Ebola in Pakistan- continued

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From: Rana Asghar Date: Thu Nov 30, 2000 6:01pm Subject: Cases of Congo haemorrhagic fever in Pakistan

Volume 356, Number 9244 25 November 2000

The Lancet

Policy and people

Cases of Congo haemorrhagic fever in Pakistan

A least two people, including a hospital nursing assistant, have died from an outbreak of Congo Crimean Haemorrhagic Fever (CCHF) in a private hospital, in Karachi, Pakistan, raising concern that the disease could spread to other cities in the country.

As a result, the provincial government has ordered hospitals in the region to take extra care when dealing with patients with haemorrhagic fever and high- grade fever, who have come from the neighbouring Baluchistan province. Health officials claim that in Baluchistan, haemorrhagic fever has already affected more than 30 people during the last 2.5 months, of whom 12 have died. Media reports, however, suggest that 30 people have died. Baluchistan borders Afghanistan, which is also endemic for CCHF and where a similar outbreak this year infected 27 people of whom 16 have died since June (see Lancet 2000: 356: 1252). CCHF is a viral disease that is transmitted to animals and man by hyalomma ticks. The disease is endemic or potentially endemic in 35 countries in Africa, Asia, the Middle East, and Europe.

"This outbreak [in Karachi] demonstrates that Congo Crimean Haemorrhagic Fever is not just confined to Baluchistran but can occur anywhere in the country, and that nosocomial transmission in a real risk", says Arif Sarwari, an infectious- disease expert at the Aga Khan Medical University Hospital, where both the deaths so far have occurred. The index case, a 45-year-old butcher from Karachi, was admitted to the hospital on Oct 12 and died on Oct 16. In the second case, a 30-year-old hospital nurse assistant who developed symptoms on Oct 22, died on Nov 3.

The hospital, considered to be one of Pakistan's leading private hospitals, has however come under strong criticism from the media for allegedly concealing the outbreak until Nov 7. Media reports have stated that the hospital concealed the deaths to avoid any possible damage to its business. But Talat Tayyabji, a spokesperson for the hospital denies such allegations, saying "We have said everything up front". On Nov 15, John Stevens, director of the Aga Khan hospital, reconfirmed that there were now no cases of the virus in the hospital. Khabir Ahmad

Rana Jawad Asghar, MD, MPH Research Associate Stanford University


-- Martin Thompson (mthom1927@aol.com), December 02, 2000


Response to Enola in Pakistan- continued

Just to clarify: this is NOT the Ebola virus. CCHF is a very serious disease, but it is quite a distinct virus from Ebola.

CCHF does cause a severe hemorrhagic illness (a "leaky capillary" syndrome), like a bunch of other viruses: Ebola, Marburg, Lassa, Rift Valley Fever, and there are many others, mostly very rare. For what it is worth, CCHF case-fatality rates vary from 2% to 50%. Ebola generally runs 50% to 90% case fatality rate. Marburg, closely related to Ebola, runs around 25%).

Like Ebola, CCHF can be a particular problem for health care workers and can be spread to them and between patients if strict modern barrier medicine is not available.

As the article points out, "[CCHF] is endemic or potentially endemic in 35 countries in Africa, Asia, the Middle East, and Europe." On the other hand, Ebola is limited to Africa, so far. (An outbreak of Ebola outside the continent of Africa would be major, CNN-special-report news, I think, even in the face of the latest legal maneuvers in Florida.)

--Andre Weltman, M.D., M.Sc.

public health physician

-- Andre Weltman (aweltman@state.pa.us), December 08, 2000.

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