Learn about Congo Virus, its risks during Eid-ul-Adha, and important safety precautions to protect yourself and your loved ones on Meri Sehat.

Congo Virus And Eid-ul-Adha

Online Consultation

Iqra Mazhar

Overview

During World War II, Soviet soldiers in Crimea became ill with a strange hemorrhagic disease<a href="#accordion">[1]</a>. Later, in 1967, scientists isolated the same virus from an ill child in the Democratic Republic of Congo with a similar illness. Thus, the name Crimean-Congo hemorrhagic fever (CCHF) virus was coined.

Over the years, multiple outbreaks of the disease have occurred across the world. It is currently endemic in Africa, Asia, the Middle East, and the Balkans<a href="#accordion">[2]</a>. 
&nbsp;

Crimean-Congo hemorrhagic fever is a tick-borne disease characterized by sudden onset of <a href="https://merisehat.pk/disease/viral-hemorrhagic-fever">fever</a>, muscle pain, headache, dizziness, back pain and stiffness, abdominal pain, vomiting, and diarrhea. This is typically followed by changes in mood and sensory perception. People may also develop tiny red spots (petechiae) on their skin, throat, and palate. As the disease progresses, severe nosebleeds, large rashes, and uncontrolled bleeding from injection sites can occur. 
&nbsp;

The CCHF virus is transmitted via ticks belonging to the Hyalomma genus. Wild and domestic animals, such as goats and cattle also serve as hosts of the virus. Infected ticks can spread the disease to animals and humans through their bites. However, humans can also become infected by coming in contact with infected animal blood or tissues, and close contact with the blood and other bodily fluids of infected individuals. Furthermore, contaminated medical supplies, used needles, and poor sterilization of medical instruments is also known to spread CCHF in hospitals<a href="#accordion">[3]</a>.

Animals serve as asymptomatic reservoirs of the disease. Therefore, livestock workers, slaughterhouse workers, and animal herders working in endemic regions are at the highest risk of contracting CCHF. Healthcare workers are also at risk due to accidental exposure to contaminated instruments and body fluids. 
&nbsp;

understanding congo threat during eid-ul-adha

Since the first human&nbsp;case of CCHF in 1976, Pakistan has experienced several sporadic outbreaks of the disease<a href="#accordion">[5]</a>. The country currently ranks fourth for CCHF cases in WHO&rsquo;s Eastern Mediterranean Region, trailing behind Turkey, Iran, and Russia<a href="#accordion">[4]</a>.

Between 2014 and 2020, a total of 356 cases were reported in the country, with the majority of cases occurring from June to September<a href="#accordion">[4]</a>. According to recent research, all four provinces have a widespread prevalence of the disease<a href="#accordion">[4]</a>. 
&nbsp;

Since the beginning of 2023, 16 cases of CCHF have occurred in Balochistan, with 11 of them detected in May<a href="#accordion">[6]</a>. According to doctors at Quetta&rsquo;s Fatima Jinnah Chest Hospital, the city has recorded three deaths within 10 days<a href="#accordion">[7]</a>. Deaths from CCHF have also been reported in Karachi<a href="#accordion">[6]</a>.

The recent deaths have placed the health authorities on high alert<a href="#accordion">[6]</a> <a href="#accordion">[7]</a>. With Eid-ul-Adha approaching fast, the threat of an outbreak looms above. Furthermore, the fact that the religious holiday is falling in the summer months, when the disease is most prevalent, is a cause of concern. 
&nbsp;

With a case fatality rate of up to 40%, CCHF outbreaks are a real threat to public health. This threat is further intensified during Eid-ul-Adha.

Eid-ul-Adha is an Islamic festival observed by Muslims across the world. More than 8 million animals are sacrificed during this annual celebration, including camels, sheep, goats, and cows<a href="#accordion">[8]</a>&nbsp;and multiple factors play a role in the increased transmission of the CCHF virus during this period. 
These include<a href="#">[8]</a>: 
&nbsp;

<ul>
	<li>Advanced purchase of animals</li>
	<li>Increased movement of animals from endemic areas to urban centers</li>
	<li>Lack of health checks on purchased animals</li>
	<li>Lack of regulation in the sales of animals</li>
	<li>Freelance and non-professional butchers</li>
	<li>Slaughtering of animals in public places</li>
	<li>Untrained butchers</li>
	<li>Delayed disposal of animal carcasses and blood</li>
	<li>Inappropriate animal waste disposal methods 
	&nbsp;</li>
</ul>

As the general public tends to gather around to watch the animal sacrifice, this further increases the risk of exposure and enables animal-to-human and human-to-human transmission of the virus.

The lack of awareness among butchers and the general public play a key role in the increase in cases during Eid-ul-Adha. 
&nbsp;

The National Institute of Health (NIH) has issued warnings on the high risk of CCHF transmission in the country<a href="#accordion">[5]</a>. They recommend butchers wear gloves and other protective clothing to prevent contact with slaughtered meat, blood, and other tissues. Moreover, meat should be drained for at least 30 minutes before public distribution.&nbsp;

The following measures can help reduce the transmission of Crimean-Congo hemorrhagic fever during Eid-ul-Adha<a href="#accordion">[4]</a> <a href="#accordion">[8]</a>. 
&nbsp;

<ul>
	<li>Regulatory health checks of animals</li>
	<li>Timely collection and disposal of waste and animal carcasses</li>
	<li>Pesticides for transported animals</li>
	<li>Implementation of effective standard operating procedures (SOPs) in livestock markets</li>
	<li>Ensuring slaughtering occurs at designated places</li>
	<li>Implementing the use of disinfecting sprays during and after the slaughtering of animals</li>
	<li>Awareness campaigns for cattle farmers, shepherds, and butchers</li>
	<li>Appropriate training of butchers on the transmission of CCHF 
	&nbsp;</li>
</ul>

Conclusion

There is currently no vaccine or cure for CCHF. Treatment is mostly supportive. Therefore, prevention is the best strategy for reducing transmission of the disease during Eid. 
&nbsp;

The increased risk of CCHF transmission during Eid calls for precautionary measures across hospitals. There is an urgent need for awareness programs aimed at the general public and animal handlers in the weeks before the religious festival. Moreover, the implementation of vector control strategies is key to reducing the threat to public health. 
&nbsp;

Key Points

<ul>
	<li>Crimean-Congo hemorrhagic fever is a tick-borne disease characterized by sudden onset of fever, muscle pain, headache, vomiting, and abdominal pain.</li>
	<li>The disease is endemic in Africa, Asia, the Middle East, and the Balkans.</li>
	<li>Pakistan currently ranks fourth for CCHF cases in WHO&rsquo;s Eastern Mediterranean Region, trailing behind Turkey, Iran, and Russia.</li>
	<li>Livestock workers, slaughterhouse workers, and animal herders working in endemic regions are at the highest risk of contracting CCHF.</li>
	<li>With a case fatality rate of up to 40%, CCHF outbreaks are a real threat to public health.</li>
	<li>Eid-ul-Adha is associated with an increase in the number of CCHF cases.</li>
	<li>The advanced purchase of animals, slaughtering in public places, lack of awareness, inappropriate animal waste disposal methods, delayed disposal of animal carcasses and blood, lack of regulatory health checks for animals, and several other factors play a role in the increased risk of CCHF virus transmission during Eid.</li>
	<li>As the general public tends to gather around to watch the animal sacrifice, this further increases the risk of exposure and enables animal-to-human and human-to-human transmission of the virus.</li>
	<li>The increased risk of CCHF transmission calls for precautionary measures across hospitals. There is an urgent need for awareness programs and the implementation of vector control strategies. 
	&nbsp;</li>
</ul>

[1]  Viral hemorrhagic fevers. Hunter’s Tropical Medicine and Emerging Infectious Disease. Published online 2013:323-343. doi:10.1016/b978-1-4160-4390-4.00192-2.

[2]  Crimean-Congo hemorrhagic fever. World Health Organization.

[3]  What is Crimean Congo Hemorrhagic Fever? WebMD.

[4]  Butt MH, Ahmad A, Misbah S, Mallhi TH, Khan YH. Crimean-Congo hemorrhagic fever and Eid-Ul-Adha: A potential threat during the COVID-19 pandemic. J Med Virol. 2021;93(2):618-619. doi:10.1002/jmv.26388.

[5]  National Institute of Health. Seasonal awareness and alert letter (SAAL); 2020.

[6]  Hussain A. Two Congo virus-related deaths cause alarm in Pakistan. Health News | Al Jazeera.

[7]  Ilyas SS| F. Two deaths from Congo Virus Alert Health Authorities. DAWN.

[8]  Mallhi TH, Khan YH, Sarriff A, Khan AH. Crimean-Congo hemorrhagic fever virus and eid-ul-adha festival in Pakistan. The Lancet Infectious Diseases. 2016;16(12):1332-1333. doi:10.1016/s1473-3099(16)30453-4.