1. Congo Virus

2. What is Viral Hemorrhagic Severe multisystem syndrome Damage to overall vascular system Symptoms often accompanied by hemorrhage  Rarely life threatening in itself  Includes conjunctivitis, petechia, echymosis

3. Importance Crimean-Congo hemorrhagic fever (CCHF) is a zoonotic viral disease that is asymptomatic in infected animals, but a serious threat to humans. This disease is a particular threat to farmers and other agricultural workers,veterinarians, laboratory workers and hospital personnel.

4. Cont… Crimean-Congo hemorrhagic fever is one of the most widely distributed viral hemorrhagic fevers. This disease occurs in much of Africa, the Middle East and Asia, as well as parts of Europe.

5. Congo Virus in Pakistan Four people, including a surgeon and a medical technician, have fallen victim to haemorrhagic fever in Quetta in Sep.2011. Reports said a patient suffering from Congo virus was brought to Quetta from Afghanistan for surgery. Unless you live in Zhob, Balochistan you do not run a direct risk of contracting the Congo virus, says Professor of Haemotology at the National Institute of Blood Diseases.

6. Cont….. Congo fever is found mainly among domestic and wild animals through which it may be transmitted to humans. The season for the tick-borne virus, which has symptoms similar to that of dengue hemorrhagic fever, is from June to September. It becomes a worry around Eid-ul Azha when thousands of animals are brought to Sindh’s urban centres ahead of the religious festival.

7. Human infections Acute infection: fever, myalgia, malaise; progression to prostration Small vessel involvement: increased permeability, cellular damage Multisystem compromise (varies with pathogen) Hemorrhage may be small in volume (indicates small vessel involvement, thrombocytopenia) Poor prognosis associated with: shock, encephalopathy, extensive hemorrhage

8. Presentation The onset of the illness is sudden, with symptoms such as fever, severe muscular pain, chills, headache and vomiting. At this stage, among other symptoms, the face is flushed, the tongue becomes dry and is often coated with blood.

9. Cont… Initially a slow pulse is recorded but with the continuous loss of blood in vomits, the blood pressure may drop drastically, making the heart weak. These are obvious signs of an imminent shock and vascular collapse. About 30% of people infected with the Crimean-Congo haemorrhagic fever are reported to eventually die.

10. WHO warns Congo Ebola outbreak could spread

11. Clinical Symptoms Differ slightly depending on virus Initial symptoms  Marked fever  Fatigue  Dizziness  Muscle aches  Exhaustion

12. More severe  Bleeding under skin  Petechiae, echymoses, conjunctivitis  Bleeding in internal organs  Bleeding from orifices  Blood loss rarely cause of death

13. Transmission The virus is transmitted by direct contact with the blood, body fluids and tissues of infected persons. Although the causative virus is often transmitted by ticks, animal-to-human and human- to-human transmission also occur.

14. Cont…. Transmission of the virus has also occurred by handling sick or dead infected wild animals including chimpanzees, gorillas, monkeys, forest antelope and fruit bats.

15. Diagnosis  Infectious Disease  Serology  PCR  IHC  Viral isolation  Electron microscopy

16. Treatment Luckily, for people who are infected with Congo, there is anti-viral drug – the same drug is used for people who are treated for Hepatitis C. Ribavirin, Not approved by FDA  Effective in some individuals  Arenaviridae and Bunyaviridae only Convalescent-phase plasma  Argentine HF, Bolivian HF and Ebola Strict isolation of affected patients is required Report to health authorities

17. Patients Care Healthcare providers treating infected patients need to be very careful. Strict universal precautions are necessary when caring for human patients. These recommendations include barrier nursing, isolation and the use of gloves, gowns, face-shields and goggles with side shields.

19. Measures to avoid tick bites In endemic regions, prevention depends on avoiding bites from infected ticks and contact with infected blood or tissues. Use of tick repellents, environmental modification (brush removal, insecticides), Avoidance of tick habitat and regular examination of clothing and skin for ticks.

20. Cont…. Clothing should be chosen to prevent tick attachment; long pants tucked into boots and long- sleeved shirts are recommended. Acaricides can be used on livestock and other domesticated animals to control ticks, particularly before slaughter or export.

21. Home taking message Protective clothing and gloves should be worn whenever skin or mucous membranes could be exposed to viremic animals, particularly when blood and tissues are handled. Unpasteurized milk should not be drunk. In meat, virus is usually inactivated by post-slaughter acidification. It is also killed by cooking.