Silent public threat: Crimean-Congo hemorrhagic fever outbreak spikes during Eid-al-Adha in Afghanistan (Reported cases to National Surveillance System, 2015-2024)

Enayatullah Hamdard; Ahmadullah Zahir; Babrak Karwand; Zabih Ullah Nazari; Fangxiong Shi

doi:10.1016/j.jiph.2024.102591

Silent public threat: Crimean-Congo hemorrhagic fever outbreak spikes during Eid-al-Adha in Afghanistan (Reported cases to National Surveillance System, 2015-2024)

J Infect Public Health. 2024 Nov 17;18(1):102591. doi: 10.1016/j.jiph.2024.102591. Online ahead of print.

Authors

Enayatullah Hamdard¹, Ahmadullah Zahir², Babrak Karwand³, Zabih Ullah Nazari³, Fangxiong Shi⁴

Affiliations

¹ College of Animal Science and Technology, Nanjing Agricultural University, Nanjing 210095, China; Veterinary Science Faculty, Kunduz University, Kunduz city, Kunduz, Afghanistan.
² Afghanistan National Agricultural Sciences and Technology University, Faculty of Veterinary Sciences, Kandahar, Afghanistan.
³ Veterinary Science Faculty, Kunduz University, Kunduz city, Kunduz, Afghanistan.
⁴ College of Animal Science and Technology, Nanjing Agricultural University, Nanjing 210095, China. Electronic address: fxshi@njau.edu.cn.

PMID: 39603058
DOI: 10.1016/j.jiph.2024.102591

Abstract

Background: Crimean-Congo hemorrhagic fever (CCHF) is a tick-borne viral disease with a Case Fatality Ratio (CFR) of 10-40 %. It spreads from livestock to humans primarily through tick bites. It is crucial to monitor the peak months of this endemic disease in Afghanistan. Currently, the country is grappling with a potential national outbreak of CCHF, facing limitations in both diagnostic and preventive measures. Therefore, this study aims to describe CCHF prevalence during spike months (June-September) from 2015 to 2024, coinciding with Eid-al-Adha, and assess CCHF familiarity among inhabitants in eight regions of Afghanistan.

Method: We have analyzed the National Surveillance System data (2015-2024) on retrospective basis. A structured questionnaire was developed to assess CCHF knowledge among inhabitants of eight regions. Data analysis included percentages, frequencies, chi-square tests, using SPSS and power BI.

Results: The national surveillance system recorded 1796 CCHF confirmed cases with 238 deaths during spike months from 2015 to 2024. The highest number of Reported cases was in 2023 (734 cases, 78 deaths), followed by 2022 (221 cases). During Eid-al-Adha months from 2015 to 2024, there were 804 CCHF cases and 176 deaths, with the most in 2023 (313 cases, 78 deaths) and the fewest in 2015 (7 cases, 2 deaths). A survey of 1440 inhabitants (80 % male, 20 % female) across eight regions of Afghanistan showed knowledge of CCHF varied within regions. Correct responses were highest in the central region (394/815), followed by north (336/760). Incorrect responses were highest in central highlands (1039/1440), followed by west (450/881), indicating limited knowledge despite annual spikes in cases.

Conclusion: The surge in CCHF outbreaks during Eid-al-Adha in Afghanistan underscores the challenge posed by limited knowledge of the disease. Uncontrolled animal movement and self-slaughter during Eid festival emphasize the urgent need for targeted public health strategies by relevant ministries.

Keywords: Afghanistan; Crimean-Congo Hemorrhagic Fever (CCHF); Eid-al-Adha; Knowledge; Public Threat.