Sero-Epidemiological Survey of Crimean-Congo Hemorrhagic Fever among the Human Population of the Punjab Province in Paki

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LETTER

Sero-Epidemiological Survey of Crimean-Congo Hemorrhagic Fever among the Human Population of the Punjab Province in Pakistan Muhammad Furqan Shahid1 • Muhammad Zubair Shabbir2 • Kamran Ashraf3 • Muzaffar Ali1 • Saima Yaqub1 • Aziz Ul-Rahman1 • Nageen Sardar1 • Nadia Mukhtar4 • Zarfishan Tahir4 • Tahir Yaqub1 Received: 18 April 2019 / Accepted: 7 November 2019 Ó Wuhan Institute of Virology, CAS 2020

Dear Editor, Crimean-Congo hemorrhagic fever (CCHF), caused by the CCHF virus (CCHFV), is a tick-borne zoonotic infection characterized by myalgia, high-grade fever ([ 38 °C), headache, nausea, bleeding from the body cavities, and in 10%–50% of cases, results in death (Swanepoel et al. 1989). As CCHFV belongs to the Nairoviridae family, the virus can be transmitted to humans through the bite of infected ticks or by contact with the tissues or blood of infected animals (Bente et al. 2013). Since the first case of CCHF in Pakistan in 1970, the number of clinical cases has increased annually (Yousaf et al. 2018). Like other resource-limited countries worldwide, most diagnoses of this disease in Pakistan are limited to clinical signs and symptoms (Haider et al. 2016; Hasan et al. 2013). Consequently, despite the endemicity of the disease in various regions of Pakistan, the majority of cases remain either undiagnosed and/or misdiagnosed, due to lack of diagnostic facilities. In order to highlight the presence of subclinical forms of the disease or underestimation of actual disease status and associated risk factors, we conducted a sero-epidemiological study involving

Electronic supplementary material The online version of this article (https://doi.org/10.1007/s12250-020-00195-5) contains supplementary material, which is available to authorized users. & Tahir Yaqub [email protected] 1

Department of Microbiology, University of Veterinary and Animal Sciences, Lahore 54600, Pakistan

2

Quality Operation Laboratory, University of Veterinary and Animal Sciences, Lahore 54600, Pakistan

3

Department of Parasitology, University of Veterinary and Animal Sciences, Lahore 54600, Pakistan

4

Institute of Public Health, Lahore 54600, Pakistan

patients originating from areas with and without a history of the disease. We reported the presence of anti-CCHFV IgG from 1052 collected blood serum samples in selected districts of the Punjab Province of Pakistan (see Supplementary Materials and Methods for data collection and immunological assay details) over a period of 8 months (from October 2016 to May 2017) and found an association between seroprevalence and different categorical variables. We found a lower CCHFV seropositivity (2.09%, 95% CI 1.23–2.96), which is not surprising, as previous studies have found that CCHFV seropositivity varies even in endemic places. For instance, using sera of individuals that had a subclinical form of infection or were clinically healthy, the percentage of patients which were seropositive was found to be 0.5%