In late June, 23-year-old Shokhida Ismailova gave birth to her second child at a hospital in the Turkistan district of Kazakhstan's southernmost South Kazakhstan Province.
But ensuing complications and surgeries led to more complications and surgeries. Within a few weeks Ismailova, her newborn, two surgeons, and a pediatrician at the hospital were dead.
Ismailova had contracted Congo-Crimean hemorrhagic fever from a tick that latched on to her in her home. Breast-feeding in turn transmitted the disease to her newborn. Continued bleeding that required two operations after her delivery spread the disease to the surgeons, and the pediatrician got it from the baby.
At least one other person in Kazakhstan has died of the fever in recent months, and many more are believed to have been infected.
The outbreak is even worse in Tajikistan, where tens are believed to have died this summer, including physicians, and the number of those infected could number in the hundreds.
Signs Of Panic
Congo-Crimean hemorrhagic fever gets its name from its discovery in the Crimea in the 1940s, and subsequent outbreak in the Congo in the late '60s. The disease is carried by ticks, which often live off wild and domesticated animals, and has been found in Eastern Europe, the Mediterranean, parts of China, and Central Asia.
Predictably, news of the latest spread of Congo-Crimean hemorrhagic fever in Central Asia has caused panic in some areas.
Sadbarg Kamolova, a resident of Tajikistan's southern Temurmalik district, in the Kulob region, gave this account of the fears that enveloped her family when a relative became ill after reports of a nearby outbreak of hemorrhagic fever.
"All our family members were in trouble when my uncle felt ill. He has some cows and sheep. Thank God, the results were negative,” she said. “Everyone in our village is engaged in agriculture and is very concerned. Already the illness is widespread in the neighboring village."
Following a request from the Tajik government, the World Health Organization (WHO) has stepped in to help.
As reports surfaced that four infected people in Kulob were recovering from the fever, WHO and Tajik officials held a joint seminar on August 24 to inform locals about preventive measures they can take.
"A group of three consultants from the WHO arrived in the country to assist us on diagnostics, cures, and preventive measures at the sources of the epidemic, and to evaluate what has been done by Tajik Health Ministry specialists,” said Tajik Deputy Health Minister Aazam Mirzoev. “They will share with us their own vision and solutions where needed, and evaluate where and what kind of aid could be helpful."
Mild And Severe Cases
Dr. Pierre Rollin, acting chief of the Special Pathogens Branch at the Center for Disease Control in Atlanta, Georgia, told RFE/RL that Congo-Crimean hemorrhagic fever is no stranger to Central Asia.
"This virus has been known in this area for decades; it's not a new virus,” Rollin said. “This virus has been described there in the 1940s, 1950s, so every year there is some that pops up here and there. There are two ways to be infected -- from ticks or from contact with [the blood of] the patient."
Stressing that one would have to come into contact with the blood of an infected person to contract the virus from a human, Rollin explained that different people can react in different ways to the virus.
Sometimes, “the disease can be very mild,” Rollin said. “We don't know why there is mild disease and severe disease. Some get fever like a flu and it goes away in a few days and people recover.”
In severe cases, however, the patient can hemorrhage under the skin and or internally. This is usually accompanied by very high fever. These symptoms are particularly dangerous, Rollin said, “if it is digestive bleeding, vomiting or diarrhea with blood, and in that case the prognosis is not very good, and the patient should be kept under very good care."
Rollin stressed that the virus cannot be passed by eating the meat of an animal that had an infected tick on it. “The animal may be infected with the virus but have no sign, no symptom, and the virus is really not in the meat,” he said.
So what can people in areas where the infection already exists do to limit the possibility of becoming infected?
"They should limit the number of people who are in contact with the patient, and then they should use gloves, or if you have to touch something that could be infectious, you can put on a plastic bag if you don't have a glove,” Rollin explains. “Bleach will destroy the virus; any detergent will destroy the virus. So for example, say you have a patient that had some bleeding and you want to take care of the bed sheets, to clean them, you should use a plastic bag to remove them or put them in a bucket of water and bleach and leave it for 30 minutes or an hour and that will destroy the virus.”
Rollin continued: “Be sure to clean all the instruments that have been used, all the tables, spoons, forks they used when they ate, all the glasses that the patient has used to drink. Disinfect it; water with bleach will destroy the virus; detergent will destroy the virus."
Rollin also stressed the importance of basic hygiene.
"Using soap, washing one’s hands very often is effective at destroying any virus that is on the skin,” he said. “We don't think the virus can penetrate the skin…so wash your hands as often as you can with detergent or soap and it will be good."
Rural areas in Central Asia are often far from the nearest medical center, meaning it could take hours, or days, before someone infected with the fever can be brought to a hospital.
Rollin emphasizes the need for speed in getting an infected person to a medical facility. He gave the following tips for helping someone who has contracted the disease in the interval before they can receive medical care.
Infected “people bleed and have diarrhea, and they are going to lose a lot of water, so [others] should keep giving liquid to the patient. Try to avoid giving aspirin, for example, as that will cause more bleeding. They should try to contact healthcare” services as soon as possible, he said. “And again, if you have a case in the family, that means most likely this individual has been bitten by a tick that has been infected, so people should really pay attention to ticks in this area.”
Rollin says that anyone bringing a potentially infected person to a medical center should inform healthcare officials immediately about contact or suspected contact with ticks, so medical staff can take the appropriate precautions.
And he said people in these rural areas should check themselves and their clothes often, especially before entering their homes, to be sure they do not have any ticks on them.
RFE/RL Kazakh Service director Edige Magauin and Salimjon Aioubov and Iskander Aliev of RFE/RL's Tajik Service contributed to this report.