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CRIMEAN-CONGO HEMORRHAGIC FEVER OUTBREAK IN RAWALPINDI, PAKISTAN, FEBRUARY 2002: CONTACT TRACING AND RISK ASSESSMENT

A 25-year-old woman, later identified as index case of Crimean-Congo hemorrhagic fever (CCHF), presented to Holy Family Hospital in Rawalpindi, Pakistan with fever and generalized coagulopathy. A retrospective contact tracing was conducted to explore the modes of exposure possibly associated with transmission of CCHF infection among contacts. We traced 32 contacts of the index case and 158 contacts of secondary cases and tested them for IgG and IgM antibodies against CCHF virus by an enzyme-linked immunosorbent assay technique. According to the type of exposure, contacts were divided into five subsets: percutaneous contact with blood, blood contact to unbroken skin, cutaneous contact to non-sanguineous body fluids, physical contact with patients without body fluids contact, and close proximity without touching. Two out of four contacts who reported percutaneous exposure tested positive for antibodies to CCHF virus. We conclude that simple barrier methods and care in provision of CCHF cases may prevent transmission of this infection.

Received June 16, 2004. Accepted for publication November 29, 2004.

Acknowledgments: We are grateful to Samina Satti and Raja Mohammad Babar Akram (Department of Medicine, Holy Family Hospital, Rawalpindi, Pakistan) for reviewing the manuscript, and to Hamayun Asghar, Athar Saeed Dil (Public Health Division, National Institute of Health, Islamabad, Pakistan) and the staff of the National Institute of Virology (Johannesburg, South Africa) for invaluable technical assistance. We are proud to be associated with Farzana Altaf (House Physician, Holy Family Hospital), whose energy in improving standards were in the best traditions of our profession.

Authors’ addresses: Muhammad Nauman Athar, Department of Internal Medicine, Mercy Catholic Medical Center, 1500 Lansdowne Avenue, Darby, PA 19023, Telephone: 610-237-4553. Mohammad Ali Khalid, Naghman Bashir, Haider Zaigum Baqai, Masood Ahmad, and Kaukab Bashir, Medical Unit II, Department of Medicine, Holy Family Hospital and Rawalpindi Medical College, Satellite Town, Rawalpindi, Pakistan, Telephone: 92-51-929-0321-27 Extension 272-277, Fax: 92-51-929-0518. Ahsan Maqbool Ahmad, Department of Community Health Sciences, Second Floor, Ibn-e-Ridwan Building, The Aga Khan University, Stadium Road, Karachi, Pakistan, Telephone: 92-(21-4859-4923. Fax: 92-21-493-4294. Abbas Hayat Balouch, Department of Pathology, Holy Family Hospital and Rawalpindi Medical College, Satellite Town, Rawalpindi, Pakistan, Telephone: 92-51-929-0321-27, Fax: 92-51-929-0518.

Reprint requests: Muhammad Nauman Athar, 151 South Bishop Avenue, Apartment #K-12, Secane, PA 19018, Telephone/Fax: 610-394-6331, E-mail: drnaumanathar{at}yahoo.com.

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