The reasons why Pakistan might be at high risk of Crimean Congo haemorrhagic fever epidemic; a scoping review of the literature

Abstract

Pakistan has faced a number of significant healthcare challenges over the past decade. In 2000, one of these events - a deadly epidemic of Crimean Congo Haemorrhagic Fever (CCHF) - struck Pakistan. The people of Pakistan are at a very high risk of acquiring CCHF, due to a number of factors which emerge from a scoping review of the literature. First, the underdeveloped healthcare system of the country is currently not prepared to cope with challenges of this nature. Healthcare professionals and medical institutes are not sufficiently equipped to properly diagnose, manage and prevent CCHF. Second, a large percentage of the general public is unaware of the spread and control of the vector. The agricultural sector of Pakistan is vast and thus many people are involved in animal husbandry and the handling of livestock which can lead to the transmission of the CCHF virus. Even in urban areas the risk of transmission is significantly higher around the time of Eid-ul-Azha, when Muslims slaughter animals. Finally, the political upheavals faced by the country have also increased Pakistan’s vulnerability because a large number of refugees from Afghanistan, a CCHF endemic country, have migrated to Pakistan as a result of the Afghan war. Most of the refugees and their animals settle in Baluchistan and Khyber Pakhtunkhwa provinces, which consequently have a higher prevalence of CCHF. This scoping review of the literature highlights the potential causes of high risk CCHF and draws conclusions and makes recommendations that policy-makers in Pakistan may wish to consider in-order to improve on the current situation.

An Emerging Biothreat: Crimean-Congo Hemorrhagic Fever Virus in Southern and Western Asia

“…First, CCHF cases occur most frequently during the summer months because tick populations are lower during the colder winter months. 36 CCHF cases may increase during more temperate winters. 36 It is therefore speculated that climate change has contributed to the increasing incidence of CCHF cases worldwide.…”

“…36 CCHF cases may increase during more temperate winters. 36 It is therefore speculated that climate change has contributed to the increasing incidence of CCHF cases worldwide. 37 With milder winters projected, CCHF emergence may continue to be observed.…”

“…39 Yet, given livestock and population migration, increased surveillance and infection precautions are warranted. 36 By contrast, Saudi Arabia, a country with intermittent CCHF cases, has developed surveillance systems for Eid al-Adha and has not encountered increased cases. 40 Third, CCHF cases have been increasingly recognized in areas that were not historically reporting cases.…”

Drug utilization evaluation among an elderly population: a retrospective cross-sectional study in a tertiary care hospital in Pakistan

“…Multiple studies have reported these interactions to be responsible for serious bleeds . There are significant financial consequences associated with inappropriate DDIs in emerging nations such as Pakistan which struggle to provide the most basic of medical amenities to a large population . Through close monitoring of patients, appropriate selection of drugs and prescribing within the target DDD numerous DDIs occurring in the hospitalized elderly could be halted in Pakistan.…”

Why is Pakistan vulnerable to COVID‐19 associated morbidity and mortality? A scoping review

“…The entered data were summarized, rechecked and charted using a data sheet. The content of the articles was analyzed by using thematic approach 33 and presented as a set of themes representing our key focus. The author name, year of publication, article type and vulnerabilities retrieved from articles are provided in Supporting Information File 1.…”