Sunday, 20 February 2011

Crimean Congo Haemorrhagic Fever: Hospitals ill-equipped to meet disease outbreaks

2011
Syed Akbar
Hyderabad, Jan 20: Hospitals in India are ill-equipped to tackle cases of highly infectious Crimean Congo haemorrhagic fever, if the disease breaks out here. Worse, most of the doctors are unaware of the clinical manifestation of CCHF and perhaps none of them ever had a direct interaction with a CCHF patient.

"We studied about Crimean Congo haemorrhagic fever in one of our microbiology lessons. But I have never come across with a CCHF patient in my career so far. If our doctors were to admit their knowledge about this fever, I am sure none of them will be able to diagnose a CCHF patient in one sitting," an expert in internal medicine attached to a corporate hospital said.

CCHF is an exotic disease capable of spreading fast through body fluids from person to person. However, its transmission from animal to humans is through tick bite. An infected person is then capable of spreading it to others through body contact and body fluids. It is such a dangerous disease that the National Institute of Virology has warned that any serum samples from an infected person collected by hospital should be sent through a three-level isolation box to NIV, Pune, for confirmatory diagnostic tests.

Crimean Congo haemorrhagic fever was first diagnosed in 1944 in Ukraine. Though it has been causing havoc regularly in different parts of the world, CCHF was not reported in India till December 2010. Early this month, the disease was diagnosed in Ahmedabad and so far it had claimed three people, including two medical staff.

Given its high infectious nature and the regularly movement of large number of people between Gujarat and Andhra Pradesh, doctors and health experts fear that any outbreak of CCHF in Hyderabad will throw the city into a sort of medical emergency. Most of the hospitals do not have special isolation wards fulfilling the WHO standards for Congo fever patients.

Says senior physician Dr Aftab Ahmed, "dealing with CCHF will be a challenging task. Since it is a viral disease, antibiotics do not work and the treatment has to be supportive. What matters is early diagnosis of the disease to save the life of the patients, as India has many tropical fevers. It has one of the highest mortality rates with 40 per cent of patients succumbing to it".

Doctors at the government-owned Sir Ronald Ross Institute of Tropical and Communicable Diseases (Fever Hospital) also admit that they do not have WHO-standard isolation ward to deal with Congo fever cases. "As of now we don’t have any isolation ward to deal with Congo fever cases. We haven’t received any guidelines from the State government about the ailment and the ways to deal with it," says a medical officer.

According to National Institute of Virology, an individual is said to be suffering from CCHF if he manifests an acute febrile (fever) illness, with bleeding/haemorrhagic manifestations or acute unexplained death, plus at least one of the following: (a) tick bite in the previous three weeks, (b) contact with livestock in the previous three weeks and or (c) direct physical contact (in the home or in a healthcare setting) or contact with bodily fluids of someone with a similar illness in the previous three weeks.

ends/syedakbar/7.40 pm

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The NIV has suggested the following precautions for hospitals and individuals to prevent spread of CCHF.

Hospitals:

1. Isolate the patient in a room separate from other patients in the hospital

2. Medical staff handling the patient should wear gloves and a gown, to avoid direct contact with the patient.

3. After handling the patient, medical staff should thoroughly wash hands, as well as any other parts of their body that came in contact with the patient, with soap and water

4. Clinical procedures that are likely to cause spraying of bodily fluids should be avoided or only performed by medical staff wearing a face shield, or a mask and eye goggles

5. Bleach can be used for disinfection. A 1:100 dilution of bleach should be used to clean surfaces, medical equipment, and bedding and clothes. A 1:10 dilution of bleach should be used to clean up bodily fluids. Alternatively 5 per cent Lysol may be used.


Individuals

1. Family members and friends who had direct contact with the patient should be monitored for 14 days, for onset of a febrile illness.



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