Saudi Gazette report

JEDDAH – Government hospitals in Jeddah have been alerted following the fresh outbreak of Alkhurma hemorrhagic fever (AHF), which is named after a township located close to Makkah, where the first cases of Alkhurma fever were reported about 20 years ago.

During the past years more than 40 Alkhurma cases have been reported in the Kingdom. The fever hits mainly shepherds and cattle owners as well as butchers, cleaners and housewives. Pilgrims who slaughter sacrificial animals may also contract the disease.

The Health Affairs in Jeddah has asked hospitals to inform it about new cases of the disease as quickly as possible, Al-Hayat Arabic newspaper reported.

Internist Dr. Sami Barood, former director general of health in Jeddah, said Alkhurma was first discovered among six patients in 1994. It is named after Alkhurma, a kind of sheep found in a township of the same name close to Taif.

Later 11 cases have been discovered in Khumra, south Jeddah, Barood said. There were new outbreaks of the hemorrhagic fever in 1999 and 2001 and 20 new cases were reported between 2001 and 2003.

Barood said domesticated animals such as cats and rabbits are likely carriers and transmitters of Alkhurma virus from animals to humans. “There is no scientific proof confirming the disease being transmitted through mosquitoes,” he said.

People who drink fresh milk of cow, sheep and camel without boiling may contract the disease, Barood said. Alkhurma is similar to Dengue but there are some basic differences between the two fevers, he added.

“Dengue is transmitted through mosquitoes while Alkhurma is transmitted through animal ticks,” he pointed out.

A person affected by Alkhurma will have fever, headache and body pain lasting for three to eight days.

Alkhurma fever is caused by Alkhurma hemorrhagic fever virus (AHFV), a tick-borne virus of the Flavivirus family. The virus was initially isolated in 1995 from a patient in Saudi Arabia.

Subsequent cases of AHF have been documented in tourists in Egypt, extending the geographic range of the virus and suggesting that geographic distribution of the virus is wide and that infections due to AHFV are underreported.

“The persistence of the virus within tick populations, and the role of livestock in the disease transmission process, are not well understood,” said the US Center for Disease Control and Prevention (CDC).

The AHFV virus is a variant of Kyasanur Forest Disease (KFD), a tick-borne Flavivirus found in Karnataka State and environs in India.

Since the first description of AHFV, several hundred cases of AHF have been reported. Cases appear to peak in spring and summer. Further study of AHFV is needed to improve public health measures.

People can become infected through a tick bite or when crushing infected ticks. Epidemiologic studies indicate that contact with domestic animals or livestock may increase the risk of human infection. No human-to-human transmission of AHF has been documented, the CDC said.

Although livestock animals may provide blood meals for ticks, it is thought that they play a minor role in transmitting AHFV to humans. No transmission through non-pasteurized milk has been described, although other tick-borne flaviviruses have been transmitted to humans through this route.

Based on limited information, after an incubation period that could be as short as 2-4 days, the disease presents initially with non-specific flu-like symptoms, including fever, anorexia (loss of appetite), general malaise, diarrhea, and vomiting; a second phase has appeared in some patients, and includes neurologic and hemorrhagic symptoms in severe form.

Multi-organ failure precedes fatal outcomes. No repeated or chronic symptoms have been reported following recovery. Evidence suggests that a milder form may exist, where hospitalization is not required.

“Given that no treatment or specific prophylaxis is presently available, prevention and increased awareness of AHFV are the only recommended measures,” the CDC said.

Complete control of ticks and interruption of the virus life cycle is impractical; in endemic regions, it is important to avoid tick-infested areas and to limit contact with livestock and domestic animals, it added.