Risk Factors of Crimean-Congo Haemorrhagic Fever in Sindh Province, Pakistan

•CCHF surveillance covered all referral hospitals in Sindh Province.•Urban Karachi had 10 times higher risk of CCHF than other urban or rural areas.•People who visited livestock markets had a high risk.•Tick bites and high-risk occupations also contributed to CCHF morbidity.•Concentration of livesto...

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Published in:	International journal of infectious diseases Vol. 146; p. 107141
Main Authors:	Syed, Muhammad Asif, Siddiqui, Muhammad Ilyas, Memon, Ishfaque Hussain, Jehandad, Kishwar, Baloch, Nayyar Nawaz, Jamal, Hamza, Hussain, Aamir, Memon, Naveed Masood, Syed, Masroor Hussain, Ahmed, Zeeshan Ansar, Fontaine, Robert E., Rullán-Oliver, Paola
Format:	Journal Article
Language:	English
Published:	Canada Elsevier Ltd 01-09-2024 Elsevier
Subjects:	Crimean-Congo haemorrhagic fever Livestock Occupational exposure Public health surveillance Risk factors Urban population Livestock Occupational exposure Public health surveillance Urban population Crimean-Congo haemorrhagic fever Risk factors
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Summary:	•CCHF surveillance covered all referral hospitals in Sindh Province.•Urban Karachi had 10 times higher risk of CCHF than other urban or rural areas.•People who visited livestock markets had a high risk.•Tick bites and high-risk occupations also contributed to CCHF morbidity.•Concentration of livestock in markets likely drove transmission. In Sindh Province, Pakistan, confirmed Crimean-Congo haemorrhagic fever (CCHF) increased from zero in 2008 to 16 in 2015-2016. To counter this increase, in 2016, we initiated structured CCHF surveillance to improve estimates of risk factors for CCHF in Sindh and to identify potential interventions. Beginning in 2016, all referral hospitals in Sindh reported all CCHF cases to surveillance agents. We used laboratory-confirmed cases from CCHF surveillance from 2016 to 2020 to compute incidence rates and in a case–control study to quantify risk factors for CCHF. For the 5 years, CCHF incidence was 4.2 per million for the Sindh capital, Karachi, (68 cases) and 0.4 per million elsewhere. Each year, the onset of new cases peaked during the 13 days during and after the 3-day Eid-al-Adha festival, when Muslims sacrificed livestock, accounting for 38% of cases. In Karachi, livestock for Eid were purchased at a seasonal livestock market that concentrated up to 700,000 livestock. CCHF cases were most common (44%) among the general population that had visited livestock markets (odds ratio = 102). Urban CCHF in Sindh province is associated with the general public's exposure to livestock markets in addition to high-risk occupations.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1201-9712 1878-3511 1878-3511
DOI:	10.1016/j.ijid.2024.107141