kashif tested positive both for dengue and Congo viruses. His occupation helped us detect Congo virus,? he says.

While Kashif fortunately recovered, another Congo fever patient lost his life three to four months ago at the Abbasi Shaheed Hospital. The victim lived in Baldia Town near a cattle farm, Dr Akhtar tells Dawn.

The incidence of Congo hemorrhagic fever has risen over the past few weeks across the country.

According to media reports, 15 suspected patients of the disease were admitted to Rawalpindi hospitals early this month. Four lady doctors and as many staff members reportedly contracted the virus while handling some patients at the Holy Family Hospital over a week ago.

Four suspected Congo virus cases also reported in Peshawar while a young doctor working at the Ayub Teaching Hospital Abbottabad died of the same disease early last month.

In Karachi, six cases have been reported so far. Of them, three patients have died.

Tick, not mosquito

There seems to be an acute lack of awareness about how Congo virus infects humans and many believe that it is transmitted by the bite of a vector mosquito as is the case in dengue.

According to the World Health Organisation website, Crimean-Congo haemorrhagic fever (CCHF) is a viral haemorrhagic fever of the Nairovirus group. Although primarily a zoonosis (any infectious disease that can be transmitted from animals to humans), sporadic cases and outbreaks of CCHF affecting humans do occur.

The CCHF virus may infect a wide range of wild and domestic animals including, sheep, goat and cattle. Many birds are resistant to infection, but ostriches are susceptible and may show a high prevalence of infection in endemic areas. Animals become infected with CCHF from the bite of infected ticks (members of the Hyalomma genus).

Humans who become infected with CCHF acquire the virus from direct contact with blood or other infected tissues from livestock during this time, or they may become infected from a tick bite. A majority of cases have occurred in those involved in the livestock industry, such as agricultural and slaughterhouse workers and veterinarians.

?The disease is highly infectious. If a patient dies of the disease then it is recommended that relatives should not open his/her coffin once it is handed over to them from the hospital. Besides, medical staff must interview all relatives who may have come in close contact with the patient and recommend preventive treatment, if necessary,? comments Dr Shobha Luxmi, who handled a Congo virus patient at the Indus Hospital a few weeks ago.

The patient, a meatman, died within two days of his admission to the hospital.

First characterised in Crimea in 1944

The disease is endemic in many countries in Africa, Europe and Asia. The disease was first characterised in Crimea in 1944 and given the name Crimean hemorrhagic fever. It was later recognised in 1969 as the cause of illness in the Congo, thus resulting in the current name of the disease.

In Pakistan, the first outbreak of CCHF was reported in 1976 in Rawalpindi. The disease is endemic in Balochistan while cases are reported off and on in other parts of the country throughout the year. Experts believe that many cases go unreported due to lack of awareness and access to health facilities.

Symptoms and treatment

According to US-Centres for Disease Control and Prevention (CDC) experts, the onset of symptoms is sudden, with initial signs and symptoms including headache, high fever, backache, joint pain, stomach pain, and vomiting.

Red eyes, a flushed face, a red throat, and petechiae (red spots) on the palate are common.

Symptoms may also include jaundice, and in severe cases, changes in mood and sensory perception.

As the illness progresses, large areas of severe bruising, severe nosebleeds, and uncontrolled bleeding at injection sites can be seen, beginning on about the fourth day of illness and lasting for about two weeks.

?The disease is more dangerous than dengue and often fatal. Some studies suggest that the mortality rate can be as high as 80 per cent. This is due to the massive internal or external bleeding that occurs due to the destruction of platelets,? says Dr Altaf Ahmed, president of the Infectious Diseases Society of Pakistan.

Treatment for CCHF is primarily supportive, he says, that includes administration of anti-viral drug, taking care of fluid balance and transfusion of blood, if required.

Prevention

Health experts suggest a number of preventive measures especially at cattle farms, slaughterhouses as well as at health facilities where a Congo virus patient is being taken care of. This includes the use of disinfectants and protective clothing. Insect repellents are recommended to be used by staff at slaughterhouses and cattle farms.

The history of the disease in Pakistan show that a significant number of cases have occurred in the past in which medical staff taking care of an infected patient contracted the virus.

?Unfortunately, medical staff generally lacks awareness of the disease and risk their life. It is important to have infection control measures at hospitals and to treat Congo virus patients in isolation,? Dr Ahmed said.

Regarding measures needed to be taken in case of any viral fever, Dr Qaiser Sajjad, a former general sectary of the Pakistan Medical Association, said that patients must avoid self-medication and must consult a doctor.

?In any viral fever, platelet level naturally goes down. And, if a patient takes any antibiotic or anti-malaria medicine, his platelet level will further go down. It is recommended that the patient only take a paracetamol to normalise his or her temperature, besides taking plenty of fluids and rest,? he said.

Both doctors emphasised the need for establishing at least one virology laboratory in each province so that prompt treatment could be provided.

Patients, they said, often died before the diagnosis of CCHF or suffered complications because of a late diagnosis of any other viral infection.

?At present, the National Institute of Health is the only government-run institution in the country that has some diagnostic facilities for viral infections and there is a dire need to establish a state-of-the-art virology laboratory in each province. Besides, the practice of taking blood samples containing the virus to Islamabad involves a serious risk that must be avoided,? says Dr Ahmed.

 

[alert]

Re: Two CCHF confirmed cases in Rawalpindi - bad testing, bad reporting

Re: Two CCHF confirmed cases in Rawalpindi - bad testing, bad reporting

I think they mean to say "no MORE reported deaths", as the NIH did confirm the death of Taufeeq/Toseef last month.

The reporting here has been horrendous.

http://tribune.com.pk/story/61895/dengue-patients-treated-for-congo-fever/

RAWALPINDI: There have been no reported deaths of Congo fever patients in Holy Family Hospital (HFH), In-charge Infection Control Committee HFH Dr Javed Hayyat stated on Monday. Two patients who were suffering from dengue fever were mistakenly diagnosed with Congo fever.

Talking to the Express Tribune, Dr Hayyat said the hospital mistakenly announced incorrect figures because the staff got confused between the test reports of dengue and Congo fever patients issued by the National Institute of Health (NIH). ?The hospital administration received information of test reports by NIH on the phone and mistakenly declared two patients positive for Dengue as positive for Congo fever,? he explained.

The first patient suspected of Congo fever was brought to the hospital on September 14. Since then, 20 more suspected patients of Crimean-Congo Haemorrhagic Fever (CCHF) have been admitted, of which, 10 were tested positive by the NIH. He said only three these patients diagnosed with CCHF are currently admitted in the hospital, the rest have been discharged after full recovery.

Dr Hayyat said there has been no decline in the number of patients suspected of CCHF and dengue coming to the hospital. A total of 139 patients suspected of dengue fever have been admitted in the hospital since January 19, out of which, 15 were tested positive of the disease by NIH. He said the hospital is awaiting test results by NIH of 37 admitted patients suspected of dengue fever.

Published in The Express Tribune, October 13th, 2010.

 

[alert]

Re: Nosocomial CCHF Cluster In Punjab, Pakistan - may be spreading

Re: Nosocomial CCHF Cluster In Punjab, Pakistan - may be spreading

http://www.dawn.com/wps/wcm/connect...sitive-for-dengue-fever-in-pindi-hospital-400

20 more test positive for dengue fever in Pindi hospital By A Reporter
Thursday, 14 Oct, 2010 MEDIA GALLERY
This is raw RAWALPINDI, Oct 13: The National Institute of Health (NIH) on Wednesday declared 20 more patients at Holy Family Hospital (HFH) as cases of dengue fever, bringing the tally to 25 at the hospital.

Besides, 40 more suspected patients arrived in the allied hospitals - HFH, Benazir Bhutto Hospital (BBH) and District Headquarters (DHQ) Hospital.

?Total 45 suspected and 25 confirmed patients of dengue fever and three suspected patients of Crimean-Congo Haemorrhagic Fever (CCHF) are admitted to Holy Family Hospital,? said Dr Javed Hayat, the in charge of the infection control committee at the HFH.

He said the hospital on Wednesday received the dengue serology reports of 20 more patients showing them as cases of dengue fever. He said there were five confirmed patients of dengue fever in the hospital.

According to figures at the HFH; 51 dengue fever suspects were brought from Rawalpindi, five from Islamabad, 63 from Chakwal, two from Haripur, five from Azad Jammu and Kashmir, one each from Gujrat and Lahore, three each from Abbottabad and Attock and two from Jhelum.

Dr Hayat said the hospital discharged 10 confirmed patients of dengue fever after providing them treatment. He said the dengue serology of 80 patients conducted at the NIH had showed them not suffering from the fever.

BBH Medical Superintendent Dr Asif Qadir Mir said 18 suspected patients of CCHF were brought to the hospital. He said one confirmed dengue fever patient and 12 suspects were already admitted to the hospital.

He said all the suspected patients were shifted to the isolated ward and their blood samples had been sent to the NIH for dengue and CCHF confirmation. He said the condition of three suspected CCHF patients was stable.

DHQ Medical Superintendent Dr Sher Ali Khan said two more suspected patients of dengue fever had arrived in the hospital. He said seven suspected and one confirmed dengue patients were admitted to the hospital.

The patients belonged to Rawalpindi city and adjoining areas

 

[alert]

Re: Reports of Nosocomial CCHF Cluster In Punjab, Pakistan - bad testing, bad reporting

Re: Reports of Nosocomial CCHF Cluster In Punjab, Pakistan - bad testing, bad reporting

http://www.promedmail.org/pls/apex/..._BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,85317

Archive Number 20101014.3731
Published Date 14-OCT-2010
Subject PRO/AH/EDR> Crimean-Congo hem. fever - Pakistan (08): (PB), not


CRIMEAN-CONGO HEMORRHAGIC FEVER - PAKISTAN (08): (PUNJAB), NOT
**************************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Wed 13 Oct 2010
Source: The Express Tribune [edited]
<http://tribune.com.pk/story/61895/dengue-patients-treated-for-congo-fever/>


Dr Javed Hayyat, in charge of the Infection Control Committee at Holy
Family Hospital (HFH), has stated that there have been no reported deaths
of [suspected] Crimean-Congo hemorrhagic fever (CCHF) patients in Holy
Family Hospital (HFH). Two patients who were suffering from dengue fever
were mistakenly diagnosed with Congo fever [CCHF].

Talking to the Express Tribune, Dr Hayyat said the hospital mistakenly
announced incorrect figures because the staff got confused between the test
reports of dengue and Congo [CCHF] patients issued by the National
Institute of Health (NIH). "The hospital administration received
information of test reports from NIH on the phone and mistakenly declared 2
patients positive for dengue [fever] as positive for [CCHF]," he explained.

The 1st patient suspected of CCHF was brought to the hospital on 14 Sep
2010. Since then, 20 more CCHF-suspected patients have been admitted, 10 of
whom were tested positive by the NIH. He said only 3 of the patients
diagnosed with CCHF are currently [still] in the hospital; the rest have
been discharged after full recovery.

Dr Hayyat said there has been no decline in the number of patients with
suspected CCHF and dengue coming to the hospital. A total of 139 patients
with suspected dengue fever have been admitted to the hospital since 19 Jan
2010, 15 [of whom] had positive tests for the disease by NIH. He said the
hospital is awaiting test results from NIH for 37 inpatients suspected of
having dengue fever.

--
communicated by:
HealthMap alerts via
ProMED-mail <promed@promedmail.org.

[Apart from presumptive seasonal cases of CCHF in Baluchistan, there have
only been 3 reliably confirmed cases elsewhere in Pakistan. These were
described in detail in the preceding post entitled "Crimean-Congo hem.
fever - Pakistan (07): revised data, WHO 20101009.3670".

In view of the misdiagnoses reported above, independent confirmation of the
new suspected CCHF cases admitted to the HFH and the 10 apparently
NIH-confirmed CCHF cases is urgently required. Likewise, the status of the
presumed nosocomial infections previously described (about which there is
some uncertainty) also needs independent verification.

The HealthMap/ProMED-mail interactive map of Pakistan can be accessed at:
<http://healthmap.org/r/0dcu>. - Mod.CP]

 

[alert]

Re: Nosocomial CCHF Cluster In Punjab, Pakistan - NOT

There is a lot potentially incorrect in this article. The case counts for CCHF here are curiously similar to the dengue counts in (http://www.dawn.com/wps/wcm/connect.../dengue-fever-cases-rising-in-twin-cities-500), raising the possibility that either the hospitals or the reporter are confusing the two diseases again.

It is still very far from clear what is going on.

http://www.dawn.com/wps/wcm/connect...ospitals-alerted-to-congo,-dengue-viruses-500

Hospitals alerted to Congo, dengue viruses By Asif Chaudhry
Friday, 15 Oct, 2010 HERALD EXCLUSIVE

Interview: John Freeman LAHORE, Oct 14: The Punjab health department has alerted health institutions across the province by issuing new guidelines on reports of feared epidemic of deadly Crimean-Congo Haemorrhagic Fever and dengue virus as it has officially confirmed 15 CCHF and 68 dengue fever patients during the last three months [not according to ProMED and NIH - alert].

These patients were tested positive in clinical reports carried out primarily by the National Institute of Health (NIH), Islamabad, and other health institutions.

Two CCHF and dengue patients had died in Rawalpindi hospitals, a health department report said.

The department has feared epidemic of deadly Congo virus during Eidul Azha due to mass movement of sacrificial animals as they are a major source of spread of the virus.

It also informed that the healthcare workers are at risk of acquiring infection from sharp injuries during surgical procedures and directed the hospital managements to follow guidelines like sterilisation, fumigation and disinfection in wards/rooms of the concerned units and ICU in which suspected CCHF patients are kept.

“Dengue fever/Dengue Haemorrhagic Fever may re-appear in coming months due to existing geographic spread and temporal patterns exhibited during 2005 to 2009,” the department said.

A Directorate General Health Services Punjab’s senior officer Director Management Information System (DMIS) Anwar Janjua told Dawn that some 15 CCHF patients had been tested positive at NIH. He said 45-year-old patient Jamila died of CCHF on Sept 26, when she was shifted to the Holy Family Hospital with Congo virus symptoms while a dengue patient also died in Rawalpindi.

He said some 68 people, 43 in Lahore alone, had been declared dengue fever patients from July 2010 to Oct 12 across the province. Of the total dengue patients, he said, 15 were females and five children below 12 years of age.

Mr Janjua said two patients each were diagnosed with dengue in Muzaffargarh, Attock, one each in Kasur, Mianwali, Sargodha, five in Chakwal and nine in Rawalpindi hospitals besides 43 in Lahore.

A source, however, claimed that the number of the suspected patients infected with CCHF and dengue virus was 20 to 30 per cent higher as compared to those declared positive by the Punjab health department.

Ironically, the PCR test facility was available in only four public sector institutions – in Lahore and Islamabad – where blood samples of thousands of suspected patients were being sent to diagnose dengue virus.

The ratio of the suspected patients was increasing alarmingly due to recent floods and accumulation of water at homes, in streets, roads and fields.

Keeping in view gravity of the situation, the DG (health services) issued guidelines in a letter on Oct 3.

“In view of the disease in Rawalpindi, expected mass movement of sheep, goats, cattle and close contact of these animals with human beings ahead of Eidul Azha, you are desired to take appropriate measures in all the districts/hospitals to prevent outbreak of CCHF in the province,” the letter said.

All EDOs (health) were directed to have advocacy meetings with the livestock department at district level for adopting measures to control the ticks in animals.

“CCHF is an epidemic tick born viral disease, whose wide geographical distribution includes the cold, arid regions of Pakistan and globally Africa, Asia, Middle East, and Eastern Europe,” health institutions were briefed in the guideline.

Sheep, goats, cattle, and camels are the natural hosts of Congo virus as these animals get high level Viremia, which is, however, infective but is epidemiologically significant.

“Humans acquire Congo virus from direct contact with blood or other infected tissues from livestock or from tick bite and human body fluids,” it further said.

The department also issued guidelines titled ‘Safe burial practices’ to avoid Congo virus while performing burial ceremony of a CCHF patient.

“Thick rubber gloves should be used as second pair for washing the body for burial and the body may also be sprayed with 1/10 bleach solution,” it said. After wrapping the deceased in coffin, it should again be sprayed with bleach and placed in plastic bag.

The transport vehicle should also be disinfected and all the clothing of the deceased should be burnt to avoid risk of Congo virus.

The symptoms through which the CCHF suspected patient could be diagnosed during clinical observation included sudden onset of high-grade fever, severe headache, dizziness, nausea, abdominal and muscular pains. The patients visiting the hospitals with rash and bleeding from many body parts like gums, mouth, rectum, nose bleeding, petichial rash (bleeding in the skin) enlarged lymph nodes and increased heartbeat should be considered CCHF patients, the health department said.

 

[alert]

Re: Nosocomial CCHF Cluster In Punjab, Pakistan - NOT

This may be another errant report. The nine reported HCW fatalities might be the same nine reported asymptomatic cases (which may be the result of poor testing/reporting or deception) that have been discharged.

http://www.promedmail.org/pls/apex/..._BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,85622

Punjab province
Date: Tue 02 Nov 2010
Source: Online News [edited]
<http://www.onlinenews.com.pk/details.php?id=169593>


CCHF virus: Health Ministry unaware of 12 deaths
------------------------------------------------
The Health Ministry turns out to be unaware of 12 deaths due to
Crimean-Congo hemorrhagic fever (CCHF) virus infection. 12 people
among 9 health officials in Holy Family Hospital Rawalpindi (Punjab
province) have died due to this virus.

Responding to questions raised in the National Assembly in this
regard, the Parliamentary Secretary for Health Mehreen Razzaq Bhutto
said that the Ministry of Health is unaware of deaths in such large
numbers [as a consequence of] CCHF and she could [not] answer the
question [until further] information in this regard [becomes
available]. She said that the deaths might be due to dengue virus as
symptoms of CCHF and dengue are similar.

--
Communicated by:
Thomas James Allen
<tjallen@pipeline.com>

[The only conclusions possible are that CCHF and dengue fever are
prevalent throughout Pakistan and although case numbers are
increasing the the precise numbers of cases and fatalities are
uncertain. There are more cases of dengue fever than CCHF which is
not unexpected in view of the different modes of transmission of
these 2 hemorrhagic fevers (mosquito-borne versus tick-borne transmission).

Overall there is evidence of confusion in diagnosis, deficiencies in
record-keeping and deliberate deception. The statement of the
Parliamentary Secretary for Health Mehreen Razzaq Bhutto deserves
commendation for its clarity and honesty.