By Bahikire Daraus
The recent confirmed cases of Crimean-Congo hemorrhagic fever (CCHF) in Nakaseke are some of the over 10,000 worldwide documented human infections in the world’s history.
This problem is not unique to Uganda considering that in the past 50 years, Uganda has registered no more than 12 cases of this deadly fever.
Outside Africa, there have been outbreaks in Russia, turkey, Albania, Georgia, Iran, China, Iraq, Saudi Arabia, United Arab Emirates and Greece making CCHF the widest spread tick borne viral infection.
More than 140 outbreaks have occurred globally and 52 countries are thought to be endemic or potentially endemic regions.
In Africa, no more than 100 cases have been reported and South Asia and Europe have suffered more brunt from CCHF. The CCHF is not a local problem that we can relegate to annals of medical history but rather an unpredictable potential global emergency.
The Crimean-Congo hemorrhagic fever virus clandestinely infects livestock; cattle, sheep, carmels, goats, hares and hedgehogs without causing symptoms of disease only to be transferred to humans by ticks.
It follows that slaughter house workers, shepherds, health care workers, and veterinarians are at a high risk of contracting the disease from tick bites, handling of ticks, exposure to blood or tissues of infected livestock, or direct contact with blood and bodily fluids of infected patients.
The virus is quite ingenious in that only 1 to 10 viruses are sufficient to cause fatal disease once in the human bloodstream. 10-30% of those infected will sadly succumb to the infection.
From the time of the tick bite (or contact with blood and body fluids of the infected), about 3 – 7 days pass and the sufferer experiences vague symptoms that may be mistaken for the common flu, food poisoning or malaria.
These include high fever, muscle pains, headache, nausea, vomiting, abdominal pain and non-bloody diarrhea. Shortly thereafter more serious symptoms and signs begin to emerge: skin rash and bruising, painful or red eyes, nosebleeds, coughing of blood, black stools, sore throat, and low blood pressure.
It is lifesaving to suspect CCHF in anyone with these symptoms particularly those residing in the cattle rearing communities or involved in the occupations above. It is always best to be wrong than sorry.
Very few therapies have been shown by studies to treat and have an effect on progression of the disease. Generally, supportive treatment with blood, platelet, fluids, electrolytes, and oxygen are all that is given.
Ribavirin, an anti-viral drug is sometimes used for treatment and prevention (for those exposed) with variable success rates. A vaccine has been tried in the Soviet Union and Bulgaria but is not widely used. Because there is no definitive cure, our best opportunity is prevention.
Those handling domesticated animals should regularly examine their clothing and skin for ticks, use tick repellents and avoid crushing ticks on bare skin. Consumption of unpasteurized milk and uncooked meat puts one at risk of CCHF, bacterial and worm infections.
If a loved one succumbs to the illness, qualified health workers should be allowed to conduct the burial following safe burial practices including the use of liquid bleach solution as a disinfectant.
A dire consequence of CCHF is the loss of lives of health workers that are a limited resource in our health care system. Our health workers must be trained and practice standard and universal precautions to minimize spread of the disease in health care settings.
These include barrier nursing, isolation, and use of protective gears such as gloves, gowns, face-shields, and goggles with side shields. Laboratory workers should practice stringent biosafety precautions.
At a public health levels, there is a need for continuous surveillance for CCHF (and other viral hemorrhagic fevers) and effective tick control methods.
This highlights the multiplicity of interventions requiring collaboration between agencies in agriculture, wildlife and human health.
Importation of CCHF from other countries by migratory bats has been demonstrated by studies. Therefore, as a region (East Africa), we must insulate ourselves as a bloc by concerted regional surveillance, building capacity for rapid diagnosis and coordinated rapid response to prevent amplification of index cases.
Because the recent CCHF outbreak may not be the last, we must build systems that last.
The writer is a concerned citizen passionate with health.