Private hospital staff put under observation after death of CCHF patient

Islamabad
As many as 15 staff members, including doctors, nurses and paramedics, at a private medical facility, Maroof International Hospital, have been under observation after handling a patient who died of Crimean-Congo Hemorrhagic Fever (CCHF) here on Saturday night.
A 30-year-old male patient, Hafeezullah, was brought to a healthcare facility in Peshawar from Afghanistan last week where he was initially treated for liver failure but his condition continued to deteriorate and he was referred to the Maroof International Hospital for ICU support on May 7.
At the Intensive Care Unit of MIH, the patient was put on a ventilator. His complete blood profile showed massive bleeding inside the body and after suspecting him to be a patient of CCHF, the hospital kept him in isolation and notified the Epidemic Investigation Cell of the National Institute of Health (NIH). The patient was given antiviral treatment and immunoglobulin, but his condition became critical and he continued to bleed inside his lungs and was like drowning in his own blood, said Dr. Muhammad Haroon, an intensive care specialist serving at the MIH and Pakistan Institute of Medical Sciences as a medical specialist.
Talking to ‘The News’ on Wednesday, he said, within two days after his admission to the hospital, the patient suffered complete lung, liver and kidney shutdown and after cardiac arrest he expired at the MIH late Saturday night.
Hafeezullah was strongly suspected for CCHF but he was confirmed positive for the infection three days after his death. Dr. Mumtaz from the EIC, NIH, visited the patient and collected sample for testing CCHF on Friday, however, the patient died on Saturday, said Dr. Haroon.
The CCHF is caused by Nairovirus of the Bunyaviridae family transmitted to humans by the bite of Hyalomma tick that is mostly found on the skin of animals including goat and sheep. The CCHF is also caused by direct contact with the blood of an infected animal or human.

Exposure to blood or tissue of the infected animal during or post slaughtering and direct contact with blood or secretions of infected person may also cause transmission. The case fatality rate of the deadly infection ranges from 2% to 50%. The CCHF was first described in Crimea in 1944 and identified in 1956 in Congo.
Medically, a confirmed patient of CCHF is an important source of exposure for other people, particularly family members and healthcare workers. To avoid spread of the infection, the transport vehicles that carry the patient or his dead body should be disinfected by spraying 1:10 liquid bleach solution on any surfaces touching the body and all clothing of the deceased should be burnt.
According to experts, the dead body of a confirmed patient should be wrapped in the winding sheet (kafan) for burial. The dead body should be sprayed with 1:10 liquid bleach solution and then placed in a plastic bag which should be sealed with adhesive tape. In case of death of a CCHF victim, safe burial practices must be followed.
The epidemiologist and assistant district health officer of Islamabad Capital Territory, Dr. Najeeb Durrani, when contacted by ‘The News’ on Wednesday, said his department was not notified of the status of CCHF patient till Wednesday morning.
He, however, said all staff members who handled the CCHF patient at the MIH are under observation and the EIC at the NIH is closely monitoring the situation. “The animal handling history of Hafeezullah was positive and I have been informed by Dr. Mumtaz that the EIC had already briefed the relatives of the patient about precautionary measures to avoid the infection,” said Dr. Durrani.
Dr. Haroon informed ‘The News’ that one of the nurses who handled the CCHF patient at the MIH is being kept in isolation after having complaints of fever though she did not develop any other symptom of the deadly CCHF. He said that her sample has been sent for confirmatory test at the NIH.