Nosocomial outbreak of Crimean-Congo hemorrhagic fever in Holy Family Hospital, Rawalpindi, Pakistan, 2010

Abstract

On 14 September, 2010, a suspected case of Crimean-Congo Hemorrhagic Fever (CCHF) was admitted in Holy Family Hospital (HFH). The case was confirmed on 20 September, 2010. The hospital had experienced loss of one intern due to CCHF in 2000s, a panic was created and the blood specimens of team taking care of index case (IC) was sent to reference laboratory for examination. On 28th September, all specimens announced positive for CCHF. A retrospective study was conducted to detect all cases and contacts of the IC. Line list of cases and contacts were built. We interviewed cases, contacts and relevant staff of the hospitals. Out of 19 suspected cases admitted in HFH on the 14th September to 4th November 2010, 11 were positive for CCHF. Nine of the 11 cases were hospital acquired infections (HAI). All the cases with HAI are exposed to IC. Four of the 11 cases had fever only and 2 of the 11 cases had fever with hemorrhagic signs and symptoms. Hemorrhagic cases were IC and another case who had fever, melena and hematuria. Five HAIs did not report any sign and symptom. Seven of the 9 HAI cases were treated with ribavirin. All cases were confirmed by polymerase chain reaction (PCR). None of their family contacts developed the disease. A nosocomial outbreak of CCHF involving 4 medical doctors, 3 nurses, 1 student of nursing school and 1 ward boy was investigated in HFH. IC and HAI cases survived. Poor infection prevention measures in the hospital were associated with the outbreak. Key words: Nosocomial infection of Crimean-Congo hemorrhagic fever (CCHF), hospital based outbreak of CCHF, Crimean-Congo hemorrhagic fever, infection prevention hospitals, Pakistan.