Risks of Crimean Congo Hemorrhagic Fever in Pakistan

What is Congo Fever?

Crimean-Congo Hemorrhagic Fever (CCHF) is a tick-borne viral disease caused by a Nairovirus, noted for its severe clinical course and a reported fatality rate ranging from 10% to 40% in different settings. Often referred to simply as “Congo fever,” it spreads to humans primarily through bites of infected Hyalomma ticks or direct contact with blood or tissues of infected animals (goats, sheep, cattle) during slaughter. Human-to-human transmission can also occur via close contact with bodily fluids of CCHF patients, particularly in healthcare or domestic settings without adequate protective measures.

In Pakistan, CCHF has been recognized as endemic since the first human case was reported in Rawalpindi in 1976. Over the decades, sporadic cases and periodic outbreaks have occurred across provinces, often linked to livestock handling during Eid-ul-Adha and movements of animals.

Congo Fever Symptoms

Key congo fever symptoms to watch for include:

1. Sudden onset fever 
   
2. Muscle aches 
   
3. Headache 
   
4. Dizziness
   
5. Nausea
   
6. Vomiting
   
7. Abdominal pain
   
8. In severe cases, hemorrhagic signs like bleeding gums or petechiae. 
   

Early recognition of this disease and quick medical attention are crucial. Unfortunately, because initial symptoms can overlap with dengue or malaria the disease can be misdiagnosed.

Latest Congo Fever Cases in Pakistan

Historically, Pakistan has experienced waves of Congo disease outbreaks twice a year, often between March–May and July–September, coinciding with tick activity peaks in warmer months. These periods overlap with increased livestock movement and slaughter practices around Eid-ul-Adha which increases the risk of exposure to a larger population.

A review of CCHF history in Pakistan shows multiple mini-outbreaks and sporadic cases since 1976, with notable clusters in Balochistan and subsequent spread to neighboring provinces. In recent years, Sindh reported 13 cases by mid-2024, treated in Karachi institutions. In early 2025, the first recorded death by Congo virus occurred in Quetta in late March.

Congo Fever Risk Factors in 2025

Several factors have heightened the risk of Congo fever spread recently:

• High-volume animal sacrifices: In 2025, an estimated over 6 million animals were slated for sacrifice during Eid-ul-Adha, many processed without strict biosecurity or quarantine measures.
• Inter-provincial livestock movement: Unchecked transport of animals across provinces can introduce infected livestock into new areas lacking surveillance.
• Insufficient tick control: Limited acaricide use on animals or in animal-holding sites allows Hyalomma ticks to persist.
• Climate factors: Monsoon rains, urban flooding, and stagnant water create humid microhabitats supporting tick populations, extending their active seasons.
• Urban expansion: Encroachment into fringe rural areas brings people closer to livestock markets and tick habitats.
  

These risk factors raise the probability of new outbreaks or sporadic cases in areas previously less affected. For instance, while KP and Sindh are established hotspots, vigilance in Punjab (including areas like Wah Cantt and Taxila) is now advised.

Healthcare Gaps and Diagnostic Challenges in Pakistan

Timely and accurate diagnosis of CCHF is often hindered by:

• Symptom overlap: Early signs (fever, myalgia, headache) mimic dengue or malaria, leading to misdiagnosis. There have been documented Karachi cases initially treated for other febrile illnesses before CCHF was confirmed.
• Limited diagnostic capacity: PCR and ELISA testing for CCHF is available mainly at central laboratories; rural healthcare units may lack trained personnel and equipment. Sample transport delays can postpone confirmation.
• No approved antiviral: Ribavirin is used off-label based on limited evidence, but there is no WHO- or FDA-approved treatment specifically for CCHF. Supportive care remains the mainstay, with emphasis on fluid management, bleeding control, and organ support.
• Lack of vaccine: Vaccines are in research stages but not commercially available for humans or livestock, leaving prevention reliant on awareness and protective practices.

Addressing these gaps requires investment in laboratory infrastructure, training of healthcare workers to suspect and isolate CCHF cases promptly, and establishing clear referral pathways for testing.

Government & Community Response to Congo Fever

Between 2023 and 2025, Pakistani authorities have introduced various measures to combat Congo Fever:

• Border and checkpoint screening: Particularly in KP to monitor livestock movements from neighboring provinces.
• Indoor Residual Spraying (IRS) and tick control campaigns in selected regions before Eid.
• SOPs for Eid sacrifices: Guidelines recommending use of gloves, safe handling of animal blood and tissues, and hygienic slaughter sites. However, these laws are not properly enforced which leaves risk for the disease to spread.
• Public advisories: NIH advisories issued in April 2025 highlighting CCHF risks alongside heatstroke warnings, urging light-colored clothing to spot ticks, avoiding tick-infested areas, and safe removal of ticks.
  

Despite all these preventative measures, the disease still poses a risk to spread in Pakistan because:

• Community education: Rural livestock handlers may lack awareness of CCHF transmission and protective measures.
• Veterinary screening: Pre-slaughter health checks of animals are limited or absent in many makeshift markets.
• Tick surveillance: Nationwide tick monitoring programs are nascent; sentinel surveillance in hospitals for febrile hemorrhagic illnesses needs strengthening.
  

Meripharmacy is doing our job in enhancing these efforts by spreading easy-to-understand guidance through our digital channels. Check out more of our informative health blogs for further reading.

Recommendations: Preventing the Next Wave

After looking at the observed patterns and problems while dealing with Congo Fever in Pakistan, we recommend to:

1. Enforce Livestock Quarantine Zones
   

• Collaborate with veterinary authorities to implement pre-slaughter quarantine for animals arriving from distant areas.
  

• Promote tick treatment (acaricide application) at holding sites at least two weeks before sacrifice.
  

2. National CCHF Awareness Campaigns
   

• Use social media, SMS alerts, and pharmacy networks to disseminate simple messages: protective clothing, tick checks, safe slaughter practices.
  

• Leverage community influencers to reach rural populations.
  

3. Strengthen Surveillance
   

• Set up sentinel programs in selected hospitals to flag febrile hemorrhagic cases promptly for lab testing.
  

• Encourage reporting of suspected animal illness or tick infestations in markets.
  

4. Biosecure Eid Sacrifice Practices
   

• Advocate for supervised slaughter zones with proper waste disposal, protective equipment (gloves, aprons), and hygiene stations for butchers and animal handlers.
  

• Offer mobile units or partnerships for safe disposal of animal remains.
  

5. Educational Materials
   

• Provide downloadable infographics and PPTs (“crimean congo hemorrhagic fever ppt”) on our website highlighting:
  

• What is congo fever and how to recognize congo fever symptoms early.
  

• Safe handling protocols and tick-control measures.
  

• Translate materials into local languages for broader reach.
  

6. Pharmacy-Based Interventions
   

• Stock and promote tick repellents suitable for humans and animals.
  

• Train pharmacy staff to counsel customers buying livestock-handling supplies on CCHF risks.
  

• Offer telehealth consultations for early symptom triage.
  

These recommendations should be underpinned by partnerships with Pakistani health authorities, veterinary services, and community organizations.

Conclusion

As Meripharmacy, our goal is to empower communities in Karachi and across Pakistan with fact-checked, recent, and authentic health information. With Pakistan’s delicate status and periodic surges it is vital to integrate prevention, early detection, and community education. Together, through informed action and collaboration, we can reduce the Crimean Congo Hemorrhagic Fever’s impact on Pakistan.