Asia Times: Congo fever spreads its deadly reach in Pakistan


	March 2, 2002	atimes.com

India/Pakistan

Congo fever spreads its deadly reach in Pakistan
By Muddassir Rizvi

ISLAMABAD - Pakistani health authorities have placed more than 100 people under quarantine on the suspicion of carrying the Congo virus as they struggle to control the spread of deadly fever that has already claimed two lives in the country's capital and its sister city.

The news of the outbreak of this deadly virus hit the headlines a couple of days ago, when a young doctor died of the fever after contracting it from her patient at a hospital in Rawalpindi, Islamabad's sister city. Twenty-five-year-old Dr Farzana Altaf and her patient, Salma, who came from a small town in Pakistan-controlled Kashmir, are yet more victims of this deadly fever, whose occurrence has become a rather yearly feature.

"As many as 110 people who had close contact with the victims, including their relatives, are being closely monitored. The people under quarantine include as many as 27 doctors and also paramedic staff who had close contact with the victims," confirmed an official at the country's Health Ministry, requesting anonymity. "While most people under quarantine are in satisfactory condition and showing no symptoms of the deadly fever, 20 have been put on an antiviral drug as a precautionary measure," the official said.

In addition to isolating the suspects, health authorities have also sealed the wards of hospitals where the two women died and incinerated all disposable equipment used for their treatment, said Dr Azhar Qureshi, who heads the Pakistan Institute of Medical Sciences, where the young doctor died.

Two deaths were reported due to this fever last March in the northwestern city of Peshawar, while 15 were reported killed in September 2000 in a remote town of the southern province of Balochistan. The epidemic was also recorded in 1975, 1986, 1996, 1998 and 1999 and 2000.

"An extremely contagious fever, it can be passed on by contact with the blood and other body fluids of an infected animal or person or by the bite of an infected tick," said Dr Athar Saeed Dil, executive director of the Islamabad-based National Institute of Health (NIH) that is supervising the official efforts to control the illness.

Medically described as Crimean Congo Hemorrhagic Fever (CCHF), doctors say that it belongs to the same family of acute hemorrhagic fevers as the ebola virus. Congo fever victims usually die within two weeks of infection, with initial symptoms including headaches, fever and vomiting. In its advanced stages, patients may suffer from massive internal hemorrhaging, vomiting and defecating blood, bleeding under the skin and from the nose, urinary tract and gums.

The fresh outbreak has sent a wave of panic among the residents of the twin cities, who know little about the symptoms and modes of transmission of Congo fever. Though the disease was first recorded 25 years ago in the remote northeastern region of Balochistan, the government has traditionally kept silent about the existence of this disease and its exact toll in the country, pursuing, what officials describe as a "policy of hide and manage".

Its surfacing in Islamabad has, however, changed that, and official agencies are coming forward more openly with latest information about the fatal fever. Doctors at local hospitals confirm that they are receiving numerous calls from people in panic. "They are just panicking because they think a person who contracts Congo virus for sure dies, which is not the case," commented Dr Shoiab Khan, district health officer in Rawalpindi. Dr Khan asked the people not to panic as the government agencies has controlled the spread of the disease by putting all suspects under quarantine. "The disease only affects those who come in direct contact with a patient," he said.

Although Khan's assertion about the fever being curable if diagnosed in early stages through the administration of the antiviral Ribavirin is medically correct, most general practitioners in Pakistan are not trained to make its clinical diagnoses, whose early symptoms resemble that of ordinary flu. Thus, the government needs to launch a public awareness campaign and train practitioners to diagnose congo fever especially in high-risk areas.

This time, it is not only the people who are panicking but also the health officials, who appear to be in a quandary. They are worried as the original carrier was brought from Bagh, Kashmir Valley, indicating the spread of the fever to the country's north. Except for last year's outbreak in Peshawar, the disease is known to have only erupted in remote areas of Balochistan province, always coinciding with its outbreak in Afghanistan.

"The endemic zone of the disease had been found in the northeastern region of Balochistan. The areas were known for sheep grazing and quasi-nomadic settlement," said a report prepared by the Rawalpindi-based Armed Forces Institute of Pathology.

The NIH has already rushed an investigation team to Bagh, Kashmir, from where Congo virus-infected patient Salma was brought to Holy Family Hospital in Rawalpindi two weeks ago. "A team of medical experts and epidemiologists from NIH and the World Health Organization [WHO] has already left for Bagh," said Dr Athar Saeed. "We need to find out the original source of the disease as part of its eradication. Our team would assist the local staff in Bagh to screen the relatives of Salma and other people in the area, who might also have contracted the disease," he explained.

The WHO local office has sent the blood samples of the victims and suspected people to a virology laboratory in South Africa for further investigation and conformation of Congo virus. Pakistan does not have a single virology lab. "In collaboration with the NIH, the WHO has also launched a crash training program for doctors and paramedics of local hospitals for handling and preventing the deadly infection," said a WHO spokesman.

The death of Dr Altaf has also pointed to the lack of capacity on the part of doctors and paramedics to deal with epidemics and their ignorance about infection control measures.

"The government should develop protocols for hospitals to follow in dealing with epidemics, and particularly train paramedic staff to handle such cases as they are at the maximum risk of acquiring infections from patients," suggested a local health activist.

(Inter Press Service)