On 23 May, 1990, the Makkah Health Directorate reported that 7 patients had presented to Makkah hospitals with suspected viral hemorrhagic fever (VHF). Five of them had died. Uncertainty about the extent of spread of this highly fatal disease and its causative agent demanded an investigation.
Methodology
We defined a suspect case of VHF as a febrile illness with a hemorrhagic diathesis beginning from 3 to 8 days after onset. We interviewed survivors and treating physicians and reviewed discharges and hematology records from all Makkah hospitals (8) since August 1989. We tested blood specimens from survivors by indirect immunofluorescence (IFA) for antibody against several viral agents of VHF.
Results
From August 1989 to July 1990, we found 28 suspect VHF cases. Of these, 16 had IFA results compatible with recent Congo Crimean Hemorrhagic Fever (CCHF) virus infection and 12 had died. All cases were among adults and 72% were in males. Five were slaughterhouse employees and 52% lived in southwest Makkah where the slaughterhouse was. Of 16 exposure histories obtained 75% had exposure to a freshly killed sheep during the 14 days before onset or had occupational exposure fresh meat.
Conclusion
CCHF is virus probably endemic in Saudi Arabia with infection related to animal slaughter and handling fresh meat.