Tim Butcher: Ebola-style killer virus sweeps Afghan border

The largest outbreak in history of a highly contagious disease that causes patients to bleed to death from every orifice was confirmed yesterday on Pakistan's frontier with Afghanistan. At least 75 people have caught the disease so far and eight have died. An isolation ward screened off by barbed wire has been set up in the Pakistani city of Quetta, and an international appeal has been launched for help. Evidence suggests the outbreak of Crimean-Congo Haemorrhagic Fever emanates from within Afghanistan, raising fears of an epidemic if millions of refugees flee across the frontier into Pakistan. CCHF has similar effects to the ebola virus. Both viruses damage arteries, veins and other blood vessels and lead to the eventual collapse of major organs. As one doctor put it, a patient suffering from haemorrhagic fever "literally melts in front of your eyes". At the Fatima Jinnah Chest and General Hospital in Quetta, capital of the Pakistani province of Baluchistan, an isolation ward with eight treatment beds and two observation bays has been set up. Nine-year-old Ismail Sadiq lay on one of the beds yesterday, his body wracked with fever and a wad of cotton wool stuffed into each nostril to stem the bleeding. Outside members of his family sat anxiously in the shade of a tree. An elderly gentleman worked a string of worry beads through his fingers, but doctors had forbidden all visits. The only people Ismail now sees are doctors and nurses wearing the complete "barrier nursing" outfit of sterilised hairnet, mask, gloves, gown and overshoes. Another patient, a 65-year-old man, lay inert on his bed, with streams of dried blood on his chin, nose and tongue. His shirt was also stained heavily with blood. Dr Akhlaq Hussain, the hospital's medical superintendent, said: "The first cases came in June. There were a number of deaths, but at first we did not know what was the cause." A number of blood samples were sent to Pakistan's national virology testing centre in Islamabad. They were then sent to South Africa's National Institute of Virology in Johannesburg for confirmation. Dr Hussain said: "When the results came back we knew we were dealing with Crimean-Congo Haemorrhagic Fever." He has compiled a list of all 75 cases, which involved refugees recently arrived from Afghanistan or people living close to the border. The first known case of the disease was among Russian soldiers serving in the Crimea in 1944 and then among villagers living near the Congolese city of Kisangani in 1956. Not until 1969 were scientists able to isolate the single virus common to both. Although there have been a number of cases since, the outbreaks have never been as large as the current one. The doctor said: "We had our first case in Pakistan in the 1970s. It would seem there is a reservoir of the virus in Afghanistan and we are now worried about the possible effects of an influx of many new refugees. "The virus is carried by domestic animals, and if they come in large numbers with large numbers of animals we can expect many more cases." The authorities in Pakistan have appealed to the World Health Organisation for additional supplies to help deal with the outbreak, including storage facilities for clean blood plasma and white blood cells which can be used to replace those lost by patients. The virus is widely distributed in the blood of sheep, cattle and other mammals across eastern Europe, Asia and Africa. It can be passed to man by a species of tick, Hyalomma marginatum, common in the same areas. If caught in time, CCHF can be treated by replacing enough of the lost body fluids to allow the patient's own immune system to take over and kill the virus. The facilities at Fatima Jinnah are basic, but the staff are dedicated and brave, treating patients even though there is a high risk of infection from spittle or blood.