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Pakistan: Doctor dies of Crimean-Congo haemorrhagic fever after treating ill patient - possibly 10 deaths total

alert

Senior Moderator
CCHF is endemic in Pakistan.

http://hisz.rsoe.hu/alertmap/woalert_read.php?glide=EH-20100927-27974-PAK

http://paktribune.com/news/index.shtml?231958

Two people, including a young doctor and a Chinese engineer, have died from a mysterious disease while a schoolboy was stated to be in critical condition at the Ayub Teaching Hospital (ATH) for the last one week, official sources said. The sources in the health department revealed that patients brought to the ATH from the flood-affected areas showed a decrease in their blood clotting ability. The sources said the patients initially suffered fever and headache, followed by fits and later their blood platelets decreased. The sources said at least four patients suffering from the dengue fever were still admitted to the ATH and the number of such cases was increasing. Most of the cases reported so far were from the Haripur district. The hospital administration has officially segregated some area in the hospital to deal with such patients. The sudden death of a young resident medical officer Dr Syed Hasnain Shah caused by the mysterious viral infection has raised concern among the senior doctors as well as the administration of the ATH. Deputy Medical Superintendent of the Causalty Department of the ATH, Dr Junaid Sarwar, told this scribe that Dr Hasnain caught fever in Bisham. Later, investigation revealed that his platelets count dropped to the range of 135,000 compared with normal range of 150,000 to 300,000. His fever was finally controlled on Sunday and he rejoined the office. But on Tuesday he fell down in the washroom of the college hostel. He was rushed to the hospital’s emergency unit. Another medical officer said that the ailing doctor’s blood pressure at that time was as low as 80/30 and emergency treatment was provided to him. “Dr Hasnain was conscious but suffering from severe headache at that time. He fell unconscious after a few minutes and developed regular fits,” he recalled. Medical specialists were immediately called, who recommended an MRI, which diagnosed brain haemorrhage. The young doctor later died. The younger brother of Dr Hasnain has been showing the same symptoms for the last few days. In a similar case, a Chinese engineer working in Allai in Battagram district remained hospitalised at the Ayub Teaching Hospital for a couple of days and later expired.
 
Last edited by a moderator:
Re: Pakistan: Doctor dies of mystery disease - younger brother of doctor possibly infected too

Re: Pakistan: Doctor dies of mystery disease - younger brother of doctor possibly infected too

A closer reading of this article indicates that the doctor may or may not have had contact with the deceased patient. He could have had an exposure to some other, still unrecognized patient, or could have simply contracted this illness outside his job.
 
Re: Pakistan: Doctor dies of mystery disease after treating ill patient - yougner brother of doctor possibly infected too

Re: Pakistan: Doctor dies of mystery disease after treating ill patient - yougner brother of doctor possibly infected too

http://www.promedmail.org/pls/apex/..._BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,85039

Archive Number 20100927.3505
Published Date 27-SEP-2010
Subject PRO/AH/EDR> Undiagnosed fatal illness - Pakistan: (NW)


UNDIAGNOSED FATAL ILLNESS - PAKISTAN: (KHYBER-PAKHTUNKHWA)
**********************************************************
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: Mon 27 Sep 2010
Source: PakTribune [edited]
<http://paktribune.com/news/index.shtml?231958>


2 people -- a young doctor and a Chinese engineer -- have died from a
mysterious disease, while a schoolboy was stated to be in a critical
condition at the Ayub Teaching Hospital (ATH) for the last one week,
official sources said.

The sources in the health department revealed that [these] patients
brought to the ATH from the flood-affected areas showed a decrease in
their blood clotting ability. The sources said the patients initially
suffered fever and headache followed by fits, and later their blood
platelets decreased.

The sudden death of a young resident medical officer, Dr H., caused by
the mysterious viral infection, has raised concern among the senior
doctors as well as the administration of the ATH. Deputy Medical
Superintendent of the Casualty Department of the ATH, Dr Junaid
Sarwar, told this [reporter] that Dr H. contracted fever in Bisham.
Later, investigation revealed that his platelet count dropped to the
range of 135 000 compared to the normal range of 150 000 to 300 000.
His fever was finally controlled on Sunday [19 Sep 2010], and he
rejoined the office. But on Tuesday [21 Sep 2010], he [collapsed] in
the washroom of the college hostel. He was rushed to the hospital's
emergency unit.

Another medical officer said that the ailing doctor's blood pressure
at that time was as low as 80/30, and emergency treatment was provided
to him. "Dr H. was conscious but suffering from severe headache at
that time. He fell unconscious after a few minutes and developed
regular fits," he recalled.

Medical specialists were immediately called; who recommended an MRI,
which diagnosed brain haemorrhage. The young doctor later died.

The younger brother of Dr H. has been showing the same symptoms for
the past few days. In a similar case, a Chinese engineer working in
Allai in Battagram district remained hospitalised at the Ayub Teaching
Hospital for a couple of days and later expired.

--
Communicated by:
ProMED-mail <promed@promedmail.org>

[The Ayub Teaching Hospital or ATH is a public sector, non-profit
tertiary level teaching hospital in Abbottabad, Khyber-Pakhtunkhwa
(previously the North-West Frontier Province), Pakistan. Established
in 1998, it has one of the largest 24-hour emergency centers in
Khyber-Pakhtunkhwa and caters to much of eastern Khyber-Pakhtunkhwa,
the Northern Areas of Pakistan, as well as certain parts of Azad
Kashmir (<http://en.wikipedia.org/wiki/Ayub_Teaching_Hospital>).

The signs and symptoms exhibited by the deceased doctor were similar
to those of Crimean-Congo hemorrhagic fever
, and a hospital such as
the Ayub Hospital might be expected to make such a diagnosis rapidly
and take immediate steps to avoid nosocomial infection. It is not
stated whether the deceased doctor, his brother and the deceased
Chinese engineer had any contact with infected livestock or with each
other. Clarification and further information is awaited.
 
Re: Pakistan: Doctor dies of mystery disease after treating ill patient - yougner brother of doctor possibly infected too

Re: Pakistan: Doctor dies of mystery disease after treating ill patient - yougner brother of doctor possibly infected too

http://www.asianews.it/news-en/Epid...scourge-for-Pakistan-flood-victims-19572.html

[snip]

Yesterday, at the Ayub Teaching Hospital (AHT), Abbotab, two people, a doctor and a Chinese engineer, died of a mysterious virus, which health authorities have not yet identified. The infection, similar to Dengue fever, lowers the level of platelets, causing severe haemorrhaging and it has also infected a dying boy who came to AHT. Other cases were registered in the district of Haripur (Khyber-Pakhtunkhwa). The heads of the department for infectious diseases in AHT fear the virus could spread rapidly in the flooded areas and have requested assistance from national authorities.
 
Re: Pakistan: Doctor dies of mystery disease after treating ill patient - yougner brother of doctor possibly infected too

Re: Pakistan: Doctor dies of mystery disease after treating ill patient - yougner brother of doctor possibly infected too

Uh oh. There seems to be a larger outbreak going on.

http://www.dowell-netherlands.com/2010/09/ten-die-of-mysterious-disease-in-dir.html

Tuesday, September 28, 2010
Ten die of mysterious disease in Dir

LOWER DIR: Ten people have died of an unknown disease in Lower Dir while another 15 have been shifted to a hospital with the same symptoms.

According to locals, the disease broke out around 15 days ago, with symptoms of severe temperature and body ache which result in death within two weeks.

Doctors say the symptoms of the disease are similar to dengue virus. The blood samples of the affected persons have been sent to National Institute of Health in Islamabad.
Three cricially ill patients have been shifted to Khyber Teaching Hospital Peshawar where they are being kept in isolation ward.

---------------
Same text as above, continuing:

http://tribune.com.pk/story/55638/ten-die-of-mysterious-disease-in-dir/


Around 345 dengue cases, all in the primary stages, have been reported in government hospitals in Karachi and Hyderabad this year.

The number is drastically lower than the approximate 2,500 cases reported last year in the cities, but doctors believe that this figure does not provide the actual picture.

One dengue patient was diagnosed with the Congo virus in Karachi causing alarm in the city.
 
Re: Pakistan: Doctor dies of mystery disease after treating ill patient - yougner brother of doctor possibly infected too

Re: Pakistan: Doctor dies of mystery disease after treating ill patient - yougner brother of doctor possibly infected too

It is not clear whether dengue itself, nor CCHF, have been excluded in any of these cases, although the apparent fatality rate appears too high for dengue, and the rate of spread seems a little high for CCHF.
 
Re: Pakistan: Doctor dies of mystery disease after treating ill patient - yougner brother of doctor possibly infected too

Re: Pakistan: Doctor dies of mystery disease after treating ill patient - yougner brother of doctor possibly infected too

There have been several unresolved hemorrhagic outbreaks in Pakistan in the past few years - the one below is from 2008.

http://www.promedmail.org/pls/apex/...CHECK_DISPLAY,F2400_P1202_PUB_MAIL_ID:X,74247

Archive Number 20081005.3144
Published Date 05-OCT-2008
Subject PRO/EDR> Undiagnosed fatalities - Pakistan: (NWFP)


UNDIAGNOSED FATALITIES - PAKISTAN: (NORTH WEST FRONTIER PROVINCE)
**************************************************************
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: Sun 5 Oct 2008
Source: The News International, online [edited]
<http://www.thenews.com.pk/daily_detail.asp?id=139200>


7 persons including 5 women died, and dozens were hospitalised
here on Saturday [4 Oct 2008] following the outbreak of a mysterious
disease in Sundhya village of Chakesar Union Council. Due to limited
health care facilities in the district, the affected people were
admitted to various hospitals in the Swat valley.

So far, the district administration could send only a dispenser
[health assistant] along with a helper to the area. Those who died
include a man and his sister, a 16-year-old girl and a 14-year-old
girl, and 3 other females of the Dandai area. The father of the 2
family members who fell victim to the disease told "The News" that it
spread on [Wed 1 Oct 2008].

Initial reports suggest that the affected persons run high
temperatures with deep red eyes followed by vomiting blood. Patients
could not receive timely medical relief due to an absence of proper
healthcare and physicians at the Chakesar Civil Hospital, [one
parent] said, adding that 2 persons died while being shifted to
Mingora. A Union Council [member] said no medical team had arrived in
the area. An official [representing] the executive district officer
(EDO health) said a 2-member team headed by a dispenser was sent to
the affected area. "The EDO is currently on leave, but has been
informed of the situation."

--
Communicated by:
ProMED-mail <promed@promedmmail.org>

[The Swat valley and district are located in the North-West Frontier
Province of Pakistan. The main town in the Swat valley is Mingora. It
can be located using the HealthMap/ProMED-mail interactive map of
Pakistan at:
<http://healthmap.org/promed?v=30,69.4,5>.
This is a mountainous and remote region not well served by
health-care facilities or hospitals with diagnostic facilities.

It is difficult to suggest a precise diagnosis for the condition
precipitating these fatalities. The symptoms of high fever and
hemorrhage suggest a hemorrhagic fever something akin to
Crimean-Congo hemorrhagic fever, which has been recorded frequently
in Pakistan (see references below). However, the fatalities appear to
have been either children or adult women, who would be less likely to
have been have been exposed to livestock carrying the tick vector
responsible for transmission of the disease (although transmission by
other means such as contaminated milk is not unknown). Further
information from the area would be appreciated. - Mod.CP]
 
Re: Pakistan: Doctor dies of mystery disease after treating ill patient - yougner brother of doctor possibly infected too

Re: Pakistan: Doctor dies of mystery disease after treating ill patient - yougner brother of doctor possibly infected too

I was not aware of the following ProMED post, from 1998. It seems that there is a history of suspected CCHF outbreaks in Pakistan that have not been confirmed (tests have come back negative), some of considerable size.

It is possible that there is a novel VHF virus here.

http://www.promedmail.org/pls/apex/...,F2400_P1001_USE_ARCHIVE:1001,19980902.1764,Y

Archive Number 19980902.1764
Published Date 02-SEP-1998
Subject PRO> Crimean-Congo hemorrhagic fever - Pakistan: not?



CRIMEAN-CONGO HEMORRHAGIC FEVER - PAKISTAN: NOT?
************************************************
A ProMED-mail post
<http://www.healthnet.org/programs/promed.html>

[see also:
Crimean-Congo hemorrhagic fever - Pakistan 980509061024
Crimean-Congo hemorrhagic fever - Afghanistan 980509061151]

Date: Mon, 31 Aug 1998 15:19:10 PDT
From: Aamir Khan <aamirjkhan@hotmail.com>
Source: Green Monkeys Pakistan Public Health Forum Volume 1 : Number 82,
Tue, 1 Sep 1998


- visit our website at <http://www.greenmonkeys.net/>
- post all contributions to greenmonkeys@maillists.com.


PCR results on 1998 hemorrhagic fever outbreaks
------------------------------------------------------------
The results of the PCR testing on the samples from the hemorrhagic fever
outbreaks in Pakistan and Afghanistan earlier this year are negative. In
light of the positive results previously reported on ELISA [IgM/IgG(?)]
for Crimean Congo Hemorrhagic Fever, it looks like Bob Swanepoel`s
suggestion that there`s more going on here than CCHF is more plausible.

Incidentally, Joe McCormick and Sue Fisher-Hoch had suggested in 1996 that
there may be cross-reactivity with a related virus on the ELISA test,
though which one was anyone`s guess. Humayun Asghar at NIH, Islamabad also
agrees we`re dealing with another hemorrhagic virus.
That makes it a whole
lot of people who know what it isn`t.

I now count 6 reported outbreaks of CCHF/hemorrhagic fevers other than
dengue occurring in Pakistan between 1976, the first reported one and 1998.
[visit <http://www.greenmonkeys.net/ahistory.htm> for details].

Mr. Zaidi at the NIH Virology Dept. mentions one in 1983-4 in Lyari,
Karachi that I`m trying to learn more about. Whether or not the Karachi
event actually occurred, it seems that these outbreaks are more frequent
than we earlier supposed and that they primarily affect health care
professionals in areas already deprived of basic health facilities
.

The NIH has pulled together a national response team to investigate the
next hemorrhagic fever outbreak within Pakistan. The team is not adequately
funded, protective equipment to handle level 4 pathogens are currently
unavailable and there is bound to be red-tapism once the need for a
response arises. But it at least has some pretty determined people on
board. If you hear of anything suggestive of a hemorrhagic fever case or
outbreak -- Quetta/Dera Ghazi Khan/Multan/Rawalpindi/Karachi(?) are likely
canditate cities - please share your information as soon as possible, both
on this forum and with Humayun Asghar <asgharh@nihpak.sdnpk.undp.org > or
myself < ajkhan@jhsph.edu / aamirjkhan@hotmail.com >
 
Re: Pakistan: Doctor dies of mystery disease after treating ill patient - yougner brother of doctor possibly infected too

Re: Pakistan: Doctor dies of mystery disease after treating ill patient - yougner brother of doctor possibly infected too

Here is another suspected hemorrhagic fever patient (from Abbottabad, where the Ayub Teaching Hospital outbreak is). Tests are pending on this one.

http://www.cmemarkets.com/v3/2010/09/28/female-patient-with-symptoms-of-congo-fever-arrives-at-bbh/

Female patient with symptoms of Congo fever arrives at BBH
Female patient with symptoms of Congo fever arrives at BBH

Tue Sep 28 13:26:20 2010 EDT

Sep 28, 2010 (MENA News from Al-Bawaba via COMTEX) -- Benazir Bhutto Hospital
(BBH) on Monday received a female patient with symptoms of deadly Crimean-Congo
Hemorrhagic Fever.

Jamila, 35, from Abbottabad arrived at BBH with continued nasal and throat
bleeding and was shifted to Intensive Care Unit (ICU) where doctors suspected
her as a patient of Crimean-Congo Hemorrhagic Fever.


The doctors said that they sent her blood sample to National Institute of Health
(NIH) for test. They said that the hospital would receive the blood test report
Tuesday from NIH and the doctors would start medication in isolation room if she
tested positive for Congo fever
.

Viral hemorrhagic fever belongs to Zoonotic diseases and it transferred from
animals to humans.aEURe
 
Re: Pakistan: Doctor dies of mystery disease after treating ill patient - yougner brother of doctor possibly infected too

Re: Pakistan: Doctor dies of mystery disease after treating ill patient - yougner brother of doctor possibly infected too

ProMed has picked up the media report (with commentary) posted by alert in post number 5 above.

Undiagnosed fatal illness - Pakistan (02): (NW)

UNDIAGNOSED FATAL ILLNESS - PAKISTAN (02): (KHYBER-PAKHTUNKHWA) ***************************************************************
Date: Tue 28 Sep 2010 Source: Express Tribune [edited] <http://tribune.com.pk/story/55638/ten-die-of-mysterious-disease-in-dir/> 10 die of mysterious disease in Dir

A total of 10 people have died of an unknown disease in Lower Dir while another 15 have been shifted to a hospital with the same symptoms. According to locals, the disease broke out around 15 days ago, with symptoms of severe temperature and body ache which resulted in death within 2 weeks. Doctors say the symptoms of the disease are similar to dengue [fever]. The blood samples of the affected persons have been sent to the National Institute of Health in Islamabad; 3 critically ill patients have been shifted to Khyber Teaching Hospital, Peshawar, where they are being kept in an isolation ward. One [suspected] dengue patient was diagnosed with the Crimean-Congo hemorrhagic fever (CCHF) virus infection in Karachi, causing alarm in the city. -- Communicated by: ProMED-mail Rapporteur Mary Marshall

[The description of the symptoms of the illness responsible for the 10 fatalities and 15 hospitalised cases in Lower Dir is not sufficient to suggest a diagnosis. Dengue fever appears to have been excluded, but CCHF virus infection remains a possibility. It is unclear at present if there is any similarity between this outbreak and the deaths of patients at the Ayub Hospital Abbottabad, also in Khyber-Pakhtunkhwa (see the preceding ProMED-mail report, archive number 20100927.3505). Further information would be welcomed. Dir is a town in Upper Dir District, Khyber-Pakhtunkhwa province (formerly North-West Frontier Province), Pakistan. It lies at the foot of the Lowarai Pass, the main motor road to Chitral, on the Dir River, a tributary of the Panjkora River. The HealthMap/ProMED-mail interactive map of Pakistan can be accessed at: <http://healthmap.org/r/00tj>. - Mod.CP]
http://www.promedmail.org/pls/apex/..._BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,85060
 
Re: Pakistan: Doctor dies of mystery disease after treating ill patient - possibly 10 deaths total

Re: Pakistan: Doctor dies of mystery disease after treating ill patient - possibly 10 deaths total

This post suggests the second outbreak (with 25 cases, 10 deaths), may indeed be due to dengue fever (and those 25 cases are just the most severe cases). Of note is that this article is older than the one that refers to that outbreak as a mystery disease.

The outbreak in Haripur and the Ayub Teaching Hospital remains undiagnosed. Dengue is possible there as well, but might be a bit of a stretch. It looks like that outbreak has H2H2H transmission (patient, doctor, brother), but they could all have been exposed to the same source, and we don't have a good enough grasp of the timing to make a judgment.

http://www.allvoices.com/contributed-news/6840527-7-died-of-dengue-virus-in-northern-pakistan

At least seven people died from fever due to the dengue virus in district Dir of Northern Pakistan. The health department official said. Dozens of people including children and women suffered Dengue Fever in the area of Biremkay and salaim sahah of Dir District Khyber Pukhtonkhwa Province of Pakistan and admitted to the nearest hospitals during the last few days, being reported to the Tehsil Adnezai Hospital Chakdara. It is learnt. Those who died of the dengue virus, suffered fever identified as wife of Bacha Khan , Umer-rehman son of Muhammad Arif, a student of seventh Class in a government school of his locality, seven year old female child Lubna Daughter of Mufasir Khan, 8 years old Ghulam Zahir, 12 year old Chamnay Khan,and three others un-identified persons of Old age. The deaths of patients suffering dengue virus spread fear in the area among the common people and have asked the government of Pakistan and WHO to take special initiatives for the urgent treatment and Control of dengue fever in the flood hit area of district Dir, Khyber Pukhtonkhwa.
 
Re: Pakistan: Doctor dies of mystery disease after treating ill patient - possibly 10 deaths total

Re: Pakistan: Doctor dies of mystery disease after treating ill patient - possibly 10 deaths total

And a new article, indicating the doctor's death was due to suspected dengue, although tests are still pending and preliminary tests were negative. No evidence of any testing for CCHF or other pathogens.

Note this article moves the death of the doctor up to September 6, a couple weeks earlier than the original post.

There is also a sign in this article that some of the cases might be a false report (the blue text) as well, although another article (http://tribune.com.pk/story/56409/dengue-grossly-underreported/) suggests dengue cases and fatalities are occurring and not being reported.

http://www.dawn.com/wps/wcm/connect...ning-system-blamed-for-false-dengue-alarm-090

PESHAWAR, Sept 29: The failure of government to implement disease early warning system in Hazara division was resulting in false alarms about the outbreak of dengue fever, officials of health department said.

They claimed that there was no recorded death, caused by the hemorrhagic dengue fever so far. The government, in collaboration with WHO, started disease early warning system in Hazara division after the earthquake in 2005.

“The department received information regarding diseases trend regularly. Compilation and sending of reports was stopped when the system was taken over by the department in 2008,” said the officials. The result was obvious as there were false reports about outbreak of dengue fever in Abbottabad, Haripur and Dir districts, they said.
Had the system been in place now, there would have been continuous flow of diseases trend in all districts of Hazara division and the department would have been able to know the problem correctly, they said.

“Not a single person has so far been died of dengue fever except a doctor, who had gone from Abbottabad to Shangla, which along with Haripur is endemic for hemorrhagic dengue fever. On return he was admitted at Ayub Teaching Hospital where he died on September 6 of suspected dengue fever,” they added.

The sample of the doctor is being tested again at the National Institute of Health Islamabad and the result of which would be made available after 72 hours to the health department. His earlier tests have also been negative.

At present 26 patients, including 20 in Ayub Teaching Hospital Abbottabad and six in Haripur, have been admitted with fever and they are being tested for dengue fever.

The Malaria Control Programme, which is supposed to look into the dengue fever and diagnose the real causes, is faced with shortage of staff, medicines and other facilities.

The programme received Rs10 million, only half of the Rs20 million allocated for it in the current year budget.

“The malaria programme also lacks services of entomologist to diagnose the causes of disease. An epidemiologist was retired in 2004 and the post has not been filled,” the officials said.

Nonexistence of Dews and MCP’s inability to know the quantum of disease have made the situation more alarming as the health department doesn’t know about the situation in Hazara and Dir. The WHO’s guidelines to prevent the disease were sent only on Monday to the executive district officers (health) of the respective districts.

The guidelines were sent very late because the August and September are high season for dengue fever.

The hospitals have been alerted about the signs and symptoms of the disease and advised to admit the suspected patients and send their throat swabs for examination to exclude dengue fever as a cause.

“The health department and WHO also met on Monday to speed up efforts to know the exact situation and take measures to reactivate Dews in Hazara and other districts where suspected dengue fever patients are coming,” health officials said.
 
Re: Pakistan: Doctor dies of mystery disease after treating ill patient - possibly 10 deaths total

Re: Pakistan: Doctor dies of mystery disease after treating ill patient - possibly 10 deaths total

Some earlier articles I missed on the outbreak at Dir. It is extremely unclear whether that outbreak was due to dengue, CCHF, some other illness or illnesses, or an unfounded/incorrect report.

http://www.thenews.com.pk/25-09-2010/National/6605.htm

Eight die in Chakdarra



By Muhammad Jalil
CHAKDARRA: Eight persons reportedly died of a disease having symptoms resembling dengue fever in one week in Barimkay village in Adenzai tehsil in Lower Dir district, local sources said.
The sources said that after the recent floods a number of diseases broke out in the area. Increase in the number of mosquitoes caused various diseases. The sources said the mosquitoes bite caused death to seven persons. Those who were killed included wife of Bacha Muhammad, a 7th class student, Rahim Said, son of Muhammad Arif, eight-year-old Lubna, daughter of Musafir Khan, eight-year old boy, son of Ghulam Zahir, and 12-year old boy, son of Chamnay Khan.
Besides, scores of the residents including women, elderly and children were affected and admitted to hospitals in Swat and Batkhela. When contacted, District Health Officer of Dir Lower Dr Shaukat said the symptoms reported by the relatives resembled that of dengue fever.

-----------------

http://www.dawn.com/wps/wcm/connect...about-dengue-fever-in-dir-villages-denied-690

Reports about dengue fever in Dir villages denied
Sunday, 26 Sep, 2010 LACK OF SECURITY
Little security for Nato supply convoys TIMERGARA, Sept 25: The executive district officer (health), Lower Dir, on Saturday termed a media report regarding spread of dengue virus in some villages of the Adenzai tehsil as baseless and said there had been no threat of dengue fever in the area.

Talking to this correspondent EDO Shaukat Ali said a medical team led by medical specialist Dr Ikram was sent to the reported villages of Adenzai. The team, he added, included other doctors like Dr Baseer, Dr Raz Mohammad, medical technicians and malaria supervisors. The team collected blood samples of the patients which were sent to medical laboratory for further investigation.

“Preliminary findings of the team suggest seasonal ailment in the area and there were no signs and symptoms of the dengue fever,” Dr Shaukat explained. He said one of the reported women had died of birth delivery complications.

However, he said, malaria and typhoid could have been there and the department was all set to cope with them. The samples collected from the affected people of the Barmaki village, the EDO said would be carefully examined so that proper treatment could be provided to them.

Some newspapers on Saturday reported that seven people including a woman and three children had possibly been killed by dengue fever in a few days in Barmaki and Salim Shah villages of Adenzai while dozens more had been admitted to different hospitals. The EDO health asked the media to play a responsible role in that regard.
 
Re: Pakistan: Doctor dies of confirmed CCHF - possibly 10 deaths total

Re: Pakistan: Doctor dies of confirmed CCHF - possibly 10 deaths total

http://www.dawn.com/wps/wcm/connect...spected-congo-fever-patients-hospitalised-200

4 suspected Congo fever patients hospitalised By Our Correspondent
Saturday, 02 Oct, 2010 LACK OF SECURITY
Little security for Nato supply convoys MANSEHRA, Oct 1: Four suspected patients of Congo Crimean Hemorrhage Fever (CCHF) have been hospitalised here after the death of a doctor in Abbottabad.

?Four suspected people with CCHF are hospitalised here in King Abdullah Teaching Hospital. We have been adopting precautionary measures at hospitals to avoid more deaths,? Mohammad Javed Tanoli, executive district officer health, told reporters here on Friday.

He said that the NIH had confirmed that Dr Hasnain?s death was due to CCHF.

He said that samples of the four suspected patients had also been sent to the NIH for investigation.
 
Re: Pakistan: Doctor dies confirmed CCHF - possibly 10 deaths total

Re: Pakistan: Doctor dies confirmed CCHF - possibly 10 deaths total

http://www.thenews.com.pk/02-10-2010/National/7853.htm

Tests confirm Abbottabad doctor died of Congo fever



By Syed Kosar Naqvi
ABBOTTABAD: The mysterious death of Dr Hasnain Shah, resident medical officer (RMO) at the Ayub Teaching Hospital, was attributed to Crimean-Congo Hemorrhagic Fever (CCHF), hospital management said on Friday.
Medical Superintendent of the hospital Dr Iftikhar told The News that the laboratory reports from the National Institute of Health (NIH) had confirmed the death of Dr Hasnain due to the deadly Congo fever.
The CCHF, also known as Congo fever, is a viral disease that occurs primarily in animals but humans are also susceptible to it. The disease is indigenous to many African, European and Asian countries. Being a tick-borne disease, majority of the people who contract the virus are involved in the livestock industry.
Dr Hasnain caught fever and died after spending a night in Bisham, Shangla district where he had gone to perform duty at the health facility established for flood affectees. He was treated at the ATH but could not survive.
Younger brother of Dr Hasnain has been showing the same symptoms for the last few days with intermittent temperature and low platelets. Sources said the ATH administration had no specialist of infectious diseases and had decided to refer the patient to the Pakistan Institute of Medical Sciences in Islamabad.
After the confirmation of death of Dr Hasnain due to Congo Virus, the hospital administration sent the blood samples of his relatives and staff to the laboratories in Islamabad. It also decided to provide free medical treatment to all the relatives of Dr Hasnain.
A special ward has been set up at the Dental Block where all patients suspected of having the disease will be kept in isolation. Another ICU unit will also be established in the hospital to provide medical treatment to dengue virus, bird flu and Congo virus patients. It is worth mentioning here that there is no virologist or specialist of infectious disease in Khyber Pakhtunkhwa.
Our correspondent adds from Mansehra: Executive District Officer (Health) Dr Javed Tanoli told reporters that four more patients suspected to be suffering from CCHF had been hospitalised. District programme in-charge of United Nations Population Fund Dr Mohammad Ali was also present on the occasion.
Dr Tanoli said the district health department was taking protective measures in Mansehra. He said the samples of four suspected CCHF patients admitted to the King Abdullah Teaching Hospital, Mansehra were also sent to NIH for tests and confirmation of the virus. Dr Tanoli said after the death of Dr Hasnain Shah, the district health department was adopting precautionary steps in accordance with the World Health Organisation guidelines.
 
Re: Pakistan: Doctor dies of mystery disease after treating ill patient - possibly 10 deaths total

Re: Pakistan: Doctor dies of mystery disease after treating ill patient - possibly 10 deaths total

http://www.promedmail.org/pls/apex/..._BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,85128

Archive Number 20101003.3579
Published Date 03-OCT-2010
Subject PRO/AH/EDR> Crimean-Congo hem. fever - Pakistan (05): (NW)


CRIMEAN-CONGO HEMORRHAGIC FEVER - PAKISTAN (05): (KHYBER-PAKHTUNKHWA)
*********************************************************************
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 2 Oct 2010
Source: The News, International [edited]
<http://www.thenews.com.pk/02-10-2010/National/7853.htm>


Tests confirm Abbottabad doctor died of CCHF
--------------------------------------------
The mysterious death of a resident medical officer (RMO) at the Ayub
Teaching Hospital (ATH), has been attributed to Crimean- Crimean
hemorrhagic fever (CCHF), hospital management said on Friday (1 Oct
2010) [This was 1st described in the ProMED-mail post "Undiagnosed
fatal illness - Pakistan: (NW) 20100927.3505"].

Medical Superintendent of the hospital Dr Iftikhar told The News that
the laboratory reports from the National Institute of Health (NIH) had
confirmed the death of the doctor was due to CCHF virus infection.
CCHF is a viral disease that occurs primarily in animals but humans
are also susceptible to it. The disease is indigenous to many African,
European and Asian countries. Being a tick-borne disease, the majority
of the people who contract the virus are involved in the livestock
industry.

The deceased doctor caught fever and died after spending a night in
Bisham, Shangla district, where he had gone to perform duties at the
health facility established for people affected by floods. He was
treated at the ATH but could not survive.

The younger brother of the deceased doctor has been showing the same
symptoms for the past few days with intermittent [increased]
temperature and low platelet [counts]. Sources said the ATH
administration had no infectious diseases specialist and had decided
to refer the patient to the Pakistan Institute of Medical Sciences in
Islamabad.

After the confirmation of death of the doctor due to to CCHF virus
infection, the hospital administration sent blood samples of his
relatives and hospital staff to the laboratories in Islamabad. It also
decided to provide free medical treatment to all the relatives of the
deceased doctor. A special ward has been set up at the Dental Block
where all patients suspected of having the disease will be kept in
isolation. Another ICU unit will also be established in the hospital
to provide medical treatment for dengue, bird flu and CCHF patients.
It is worth mentioning here that there is no virologist or infectious
disease specialist in Khyber Pakhtunkhwa [province].

The Executive District Officer (Health) in Mansehra, Dr Javed Tanoli,
told reporters that 4 more patients suspected to be suffering from
CCHF had been hospitalised. Dr Tanoli said the district health
department was taking protective measures in Mansehra. He said the
samples of the 4 suspected CCHF patients admitted to the King Abdullah
Teaching Hospital, Mansehra, were also sent to NIH for tests and
confirmation of the infection. Dr Tanoli said after the death of the
hospital doctor, the district health department was adopting
precautionary steps in accordance with the World Health Organisation
guidelines.

[Byline: Syed Kosar Naqvi)

--


[This press report confirms that that the fatal undiagnosed illness
suffered by a resident physician at the Ayub Teaching Hospital (ATH)
in Abbottabad, Khyber-Pakhtunkhwa (previously North-West Frontier
Province) was in fact Crimean-Congo hemorrhagic fever as suggested as
a possibility in the original ProMED-mail report. A verdict on other
cases at the ATH is awaited. In view of the number of new suspected
cases accumulating and the nosocomial cases in Rawlpindi it may be
that the infection is spreading from person to person rather than from
infected livestock or via the tick vector.

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

[For readers who are wondering what a disease named Congo-Crimean
hemorrhagic fever is doing in Pakistan, thereby hangs a tale. The
disease was first identified as the cause of an epidemic in the
Crimean peninsula in the Black Sea in the former USSR. Years later,
the virus was isolated from the blood of a febrile patient in the
former Belgian Congo by a Belgian doctor, and sent to the regional
reference lab, which was the East African Virus Research Institute
(EAVRI) in the British colony of Uganda (now the Uganda VRI). There
it was isolated by staff and sent by me to the world reference lab at
the Rockefeller Foundation Virus Laboratory in New York, where it was
found to be new. I asked the Belgian what he would like to name it,
and he said Congo virus, which is the name I published it under.
Later, the Soviets succeeded in isolating the virus from their own
patients, and were surprised to find it was Congo virus. They decided
this would never do, hence the current name. It has since been found
to be carried by migrating birds and their ticks all over their
migration routes in much of the Old World. - Mod.JW]
 
Re: Pakistan: Doctor dies of mystery disease after treating ill patient - possibly 10 deaths total

Re: Pakistan: Doctor dies of mystery disease after treating ill patient - possibly 10 deaths total

http://tribune.com.pk/story/57868/congo-fever-kills-young-doctor/

Congo fever kills young doctor
Ayub Teaching Hospital in Abbottabad quarantines patients
ABBOTABAD: A young resident medical officer (RMO), Dr Husnain Shah, working in the Ayub Teaching Hospital died of Crimean-Congo haemorrhagic fever, the hospital management confirmed on Saturday.

The hospital?s Medical Superintendent Dr Iftikhar said that pathological tests conducted by the National Institute of Health (NIH)have determined that Dr Husnain?s death occurred due to the deadly Congo fever.

Dr Husnain died after spending a night in Besham, district Shangla, in a health facility established for flood survivors. His younger brother also appears to be suffering from the same disease and has been suffering fluctuating temperature and low platelets for the past few days. The case was referred to Pakistan Institute of Medical Sciences in Islamabad.

The hospital administration has sent the blood samples of his relatives and hospital staff to laboratories in Islamabad. The hospital administration has decided to provide free medical treatment to all relatives of the deceased doctor, while blood samples of the medical staff of the other complex are going to be sent to National Institute of Health for further investigation.

A special ward in the dental block is being used to quarantine patients suspected to be infected with the Congo virus. Another ICU unit will also be established in the hospital to provide medical treatment to dengue virus, bird flu and Congo virus patients.

Published in The Express Tribune, October 3rd, 2010.
 
Re: Pakistan: Doctor dies of Crimean-Congo haemorrhagic fever after treating ill patient - possibly 10 deaths total

It is increasingly looking like the doctor contracted CCHF (from an unidentified previous case) in the middle of a large dengue outbreak.

http://www.reliefweb.int/rw/rwb.nsf/db900sid/VVOS-89XP5Q/$File/full_report.pdf

Tragic death of medical doctor confirmed due to CCHF. 14 contacts
tested negative for both CCHF and Dengue. 8 samples were reported to
be positive for Dengue in private labs.


[snip]

Crimean-Congo Hemorrhagic Fever (CCHF)
Of three cases testing positive for CCHF in the past month, two have died, and an additional seven have become infected by nosocomial
transmission at a Rawalpindi hospital. In Pakistan, the incidence of CCHF peaks in June and October but cases occur throughout the year.
Similar to Dengue Hemorrhagic Fever (DHF), CCHF presents as a fever of 2‐7 days which does not respond to antibiotics or anti‐malarial treatment
and is associated with dropping platelets and hemorrhagic signs with case fatality rate as high as 50%. Two main differences are that
CCHF is transmissable from the blood of patients with the disease, and it is successfully treated with high dose Ribavirin, while DHF does not
respond to antivirals and it is not transmissable directly from the patient.

CCHF is caused by a Nairovirus and transmitted to humans by the bite of the Hyalomma tick or by direct contact with blood of an infected
animal or human. The disease was first described in Crimea in 1944 and identified in 1956 in Congo and thus developed the current name for
the disease and its causative virus. Population migration with animals contributes to the higher probability of susceptible animals being bitten
by infected ticks, thus increasing the risk of transmission to humans who handle the animals.
CCHF was first reported in Pakistan in 1976 but the number of cases has shown a dramatic rise since 2000 with 50‐60 cases being reported
annually. It is endemic in Balochistan, but every province has seen a few cases
 
Re: Pakistan: Doctor dies of Crimean-Congo haemorrhagic fever after treating ill patient - possibly 10 deaths total

Different hospital, same area (about 3 miles away). One of three samples positive for dengue. I hope they are isolating these cases, as some may very well be CCHF.

http://www.dawn.com/wps/wcm/connect...l/peshawar/dengue-fear-spreads-in-haripur-800

Dengue fear spreads in Haripur By Our Correspondent
Friday, 08 Oct, 2010 SPEWING HATE
Hate on the Internet HARIPUR, Oct 7: Two suspected dengue patients have died here while 14 others with symptoms of high fever are under observation in a ward of district headquarters hospital, informed sources told Dawn here on Thursday.

The two victims were identified as Muslim s/o Safdar and Mohammad Abbas s/o Mohammad Sadiq. However, local health authorities said that they had not yet received reports of the blood samples of the two victims that were sent to National Institute of Health (NIH), Islamabad, two weeks ago.

The suspected prevalence of dengue fever has been reported from different parts of the district and the sources said that the DHQ hospital and the women and children hospital had so far received around 40 patients suffering from high fever, body pain, nausea and loss of appetite.

The sources said that of these patients some were admitted with their mouth, nose and gums bleeding.

“Blood samples of over 60 suspected patients have been sent to the NIH for dengue test and 14 patients are still under observation,” Dr Bilal, district coordinator Health Information Services, told this correspondent.


Dr Nasir, a medical specialist at the DHQ hospital, confirmed that of the three cases they referred to Agha Khan Laboratory for dengue test, one was found positive.

When approached for comments, Dr Ejaz Masood, the district in-charge of dengue campaign, confirmed the prevalence of dengue fever in Haripur. He said that patients with high fever, body pain, loss of appetite and fatigue must immediately visit the DHQ hospital for complete check-up and blood test.

Dr Hasnain Raza, chief executive of Al-Ghazi Hospital said that clinically there were two types of dengue viral diseases -- dengue classical and dengue haemorrhagic.

“The classical dengue starts with abrupt onset of fever with generalised body pain, especially headache and backache, and sometimes vomiting and generalised rash on the body could precede the disease,” he said, adding that haemorrhagic fever was the dangerous form of dengue fever.

In dengue haemorrhagic, initially the onset of disease is very slow; the patient might feel soar throat, body pain, and malaise, but after that patient starts bleeding. The bleeding can be from nose, eyes, and gums and with stool and urine, he added.

The World Health Organisation (WHO) has also declared Haripur district as one of the dengue endemic-hit zone in Pakistan. The disease was first reported in 2003 when some military cadets were hospitalised with dengue symptoms.
 
Re: Pakistan: Doctor dies of Crimean-Congo haemorrhagic fever after treating ill patient - possibly 10 deaths total

The date of death for the doctor is September 23, not the 6th.

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

[snip]

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
.
 
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