Crimean-Congo haemorrhagic fever associated with Eid-ul-Adha festival

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Balochistan is the poorest province bordering Iran and Afghanistan. Before the festival Eid-ul-Adha, animals are transported domestically from Afghanistan and Iran to Balochistan and then supplied to the other provinces. CCHFV is most likely being transported by the imported animals, which would explain why Balochistan had the highest number of positive cases. To confirm this hypothesis, we performed ELISAs on samples from 21 randomly selected transported animals from Afghanistan and Iran, and found that 13 (62%) of them were CCHFV positive. Furthermore, according to our demographic data from the patients, 58% (22 of 38) of the patients who tested positive had been to fa-flung areas of Afghanistan. Therefore, border control regulations must be abided, because movement of people from Afghanistan into Pakistan without any monitoring or health checks has overwhelmed the local public health system, as previously described. To show that the festival of Eid-ul-Adha (held on September 13-15 in 2016) is a vulnerable period for CCHF outbreaks, we calculated the number of positive cases and deaths during each month of 2016. The highest numbers of positive cases and deaths were observed in August, 2016, just before the festival. During this period, there were many chances for people to come into contact with domestic or imported animals that might have be infected with CCHFV, suggesting that the festival could play an important part in CCHF outbreaks. Therefore, the general public, farmers, animal handlers, and health-care workers need to be educated about periods of high risk for CCHF infection.

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