CCHF 2013

April 13, 2023 Dr. Sunil Panjwani, 9825331039 1

Crimean-Congo hemorrhagic fever

Dr. Sunil Panjwani, M.D.(Medicine)Associate Professor(Medicine)Medical College, Bhavnagar.


Historical BackgroundCCHF like symptoms were described initially by physicians in 12th century from the region currently known as Tazhikistan.

In 1944-1945 when 200 Soviet military personnel were infected during war in Crimea.

In 1967 peoples from Congo and Uganda were infected by similar disease thus the name Crimean Congo hemorrhagic fever.

In 1967, Chumakov in Moscow first used newborn white mice for the isolation of CCHF virus. This resulted in a Drosdov strain which became the prototype strain for experimental work.


Problem statement

52 countries

More than 6,000 cases

Nearly 140

outbreaks


Geographical distribution

• Geographically this tick borne viral infection has been reported from different countries in Southeast EuropeAsiaMiddle East Africa


Dr. Sunil Panjwani, 9825331039April 13, 2023 6

Southeast Europe: outbreaks recorded in Crimea (1944-45), Astrakhan (1953-63), Rostov (1963-1969), Bulgaria (1953-74, 1975-96, 1997-2003), Albania (2001), Kosovo (2001), and Turkey (2002-2005 & 2007-2008) .

Asia: outbreaks recorded in China (1965-94, 1994-1995), Kazakhstan (1948-1968), Tajikistan (1943-1970), Pakistan (1976, 1994, 2010) and India Ahmedabad (2011) .

Middle East: outbreaks recorded in United Arab Emirates (1979, 1994-1995), Sharjah (1980), Iraq (1979-1980), Saudi Arabia (1990), Oman (1995-1996), and Iran (2003) .

Africa: outbreaks recorded in Zaire (1956), Uganda (1958-1977), Mauritania (1983, 2004), Burkina Faso (1983), South Africa (1981-1986), Tanzania (1986), Southwest Africa (1986), Kenya (2000), and Sudan (2008).

Dr. Sunil Panjwani, 9825331039April 13, 2023 7

Amina (30), Patient- Died 3 Jan 2011 - Laboratory confirmed, epidemiologically linked

Male nurse – Died January 21, Laboratory confirmed, treated Amina

Hussain Rehman - Alive, recovered, Lab confirmed,

Amina's husband

Asha John (25), Nurse - Died January 18 - Laboratory confirmed, treated Amina

Gagan Sharma (30), doctor - Died January 13 - Laboratory confirmed, treated Amina

Shabbir Ali Umatiya (25),Intern - Died January 31- Laboratory confirmed

Gujarat Epidemic (14 cases and 5 deaths)


• Crimean-Congo haemorrhagic fever (CCHF) is a viral haemorrhagic fever caused by Nairovirus.

• Primarily an animal disease, sporadic cases and outbreaks of CCHF affecting humans do occur.

• CCHF outbreaks constitute a threat to public health because of its Epidemic potential.High case fatality.Potential for nosocomial outbreaks.Difficulties in treatment and prevention.


• Serious endemic CCHF outbreaks in Europe, Asia and Africa .

• The presence of human antibodies to CCHF virus were shown in WoodcuttersFarmersHealth and animal care workers Slaughterhouse workersPeople that had tick bites in endemic areas


• Nosocomial outbreaks have been reported in recent years in Pakistan, Iraq, Dubai, India and South Africa

Year of outbreak Location No. of Cases

2008 Bulgaria 1(1)2008 Sudan 100(3)2008 Turkey 688(1)2009 Iran 2(4)2009 Kazakhstan 19(3)2009 Tajikistan 19(3)2010 pakistan 90(10)2011 India 14(5)

Dr. Sunil Panjwani, 9825331039

India

• CCHF viral infection had not been reported in humans from India before 2011, though previous seroprevalence studies have shown viral antibodies both in animals and humans.

April 13, 2023 11

Shanmugam et al. in 1973 evidence of CCHF virus antibodies ( Sample from all over India)

643 Human Sample -9 +ve from Kerala and Pondicherry

655 serum samples from sheep, horse, goat, and domestic animals - 34 +ve


• This virus has veterinary importance in India and has been demonstrated in ticks, men, and sheep.

• The recent outbreak in 2011 of CCHF viral infection in Gujarat is the first notable report from India.

• The striking feature of this outbreak was high fatality and rapid spread among treating medical team.


The Etiological Agent

• The CCHF virus is a member of the Nairovirus genus under family Bunyaviridae.

• Genus Nairovirus hasSeven serogroups 34 tick-borne species.

• Among these, only three members are known to cause disease in humans and they are

CCHFVNairobi sheep disease virus, Dugbe virus.

Dr. Sunil Panjwani, 9825331039

Virion Structure

• Spherical• 80-120 nm diameter• Enveloped• Glycoprotein spikes 8-10 nm in length.• Helical nucleocapsid• No matrix protein• Possess small morphologic surface units with

no order in central holes arrangement.

April 13, 2023 14


Structural ProteinsMembrane glycoproteins (G1 and G2)

Nucleocapsid proteins (N)

Polymerase (L)

With the availability of nucleotide and amino acid sequence information, extensive genetic diversity has been shown in these viruses.


DISSEMINATION• RESERVOIR: Mammals, including hares, hedgehogs,

rodents, and birds have been implicated as reservoirs of CCHFV; however, it is believed that they are more likely to be amplifying hosts rather than true reservoirs .Ticks of the Hyalomma spp. also act as a reservoir .

• ZOONOSIS: CCHFV can be transmitted to humans via exposure to infected tissues/secretions during the slaughtering of infected animals, and via exposure to small-particle aerosols from infected rodent excreta . Zoonosis is also possible indirectly via infected tick bites .

• VECTORS: The Hyalomma species of tick (in gujarati it’s known as “itaddi”) are the most important vector for CCHFV. Other tick species vectors of CCHFV include Rhipicephalus, Ornithodoros, Boophilus, Dermatocentor, and Ixodes species


• These vectors have both trans-ovarial and trans-stadial transmission of virus.

• Immature ticks (nymphs) generally inhabit smaller animals, while mature ticks transmit the infection to large vertebrates such as livestock.



Figure 1Modes of transmission of CCHF virus, (a) Tick cycle, 1- adult, 2- eggs, 3- larvae, 4- nymph; (i) Trans-ovarian, (ii) Trans-stadial; (b) Tick- Small vertebrate cycle; (c) Tick- Large vertebrate/bird/human cycle; (d) Human- Human cycle (community/ nosocomial)


At-risk population

• Animal handlers, livestock workers, and slaughter houses in endemic areas are at risk of CCHF.

• Healthcare workers in endemic areas are at risk of infection through unprotected contact with infectious blood and body fluids.

• Individuals and international travelers with contact to livestock in endemic regions may also be exposed.

• Age – all ages.• Sex – 3 times more in males than females.• Immunity – Life time immunity for that genome.


Environmental factors• Highest incidence of the disease has been reported

between March to May and again between August to October .

• This incidence increase was mainly attributed in climatic conditions changes that facilitated tick reproduction.

• Global warming may change the epidemiological behaviour of CCHF and in particular it may create a great problem in prevalent areas by altering the ticks’ growth patterns, as well as in areas free of CCHF, by redirecting the migration routes of birds -which host the affected ticks- to areas newly warmed by earth’s altered temperature patterns.


Mode of transmission• Bite of an infective adult tick, particularly

Hyalomma marginatum or Hyalomma anatolicum.

• Skin lesions when crushing an infected tick. • Nosocomial outbreaks due to exposure to

infected blood and secretions. • Slaughtering of infected animals via small-

particle aerosol from infected rodent excreta.• From contaminated needle sticks or infected

fomites.




Incubation period

• This depends on the route of exposure to virulence and viral dose.

• The incubation period after tick bite is usually 1 to 3 days, with a maximum of 9 days.

• The incubation period following contact with infected blood or tissues is usually 5 to 6 days, with a documented maximum of 13 days.


Case definitions

• Suspected CasePatient with sudden onset of illness with

high-grade fever over 38.5°C for more than 72 hrs and less than 10 days, especially in CCHF endemic area and among those in contact with sheep or other livestock (shepherds, butchers, and animal handlers).

Fever is usually associated with headache and muscle pains and does not respond to antibiotic or antimalarial treatment.


• Probable case– Suspected case with acute history of febrile illness

10 days or less, AND Thrombocytopenia < 50,000/cmm AND any two of the following haemorrhagic manifestations :Petechiae, Purpuric rash, Epistaxis, Haematemesis, Haemoptysis, Blood in stools, Ecchymosis, Gum bleeding, or any other haemorrhagic symptom in absence of any known precipitating factor for haemorrhagic manifestations.


• Confirmed case– Probable case with positive diagnosis of

CCHF in blood sample, performed in specially equipped high bio-safety level laboratories, shows,

– Confirmation of presence of IgG or IgM antibodies in serum by ELISA

– Detection of viral nucleic acid in specimen by PCR

– Isolation of virus


Definition of “contact”

Contacts include: family, neighborhood and health care facility contact

Monitoring contacts

All contacts should be self monitored for twice daily for any clinical symptoms

(such as fever, muscular pain or bleeding) 14 days (maximum) from the day of last contact with the patient or other source of infection.

In case of onset of any symptom, he/ she should immediately report to the nearest health facility.

Testing bloodfor CCHF

Appropriate laboratory test is recommended in persons meeting the case definition.

Definition, monitoring of contacts and Laboratory testing for contacts of CCHF

cases.


Patients are divided into 3 categories:

Category-A

Those that have relatively mild disease Fever < 38.50C, No systemic bleeding, Alanine Transaminase (SGPT) levels < 150 IU, Platelet count > 50,000).

These patients improve spontaneously in about day 10 of illness. Patient can be managed with supporting therapy and regular monitoring for worsening of symptoms.

These patients do not require Ribavirin.


Patients are divided into 3 categories:• Category-BThose who are in the first 5 days of illness and are severely ill with High

grade fever (> 38.50C), Local and systemic bleeding manifestations Alanine Transaminase (SGPT) levels of 150 IU or more, Aspartate aminotransferase (SGOT) of 200 IU or more, Platelets (< 50,000) or D

Activated Partial Thromboplastin Time (APTT) of >60 seconds Even if the patients still look comparatively well at this stage these

clinical path values are markers of poor prognosis if recorded during the first 5 days of illness and persons in this group should be treated as soon as possible with ribavirin.

Those who are recognized and treated early enough respond remarkably well to ribavirin(11).

http://www.healthizen.com/health-articles/treatment-procedures/aptt-activated-partial-thromboplastin-time.aspx






Patients are divided into 3 categories:• Category-C• Patients first seen/recognized as CCHF after day 5

and are in comatose/terminal state with DIC and multi organ failure.

• Treatment with ribavirin is indicated but the prognosis is very poor.

• Category B & C patients, even if they subsequently test negative, should receive the full course of ribavirin.


Clinical Features• Course of this disease follows four distinct

phases in humans–Incubation phase–Pre-hemorrhagic phase–Hemorrhagic phase –Convalescence phase


Incubation phase

• The length of the incubation period for the illness appears to depend on the mode of acquisition of the virus. Following infection via tick bite, the incubation period is usually 1 to 3 days, following contact with infected blood or tissues is usually 5 to 6 days.


Pre-hemorrhagic phase

Pre-hemorrhagic phase is characterized by a Sudden onset of fever as high as 39-41°C, chills Severe headache, myalgia, rashArthralgia, dizziness, photophobia.Back and abdominal pain.

Additional symptoms such as Nausea, vomiting, diarrhea Loss of appetite.Neuropsychiatric manifestations like violent behavior,

psychosis, change in mood and confusion etc.Hypotension , tachycardia


Hemorrhagic phase

• In severe cases after 3-6 days of the onset of symptoms hemorrhagic manifestations occur. The spectrum of hemorrhages varies from petechiae & ecchymoses over skin and mucus membranes to serious intracraneal bleed.

• Red eyes, flushing of face, • Throat congestion and petechiae over palate. • Epistaxis or dark coffee-colored vomitus due to hematemesis

or tar-colored stools i.e. malena or hematuria.• Bleeding from other sites like vagina, gum bleeds and

intracerebral bleeds.• Jaundice, hypovolumic shock, disseminated intravascular

coagulation (DIC), • Prerenal failure and Lung failure.• Multiorgan dysfunction syndrome (MODS)


Convalescence phase

Patients who survive this phase, the convalescence period begins about 15–20 days after onset of illness. It is generally characterized by

• Prolonged and pronounced generalized weakness• Sometimes complete loss of hair. • Sequelae include polyneuritis, headache, dizziness,

poor appetite, poor vision, loss of hearing, and loss of memory.

• These are rarely permanent, but may persist for a year or more.


Symptoms -First 5 days

Symptoms %• Malaise and fatigue 94-100• Myalgia and arthralgia 62-100• Fever 75-100• Nausea and vomiting 73-90• Headache 76-85• Diarrhea 30-38• Cough 29-30• Abdominal pain 28• Confusion 8-14


Symptoms -After 5 days

Symptoms %• Epistaxis 17-52 • Hematemesis 7-34• Melena 1-14• Hemoptysis 9• Hematuria 8-19

Bleeding from Other sites %• Vagina 11• Subcutanous 30• Gingiva 8• Ear 1• Intaabdominal 2• Intracranial 1• Multiple sites 3-25


Signs of CCHF Signs• Fever• Bleeding• Hepatomegaly• Lymhadenopathy• Maculopapular rash• Pethechia and ecchymosis• Lung involvement• Splenomegaly• Peritoneal irritation• Conjunctivitis• Cardiac involvement• Neck stiffness• Jaundice

%

43-85

29-48

30-43

13-40

29-57

30-46

4-28

14-23

12-21

11-50

1-11

11

1-12








Diagnosis• There are no rapid diagnostic tests.• ELISA-for IgG and IgM from 6th day of illness.

IgM - upto four monthsIgG - upto five years.

• The virus may be isolated from blood or tissue specimens in the first five days of illness, and grown in cell culture.

• PCR and RT PCR-for detecting the viral genome


Laboratory diagnostic of CCHF

April 13, 2023 49

Laboratory Findings Increased %• Lactate dehydrogenase(LDH) 98--100 • Aspartate aminotransferase(AST) 91--100• Alanine aminotransferase(ALT) 73--100• Creatine phosphokinase(CPK) 24--90• Blood urea nitrogen(BUN) 21• Creatinine levels 91• Thrombocytopenia 99• Leukopenia 98-100• Anemia 75-90• Proteinuria 11-53• Hematuria 42 Prolonged %• Prothrombin time (PT) 21• Active prothrombin time ( aPTT) 24-66Dr. Sunil Panjwani, 982533aPTT1039


Pathogenesis• Capillary fragility suggesting infection of the

endothelium. • Haemostatic failure by stimulating platelet

aggregation and degranulation, with consequent activation of the intrinsic coagulation cascade.

• Reactive hemophagocytosis.• Proinflammatory cytokines like IL-1, IL-6, and

TNF-alpha also contribute in pathogenesis and mortality


Differential Diagnosis• There are a number of tropical infections which presents

similar clinical features and hence they should be suspected and ruled out while making a diagnosis of CCHF. The differentials include – Dengue Hemorrhagic Fever– Falciparum malaria– Leptospirosis– Typhoid Fever– Septicemic Plague– Rickettsial Infections– Meningococcemia– Viral Hepatitis – Other viral hemorrhagic fevers.


Treatment• The mainstay of treatment in CCHF is

supportive in nature Maintenance of fluid and electrolyte balance.Maintenance of circulatory volume, and blood

pressure.Platelet transfusion, PCV transfusion. Management of DIC, sepsis, shock and MODS

• Possible benefits with gammaglobulin obtained from immunization of horses.


• Antivirus drug Ribavirin, the dosage recommended by the WHO within 24 hours of hospital admission for better results are2 gm loading dose 4 gm/day in 4 divided doses for 4 days. 2 gm/day in 4 divided doses for 6 days.


Dosage in Adults

IV Oral

D1 17 mg/kg(max 1000 mg per dose) 2000 mg

Loading dose

d1-4 17 mg/kg(max 1000 mg per dose) q 6h 1000 mg q 6h

d5-10 8 mg/kg(max 500 mg per dose) q 8h 500 mg q 6h


Dosage in Children

IV Oral

D1 Loading dose 17 mg/kg 30 mg/kg

d1-4 17 mg/kg q 6h 15 mg/kg q 6h

d5-10 8 mg/kg q 8h 7 mg/kg q 6h


• Currently in Indian markets Ribavirin available in oral form with tablet strength of 200 mgs, if it is considered for use the approximate cost of 10 day therapy with this drug would currently be around Rs 6000/- for each patient with an average weight of 50 Kg.

• Ribavirin is contraindicated in pregnancy and in children.


Treatment Protocol

• If the patient meets the case definition for probable & confirm CCHF, ribavirin treatment protocol needs to be initiated immediately.

• Pregnancy should be absolutely prevented (whether female or male partner) within six months of completing a course of ribavirin.

Treatment Protocol for CCHF diseaseHigh-dose oral Ribavirin therapy : 2 gm loading dose 4 gm/day in 4 divided doses (6 hourly) for 4 days. 2 gm/day in 4 divided doses for 6 days.


New treatment strategies

• Interferons and interferon-stimulated antiviral proteins:– MxA (interferon-induced GTPases)

• Antibodies to CCHF:– Gammaglobulin obtained from immunisation

of horses – Development of monoclonal antibodies would

allow better control Appropriate treatment of secondary infections should be instituted.


Postexposure Prophylaxis Mucous membrane contact (kissing or sexual contact

with a patient)

Percutaneous injury in contact with the patients’ secretions, excretions, or blood.

Exposed to hemorrhagic fever viruses (including CCHFV) in a bioterroristic attack

Living or in cotact with the patients

Who process laboratory specimens.


Prophylaxis ProtocolIndirect contact with case body fluids should be monitored for 14 days from the date of last contact with the patient or other

source of infection by taking the temperature twice daily.

OR

If the patient develops a temperature of 38.5° C or greater, headache and muscle pains, he/she would be considered a

probable case and should be admitted to hospital and started on ribavirin treatment.

Treatment Protocol for CCHF diseaseHigh-dose oral Ribavirin therapy : 2 gm loading dose 4 gm/day in 4 divided doses (6 hourly) for 4 days. 2 gm/day in 4 divided doses for 6 days.


Prognosis

Overall case-fatality rate

Case-fatality rate with Hemorrhagic manifestations,

confusion, and laboratory evidence of marked

elevation of AST, ALT, GGT, CPK, LDH, frank DIC, thrombocytopenia.

5% to 40%

15% to 70%


Prevention of transmissionReducing the risk of infection in people• Awareness and educating to reduce the exposure to

the virus.• How to safely remove ticksPublic health educational messages should focus on

the following:• Reduce the risk of animal-to-human transmission

– Eliminating or at least controlling tick infestations on animals or in stables/barns.

– Quarantine for animals before they enter slaughterhouses or routine treatment of ruminants with pesticides 2 weeks prior to slaughter.

– Using masks, gloves and gowns when slaughtering and butchering animals.


• Reduce the risk of tick-to-human transmission– Avoid tick bites– Remove ticks safely from the skin.

• Close physical contact with CCHF patients should be avoided. Use PPE during care of ill patients at home.

• Regular hand-washing after visiting sick relatives in hospital, as well as while taking care of ill patients at home should be carried out.


Prevention and Control in Public

Educate public about the mode of transmission.Tick control with acaricide(DDT,BHC,Malathion)Avoid tick-infested areas from spring to fall to

minimize exposureWear light clothing that covers legs and arms, tuck

pants into socks, regularly examine clothing and skin for ticks

Apply tick repellent such as diethyltoluamide (Deet, Autan) to the skin or permethrin (a repellent and contact acaricide) to pant legs and sleeves.


Consumption of unpasteurized milk and uncooked meat should be avoided.

Butchers should wear gloves and other protective clothing to prevent skin contact with infected tissues or blood.

In case of death of CCHF patient, family should be informed to follow safe burial practices.


Safe Burial practices

• Thick and long rubber gloves or double pair of surgical gloves should be used for washing the body 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.

• It should then be wrapped in the winding sheet (kafan) for burial / burn .

• Disinfect the transport vehicle by spraying 1:10 liquid bleach solution on any surfaces touching the body and burn all clothing of the deceased.


Prevention and Control: Hospitals and Health Facilities

• Healthcare workers who have had contact with tissue or blood from patients should be followed up with daily temperature and symptom monitoring for at least 14 days .

• Doctors and healthcare workers in endemic areas where the virus has emerged should be sensitized to the occurrence and educated to diagnose, report, and treat the cases.

• Community education initiatives should be instituted in the event of an observed outbreak.


• Hospitals should maintain stock of Ribavirin.• CCHFV can be inactivated by

1% hypochlorite ,2% glutaraldehyde, 70% alcohol Heating at 56°C for 30 min, 60°C for 15 minutes. UV light (1,200 to 3,000 μW/cm2), Low pH (less than 6).


SURVIVAL OUTSIDE HOST

• The virus is stable under wet conditions for 7 hours at 37 °C 11 days at 20 °C 15 days at 4°C.

• Under dry conditions, the virus is stable for 90 minutes to 24 hours.


Bio-safety measures

1) The patient should be treated in a separate room under

strict barrier nursing.

2) Only designated medical / para-medical staff and

attendants should attend the patient. Non-essential staff

and attendants should not be allowed to enter the room.

3) All secretions of the patient and hospital clothing in use of

the patient should be treated as infectious and should be

autoclaved before incinerating.

4) All medical and para-medical staff and attendants should

wear disposable gloves, disposable masks and gowns

(gowns should be autoclaved before sending to the

laundry or incineration). Use of disposable items should

be ensured by supervisor.


Bio-safety measures contd…

5) Every effort should be made to avoid spills, pricks,

injury and accidents during the management of

patients. Needles should not be re-capped but

discarded in proper safety disposal box.

6) All used material e.g. syringes, gloves, canulla, tubing

etc, should be collected in autoclave-able bag and

autoclaved before incinerating.

7) All instruments should be de-contaminated and

autoclaved before re-use.

8) All surfaces should be decontaminated with liquid

bleach.


9) The samples for laboratory testing should be properly collected, labelled, sealed, and decontaminated from outside with liquid bleach and packed in triple container packing.

10) The designated laboratory should be informed about the sample and it should be transported to the designated laboratory with great caution, ensuring there would be no breakage or spills.

11) After the patient is discharged, room surfaces should be wiped down with liquid bleach to kill the virus and the room should be fumigated.

Bio-safety measures contd…


Outbreak response • Reduce the disease burden through

– Integrate standard operating procedures for outbreak response that include vector (ticks), animal and human health components.

– Design and perform "Train-the-Trainer" courses for CCHF outbreak response with regional teams.

– Develop standard case management training for CCHF.– Develop a manual for healthcare providers that would include

clinical descriptions, treatment options and recommended laboratory tests.

– Improve emergency preparedness and response.– Implement/Strengthen national tick-control programmes.– Health education


Check list for Hospitals treating suspected case of CCHF

No. Particulars Action 1 Suspected for CCHF? Yes/ No 2 Patient Isolated? Yes/ No

Exposure to cattle or same symptomatic patient in last week? History of visit abroad or across state within last week?

3 Are the patients relatives screened for similar symptoms? Yes/ No 4 Are the patient's attendant counselled temp monitoring regularly? Yes/ No 5 Is the local health authority informed? Yes/ No 6 Use PPE by treating staff Yes/ No 7 Blood Sample taken? Yes/ No 8 Blood Sample sent to NIV using triple layer container and

in reverse cold Chain?? Yes/ No 9 Is the duly filled CRF in standard format along with sample? Yes/ No 10 Whether following Blood Investigation conducted?

SGPT, Yes/ No SGOT, Yes/ No Platelet count Yes/ No APTT Yes/ No


11 Whether the daily laboratory findings are being plotted? Yes/ No 12 Categorize the patient according to annexure I Yes/ No 13 If category A, supportive treatment given? Yes/ No 14 If category B, Ribavirin given? Yes/ No 15 Is patient recovering or clinically worsening? Yes/ No 16 Critical care given? Yes/ No 17 If category C, Ribavirin given? Yes/ No 18 Critical care given? Yes/ No 19 Does patient show signs of DIC? Yes/ No 20 Multi organ failure? Yes/ No 21 Is patient Intubated? Yes/ No 22 Is bio medical waste disposal guidelines adhered strictly? Yes/ No 23 Patient's outcome

Recovered - Follow up & Precautions for future advised? Yes/ No

Check list for Hospitals treating suspected case of CCHF( Cont… )


No. Particulars Action 1 Suspected for CCHF? Yes/ No 2 Referred to tertiary care hospital? Yes/ No 3 State and District authorities are informed? Yes/ No 4 Other concerned departments are informed? Yes/ No 5 Surveillance started? Yes/ No 6 Is the surveillance team is duly protected by PPE? Yes/ No 7 Close Contact identified? Yes/ No 8 Contact list prepared? Yes/ No 9 Contact Blood samples are taken? Yes/ No 10 Daily Temperature Monitoring of close contact ensured? Yes/ No 11 Tick Control measures initiated? Yes/ No 12 Tick samples taken and sent? Yes/ No 13 Animal sera samples taken? Yes/ No 14 Health Education given? Yes/ No 15 Risk Analysis done? Yes/ No 16 Private consultation for same symptomatic patients? Yes/ No 17 Inter Departmental Co-ordination ensured? Yes/ No

Check list for Field Health staff in suspected case of CCHF


Thank you!!!

Health & Medicine

CCHF 2013