Crimean-Congo Hemorrhagic fever claims one life

Niël Terblanché

A deadly outbreak of Crimean-Congo Hemorrhagic fever in the Gobabis district claimed its first life at the end of last week.

According to Ben Nangombe, the Executive Director of the Ministry of Health and Social Services, the patient with a suspected infection of Crimean-Congo Hemorrhagic Fever (CCHF) was treated at a private health facility in Gobabis on 16 May. He was referred to Lady Pohamba Private Hospital on 17 May 2023, and in the early hours of 18 May 2023, the patient was referred and admitted to the Windhoek Central Hospital, Isolation Unit. Blood samples for CCHF investigation were taken before the patient passed away the same day.

Nangombe said that on 21 May, the laboratory results confirmed that the patient was positive for Crimean-Congo Hemorrhagic Fever (CCHF) virus.

“From 18 May 2023, a total of 27 contacts were identified of whom 24 are health workers, one co-worker of the deceased, and two household contacts,” Nangombe said

He said that according to the protocols of the Ministry of Health and Social Services and the World Health Organization Standards, one laboratory-confirmed case of CCHF in a jurisdiction is considered an outbreak and requires that public health measures be instituted to prevent further transmission.

According to Nangombe, CCHF is a viral hemorrhagic fever caused by a nairovirus.

“It is transmitted to humans through the bites or crushing of ticks, by contact with the bodily fluids of a patient infected with the CCHF virus during the acute phase of infection, or by contact with blood or tissues from livestock with the CCHF virus in its blood,” he said.

In documented outbreaks of CCHF, fatality rates in hospitalized patients have ranged from 9 percent to as high as 50 percent.

He said that Namibia experienced CCHF outbreaks in the past with six confirmed cases and three deaths.

Nangombe said that for CCHF, the length of the incubation period depends on the mode of acquisition of the virus.

If the infection is caused by a tick bite, the incubation period is usually one to three days, with a maximum of nine days.

If a person was infected by contact with infected blood or tissues, the incubation period is usually five to six days. with a documented maximum of 13 days.

Nangombe said that the onset of CCHF is sudden. with initial signs and symptoms including headaches, high fever, back pain, joint pain, stomach pain, vomiting, red eyes, a flushed face, a red throat, and petechiae (red spots) on the palate are common.

He added that symptoms may also include jaundice, and in severe cases, changes in mood and sensory perception.

“As the illness progresses, large areas of severe bruising, severe nosebleeds and uncontrolled bleeding at injection sites can be seen, beginning on about the fourth day of illness and lasting for about two weeks,” he said.

According to Nangombe, animal herders, livestock workers, and slaughterhouse workers in endemic areas are at risk of CCHF. He added that healthcare workers in endemic areas are at risk of infection through unprotected contact with infectious blood and body fluids. Individuals and international travellers with contact with livestock in endemic regions may also be exposed.

Nangombe said that a laboratory diagnosis of a patient with a clinical history compatible with CCHF can be made during the acute phase of the disease.

“There is no treatment to cure CCHF. The treatment is primarily supportive and care should include careful attention to fluid balance, oxygenation, blood therapy, and appropriate treatment of secondary infections,” he warned.

Nangombe advised that livestock must be sprayed by using pesticides to kill ticks. He added that people must wear protective clothing (long sleeves, gloves, and long trousers) when handling animals or their tissues notably during slaughtering, butchering, and culling procedures in slaughterhouses or at home.

“Examine your clothing and skin regularly for ticks; if found please report to the nearest health facility or remove them safely using the following steps: Use fine-tipped tweezers or tick removal tools to grasp the tick as close to the skin surface as possible. Pull upward with steady, even pressure without shaking or twisting while avoiding squeezing the tick’s body. Do not squeeze the tick’s body and do not apply heat or any substance to the tick, as this may cause it to empty its stomach content into the wound/skin which can cause infection. Use insect repellent on exposed skin and clothing. Wash your hands with soap regularly after visiting or caring for sick people. Avoid areas where tick vectors are plentiful,” he advised.

Nangombe said that since the CCHF case was confirmed several Health Emergency Management Committees were activated in Khomas and Omaheke Regions as well as at the national level.

“All identified contacts in Gobabis and Windhoek health districts are being monitored closely. Social mobilization is being conducted in the affected communities to sensitize the community members and create awareness of the signs and symptoms as well as prevention measures of CCHF,” he said.

Nangombe urged the public not to panic, but to cooperate, support and comply with the control measures put in place in order to contain and prevent further spread of the infection.

“All persons who were in direct contact with the patient are requested to report to their nearest health facilities,” he advised

Nangombe gave the assurance that the Ministry of Health and Social Services will continue to be proactive on any emerging or re-emerging infectious diseases. We continue to monitor the situation and the public will be updated accordingly.

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