Nosocomial infection of CCHF among health care workers in Rajasthan, India

Abstract

BackgroundEver since Crimean-Congo hemorrhagic fever [CCHF] discovered in India, several outbreaks of this disease have been recorded in Gujarat State, India. During the year 2011 to 2015 several districts of Gujarat and Rajasthan state (Sirohi) found to be affected with CCHF including the positivity among ticks and livestock. During these years many infected individuals succumbed to this disease; which subsequently led to nosocomial infections. Herein, we report CCHF cases recorded from Rajasthan state during January 2015. This has affected four individuals apparently associated with one suspected CCHF case admitted in a private hospital in Jodhpur, Rajasthan.Case presentationA 30-year-old male was hospitalized in a private hospital in Jodhpur, Rajasthan State, who subsequently had developed thrombocytopenia and showed hemorrhagic manifestations and died in the hospital. Later on, four nursing staff from the same hospital also developed the similar symptoms (Index case and Case A, B, C). Index case succumbed to the disease in the hospital at Jodhpur followed by the death of the case A that was shifted to AIIMS hospital, Delhi due to clinical deterioration. Blood samples of the index case and Case A, B, C were referred to the National institute of Virology, Pune, India for CCHF diagnosis from the different hospitals in Rajasthan, Delhi and Gujarat. However, a sample of deceased suspected CCHF case was not referred. Subsequently, blood samples of 5 nursing staff and 37 contacts (Case D was one of them) from Pokhran area, Jaisalmer district were referred to NIV, Pune.ConclusionsIt clearly indicated that nursing staff acquired a nosocomial infection while attending the suspected CCHF case in an Intensive Care Unit of a private hospital in Jodhpur. However, one case was confirmed from the Pokhran area where the suspected CCHF case was residing. This case might have got the infection from suspected CCHF case or through other routes. CCHF strain associated with these nosocomial infections shares the highest identity with Afghanistan strain and its recent introduction from Afghanistan cannot be ruled out. However, lack of active surveillance, unawareness among health care workers leads to such nosocomial infections.

Seroprevalence of Crimean-Congo hemorrhagic fever in humans in the World Health Organization European region: A systematic review

“…The infection can also be acquired through direct contact with blood and other bodily fluids from infected animals and humans, mainly those with a high viral load, including hospitalized patients with hemorrhagic fever. Thus, there is a high risk of transmission in healthcare environments [8,[12][13][14]. Currently, the CCHF virus (CCHFV) is considered a level 4 biosecurity risk pathogen by the Centers for Disease Control and Prevention (CDC) [15,16].…”

Dual RNA-Seq characterization of host and pathogen gene expression in liver cells infected with Crimean-Congo Hemorrhagic Fever Virus

“…Transmission to humans occurs as a result of bites from infected ticks or via exposure to body fluids from viremic animals or humans [3]. Therefore, nosocomial transmission to healthcare workers is an important concern [4,5].…”

Molecular screening of ticks for the presence of Rickettsia species: A public health concern

“…There are scanty reports on the ability of this species to transmit diseases in both humans and animal. However, it is a known vector agent of the protozoan Babesia bigemina, Crimean-Congo hemorrhagic fever virus (CCHFV), and Ehrlichia ruminantium [55][56][57]. Mediannikov et al [54] has reported on the ability of R. evertsi evertsi to transmit rickettsial agents in ticks that were collected in Senegal.…”