Pakistan: Crimean Congo haemorrhagic fever and brucellosis in human and livestock populations

Crimean Congo haemorrhagic fever

Crimean Congo haemorrhagic fever (CCHF) is a viral zoonotic disease with a ruminants reservoir. Infections in cattle, sheep and goats are not accompanied by clinical signs, and the majority of human infections are also subclinical. However, on rare occasions, the disease manifests in humans as a severe haemorrhagic fever with a case fatality rate of up to 50%.

The first human case was reported in Pakistan in 1976, and the disease is now endemic in Pakistan with sporadic outbreaks occurring throughout Pakistan.

View preliminary results.

Brucellosis

Brucellosis is a globally important zoonotic disease. Although very few human cases of brucellosis are reported in Pakistan, serosurveys of community members report sero-positivity prevalences of between 10–20%. Reported seroprevalences for cattle, buffalo, sheep and equids range between 1% to 33% positive.

The problem being addressed

Although both of these diseases are endemic in Pakistan, a lack of reliable information about the occurrence and distribution of these zoonoses is preventing the development of surveillance, prevention and control programs.

Study design

This project will involve two districts within each of two provinces in Pakistan — Baluchistan and Khyber Pakhtunkhwa.

It comprises two studies:

  1. Cross-sectional seroprevalence survey of CCHF and brucellosis

  • It is aimed to collect blood samples from 1,500 humans, 3,000 small ruminants and 640 cattle from 480 households.
  • All sera will be tested with the brucellosis Rose Bengal Plate Agglutination test (RBT). RBT-positive samples will be further tested using a competitive ELISA. 
  • An IgG based ELISA will be used for CCHF testing.
  • Questionnaires will be used to collect human demographic data and CCHF and brucellosis exposure data.
  • Data will also be collected regarding  the peoples' knowledge, attitudes and practices (KAP) related to these diseases.
  1. Spatio-temporal analysis of primary CCHF cases

  • The residential location and date of onset of clinical symptoms for primary CCHF cases will be identified from healthcare reports.
  • Analysis of spatio-temporal patterns will enable an evaluation to be made of the trends of CCHF in geographical space and over time.

Intended Outcomes

Reliable information on the prevalence of serological evidence of CCHF and brucellosis in animals and humans in selected villages and households which will be useful for:

  • Understanding the level of exposure of people to both CCHF and brucellosis in these districts.
  • Understanding the disease burden imposed by exposure to these diseases.
  • Designing appropriate interventions for control programs.
  • Providing baseline information, which will be useful for evaluating the efficacy of control programs.
  • Providing public health information regarding the most effective measures for reducing the risks of exposure to these diseases.
  • Identifying the emerging nature of CCHF and facilitating the identification of possible risk factors for the spread.

In addition, a serum bank will be established that may be useful for providing insight into other diseases in people and livestock in these districts.

 

 

Key organisations and people

Ministry of Health

  • The National Institute of Health
  • The Cabinet Secretariat
  • The Cabinet Division
  • The Public Health Laboratories
  • The Epidemic Investigation Cell

Ministry of Food, Agriculture and Livestock

  • The Pakistan Research Council
  • The National Agricultural Research Centre
  • The Animal Sciences Institute 

Livestock and Dairy Department

  • The Directorate General (Extension) Livestock and Dairy Development Services
  • The Directorate General (Research) Livestock and Dairy Development Services
  • The Veterinary Research Institute

 

Principal Investigators

       
Dr Khalid Naeem             Chief Scientist      Animal Sciences Institute, National Agricultural Research Centre
Dr Muhammad Safdar    Principal Scientific Officer   National Institute of Health, Islamabad
         

Provincial coordinators

       

Khyber Pukhtunkhwa

       
Dr Fazal Manan Salarzai   Deputy Medical Superintendent   Ayub Medical Complex, KPK
Dr Muhammad Tariq Shah   Veterinary Officer   Livestock and Dairy Development Department, KPK
         

Balochistan

       
Dr Mohammad Younas   Veterinary Officer   Livestock and Dairy Development Department, BAL
Dr Essa Khan Jogezai   Director   Health Services, Department of Health, BAL
         

Co-Investigators

       
Dr Aman Ullah   Scientific Officer   National Agricultural Research Centre (NARC)
Dr Jaleel Kamran   Head   Epidemic Investigation Cell, National Institute of Health
Dr Najamullah Baig   Scientific Officer   National Institute of Health, Islamabad
Dr Zahida Fatima   Senior Scientific Officer   National Agricultural Research Centre (NARC)
         

Members

       
Dr Sher Muhammad   Director General   Livestock and Dairy Development Department, KPK
Dr Nisar Ahmed   Director General   Livestock and Dairy Development Department, BAL
Dr Zaibullah Khan                     Veterinary Officer                         Livestock and Dairy Development Department, KPK
Dr Imtiaz Ali Shah   Research Officer     Veterinary Research Institute, KPK
Dr Mirza Ali Khan   Principal Research Officer   Veterinary Research Institute, KPK
Dr M Naeem Riaz   Senior Scientific Officer  
National Agricultural Research Centre (NARC)
Dr Asad Ali Shah   District Livestock Officer   Livestock and Dairy Development Department, KPK
Dr Uzma Amir   Senior Virologist   National Institute of Health, Islamabad
Dr Rana Asghar   Resident Advisor   National Institute of Health, Islamabad
Dr Amir Baig   Visiting Faculty   National Institute of Health, Islamabad
Dr Inaam Haq   Senior Health Specialist   The World Bank, Islamabad
Dr Sharif Khan   Director General   Health Services, KPK, Peshawar
Dr Fahad Lodhi   Assistant Professor   International Medical College, Abbottabad
Dr Maqsood Nousherwani   Director General   Health Services, Quetta, Balochistan
Dr Mehmood Paracha   Epidemiologist   Department of Health, Quetta, Balochistan
Dr Muhammad Salman   Consultant Microbiologist   National Institute of Health, Islamabad
Mr Syed Zaidi   Head of Department   Provincial Health Directorate
         

Project Mentors

       
Dr Ron Jackson    Consultant Epidemiologist   EpiCentre, Massey University
Dr Toby Leslie   Research Fellow   London School of Hygiene and Tropical Medicine
         

Project Activity Coordinator

       
Dr Joanna McKenzie   Consultant Epidemiologist   EpiCentre, Massey University