Management of Crimean-Congo Hemorrhagic Fever - Report Example

Management of Communicable Diseases Name Institution Management of Crimean-Congo hemorrhagic fever Introduction The Crimean Congo hemorrhagic fever spread by ticks, affects humans, and has a case fatality of more than 30%. Among the contagious viruses, the Crimean Congo hemorrhagic fever has affected human for centuries as various accounts during the 12th century indicate the presence of the disease in areas such as Tadzhikistan (Whitehouse, 2004). Recent major outbreaks of the disease occurred in the Crimean Peninsula where many agricultural workers contacted the disease. This incident, which occurred 1940s, represents a major outbreak with extensive documentation (Whitehouse, 2004). Today, Crimean Congo hemorrhagic fever occurs in many parts of the world in Asia, Eastern Europe, Africa, and Middle East where it affects humans who contact ticks, of the genus Hyalloma or came into contact with fluids from infected humans (Maltezou et al, 2010). Ticks are the primary vectors of the Crimean Congo hemorrhagic fever exposing a wide array of people to the risk of contracting the virus. However, contact of humans with infected persons is another pathway, which exposes humans to the Crimean Congo hemorrhagic fever known to cause muscle pain, fever, diarrhea, nausea, and vomiting among victims. This paper reviews pathways to the spread of Crimean Congo hemorrhagic fever, examines Kenya as a county at risk of the disease and outlines responsible of federal and international agencies in the management of the disease. Pathways for the Spread of Crimean-Congo Hemorrhagic Fever Among animals such as cows, sheep or goals, Crimean-Congo hemorrhagic fever does is symptomless, but this is not the case with humans carrying the virus causing the disease. The Crimean-Congo hemorrhagic fever is zoonotic disease that starts with little harm, but progress into a deadly hemorrhagic fever. More often than not, an outbreak of Crimean-Congo hemorrhagic fever results in high facility rate of more than 30% of affected persons (Shetty, Tang, & Andrews, 2009). The impact of the disease stems from its effects on humans, along with the ability of the disease to experience nosocomial transmission among victims (Gozel et al., 2013). Such transmission often takes place when patients contract fluids or blood of persons with the disease. While the disease exists in the tick-vertebrate cycle, the disease affect human who encounters blood of infected animals or receive tick bites. In animals both wild, and domestic, the Crimean-Congo hemorrhagic fever does not have any reported effect on health nor does it cause death. However, the virus relies on ticks that bite humans and cause infection. Ticks from the Hyalloma genus are excellent carriers of the virus. The virus, which causes the disease, belongs to the genus Nairovirus and relies on hard ticks, which acts are carriers of the virus (Maltezou et al, 2010). In many regions where the disease has widespread occurrence, both wild and domestic animals helps in the transmission of the ticks. Many wild animals, such as hedgehogs or hares act as amplifying agents because they help spread the ticks to other domestic animals. Most domestic animals are the primary hosts of adult ticks that affect animals like sheep, cows, and goats. The fact that humans interact with domestic animals means that ticks have the chance of biting humans and infecting them with the virus. The introduction of the virus into human blood stream through tick bite may not be rampant as other means of infection such as nosocomial infection at home or health care centers where patients with the fever are receiving treatment. In areas where there are infected ticks, individuals who engage in outdoor activities could be at risk of having tick bite. Farmers and other professionals who interact with domestic animals are at risk of contracting through Crimean-Congo hemorrhagic fever. The occurrence of Crimean-Congo hemorrhagic fever infection via tick bites are common in areas where either infected ticks roam through intermediary or primary hosts such as sheep. The transmission of Crimean-Congo hemorrhagic fever through tick bites is the primary mean through, which the disease spreads. The occurrence of the disease corresponds with the geographical distribution of Hyalloma ticks (Zavitsanou, Bavatsikou, & Koutis, 2009). This form of transmission is the most acute because the incubation period of the disease is normally between one and three days. Sometimes, the incubation period take between 1 to 3 days (Flick & Whitehouse, 2005). In comparison to other modes of transmission, infection via tick bites is the most acute form since most ticks of the genus Hyallomma, serve as both reservoirs and vectors for the transmission of the virus. Another form of transmission of the Crimean-Congo hemorrhagic fever is through contact with animals carrying the Nairovirus. Many domestic ruminant act as carriers of the virus and humans who contact blood or body fluids from such animals are at risk. Because Nairovirus infects domestic animals and multiply in their blood, humans who contact infected blood and tissue are at risk of getting the infection of Crimean-Congo hemorrhagic fever (Flick & Whitehouse, 2005). In most places, people who interact with farm animals are at greater risk than those who do not. For instance, farmers who keep domestic animals are likely to touch or get into contact with body fluids or blood of infected animals. Veterinary officers also face the risk of contracting infected blood during the course of the veterinary practice. Apart from farmers and veterinary personnel, other group of people at risk include abattoir workers who may not have protecting measures against ticks or blood of infected animals (Long, Pickering, & Prober, 2012). Infected domestic animals that come to the slaughterhouse are likely to propagate infection of Crimean-Congo hemorrhagic fever. A large number of humans who interact with animals that could be carrying the virus. Consequently, the transmission of the disease through this means is significant. However, the incubation period of the disease is not as acute as that of tick bite. The Crimean-Congo hemorrhagic fever may also spread through contact of humans and aerosol of excreta of infected rodents (Schwartz, 2009; Mihalca & Sándor, 2013). During the slaughtering of infected animals, people who work in the abattoir are likely to encounter fecal matter with infection of the Crimean-Congo hemorrhagic fever virus. Farmers and shepherds who may contact excreta from animals and this could lead to spread of the virus causing disease through aerosol (Schwartz, 2009). The transmission of the virus causing Crimean-Congo hemorrhagic fever virus through aerosol is limited to exposure of human to excreta containing the virus. However, such exposure is important means of transmission because people who handle domestic animals are at risk of getting into contact with infected excreta (Flick & Whitehouse, 2005). Often direct contact or contact with aerosol from infected animals causes infection of Crimean-Congo hemorrhagic fever among animal handlers. There are cases of Crimean-Congo hemorrhagic fever transmission through nosocomial infections. The threat of Crimean-Congo hemorrhagic fever does not end up with lack of contact between humans and infected animals. Instead, humans with infection of the virus causing the Crimean-Congo hemorrhagic fever are likely to infect other human through contact with blood or body fluid. When caring for persons infected with Crimean-Congo hemorrhagic fever, caregivers at home or health care professionals are at risk of contracting Crimean-Congo hemorrhagic fever infection (Mardani M, & Keshtkar-Jahromi, 2007). Such infection occur when healthcare workers work with patients with hemorrhagic fever. In comparison to the other mode of transmission, the spread of Crimean-Congo hemorrhagic fever through nosocomial route is acute and likely to have severe fatalities. This is because there are few medical centers that can diagnose Crimean-Congo hemorrhagic fever, which implies that the transmission could be sporadic within a health care facility. During severe outbreak of diseases, nosocomial infection can have sporadic impact many people as the disease could affect many people within a small area. More important, the lack of safety and preventive measures could also accelerate the spread of Crimean-Congo hemorrhagic fever with humans having the virus infecting other persons who come into contact. Occurrence and likely impact of Crimean-congo hemorrhagic fever in Kenya The discussion of the Crimean-Congo hemorrhagic fever underscore the prevalence of the virus causing disease in ticks of the genus Hyalomma. This is not a coincidence since most of the regions with high prevalence of the disease have high number of domestic animals, which are the primary host of adult ticks. Many countries in Africa, such as Kenya, are at risk of Crimean-Congo hemorrhagic fever. Kenya, an East African Company has a combination of factors that exposes it to the risk of expiring an outbreak of the Crimean-Congo hemorrhagic fever. Many regions of Kenya has high number of domestic animals where farmers engage in animal husbandry with little emphasis on safety and healthy. Coupled with poor infrastructure where both human and animals share basic resources such as water and grazing field, the risk of Crimean-Congo hemorrhagic fever outbreaks are high. With the lack of stringent immunization programs and logistics challenges of nomads, many farmers continue to expose themselves to diseases from virus such as Nairovirus , which could have far reaching effects on the health of an array of human population. Some parts of Kenya have a high number of livestock’s such as cows, sheep, and goals. Such areas include Northeaster towns of Garissa, Turkana, and Manderra (Sang et al., 2011). In addition, many parts of the Rift Valley have high number of animals making animal husbandry the primary economic activity. In these areas, there are significant number of animal abattoirs and markets making movement of animals in the region high and extensive (Sunit & Ruzek, 2013). While there are few cases of Viral Hemorrhagic Fevers reports in the region, there is a high chance that people in these regions could suffer from Viral Hemorrhagic Fevers such as Crimean-Congo hemorrhagic fever. First, there are high number of interactions between animals and humans along with few practices such as use of acaricides, which are helpful in killing of ticks. Instead, many communities living in these parts of Kenya spend less time in managing ticks, which could help carry Nairovirus and consequently infect animals (Sang et al., 2011). The lack of proper structures for animal management is not a mere coincidence. A majority of animal owners are nomads who move from one region to another in search of pasture. Such movements are seasonal and unpredictable making it difficult for the Kenyan government to introduce animal management practices and facilities. The lack of proper veterinary programs that could otherwise reduce the density of ticks implies that animals and humans are at risk of infection. The lack of development program in marginalized areas of Kenya is well evident. There are some areas in Kenya, such as Northeastern where communities barely survive with limited resources. For instance, the climatic conditions of these areas have water resources a scare facility that causes feuds among communities. At the community level, both animals and humans share water holes, as there are a handful of watering point. In places such as Turkana, both humans and animals share wells, which increases contact between humans and animals. Considering that Crimean-Congo hemorrhagic fever spread through contact of humans with body fluid, blood and excreta from infected animals, the danger of Crimean-Congo hemorrhagic fever outbreak is imminent. The increase interaction between people of Kenya in these regions continue to increase the chances of disease outbreak spread by exposure of humans to infected ticks, tissue or excreta from infected persons. The lack of sewerage and water solutions compound the challenge of communities to prevent possible contact with Crimean-Congo hemorrhagic fever infection. In addition, families in marginalized areas suffer from lack of proper health facilities, as well as having to contend with poor living standards. The fact that Crimean-Congo hemorrhagic fever spread through nosocomial means makes the disease quick to spread from one person to another. Such a spread could affect communities of Kenya who have poor health care facilities because health centers are far and infrastructure such as roads are inexistent (Sang et al., 2011). A typical scenario would be a devastating outbreak where persons infect each other with the disease. This is because communities in these areas live in crowded areas, but also practice poor hygiene. Such societal configuration fuel spread of diseases, as there are high contact of body fluid among community members. Given the impact of the above factors, many areas of Kenya, such as those above, continue to face high risk of witnessing outbreak of Crimean-Congo hemorrhagic fever. Role agencies in the management of the diseases The management of Crimean-Congo hemorrhagic fever at the local and international level is a critical agenda. As a country that relies on animal keeping to driver its economy, Kenya has an important role of preventing animal husbandry becoming a threat to the lives of many people who consider domestic animals the center of their livelihoods. The government of Kenya has an important role of preventing spread of ticks and establishing research centers and surveillance areas to prevent outbreak of the fever (Brachman et al., 2001). First, the national government and county government have an important responsibility of improving farming by supporting farmers establish best practice of animal keeping. The use of modern techniques to control ticks could serve as a robust way of preventing spread of ticks that could be infected with Nairovirus (Howard, 2005). Such efforts could lay groundwork necessary in reducing the number of ticks that could serve as vectors for Crimean-Congo hemorrhagic fever. Apart from improving animal husbandry, creating meaningful structure such as watering point and advancing veterinary service to marginalized areas could improve Kenya’s preparedness in tacking potential outbreak of Crimean-Congo hemorrhagic fever. Most important, the government of Kenya has a critical role in working with international organizations such as WHO and CDC. Kenya could benefit from a wealth of expertise and research work by working with WHO. For instance, Kenya needs to create surveillance centers in various parts of the country where rate of infection of Crimean-Congo hemorrhagic fever will be examined. Data from surveillance programs may then help project on potential impact of the disease in Kenya, which could help create corrective programs. For instance, WHO could provide training to experts in Kenya, along with equipment necessary for collecting of data. Funding secured from other organizations such as CDC could help further research of disease and other drivers with the aim of reducing widespread and impact of the disease in Kenya. Concerted efforts between Kenyan government and other international organizations, such as CDC and WHO, is necessary to enable Kenya reduce the risk of its population suffering from Crimean-Congo hemorrhagic fever, which still lacks an effective cure. References Brachman, P. S., O'Maonaigh, H., Miller, R. N., & Institute of Medicine (U.S.). (2001). Perspectives on the Department of Defense Global Emerging Infections Surveillance and Response System: A program review. Washington, D.C: National Academy Press. Flick, R. & Whitehouse, C.A. (2005). Crimean-Congo hemorrhagic fever virus. Curr Mol Med. 5(8):753-60. Gozel, M. G, Bakir, M., Oztop, A.Y, Engin, A, Dokmetas. I, Elaldi. N. (2013). Investigation of Crimean-Congo Hemorrhagic Fever Virus Transmission from Patients to Relatives: A Prospective Contact Tracing Study. Am J Trop Med Hyg. 13(2):233-42 Howard, C. R. (2005). Viral haemorrhagic fevers. Amsterdam: Elsevier. Long, S. S., Pickering, L. K., & Prober, C. G. (2012). Principles and practice of pediatric infectious disease. Edinburgh: Elsevier/Saunders. Maltezou HC, Andonova L, Andraghetti R, Bouloy M, Ergonul O, Jongejan F, Kalvatchev N, Nichol S, Niedrig M, Platonov A, Thomson G, Leitmeyer K, Zeller H. (2010). Crimean- Congo hemorrhagic fever in Europe: current situation calls for preparedness. Euro Surveill. ; 15(10):1-4 Mardani M, & Keshtkar-Jahromi, M. (2007). Crimean-Congo hemorrhagic Fever. Arch Iranian Med, 10: 204-214. Mihalca, A.D, Sándor, A.D. (2013). The role of rodents in the ecology of Ixodes ricinus and associated pathogens in Central and Eastern Europe. Front Cell Infect Microbiol. 1(3):56. Nijhof, A.M, Bodaan C, Postigo M, Nieuwenhuijs H, Opsteegh M, & Franssen L. (2007).Ticks and associated pathogens collected from domestic animals in the Netherlands. Vector Borne Zoonotic Dis; 7(4):585-95. Schwartz, E. (2009). Tropical Diseases in Travelers. Chichester: John Wiley & Sons. Shetty, N., Tang, J. W., & Andrews, J. (2009). Infectious disease: Pathogenesis, prevention, and case studies. Chichester, UK: Wiley-Blackwell. Singh, S. K & Ruzek, D. (2013). Viral Hemorrhagic Fevers. New York: CRC Press. Whitehouse, C.A. (2004). Crimean-Congo hemorrhagic fever. Antiviral Res; 64(3):145-60. Read More