Determinants of Crimean-Congo hemorrhagic fever (CCHF) outbreaks in Khyber Pakhtunkhwa, Pakistan: A retrospective cross sectional study

Title : Determinants of Crimean-Congo hemorrhagic fever (CCHF) outbreaks in Khyber Pakhtunkhwa, Pakistan: A retrospective cross sectional study

Abstract:

Introduction: Crimean-Congo Hemorrhagic Fever (CCHF), a viral tick-borne zoonotic disease with high mortality rates, poses a particular threat in Pakistan during religious event of Eid-ul-Azha, due to increased contact with livestock. This study aims to analyze CCHF cases from three outbreaks in Peshawar, Khyber Pakhtunkhwa (KP), Pakistan, to identify patterns in demographics, clinical characteristics, of this infection. Understanding these patterns can inform targeted interventions for future outbreaks.
Methods:  A retrospective cross-sectional study was conducted to examine three CCHF outbreak investigations between July 2^nd and August 12^th, 2023 in Khyber Pakhtunkhwa. Multisectoral teams, including human and animal health departments, investigated these outbreaks. Data was collected through semi-structured case and contact investigation tools. The healthcare providers, patients and family members were interviewed and examined. During active case surveillance, 41 probable contacts were traced and interviewed during all three outbreaks.
Results: Among positive cases, male predominance (71.4%) was observed. The highest proportion of cases occurred in the 15-29 year age group (42.9%, n=6). Individuals involved in animal handling professions like butchers and general workers had the highest prevalence (50%, n=7), followed by students (21.4%, n=3). Common clinical manifestations included high-grade fever (100%), muscle pain (92.9%), and bleeding symptoms (85.7%), with 64.3% of cases reporting vomiting blood. The average recovery time was 7.1 days, while fatal cases had an average of 6.8 days from symptom onset to death. Recovery was observed in 64.3% of cases, with a mortality rate of 35.7%. Chi-square analysis showed significant associations between gender, occupation, and disease outcome (p < 0.05).
Conclusion: This study identified a higher risk of CCHF in males, young adults, and individuals involved in animal handling during outbreaks. Public health interventions targeting occupations, demographics, particularly education and protective measures for animal handlers during Eid-ul-Azha days, are crucial to mitigate future outbreaks.

Biography:

Dr. Muhammad Gul Sartaj with an experience of more than 13 years in Public Health working on different position studied bachelors of Medicine & Bachelors of Surgery ( MBBS) from KMU, Peshawar, Pakistan in 2011 with Masters in Public Health ( MPH) in 2019 and Field Epidemiology Training Program ( FETP) Short Course in 2023. He  joined Health department Khyber Pakhtunkhwa as Provincial Surveillance Officer in Decemeber, 2021 and He is still working on the same post. His technical lead of provincial Disease surveillance and response Unit (PDSRU) at health Department, Khyber Pakhtunkhwa.
Integrated disease surveillance and response system is dealing with all kinds of emergencies such as Flash Floods, Monsson and Terrestrial rains, Earth Quakes ,Bombs blasts ,forest fires ,Pandemics like COVID-19 and other local Epidemics. It is the technical head of operations for planning and execution of Surveillance and response activities of 42 notifiable diseases of top priority in Health Département of Khyber Pakhtunkhwa.