VFUs spraying the Kabul Animal Market. @FAO

Gulab Jan, a livestock owner from Nangarhar province, tells us about how he experienced CCHF: “I attempted to manually remove the ticks from my livestock, unaware of the risks involved. I contracted the illness myself, experiencing symptoms such as fever, headache and muscle pain. It became clear this was not a normal fever when I started bleeding under my skin. The pain was unbearable and my fever stayed high, so I sought medical help. I was admitted to the hospital and placed in isolation, with only authorized doctors and nurses allowed to visit me. After a challenging period of 12 days, I fortunately recovered my health. Prior to this incident, I had limited knowledge about this dangerous disease. I am glad that the Veterinary Field Units operating in our area are spreading awareness about it”.

Gulab Jan may count himself lucky. The Crimean-Congo Hemorrhagic Fever has fatality rates of 10-40% according to the WHO, which uses as standard a 30% chance on death in the second week of illness among infected people. There is neither vaccine nor a specific treatment available. In the current outbreak of the disease in Afghanistan, 114 people have died so far from 1236 recorded cases[1] – a mortality rate slightly lower than 10% for the sturdy Afghans.

Given the high mortality rate and the lack of preventive or curative treatment, the World Health Organization takes CCHF very seriously; for the current outbreak in Afghanistan, it contracted @FAOAfghanistan to carry out a thorough campaign between October 2023 and February 2024. That is not an easy task in a country counting around 4.9 million cattle and 21 million sheep and goats[2].

CCHF is a viral infection that spreads between livestock and to humans mostly through tick bites. Another vector of transmission is direct contact with the blood or bodily fluids of infected animals or people, which is why butchers, veterinarians and health workers are particularly vulnerable to CCHF. Animals themselves don’t seem to be affected by the disease, or only slightly. But they can carry the disease for a long period, serving as a breeding ground.

When a person is infected by CCHF, after an incubation period of usually 1-3 days, typical fever symptoms set in alongside sore eyes and a high sensitivity to light. Nausea, vomiting, diarrhea, and a sore throat may also occur. After two to four days, initial mood swings give way to fatigue and depression; but the most telling sign of CCHF is internal bleeding (hemorrhage) on internal mucosal surfaces such as the mouth and throat. This eventually also occurs in the internal organs – liver, kidneys, lungs – which swell and burst, causing the patient’s death.

in 2023, FAO and WHO agreed on a project called “CCHF Outbreak Emergency Health Response in Kabul, Balkh, Nangarhar, Takhar, Kunduz, Herat and Kandahar”. It sought to minimize the likelihood of CCHF transmission by raising awareness, enhancing surveillance for early detection and taking preventive measures.

FAO used the “One Health” approach, bringing together veterinarians, healthcare providers, and various sectors to train veterinary field units (VFUs) in the early detection, treatment, prevention, control, and management of CCHF disease. These measures were incorporated into local-level planning, with implementation plans beginning at the district level and progressing to the national level.

FAO disseminated a million brochures in local languages along with 20 000 posters to raise awareness about CCHF prevention, directly reaching 55 520 households. The project also trained 519 veterinarians and 766 butchers on CCHF identification; these helped FAO collect more than 1 000 tick samples from the targeted areas, as well as 500 blood samples to monitor the spread of the disease. The extensive spraying that took place in 28 770 stables, 57 live animal markets and 16 entry gates to towns seems to have borne fruit: By the end of 2024 the disease seemed controlled, and there were only 26 new cases in January and 21 in February, causing no deaths.

The disease had a clear impact on the livestock sector. Murtaza shared his experience as a livestock trader in Herat. “When people became aware of CCHF, this had a significant impact on my business. Potential buyers were reluctant to purchase cattle from my stockyard due to concerns about the disease”. During this time, Murtaza instructed one of his farmhands to check the cattle for ticks. The worker attempted to remove ticks with his bare hands and subsequently fell seriously ill. Initially, they thought it was a common flu, but his condition worsened day by day. They had no choice but to rush him to the hospital, where the doctors diagnosed him with CCHF. Murtaza bore the financial burden of his farmhand’s treatment, spending nearly USD 1300, a significant setback for his business.

Ahmad Jan, a livestock farmer from Kandahar, stressed the difficulties faced by farmers during the recent CCHF outbreak. Potential buyers were cautious about purchasing animals that might be carrying the disease, inducing farmers to sell their sheep at significantly reduced prices, or not at all.

Although the disease seems largely controlled now, it may have ripple effects on the livestock market in the coming months. During Eid ul-Adha a great number of animals are sacrificed, leading to a higher risk environment for the spread of CCHF, as animals are moved from one region to the other and not all of them are slaughtered professionally. Since Eid ul-Adha takes place in hot weather this year (16-19 June), this risk is even higher. On the other hand, unreasonable and unfounded fears about CCHF unnecessarily affect the livestock market, despite our awareness-raising efforts.

We request all Afghans involved in the livestock sector to remain vigilant and take appropriate measures to reduce the chance of contamination.