1. Crimean Congo Hemorrhagic Fever- Pakistan Perspective National Institute of Health, Islamabad-Pakistan

2. Case Reporting of CCHF at NIH First Case: reported in 1976 1976-2002: Cases reported = 187 2003-2004: Cases reported = 403 2005-2011:Cases reported = 922 All recorded Sporadic and Nosocomial outbreaks Risk factors: Prevalence of tick vector, Animal trade

3. Lab Methodologies used at NIH Routine/Current Diagnosis: ELISA Kits used: BDSL IgM Capture ELISA RT-PCR Reference protocol: “Polymerase Chain Reaction for Diagnosis and Identification of Distinct Variants of Crimean-Congo Hemorrhagic Fever Virus in the United Arab Emirates. American Journal of Tropical Medicien and Hygiene, 55(2), 1996, pp. 190-196” Genetic Sequencing: National Institute of Health, Pakistan holds the thorough capability including infrastructure and trained personnel but deficit of resources Discontinued methodologies: Electron Microscopy Inoculation in suckling mice Fluorescent Microscopy

4. Phylogenetic relationship of CCHF viruses detection during 2008-Quetta-Pakistan Outbreak 2008 PAK viruses (denoted by●) with Closest homology to: Asia Type-I Pakistan 1976, 2001 and 2002 viruses (denoted by ) as well as with Iran, Afghanistan Under Publication

5. Future Needs for CCHF Lab Diagnosis at HIH No recent changes to the lab diagnostic protocols Need to establish a separate Core laboratory facility early service provision under improved standards Establishment of standard guidelines for lab diagnosis

6. Safety Precautions being used at NIH BSL-II+ Laboratory with enhanced PPE Separate Designated areas for sample receipt, processing and testing Restricted personnel access Waste management through Autoclaving and incineration

7. Thanks