Integrated One Health Surveillance and Tick-Control Shorten Time-to-Diagnosis in Crimean-Congo Hemorrhagic Fever, Pakistan (2014–2024)

Abstract Crimean-Congo Hemorrhagic fever (CCHF) causes seasonal outbreaks in Pakistan, amplified by Hyalomma tick-infested livestock traded during Eid-ul-Adha. Historically, fragmented human and veterinary surveillance impeded timely response. In 2019, Pakistan’s National Institute of Health (NIH) launched a One Health Hub which, with provincial partners, piloted an integrated CCHF surveillance and control program (2021–2024) in three high-risk districts (Quetta, Zhob, and Dera Ghazi Khan). Key components included: (i) a real-time One Health Dashboard merging alerts from the human Integrated Disease Surveillance & Response (IDSR) system, a Veterinary Field Unit mobile app, and abattoir tick counts; (ii) bi-annual acaricide (tick pesticide) campaigns on livestock; and (iii) risk communication delivered through religious leaders to encourage community engagement in tick control. A mixed-methods, retrospective cohort evaluation compared outcomes before and after the intervention. Quantitatively, the integration reduced the median onset-to-diagnosis interval from 9 days to 5 days (–43%, p < 0.001) and lowered tick-infestation indices by 31%. An economic analysis using disease burden estimates and DALYs found an incremental cost-effectiveness ratio (ICER) of US$610 per DALY averted, well below Pakistan’s GDP-per-capita threshold for “highly cost-effective” interventions. Qualitative interviews indicated improved cross-sector trust but noted persistent bottlenecks in personal protective equipment (PPE) and acaricide supply. This case details the transdisciplinary process, integrating human, animal, and environmental data, and assesses the impact against International Health Regulations (2005) core capacities. It offers a practical example of One Health co-innovation in a resource-limited setting and suggests strategies for sustainable scaling of integrated surveillance and control of vector-borne zoonoses. Information © The Authors 2025