Abstract
Being an endemic country for Crimean Congo hemorrhagic fever (CCHF), this study aimed to explore the genetic diversity of CCHF virus (CCHFV) detected in Pakistan during 2019. Serum samples from patients with clinical signs of hemorrhagic fever attending tertiary care hospitals in Pakistan were tested for CCHFV RNA using real-time PCR at Department of Virology, National Institute of Health. The partial S-gene fragments were directly sequenced to determine the prevailing CCHFV genotypes and their molecular epidemiology in Pakistan. During January-December 2019, 280 samples from suspected CCHF patients were tested and 28 (10%) were found positive on real-time PCR. Positive cases were detected from 14 districts and across all four provinces of Pakistan with majority reported during August-September. The mean age of CCHFV positive patients was 37.25 years (range 5–65 years) with a high frequency in males (92.8%; n = 26) and a case fatality rate of 40.7% was observed. Phylogenetic analysis showed that S- segment of 2019 PAK CCHFV strains (n = 13) belonged to Asia-1 genotype and clustered with regional strains from Iran, Oman, and Afghanistan. We conclude that Asia-1 genotype of CCHF virus remains endemic in Pakistan. Our findings emphasize to establish a laboratory based surveillance program to monitor the disease burden and identify outbreak hotspots for effective control.
Highlights
Crimean-Congo hemorrhagic fever (CCHF) is a tick-borne zoonotic viral disease that was first recognized in 1944 in Crimea and later in 1969 in Congo given the name after its place of origin
We found a mortality rate of 40.7% due CCHF which is high in comparison to studies from regional countries Iran, Afghanistan and Oman
Genetic analysis revealed Pakistani CCHF viruses to be closely related with strains from bordering countries Iran and Afghanistan as well as with Oman indicating that animal trade and movement of people serve as a common source for the disease transmission
Summary
Crimean-Congo hemorrhagic fever (CCHF) is a tick-borne zoonotic viral disease that was first recognized in 1944 in Crimea and later in 1969 in Congo given the name after its place of origin. The causative agent of the disease is Crimean-Congo hemorrhagic fever virus (CCHFV) which belongs to the Nairovirus genus in the Bunyaviridae family. The genome of CCHFV consists of single-stranded negative sense RNA that is divided into small (S), medium (M) and large (L) segments. CCHFV is transmitted through Ixodid ticks (mainly of genus Hyalomma) which serve as reservoir and vector for the virus as well as through contact with blood or tissue from an infected human or animal. Infected animals are asymptomatic, clinical features in humans include fever of abrupt onset, headache, myalgia, and thrombocytopenia complications can lead to hemorrhage, multiorgan failure and death [3, 4]. CCHFV is classified into 7 genetic groups: two Asian, two European and three African [6] that correlate to geographic origin
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