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Eid-ul-Azha festival in Pakistan: A vulnerable time for Crimean-Congo hemorrhagic fever outbreak

      To the Editor:
      Crimean-Congo hemorrhagic fever (CCHF), a tick-borne viral hemorrhagic fever, is endemic to certain parts of Africa, Russia, Central Asia, and Pakistan. Due to its deadly complications and highly infectious nature, CCHF virus can be considered the Asian Ebola virus. In Pakistan, CCHF is endemic in the province of rural Balochistan and most cases reported in the country originate from this area.
      • Smego Jr., R.A.
      • Sarwari A.R.
      • Siddiqui A.R.
      Crimean-Congo hemorrhagic fever: prevention and control limitations in a resource-poor country.
      Many nosocomial outbreaks of CCHF have occurred in various cities of this country, including Quetta (1994), Karachi (2000), and Rawalpindi (2002).
      • Altaf A.
      • Luby S.
      • Jamil A.
      • Najam A.
      • Aamir Z.
      • Khan J.
      • et al.
      Outbreak of Crimean-Congo haemorrhagic fever in Quetta, Pakistan: contact tracing and risk assessment.
      • Athar M.N.
      • Baqai H.Z.
      • Ahmad M.
      • Khalid M.A.
      • Bashir N.
      • Smith E.J.
      • et al.
      Short report: Crimean-Congo hemorrhagic fever outbreak in Rawalpindi, Pakistan, February, 2002.
      • Jamil B.
      • Hasan R.S.
      • Sarwari A.R.
      • Burton J.
      • Hewson R.
      • Clegg C.
      Crimean-Congo hemorrhagic fever: experience at a tertiary care hospital in Karachi, Pakistan.
      These outbreaks have repeatedly demonstrated the vulnerability and lack of preparedness of the health care system for handling such problems.
      On the occasion of Eid-ul-Azha, an annual religious festival observed by Muslims, nearly 5 million animals are sacrificed across the country.
      • Hussain S.W.
      • Khan M.M.
      Poverty alleviation: the redistribution impact of Eid-ul-Azha animals' sacrifice on rural economy.
      However, no regulations have been implemented regarding the site and method of slaughter of animals for this festival. Most butchers slaughtering animals on the occasion of Eid-ul-Azha have received no formal training whatsoever, and are completely oblivious of the health hazards posed by direct exposure to blood. Consequently, most animals are slaughtered openly on the roads and streets without use of protective wear by the butcher. Cultural tradition is that many spectators gather around the butcher to watch the animal being slaughtered, potentially exposing themselves to contact with blood. Moreover, in many villages, and some urban areas, the blood and carcasses of slaughtered animals are left unattended for several days, which further compound the problem.
      Shepherds from Balochistan travel to other parts of the country on occasion of Eid-ul-Azha to sell their livestock. This provides a route for CCHF-infected animals from Balochistan to reach other parts of the country. Slaughtering of such animals in unhygienic ways can expose all involved to this highly contagious virus, and subsequent person-to-person transmission can potentially give rise to CCHF epidemics, thereby posing a serious threat to public health. Moreover, the aforementioned issues are not exclusive to Pakistan; many other countries from the Muslim world face similar issues on this particular religious occasion. There is a dire need to implement policies and enforce regulations on the sacrifice of animals during this religious festival to prevent potential catastrophes. The media can play a key role in this regard by highlighting this issue and bringing it to the attention of policy makers.

      References

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        • Sarwari A.R.
        • Siddiqui A.R.
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        • Altaf A.
        • Luby S.
        • Jamil A.
        • Najam A.
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        • Khan J.
        • et al.
        Outbreak of Crimean-Congo haemorrhagic fever in Quetta, Pakistan: contact tracing and risk assessment.
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        • Athar M.N.
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        Short report: Crimean-Congo hemorrhagic fever outbreak in Rawalpindi, Pakistan, February, 2002.
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        Crimean-Congo hemorrhagic fever: experience at a tertiary care hospital in Karachi, Pakistan.
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        Poverty alleviation: the redistribution impact of Eid-ul-Azha animals' sacrifice on rural economy.
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