Risk communication & community engagement | By Dr Asif Maqsood Butt

Risk communication & community engagement

IN Pakistan, we probably only attribute diseases according to seasons but in fact the diseases are living with us till we are able to recognize them and take remedial steps before they could cause greater loss to the community.

As Islamic 2nd festival is near and to accomplish the obligations of sacrifice, Muslims are rushing towards the cattle markets, thus posing to the risk of attracting Crimean-Congo haemorrhagic fever, cases of which are increasing day by day.

Congo is a viral haemorrhagic fever usually transmitted by ticks. It can also be contracted through contact with viraemic animal tissues (animal tissue where the virus has entered the bloodstream) during and immediately post-slaughter of animals.

CCHF outbreaks constitute a threat to public health services as the virus can lead to epidemics, has a high fatality ratio (10-40%), potentially results in hospital and health facility outbreaks, and is difficult to prevent and treat.

CCHF is endemic in the whole of Africa, the Balkans, the Middle East and Asia. The disease was first diagnosed in Crimea in 1944 and given the name Crimean haemorrhagic fever.

In 1969, it was recognized that the pathogen causing Crimean haemorrhagic fever was the same as that responsible for an illness identified in 1956 in the Congo.

The linkage of the two place names resulted in the current name for the disease and the virus.

The one and the only way to stay safe are protective measures which include the following: wear protective clothing (long sleeves, long trousers); light colored clothing to allow easy detection of ticks on the clothes; use approved acaricides (chemicals intended to kill ticks) on clothing; use approved repellent on the skin and clothing; regularly examines clothing and skin for ticks; if found, remove them safely; seek to eliminate or control tick infestations on animals or in stables and barns; Avoid areas where ticks are abundant and seasons when they are most active.

Wearing gloves and other protective clothing while handling animals or their tissues in endemic areas, notably during slaughter, butchering and culling procedures in slaughterhouses or at home; Quarantine animals before they enter slaughterhouses or routinely treat animals with pesticides two weeks prior to slaughter.

avoid close physical contact with CCHF-infected people; wear gloves and protective equipment when taking care of ill people; Wash hands regularly after caring for or visiting ill people.

In case of contracting with the disease; Onset of symptoms is sudden, with fever, myalgia, (muscle ache), dizziness, neck pain and stiffness, backache, headache, sore eyes and photophobia (sensitivity to light).

There may be nausea, vomiting, diarrhoea, abdominal pain and sore throat early on, followed by sharp mood swings and confusion.

After two to four days, the agitation may be replaced by sleepiness, depression and lassitude and the abdominal pain may localize to the upper right quadrant, with detectable hepatomegaly (liver enlargement).

Other clinical signs include tachycardia (fast heart rate), lymphadenopathy (enlarged lymph nodes) and a petechial rash (a rash caused by bleeding into the skin) on internal mucosal surfaces, such as in the mouth and throat, and on the skin.

The petechiae may give way to larger rashes called ecchymoses, and other haemorrhagic phenomena.

There is usually evidence of hepatitis, and severely ill patients may experience rapid kidney deterioration, sudden liver failure or pulmonary failure after the fifth day of illness.

The mortality rate from CCHF is approximately 30%, with death occurring in the second week of illness.

In patients who recover, improvement generally begins on the ninth or tenth day after the onset of illness.

Health-care workers caring for patients with suspected or confirmed CCHF, or handling specimens from them, should implement standard infection control precautions.

These include basic hand hygiene, use of personal protective equipment, safe injection practices and safe burial practices.

As a precautionary measure, health-care workers caring for patients immediately outside the CCHF outbreak area should also implement standard infection control precautions.

—The writer is contributing columnist, based in Rawalpindi.

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