Assessment of the CCHF Burden in Afghanistan

In Afghanistan, Crimean-Congo Hemorrhagic Fever (CCHF) exists with high case fatality, but the burden of CCHF is not well-characterized due to a lack of data. With the establishment of the Disease Early Warning System (DEWS) in 2006, more sentinel sites were set up and better country-wide coverage was achieved, revealing increased numbers of suspected and confirmed cases of CCHF. This study was undertaken in order to synthesize all DEWS collected data on CCHF cases in Afghanistan from 2007 through 2013 to better inform national health policy. The study aimed to categorize human CCHF patients by demography and geography and identify the rate of case fatality.  The total number of confirmed cases in this time period was 57 with 19 deaths (case fatality rate 13.03%). DEWS reported the first laboratory confirmed CCHF case from Ghoryan district, Herat province in 2007. The sample was tested at the Central Public Health Laboratory using ELISA. The number of suspected cases and the number of confirmed cases showed increase from 2007-08 and from 2011-2013. Each year the number of suspected cases is greater than the number of laboratory confirmed cases, with the greatest disparity occuring in 2013 with only 18 out of 63 cases being confirmed. Ages of confirmed CCHF patients ranged from 1.5 years to 70 years with a median of 23 years. 40.3% of the total reported cases occurred in women aged 20–40 and out of all confirmed cases, 40.35% were female. In almost all of the confirmed cases, patients had a history of exposure to livestock. One third of the confirmed cases were housewives and two thirds of cases were composed primarily of butchers and farmers. The findings show that farmers, butchers and housewives are among the vulnerable groups due to regular interaction with animals and animal products, and CCHF is more prevalent in the western, north-western and southern regions of the country. The great number of suspected but unconfirmed cases demonstrates that better surveillance and diagnosis are still required to accurately assess the burden of CCHF in Afghanistan. Additionally, the high rate of zoonotic infection shows that a coordinated mechanism between human and animal health sectors in Afghanistan is needed.