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Crimean-Congo Hemorrhagic Fever Outbreak Affecting Healthcare Workers In Pakistan: An Urgent Rising Concern
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... Unfortunately, several hours later, the woman passed away, likely due to complications from the JHR triggered by antibiotic treatment [7] . Other conditions such as dengue hemorrhagic fever, and Crimean-Congo hemorrhagic fever could be misdiagnosed as severe malaria as well [8,9] . ...
... Unfortunately, several hours later, the woman passed away, likely due to complications from the JHR triggered by antibiotic treatment [7] . Other conditions such as dengue hemorrhagic fever, and Crimean-Congo hemorrhagic fever could be misdiagnosed as severe malaria as well [8,9] . ...
Background:
The Jarisch–Herxheimer reaction (JHR) was a nonspecific adverse effect manifested by fever, chills, headache, myalgia, and exacerbations of skin rash that’s firstly described with anti-spirochetes medications and later with fluoroquinolones, cephalosporins, meropenem, and tetracyclines but not with antiparasitic drugs. Herein we reported JHR in a young Sudanese male due to antimalarial medications with good outcomes.
Case Presentation:
A 27-year-old Sudanese man presented with malaria-like symptoms and was given an oral artemisinin combination. However, within 8 h, the patient developed high-grade fever, chills, rigors, recurrence of the headache, tachycardia, myalgia, and tachypnoea, which was diagnosed as a JHR. The drug was temporarily stopped, the patient was hydrated, and an antipyretic was given, then the drug was restarted with a good response. Viral screening and syphilis tests were negative while blood tests showed leukocytosis, lymphopenia, and left shift in granulocytes.
Discussion:
In this case, the patient received Coartem 80/480 (artemether 80 mg/lumefantrine 480 mg). Eight hours after starting treatment, his fever dropped to 37.8°C, with other symptoms improving. Surprisingly at 8 h, the patient developed a second fever of 39.4°C, with chills, headache, tachycardia, a pulse rate of 103, myalgia, and hyperventilation. This is comparable with Koefoed’s case, where the patient received Fansidar (sulfadoxine/pyrimethamine). His JHR started 10 h later, indicated by the second rise in temperature.
Conclusion:
JHR can occur with antimalarial medications, most commonly by non-specific symptoms and worsening of pre-existing skin lesions; this requires a high clinical susceptibility, particularly within the first 24 h, with treatment discontinuation and hydration as the mainstay of management, with good outcomes.
... Being a zoonotic disease, the main risk groups are farmers, veterinarians and slaughterhouse workers in endemic areas, and the most affected occupational groups are farmers and/or domestic workers and slaughterhouse workers. The second most affected group is medical staff in contact with infected patients using inappropriate personal protective equipment and processing inappropriate clinical practices [8,9]. From November 2015 to November 2019, human health services in Senegal confirmed eight human cases of CCHF, including four cases in 2019 in different geographical areas and three other cases imported from Mauritania, a neighboring country. ...
Citation: Gahn, M.C.B.; Diouf, G.; Cissé, N.; Ciss, M.; Bordier, M.; Ndiaye, M.; Bakhoum, M.T.; Djiba, M.L.; Brown, C.; Faburay, B.; et al. Abstract: Crimean-Congo hemorrhagic fever (CCHF) and Rift Valley fever (RVF) are among the list of emerging zoonotic diseases that require special attention and priority. RVF is one of the six priority diseases selected by the Senegalese government. Repeated epidemic episodes and sporadic cases of CCHF and RVF in Senegal motivated this study, involving a national cross-sectional serological survey to assess the distribution of the two diseases in this country throughout the small ruminant population. A total of 2127 sera from small ruminants (goat and sheep) were collected in all regions of Senegal. The overall seroprevalence of CCHF and RVF was 14.1% (IC 95%: 12.5-15.5) and 4.4% (95% CI: 3.5-5.3), respectively. The regions of Saint-Louis (38.4%; 95% CI: 30.4-46.2), Kolda (28.3%; 95% CI: 20.9-35.7), Tambacounda (22.2%; 95% CI: 15.8-28.6) and Kédougou (20.9%; 95% CI: 14.4-27.4) were the most affected areas. The risk factors identified during this study show that the age, species and sex of the animals are key factors in determining exposure to these two viruses. This study confirms the active circulation of CCHF in Senegal and provides important and consistent data that can be used to improve the surveillance strategy of a two-in-one health approach to zoonoses.
Congo virus, or Crimean–Congo hemorrhagic fever (CCHF), is a tick-borne disease caused by a single-stranded RNA virus (genus nairovirus, Bunyaviridae family). It spreads through infected ticks' bites or contact with viremic individuals or livestock. Factors supporting its spread include hot, humid climates, limited pesticide use, poor animal control, inadequate irrigation during monsoons, and vector control deficiencies. Nosocomial transmission in under-resourced hospitals poses a threat to healthcare workers. Decades of CCHF cases persist in Pakistan due to these factors, with six deaths reported by June 2023. To combat the epidemic, Pakistan should raise awareness, improve irrigation, establish surveillance systems, and implement livestock quarantine and vaccination.
The Crimean-Congo hemorrhagic fever (CCHF) virus is a tick-borne virus that can spread from infected people and other animals, including cattle and ticks of the Hyalomma genus. People who are infected describe symptoms that range from flu-like manifestations to severe multi-organ failure. With a death rate between 10% and 30%, the virus is undoubtedly a disease of high concern. With 10,000-15,000 cases/y, it is endemic in parts of Asia, Africa, and South-Eastern Europe. There has been a recent CCHF outbreak in Iraq, with 212 cases documented, 80% of which were reported between April and May and led to 27 fatalities.
Crimean-Congo hemorrhagic fever (CCHF), caused by Crimean-Congo hemorrhagic fever virus (CCHFV), is endemic in Africa, Asia, and Europe, but CCHF epidemiology and epizootiology is only rudimentarily defined for most regions. Here we summarize what is known about CCHF in Central, Eastern, and South-eastern Asia. Searching multiple international and country-specific databases using a One Health approach, we defined disease risk and burden through identification of CCHF cases, anti-CCHFV antibody prevalence, and CCHFV isolation from vector ticks. We identified 2,313 CCHF cases that occurred in 1944–2021 in the three examined regions. Central Asian countries reported the majority of cases (2,026). In Eastern Asia, China was the only country that reported CCHF cases (287). In South-eastern Asia, no cases were reported. Next, we leveraged our previously established classification scheme to assign countries to five CCHF evidence levels. Six countries (China, Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan, and Uzbekistan) were assigned to level 1 or level 2 based on CCHF case reports and the maturity of the countries’ surveillance systems. Two countries (Mongolia and Myanmar) were assigned to level 3 due to evidence of CCHFV circulation in the absence of reported CCHF cases. Thirteen countries in Eastern and South-eastern Asia were categorized in levels 4 and 5 based on prevalence of CCHFV vector ticks. Collectively, this paper describes the past and present status of CCHF reporting to inform international and local public-health agencies to strengthen or establish CCHFV surveillance systems and address shortcomings.
Crimean‐Congo hemorrhagic fever (CCHF) is an infection caused by a tick‐borne virus (genus: Nairovirus, family: Bunyaviridae). The most important vector for CCHF is the ixodid tick. Along with tick bite, direct contact with the virus‐affected animal is responsible for its spread. Pakistan witnessed its first case of CCHF in 1976 and has been a major victim of CCHF for years, but spikes in cases are seen after Eid‐ul‐Adha, an Islamic festival involving the sacrifice of cattle. The disease, in particular, is common among butchers, veterinarians, and livestock workers. From the start of this year till June 22, 2022, a total of four cases have been reported across the country. Pakistan faces major challenges in combating CCHF every year due to its specific geographical position and a majority of the population being involved with animal husbandry. There is no approved vaccine for its prevention. All these factors contribute to the burden on the already weakened healthcare system of Pakistan. Strict actions should be taken to contain the spread of the disease. The need of the hour is to engage the general population, raise awareness, and develop policies to ensure disease surveillance. This should be accompanied by fostering collaboration among animal and human health departments for efficient communication and early intervention. The focus should be on medical research to find an efficacious treatment and prophylaxis for the CCHF virus, which will be the cornerstone of future CCHF prevention and control strategies.
Introduction: Crimean-Congo hemorrhagic fever (CCHF) is an acute fetal illness the case fatality rate (CFR), which without treatment is between 26% to more than 80%. Despite the administration of ribavirin as a specific antiviral drug for the treatment of CCHF from many years ago, its clinical efficacy is still controversial. Objectives: This systematic review aimed to evaluate the clinical efficacy of ribavirin, favipiravir, and other treatment options for CCHF, including steroids, immunoglobulin, etc. Method: This systematic review included 31 articles, three factsheet from WHO, CDC, and ECDC, two editorial letters, and two textbooks from 2002 to 2020. The following databases were searched: Google Scholar, PubMed, Medscape, Cochrane, WHO, CDC, and ECDC. Results: The selected results of the above articles were concentrated on the different options of supportive treatment, including steroids, immunoglobulin, etc., as well as the efficacy of antiviral drugs, especially ribavirin and favipiravir. While some studies confirmed the clinical efficacy of ribavirin in the treatment of CCHF, some other studies did not confirm its efficacy. All studies justified that supportive therapies are the mainstay of treatment. Conclusions: The cornerstone of therapy of CCHF is supportive treatment. The clinical efficacy of ribavirin for CCHF treatment is questionable, and further randomized case-control clinical trials are required to confirm and recommend it for CCHF treatment. Also, other treatment strategies, including administration of steroids, immunoglobulin, and monoclonal antibodies (mAbs) require more conclusive data. The promising antiviral drug for CCHF treatment is favipiravir.
There are uncertainties about the global epidemiological data of infections due to Crimean-Congo hemorrhagic fever virus (CCHFV). We estimated the global case fatality rate (CFR) of CCHFV infections and the prevalence of CCHFV in humans, ticks and other animal species. We also explored the socio-demographic and clinical factors that influence these parameters. In this systematic review with meta–analyses we searched publications from database inception to 03rd February 2020 in Pubmed, Scopus, and Global Index Medicus. Studies included in this review provided cross-sectional data on the CFR and/or prevalence of one or more targets used for the detection of CCHFV. Two independent investigators selected studies to be included. Data extraction and risk of bias assessment were conducted independently by all authors. Data collected were analysed using a random effect meta-analysis. In all, 2345 records were found and a total of 312 articles (802 prevalence and/or CFR data) that met the inclusion criteria were retained. The overall CFR was 11.7% (95% CI = 9.1–14.5), 8.0% (95% CI = 1.0–18.9), and 4.7% (95% CI = 0.0–37.6) in humans with acute, recent, and past CCHFV infections respectively. The overall CCHFV acute infections prevalence was 22.5% (95% CI = 15.7–30.1) in humans, 2.1% (95% CI = 1.3–2.9) in ticks, and 4.5% (95% CI = 1.9–7.9) in other animal species. The overall CCHFV recent infections seroprevalence was 11.6% (95% CI = 7.9–16.4) in humans and 0.4% (95% CI = 0.0–2.9) in other animal species. The overall CCHFV past infections seroprevalence was 4.3% (95% CI = 3.3–5.4) in humans and 12.0% (95% CI = 9.9–14.3) in other animal species. CFR was higher in low-income countries, countries in the WHO African, South-East Asia and Eastern Mediterranean regions, in adult and ambulatory patients. CCHFV detection rate in humans were higher in CCHFV suspected cases, healthcare workers, adult and hospitalized patients, ticks of the genus Ornithodoros and Amblyomma and in animals of the orders Perissodactyla and Bucerotiformes. This review highlights a significant disease burden due to CCHFV with a strong disparity according to country income levels, geographic regions, various human categories and tick and other animal species. Preventive measures in the light of these findings are expected.
Crimean-Congo hemorrhagic fever virus (CCHFV) is an arthropod-borne virus (arbovirus), mainly transmitted by ticks, belonging to the genus Orthonairovirus (family Nairoviridae, order Bunyavirales). CCHFV causes a potentially severe, or even fatal, human disease, and it is widely distributed in Africa, Asia, eastern Europe and, more recently, in South-western Europe. Until a few years ago, no cases of Crimean-Congo hemorrhagic fever (CCHF) had been reported in western Europe, with the exception of several travel-associated cases. In 2010, the CCHFV was reported for the first time in South-western Europe when viral RNA was obtained from Hyalomma lusitanicum ticks collected from deer in Cáceres (Spain). Migratory birds from Africa harboring CCHFV-infected ticks and flying to Spain appear to have contributed to the establishment of the virus (genotype III, Africa-3) in this country. In addition, the recent findings in a patient and in ticks from deer and wild boar of viral sequences similar to those from eastern Europe (genotype V, Europe-1), raise the possibility of the introduction of CCHFV into Spain through the animal trade, although the arrival by bird routes cannot be ruled out (Africa-4 has been also recently detected). The seropositive rates of animals detected in regions of South-western Spain suggest an established cycle of tick-host-tick in certain areas, and the segment reassortment detected in the sequenced virus from one patient evidences a high ability to adaptation of the virus. Different ixodid tick genera can be vectors and reservoirs of the virus, although Hyalomma spp. are particularly relevant for its maintenance. This tick genus is common in Mediterranean region but it is currently spreading to new areas, partly due to the climate change and movement of livestock or wild animals. Although to a lesser extent, travels with our pets (and their ticks) may be also a factor to be considered. As a consequence, the virus is expanding from the Balkan region to Central Europe and, more recently, to Western Europe where different genotypes are circulating. Thus, seven human cases confirmed by molecular methods have been reported in Spain from 2016 to August 2020, three of them with a fatal outcome. A One Health approach is essential for the surveillance of fauna and vector populations to assess the risk for humans and animals. We discuss the risk of CCHFV causing epidemic outbreaks in Western Europe.
Members of the family Nairoviridae produce enveloped virions with three single-stranded RNA segments comprising 17.1 to 22.8 kb in total. These viruses are maintained in arthropods and transmitted by ticks to mammals or birds. Crimean-Congo hemorrhagic fever virus is tick-borne and is endemic in most of Asia, Africa, Southern and Eastern Europe whereas Nairobi sheep disease virus, which is also tick-borne, causes lethal haemorrhagic gastroenteritis in small ruminants in Africa and India. This is a summary of the International Committee on Taxonomy of Viruses (ICTV) Report on the family Nairoviridae, which is available at ictv. global/ report/ nairoviridae.
p>In March 2020, following the annual International Committee on Taxonomy of Viruses (ICTV) ratification vote on newly proposed taxa, the phylum Negarnaviricota was amended and emended. At the genus rank, 20 new genera were added, two were deleted, one was moved, and three were renamed. At the species rank, 160 species were added, four were deleted, ten were moved and renamed, and 30 species were renamed. This article presents the updated taxonomy of Negarnaviricota as now accepted by the ICTV.</p
Objective: Crimean-Congo hemorrhagic fever (CCHF) is an acute and highly fatal disease. In this study, our aim was to compare and evaluate the prevalence of CCHF virus (CCHFV) antibody among occupational high-risk groups by using the enzyme-linked immunosorbent assay and draw attention to the occupational groups that are at high risk for CCHF infection in an endemic region for this zoonotic infection in Erzurum, Turkey.
Materials and Methods: The antibody levels against CCHFV were surveyed among slaughterhouse workers, animal breeders, and veterinarians. The study population was composed of 72 participants having direct contact with animals and 19 blood donors who were not in direct contact with animals.
Results: The overall rate of CCHF immunoglobulin G positivity in risk groups was found to be 6.94% (5/72). CCHFV antibodies were found in 4 (12.5%) individuals of the animal breeder group. This ratio was considered significantly higher compared with the healthy control group. CCHFV antibodies were found in only one person (4.0%) who was an abattoir worker. In the veterinarian group, all people were found negative.
Conclusion: In our study, the variables showing important associations with the prevalence of anti-CCHFV antibodies were livestock breeding, rural areas, and age. It was concluded that our region is endemic with regard to CCHF infection and persons who had direct contact with animals are at high risk. Thus, these participants must take necessary measures to protect themselves from CCHF and should be trained by health authorities.
Keywords: Animal breeder, Crimean-Congo hemorrhagic fever, seroprevalence, slaughterhouse worker, veterinarian
Crimean-Congo haemorrhagic fever (CCHF) is a widespread tickborne disease that circulates in wild and domestic animal hosts, and causes severe and often fatal haemorrhagic fever in infected humans. Due to the lack of treatment options or vaccines, and a high fatality rate, CCHF virus (CCHFV) is considered a high-priority pathogen according to the WHO R&D Blueprint. Several commercial reverse transcriptase PCR (RT-PCR) and serological diagnostic assays for CCHFV are already available, including febrile agent panels to distinguish CCHFV from other viral haemorrhagic fever agents; however, the majority of international laboratories use inhouse assays. As CCHFV has numerous amplifying animal hosts, a cross-sectoral ‘One Health’ approach to outbreak prevention is recommended to enhance notifications and enable early warning for genetic and epidemiological shifts in the human, animal and tick populations. However, a lack of guidance for surveillance in animals, harmonisation of case identification and validated serodiagnostic kits for animal testing hinders efforts to strengthen surveillance systems. Additionally, as RT-PCR tests tend to be lineage-specific for regional circulating strains, there is a need for pan-lineage sensitive diagnostics. Adaptation of existing tests to point-of-care molecular diagnostic platforms that can be implemented in clinic or field-based settings would be of value given the potential for CCHFV outbreaks in remote or low-resource areas. Finally, improved access to clinical specimens for validation of diagnostics would help to accelerate development of new tests. These gaps should be addressed by updated target product profiles for CCHFV diagnostics.
Crimean-Congo hemorrhagic fever (CCHF) is the most wide-spread, tick-borne viral disease affecting humans. The disease is endemic in many regions such as Africa, Asia, Eastern and Southern Europe, and Central Asia. Recently, the incidence of CCHF has increased rapidly in the countries of the Eastern Mediterranean Region of the World Health Organization (WHO), with sporadic human cases and outbreaks of CCHF being reported from a number of countries in the region. Despite the rapidly growing incidence of the disease, there is currently no accurate data on the burden of the disease in the region due to different surveillance systems for CCHF in the countries. In an effort to increase our understanding of the epidemiology and risk factors for the transmission of CCHF virus (CCHFV; a Nairovirus of the family Bunyaviridae) in the WHO Eastern Mediterranean Region, and to identify the current knowledge gaps that are hindering effective control interventions, a sub-regional meeting was organized in Muscat, Oman, from 7-9 December, 2015. This article summarizes the current knowledge of the disease in the region, identifies the knowledge gaps which present challenges for the prevention and control of CCHFV and details a strategic framework for research and development activities which would be necessary to curb the ongoing and new threats posed by CCHFV.
PurposeCrimean-Congo hemorrhagic fever (CCHF) is a zoonotic viral disease with high mortality. The agent causing CCHF is a Nairovirus. The virus is typically transmitted to humans through tick bites. CCHF is a life-threatening disease observed endemically over a wide geographical regions in the world and a little known about pulmonary findings in CCHF patients. Methods
The patients that were admitted and diagnosed with CCHF between April 2010 and September 2015 were examined. Patients’ medical records were then evaluated retrospectively. Patients who underwent thorax CT evaluation based on the clinical findings at the time of admission and/or during the hospital stay were included in the study. Patients’ laboratory test results and thorax CT findings for respiratory assessment along with demographic characteristics. ResultsForty patients diagnosed with CCHF that underwent thorax CT based on their indications were included in the study. Twenty-seven patients (62.5 %) were male with a mean age of 55.22 ± 19.84 years. According to these results, the three most common thorax CT findings were parenchymal infiltration [32 patients (80 %)], pleural effusion [31 patients (77.5 %)], and alveolar infiltration [28 patients (70 %)]. Moreover, we determined that the most frequently seen radiological findings often occurred bilaterally. Conclusions
There is still not enough information regarding this life-threatening disease. We also would like to emphasize that both direct radiography and thorax CT are highly successful in detecting frequently encountered radiological findings such as pleural effusion, alveolar hemorrhage, and parenchymal infiltration that indicate pulmonary involvement.
Crimean-Congo hemorrhagic fever virus (CCHFV) is a widely distributed hemorrhagic fever virus found throughout Eastern Europe, Africa, the Middle East and Asia. It is spread through bites from infected ticks, animal husbandry and can also be acquired in the healthcare setting during care of infected patients. In humans, CCHFV can cause a sudden onset of a non-specific febrile illness that can rapidly progress to severe hemorrhagic manifestations. Currently, there is no widely available vaccine and although ribavirin has been suggested for the treatment of CCHFV, clinical efficacy in both animal models and humans is inconsistent suggesting more potent antivirals are needed for CCHFV. Favipiravir is approved in Japan for the treatment of influenza virus infections and has shown promise against other highly pathogenic RNA viruses including CCHFV with demonstrated efficacy in the type I interferon deficient mouse model. In this report we utilized the cynomolgus macaque model to evaluate the efficacy of once- and twice-daily favipiravir treatment against CCHFV infection. We found that favipiravir treatment suppressed viremia and viral shedding when treatment was initiated 24 h post-infection and viral burdens in key tissues trended lower in favipiravir-treated animals. Our data indicate that favipiravir has efficacy against CCHFV in vivo in a non-human primate model of infection.
Crimean-Congo hemorrhagic fever (CCHF) is the most popular tick-borne disease causing by Crimean-Congo hemorrhagic fever virus (CCHFV). There are several valuable reviews considering some fields of the CCHF aspects. While there is no a systematic review about means and trends of CCHF cases and fatality rate, means and trends of CCHF cases and fatality rates of human occupations involved in CCHF. Therefore, this meta-analysis review performed to highlight and provide a global detailed of the above CCHF aspects. Among 398 collected papers, 173 papers were become this meta-analysis review. The study results confirm that an apparent increasing CCHF cases occurred through the past decades. The trends of annually and periodically CCHF cases and fatality rates were also increased. The means of annually and periodically CCHF cases and fatality rates were 57 and 432 cases, and 10 cases and 32.2 % and 49 cases and 28.8 %, respectively. The means of annually and periodically CCHF fatality rates are about one-tenth of CCHF human cases. The mean of CCHF fatality rates in Africa (22.0 %) is lower than Asia (33.5 %) and Europe (33.8 %). Among occupations involved in CCHF, agricultural (28.9 %), health-care (19.2 %) and slaughterhouse (16.7 %) workers, and farmers (13.9 %) had the maximum CCHF fatality rates in order. Based on literature review of CCHFV S-segment aspects, several clades and genotypes are reported to distribute in Africa, Asia and Europe regions. There are very wide fields to investigate the epidemiology characteristics of CCHFV clades, genotypes and their distribution in the future.
Crimean-Congo hemorrhagic fever (CCHF) is one of the most important public health threats in many regions across Africa, Europe, and Asia. This study used ecological niche modeling analyses to map the environmental suitability of both CCHF virus (CCHFV), and its tick vectors (Amblyomma variegatum, Dermacentor marginatus, Hyalomma marginatum, Hyalomma rufipes, Hyalomma truncatum, Rhipicephalus appendiculatus, and Rhipicephalus evertsi evertsi) in the Old World countries. The CCHFV was anticipated to occur with high environmental suitability across southern and central Europe, northwestern Africa, central Asia, and western Mediterranean region. Ecological niche models of tick vectors anticipated diverse patterns based on the tick species in question; D. marginatus and H. marginatum showed high environmental suitability in southern and central Europe, and North Africa. The remaining vector species were anticipated to occur in Africa. All models were statistically robust and performed better than random (P < 0.001). Finally, we tested the niche similarities between CCHFV and diverse tick vectors and could not reject the null hypotheses of niche similarity in all vector-virus combinations (P > 0.05) except the combinations of CCHFV with A. variegatum, R. evertsi evertsi and R. appendiculatus (P < 0.05).
Tick-borne Crimean-Congo hemorrhagic fever virus (CCHFV) is endemic in numerous countries, but the epidemiology and epizoology of Crimean-Congo hemorrhagic fever (CCHF) remain to be defined for most regions of the world. Using a broad database search approach, we reviewed the literature on CCHF and CCHFV in Southern and Western Asia to better define the disease burden in these areas. We used a One Health approach, moving beyond a focus solely on human disease burden to more comprehensively define this burden by reviewing CCHF case reports, human and animal CCHFV seroprevalence studies, and human and animal CCHFV isolations. In addition, we used published literature to estimate the distribution of Hyalomma ticks and infection of these ticks by CCHFV. Using these data, we propose a new classification scheme for organizing the evaluated countries into five categories by level of evidence for CCHF endemicity. Twelve countries have reported CCHF cases, five from Southern Asia and seven from Western Asia. These were assigned to level 1 or 2. Eleven countries that have evidence of vector circulation but did not report confirmed CCHF cases were assigned to level 3 or 4. This classification scheme was developed to inform policy toward strengthening CCHF disease surveillance in the Southern and Western Asia regions. In particular, the goal of this review was to inform international organizations, local governments, and health-care professionals about current shortcomings in CCHFV surveillance in these two high-prevalence regions.
Crimean-Congo haemorrhagic fever has been reported in more than 30 countries in Africa, Asia, the Middle East and Eastern Europe, with an increasing incidence in recent years, especially in Europe. Because no specific treatments have demonstrated efficacy, supportive treatment is essential, as well as the provision of a centre with the appropriate means to guarantee the safety of its healthcare professionals. Laboratory monitoring of thrombocytopenia, severe coagulopathy or liver failure is of critical importance. Patients with Crimean-Congo haemorrhagic fever should be admitted to High Level Isolation Units where appropriate biocontainment procedures can prevent nosocomial transmission through infected fluids or accidents with contaminated material. In case of high-risk exposures, early administration of ribavirin should be considered.
Crimean-Congo haemorrhagic fever (CCHF) is a lethal disease caused by Crimean-Congo hemorrhagic fever virus (CCHFV). It is one of the most widespread medically significant tick-borne pathogens, with a distribution that coincides well with the geographical occurrence of its tick vector, Hyalomma marginatum marginatum. Sporadic outbreaks of CCHF have previously been recognized in Asia, Africa, the Middle East and Europe but, in the 21st century, outbreaks have become more frequent in former Yugoslavia, Turkey and Iran. It has been suggested that CCHFV is a migrating pathogen, but it is not clear to what extent. We have, for the first time, analysed the worldwide migration pattern of CCHFV. Our results showed that Turkey may be a donor in Europe, towards both the east and the west, while the United Arab Emirates acted as a donor in the Middle East, and China was found to be the origin for genotype 2. Finally, we showed that migration of CCHFV was unrestricted between Iran and Pakistan. Considering the distribution and coincidence of the tick vector with CCHFV and CCHF, and the fact that the tick vector is present in western Europe, future outbreaks may extend to include hitherto-naïve areas, suggesting that increased surveillance and geographical mapping of this lethal pathogen are needed.
Clin Microbiol Infect 2010; 16: 647–650
Crimean-Congo Hemorrhagic fever (CCHF) is a potentially fatal viral infection with reported case fatality rates of 5–30%. Humans become infected through tick bites, by contact with a patient with CCHF during the acute phase of infection, or by contact with blood or tissues from viraemic livestock. In this first report in the literature, we present the characteristics of three pregnant women with CCHF infection and the outcome of their babies. Transmission of the CCHF infection could be either intrauterine or perinatal. In endemic regions, CCHF infection should be considered in the differential diagnosis of HELLP syndrome (haemolytic anaemia, elevated liver enzymes, low platelet count), and obstetricians should be familiar with the characteristics of CCHF infection. In the aetiology of necrotising enterocolitis, CCHF should be considered.
Crimean-Congo haemorrhagic fever (CCHF) is an often fatal viral infection described in about 30 countries, and it has the most extensive geographic distribution of the medically important tickborne viral diseases, closely approximating the known global distribution of Hyalomma spp ticks. Human beings become infected through tick bites, by crushing infected ticks, after contact with a patient with CCHF during the acute phase of infection, or by contact with blood or tissues from viraemic livestock. Clinical features commonly show a dramatic progression characterised by haemorrhage, myalgia, and fever. The levels of liver enzymes, creatinine phosphokinase, and lactate dehydrogenase are raised, and bleeding markers are prolonged. Infection of the endothelium has a major pathogenic role. Besides direct infection of the endothelium, indirect damage by viral factors or virus-mediated host-derived soluble factors that cause endothelial activations and dysfunction are thought to occur. In diagnosis, enzyme-linked immunoassay and real-time reverse transcriptase PCR are used. Early diagnosis is critical for patient therapy and prevention of potential nosocomial infections. Supportive therapy is the most essential part of case management. Recent studies suggest that ribavirin is effective against CCHF, although definitive studies are not available. Health-care workers have a serious risk of infection, particularly during care of patients with haemorrhages from the nose, mouth, gums, vagina, and injection sites. Simple barrier precautions have been reported to be effective.
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