Afghanistan: Ticks with CCHF Virus?

Sara Carter of The Washington Times has an exclusive on a rare virus found in Afghanistan (Rare virus poses new threat to troops | Nov 6, 2009):

“U.S. military officials sent a medical team to a remote outpost in southern Afghanistan this week to take blood samples from members of an Army unit after a soldier in the unit died from an Ebola-like virus.”

The report says that Sgt. Robert David Gordon, 22, from River Falls, Ala., died Sept. 16 from what turned out to be Crimean-Congo hemorrhagic fever after he was bitten by a tick. Read the whole thing here.

According to the CDC, the Crimean-Congo hemorrhagic fever (CCHF) is caused by infection with a tick-borne virus (Nairovirus) in the family Bunyaviridae. The disease was first characterized in the Crimea in 1944 and given the name Crimean hemorrhagic fever. It was then later recognized in 1969 as the cause of illness in the Congo, thus resulting in the current name of the disease.

Symptoms according to the CDC factsheet:

The onset of CCHF is sudden, with initial signs and symptoms including headache, high fever, back pain, joint pain, stomach pain, and vomiting. Red eyes, a flushed face, a red throat, and petechiae (red spots) on the palate are common. Symptoms may also include jaundice, and in severe cases, changes in mood and sensory perception. As the illness progresses, large areas of severe bruising, severe nosebleeds, and uncontrolled bleeding at injection sites can be seen, beginning on about the fourth day of illness and lasting for about two weeks.

The CDC also says:

• There is no safe and effective vaccine widely available for human use.

• Fatality rates in hospitalized patients have ranged from 9% to as high as 50%.

• Insect repellants containing DEET (N, N-diethyl-m-toluamide) are the most effective in warding off ticks.

The WHO info on CCHF indicates that the length of the incubation period for the illness appears to depend on the mode of acquisition of the virus. Following infection via tick bite, the incubation period is usually one to three days, with a maximum of nine days. The incubation period following contact with infected blood or tissues is usually five to six days, with a documented maximum of 13 days.

This is actually not the first time that CCHF was found in Afghanistan. According to the Federation of American Scientists, 41 deaths from "a form of hemorrhagic fever"were reported in eastern Afghanistan in 2002. In August 2008, the WHO reported a total of 19 CCHF cases with 5 deaths in the Herat region. Click here for info on previous CCHF outbreaks in the area from the International Society for Infectious Disease.

If you’re heading out that way, don’t forget to pack some DEET insect repellants.

Related Items:

• CDC | Crimean-Congo Hemorrhagic Fever
• WHO | CCHF | Prevention and Control
• CDC | Protection Against Mosquitoes, Ticks, and Other Insects and Arthropods
• EPA | The Insect Repellent DEET
• EPA | Insect Repellents: Protection Times |Products that Repel Mosquitoes and Ticks | October 23, 2009 | HTML

H1N1 Vaccine for Foreign Service Personnel

Image by ghinson via Flickr

At the DPB yesterday, a reporter inquired about provisions for Foreign Service personnel in the H1N1 outbreak:

QUESTION: In regard to the H1N1 outbreak, what provisions are being made by the State Department on behalf of Foreign Service Officers serving at posts overseas? Are vaccines being made available to those serving overseas?

ANSWER: The Office of Medical Services expects the H1N1 vaccine will be available to most of our overseas missions sometime in December.Because of the extremely limited amounts of vaccine available to the Department of State through the Centers for Disease Control and Prevention, the Office of Medical Services is purchasing additional H1N1 vaccine doses from the Department of Defense for shipment overseas to try to address our needs.

The Office of Medical Services already has shipped its initial allotments of the vaccine to Baghdad and Kabul where employees live in barrack-like conditions. The next distribution priority is to hardship posts where local medical care is inadequate, and these shipments have begun.

H1N1 remains sensitive to Tamiflu and Relenza, therefore all posts overseas have been stocked with enough of these anti-viral drugs to treat all individuals at post.

* * *

Would you zap me an email if you don't get it by December? Excerpt below from U.S. Government Pandemic Policy for Americans Abroad, in case you have not seen it:

It is U.S. Government policy for all overseas employees under Chief of Mission authority and their accompanying dependents to plan for the possibility that they will remain abroad during a severe pandemic. Information for both official and private Americans on how to prepare for this possibility is contained in the flyer “ Options During a Pandemic ,” which urges Americans to maintain adequate provisions for a pandemic wave or waves that could last from two to twelve weeks.

Once the World Health Organization (WHO) confirms a severe pandemic, American citizens (including non-emergency government personnel and their dependents, as well as private citizens) who are residing or traveling overseas should consider returning to the United States while commercial travel options are still available. Americans will be permitted to re-enter the United States, although the U.S. Department of Health and Human Services/Centers for Disease Control and Prevention (HHS/CDC) may quarantine or isolate incoming travelers, depending on their health status and whether they are traveling from or through an area affected by pandemic influenza.

In the event of a severe pandemic, non-emergency U.S. Government employees and all dependents in affected areas will be encouraged to return to the United States while commercial transportation is still available. U.S. Government employees who return to the United States will be expected to work there during the pandemic unless they take leave. Private American citizens should make an informed decision: either remain abroad to wait out the pandemic, as noted above, or return to the United States while this option still exists. Any American (whether overseas in a private capacity or a U.S. Government employee or dependent) who chooses not to return to the United States via commercial means might have to remain abroad for the duration of the pandemic if transportation is disrupted or borders close. Americans should be aware that only in cases of a complete breakdown in civil order within a country will the U.S. Government consider a U.S. Government-sponsored evacuation operation.

Continue reading here:

Related Item:Fact Sheet: 2009-H1N1, Pandemic Influenza, and H5N1 | HTMLThe Atlantic: Does the Vaccine Matter | November 2009

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