CCHF in Afghanistan: Know-hows and Visualizing the Way Forward in One-Health Approach

A tick-borne viral disease known as Crimean Congo Hemmorrhagic Fever (CCHF) that transmits from animals to human being is showing increasing trends over the last few years in Afghanistan. Recent studies pointed out that the disease is becoming endemic to Afghanistan with case fatality rates of 21.6 to 43.3% (Sahak, et al, 2019; Qaderi, et al, 2021). The disease has high occupational risk mostly affecting shepherds, butchers, veterinarians, animal dealers and farmers in addition to housewives, health workers and students. The provinces of Afghanistan with the highest prevalence are Herat, Kabul, Balkh, Parwan, Nangarhar and Ghazni. With clinical symptoms of sudden onset of headache, high fever, bruise, nosebleeds, joint pain, vomiting etc and death if not treated soon, the disease can potentially be a bioweapon in countries like Afghanistan.   

Although the disease is sub-clinical in animals with nearly no signs, sero-epidemiological studies reported that the prevalence of the disease in Afghanistan is 5.6% in Cattle and 9% in goats. Ingel District in Herat Province has the highest prevalence of 75% in sheep and 79.1% in cattle (Spengler, et al, 2016). The spread of the disease is during Ed-al Adha holiday due to rampant mobility of animals and large scale slaughtering for the festivities.

Fig 1: life cycle of Hyalomma Tick and vertical plus horizontal transmission of CCHF between animals and human beings (Spengler, et al, 2016).

A one-health approach is in progress through partnerships between different agencies to manage the disease. The efforts made by funding agencies such as USDA; roles plaid by UN agencies (eg. FAO, WHO); NGOs (eg. Dutch Committee for Afghanistan - Livestock Programs/DCA-LS); government departments (eg. Ministry of Agriculture, Irrigation and Livestock; Ministry of Public Health) and the likes are excellent examples to mention. 

Moving forward, more capacity building, fund raising and national resources mobilization is necessary to control and prevent the disease. A one health approach of controlling the vector, managing the environment and reducing the number of cases in human being is the strategy moving forward. Easier said than done, it requires strong partnership, networking and sustainable financing to effectively and efficiently prevent the disease. Collaborations and policies to control the disease in the neighboring countries is an important element as livestock mobility is very common during holidays and is one of the ways of pastoralist husbandry that move between national borders.  

In order to reduce and eventually eradicate the disease, the following approaches are essential.

1.      Capacity Building: the public health officers, veterinarians, extension workers and the likes need to have a very good knowledge and skills of the disease so they can train the communities focusing on high risk groups. Excellent extension packages that are easily plausible to the farmers and pastoralists are necessary. DCA-LS is well experienced in developing extension packages and its project teams and veterinary field units (VFUs) are already training farmers and pastoralists in herd-health, zoonotic diseases control, livestock feeding, pastoralists livestock health etc.

2.      Vector Control: surveillance and treatment of external parasites using acaricide spray/dipping or injections such as ivermectin; investing in control of reproduction of the Hyalomma ticks in the rangelands through rotational grazing etc helps to reduce the prevalence of CCHF.

3.      Minimize Inter-Human and Nosocomial Transmission: health workers and other patients are at high risk if CCHF patients visit the medical center. Personal protective equipment (PPE) and enhanced awareness as well as maintaining distance between patients will help to curb the disease.

4.      Environmental Protection: Environmental hygiene and personal protection during mobility, ante-mortem and postmortem diagnosis, slaughtering, butcher shops and cooking are indispensable parts of prevention. Controlled mobility of animals between neighboring countries particularly during holidays such as Ed-al Adha is an important part of the mechanisms to prevent the disease. Transboundary transmissions need to be controlled by quarantines, official regulations and penalties.