Introduction
Viral hemorrhagic fevers (VHFs) are a group of viruses that affect multiple systems in the body (including the vascular system) and might cause bleeding. while the bleeding is often not life threatening, the virus however may cause illness ranging from mild to severe life threatening. Alkhurma virus belongs to the Flavivirdae family, an RNA single stranded virus, transmitted through tick bite, and is a variant of the virus kyasanur forest disease. It was first isolated in Saudi Arabia in 1994 and then 37 cases identified in Alkhumra district in Jeddah, 20 were laboratory confirmed and 5 died (fatality rate 25%). Later, it was isolated in a patient in Egypt and Djibouti thus geographical variation shows extended transmission of the virus and possible underreporting. "The persistence of the virus within tick populations, and the role of livestock in the disease transmission process, are not well understood." And so, the need for further investigation and understanding of the virus is needed.
Objectives:-Explore data of Alkhurma virus patients available.-Describe patients in terms of demographic, Symptoms, and animal contact and transmission hazards.-Establish an understanding of the pattern of the virus in the population.
Methodology
The study was conducted as observational descriptive study based on reviewing the reports of confirmed Alkhurma cases from all the regions of the kingdom (reported to ministry of health in Riyadh) which totals to 169 confirmed reports for the period 1-Jan 2014 till 31-Dec 2016. Data collected, entered, cleaned, then general frequencies and means were made and (chi square and P values were difficult to obtain due to lack of data).
Results
Reported patients between Jan-2014 until Dec-2016 (N=169) had 78.6% of cases originating from Najran followed in frequency by Jeddah 12%. While Mecca had 5.3% of cases, and Taif with 4.1% of cases. Majority are of Saudi Nationality (60%) followed by Yemeni Nationality (25%) and then the other nationalities (Egyptian, Indian, Ethiopian, Sudanese, Syrian, Pakistani, Palestinian, Nepal, UAE, and Manymar -ranging from 0.6% to 4.7%-). Male patients were 65.7% Age Range between 14 - 44 years old account for 70%. Only 20% had a contact-with-animal occupation whether it was cows, sheep, or camels. 30% were housewives with not enough data about contact with raw meat, and 28% either employees or student also with not enough data about possible contact. The rest of the patients in the study population were either children or had no jobs. Most were hospitalized (91%) with symptoms including fever, malaise, headache, myalgia, anorexia, nausea, vomiting, arthralgia, and chills (ranging from 54%-89%) but with low frequency of any kind of hemorrhage. Vital signs wise, mostly normotensive with normal pulse. respiratory rate and temp were increased in 66.4% and 62% respectively. No significant movement outside residence area or tick presence around the house or bite, but around 40% were exposed to mosquito bite and 35% reported presence of mosquitos in their house (Refer to tables 4 and 5). Additionally, 55% weren't even exposed to animals. 30.55% had animals beside home, and 24.29% had animals inside their house. No significant complications were found and mostly recovering completely (94%) with only 1 recorded death. It takes 5 days (±3.9) from onset of symptoms to presentation to hospital and admission. And 17 days (±27) to reach final diagnosis.
Conclusion
Though the virus causes a mild infection that mostly recovers completely with no consequences with very rare morbidity and mortality yet the burden on the hospital stays, medication, and days off activities (work/home) Needs attention. Educate\implement proper filling of reports for further data availability for further understanding of the virus's patterns. Further investigation of other reports from previous years or future reports might merit better results and more information. Focus attention on Najran in terms of prevention and education. Further study of female, student, and employee patient population for mode of infection (raw meat handling, animal contact, patient contact, or other risks). Education of high risk population about the virus. Possible legislation of foreign workers to be educated about the virus and how to handle livestock and control over slaughter houses and selling market.