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Outbreak claimed two lives


The majority of patients recover, but up to 30% develop severe illness with multi-organ failure and have a fatal outcome.

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IN 2017, an outbreak of Crimean-Congo haemorrhagic fever (CCHF), commonly known as Congo fever, claimed the lives of two people in the Northern Cape, prompting the provincial Department of Health to warn community members to be vigilant about the signs and symptoms of CCHF.

Since the beginning of that year eight confirmed cases of CCHF were reportedly treated in the Northern Cape, with two of these ending in fatalities.

The first patient death was a farmer from the John Taolo Gaetsewe district who died as a result of the fever in January 2017, while a second patient, a man who helped slaughter sheep during a funeral, also in the John Taolo Gaetsewe district, died at the beginning of November that year.

There were no CCHF cases in 2018 from the Northern Cape, although one was reported from the Free State and one from the North West.

So far this year, there have been two confirmed cases in South Africa.

At the time of the 2017 outbreak, the Northern Cape Department of Health warned residents throughout the Province to be vigilant about the signs and symptoms of CCHF and immediately report to the nearest health facility if experiencing such symptoms.

“CCHF is caused by a tick-borne virus (Nairovirus) in the family Bunyaviridae and is common in our Province because of livestock farming and hunting of wildlife,” department spokesperson, Lulu Mxekezo, said at the time

“It is critical for patients to disclose tick bites or contact with animals when visiting a health facility so that health practitioners become aware during diagnosis.

“The onset of CCHF is sudden, with initial signs and symptoms including headache, high fever, back pain, joint pain, stomach pain, and vomiting.”

Mxekezo added that animal herders, farmers, livestock workers, hunters and slaughterers in endemic areas were at risk of CCHF.

“Health care workers in endemic areas are also at risk of infection through unprotected contact with infectious blood and body fluids. Individuals and international travellers with contact to livestock in endemic regions may also be exposed.

“Farm workers and others working with animals should use insect repellent on exposed skin and clothing. Insect repellents containing DEET (N, N-diethyl-m-toluamide) are the most effective in warding off ticks. Wearing gloves and other protective clothing is recommended.

“Individuals should also avoid contact with the blood and body fluids of livestock or humans who show symptoms of infection.”

Mxekezo went on to explain that hard ticks, especially those of the genus Hyalomma (Bond poot), were both a reservoir and a vector for the CCHF virus.

“Numerous wild and domestic animals, such as cattle, goats, sheep and hares, serve as amplifying hosts for the virus. Transmission to humans occurs through contact with infected animal blood or ticks. CCHF can be transmitted from one infected human to another by contact with infectious blood or body fluids,” she stated.

The virus is transmitted by Hyalomma ticks, which have distinctive brown and white bands on their legs, and are known in South Africa as bont-legged ticks.

There are three species of Hyalomma in South Africa, and although they are widely distributed, the ticks tend to be most numerous in the drier north-western parts of the country – the Karoo, western Free State, Northern Cape and North West Province.

According to the Institute for Communicable Diseases, human CCHF cases have been reported annually from South Africa since 1981, when it was first recognised in the country.

Through nearly thirty years of passive surveillance, over 180 cases have been laboratory confirmed. Although cases have been reported from all of the nine provinces, more than half originate from the semi-arid areas of the Northern Cape and the Free State.

Animals bitten by infected ticks do not develop the disease, but can circulate the virus in their blood for a few days, up to a week, and thereafter become immune to further infection. Non-infected ticks become infected if they feed on the animals during the short period when the virus is in circulation, thereby ensuring the perpetuation of the virus.

The majority of patients recover, but up to 30% develop severe illness with multi-organ failure and have a fatal outcome.