Crimean-Congo Hemorrhagic Fever Cases Research Articles

Relation between the Pandemic COVID-19 and the outbreak of Crimean-Congo Hemorrhagic Fever in Iraq, 2023

Objective: This review examines the link between the COVID-19 pandemic and the outbreak of Crimean-Congo Hemorrhagic Fever (CCHF) in Iraq. Methods: We reviewed literature and data to explore potential associations between the two diseases. Results: No direct causative link between COVID-19 and increased CCHF cases in Iraq was found. However, changes in healthcare,agriculture, and human-animal interactions during the pandemic may have indirectly affected CCHF transmission. Conclusion: This review highlights the need for further research to confirm any connections between the COVID-19 pandemic and CCHFoutbreaks in Iraq. Understanding these links is crucial for effective public health responses to emerging infectious diseases.

Crimean-Congo Hemorrhagic Fever Virus Diversity and Reassortment, Pakistan, 2017-2020.

Sporadic cases and outbreaks of Crimean-Congo hemorrhagic fever (CCHF) have been documented across Pakistan since 1976; however, data regarding the diversity of CCHF virus (CCHFV) in Pakistan is sparse. We whole-genome sequenced 36 CCHFV samples collected from persons infected in Pakistan during 2017-2020. Most CCHF cases were from Rawalpindi (n = 10), followed by Peshawar (n = 7) and Islamabad (n = 4). Phylogenetic analysis revealed the Asia-1 genotype was dominant, but 4 reassorted strains were identified. Strains with reassorted medium gene segments clustered with Asia-2 (n = 2) and Africa-2 (n = 1) genotypes; small segment reassortments clustered with the Asia-2 genotype (n = 2). Reassorted viruses showed close identity with isolates from India, Iran, and Tajikistan, suggesting potential crossborder movement of CCHFV. Improved and continuous human, tick, and animal surveillance is needed to define the diversity of circulating CCHFV strains in Pakistan and prevent transmission.

Case Management of Imported Crimean-Congo Hemorrhagic Fever, Senegal, July 2023.

We report an imported Crimean-Congo hemorrhagic fever case in Senegal. The patient received PCR confirmation of virus infection 10 days after symptom onset. We identified 46 patient contacts in Senegal; 87.7% were healthcare professionals. Strengthening border crossing and community surveillance systems can help reduce the risks of infectious disease transmission.

Crimean-Congo Hemorrhagic Fever in the World. Epidemiological and Epizootiological Situation in the Russian Federation in 2023 and Forecast for 2024

The review features the situation on Crimean-Congo hemorrhagic fever (CCHF) in the world and the analysis of the epidemiological and epizootiological situation in the Russian Federation in 2023. The number of CCHF cases (26) in Russia was 2.3 times less than in 2022, and 71.6 % lower than the long-term average (in 2013–2022 – an average of 88.8 cases per year, mortality (8 %) is 2.4 times higher than the long-term average (3.3 %). The epidemically significant indicator of the abundance of the main vector of the CCHF virus, ticks Hyalomma marginatum, was 5 times higher than the threshold value (abundance index for cattle – 15.5) at long-term observation points in April. For the first time, one case of CCHF disease was registered in a new epidemically active territory – in the Botlikh and Novolaksky districts of the Republic of Dagestan. For the first time in the Zaporozhye Region, RNA of the CCHF virus was detected in ticks H. marginatum and Rhipicephalus rossicus. Markers of CCHF virus were found in 0.67–18.27 % of samples, CCHF virus variants of the genetic line Europe 1 were circulating on the territory of Russia in 2023. According to the forecast of the epidemic situation for 2024, CCHF morbidity is likely to increase in the south of the European part of Russia. The recommendations for undertaking preventive measures have been provided.

The Risk of Crimean Congo Haemorrhagic Fever in India as a Growing Health Concern.

Every year witnesses an outbreak of some or the other zoonotic disease that causes the unparalled loss of human life. The year 2022 presented the outbreak of Crimean Congo haemorrhagic fever (CCHF), which brought unprecedented challenges to individuals as well as to the healthcare system all around the world, making it a serious health concern. Rising health concerns have highlighted the importance of managing and decreasing the further transmission of the CCHF virus. CCHF is one of tick-borne viral diseases, which spreads due to various reasons like changes in global warming, environmental influences, and other ecological factors. All these factors somehow impact the disease prevalence. This disease has a negative impact on both humans and livestock. The diverse climate and significant livestock population of India make it susceptible to the prevalence of CCHF. Therefore, it is the need of the hour to develop some strategies in order to tackle the challenges posed by CCHF. This article includes all the cases of CCHF that have occurred in India from the year 2011, along with the fatality rates associated with this disease. Also this study discusses the need to explore some specific drugs for the management and prevention of such diseases. In addition, the pathogenesis of the disease progression, along with some protective measures suggested by the government has been described for prevention of CCHF. Subsequently, this article attempted to draw attention towards the risk that may be posed by CCHF in the coming scenario, emphasizing the importance of taking proactive measures in anticipation of such risks.

Crimean-Congo Hemorrhagic Fever: A Systematic Review

Crimean-Congo hemorrhagic fever is an predominatingly lethal viral contagion qualified in around thirty countries, and it has the roughly inclusive geographic allocation of the medically significant tick borne viral infections. Human become infected by tick bites, through pulverize infected ticks, next to contact with a case of Crimean-Congo hemorrhagic fever pending the acute stage of infection, or through handle with tissues or blood from viremic kine. Clinical features mostly display a spectacular progression recognized by myalgia, fever and bleeding. The best method used for diagnosis of Crimean-Congo hemorrhagic fever virus by real time polymerase chain reaction.

Another Crimean-Congo hemorrhagic fever outbreak in Uganda: Ongoing challenges with prevention, detection, and response

ObjectivesTo highlight the challenges associated with Crimean-Congo hemorrhagic fever (CCHF) prevention, detection, and response in Uganda. MethodsWe describe a single confirmed CCHF case in Rakai District in 2022. We reviewed medical records and conducted interviews on the case patient’s history and possible exposures. To understand CCHF prevention and response efforts, we conducted key informant interviews with the district health and veterinary officers and focus group discussions with farmers in the affected village. ResultsAn 18-year-old Rakai District resident had fever onset on July 5, 2022. Despite hemorrhaging during hospital admission on July 6, a viral hemorrhagic fever was not suspected for 24 h and appropriate personal protective equipment was not used. A blood sample was collected for viral hemorrhagic fever testing on July 8; however, the patient was discharged before receiving results. The case patient tested positive for CCHF on July 12 and was readmitted. Key informant interviews and focus group discussions indicated poor tick control measures in the district. The district lacked a formal One Health team and experienced challenges with coordination for outbreak response. ConclusionsCCHF prevention, detection, and response face challenges in Uganda and require strong clinical awareness for quick detection, collaboration between animal and human health stakeholders, and implementation of effective tick control measures.

Epidemiology and Outcomes of Crimean-Congo Hemorrhagic Fever in Afghanistan: A Review of 2010–2019

Background: The study investigates the recent surge in Crimean-Congo Hemorrhagic Fever (CCHF) cases in Afghanistan, a high-risk viral disease transmitted through tick bites and livestock, and aims to identify patterns of the increase and offer prevention strategies. Methods: A systematic review of all scholarly articles published on CCHF in Afghanistan between 2010 and 2019 was conducted using a comprehensive and rigorous search strategy using the PubMed database. The quality of the included studies was assessed using the Newcastle-Ottawa Scale and the Cochrane Risk of Bias Tool. Results: During the study period, 1537 suspected cases of CCHF were reported in Afghanistan, with the highest number and deaths in the western region. The majority of cases were male, aged 16-84, and involved in animal husbandry, agriculture, and healthcare workers, with a 2:1 male-to-female ratio. The majority of cases were aged 16-84. Conclusion: This study highlights the need for effective measures to prevent CCHF transmission in Afghanistan, such as education, improved animal management, and infection control in hospitals and laboratories, to reduce outbreak risks and enhance public health.

Emerging of Hyalomma Species Infestations on Animal in Different Region of Iraq: A Review

This review article aims to cover some published research of the ticks of the genus Hyalomma which is endemic in Iraq, and known of its direct and indirect impact on both humans and animals. About 13 species of the ixodid tick of two genera Rhipicephalus, Hyalomma are recorded in Iraq that transmits a wide range of etiological agents. Being a multi-host species, ticks are considered the major challenge for enhancing livestock health and productivity especially around in development countries. The Hyalomma spp. assign of their veterinary significance as the high ability for transmit haemoprotozoan parasite of Babesia and thieleria species. The manuscript cover some regional and local medical studies of tick borne diseases (TBD) caused by either viruses or bacteria, that impact human which receintilly gained additional attention. Various confirmed cases of Crimean-Congo hemorrhagic fever (CCHF) in 2022 over governorates in the southern of Iraq mainly, Dhi Qar and Maysan, which is considered the largest outbreak recorded since the disease was first reported forty years ago. The diagnosis and identification of ticks usually, depend on the morphological characterizations however, Polymerase chain reactions (PCR) found to be more accurate for identifying a variety of tick genera and species. The use of chemical acaricides is the fundamental strategy of ticks control, however, this traditional method started to be ineffective and switched to alternative tick control after the successful development of vaccines against cattle tick.

A Case Report of Crimean-Congo Hemorrhagic Fever in Iran

Introduction: Crimean Congo hemorrhagic fever (CCHF) is a tick-borne, zoonotic disease distributed globally. As the clinical features of CCHF and COVID-19 are similar, getting an early and reliable diagnosis may be difficult. Case Presentation: We report the first misdiagnosed case of CCHF in the setting of a COVID-19 pandemic from Ravansar County of Kermanshah province in Iran. Our patient was initially misdiagnosed with COVID-19, got hospitalized, but later tested positive for CCHF. However, the delay in diagnosis caused her death. Conclusions: Crimean Congo hemorrhagic fever should be considered among people in endemic areas who show COVID-19 symptoms for urgent medical attention.

Mapping the risk of exposure to Crimean-Congo haemorrhagic fever virus in the Iberian Peninsula using Eurasian wild boar (Sus scrofa) as a model

Crimean-Congo haemorrhagic fever (CCHF) virus (CCHFV) is a tick-borne zoonotic pathogen that can cause a lethal haemorrhagic disease in humans. Although the virus appears to be endemically established in the Iberian Peninsula, CCHF is an emerging disease in Spain. Clinical signs of CCHFV infection are mainly manifested in humans, but the virus replicates in several animal species. Understanding the determinants of CCHFV exposure risk from animal models is essential to predicting high-risk exposure hotspots for public health action. With this objective in mind, we designed a cross-sectional study of Eurasian wild boar (Sus scrofa) in Spain and Portugal. The study analysed 5,291 sera collected between 2006 and 2022 from 90 wild boar populations with a specific double-antigen ELISA to estimate CCHFV serum prevalence and identify the main determinants of exposure probability. To do so, we statistically modelled exposure risk with host- and environment-related predictors and spatially projected it at a 10 × 10 km square resolution at the scale of the Iberian Peninsula to map foci of infection risk. Fifty-seven (63.3 %) of the 90 populations had at least one seropositive animal, with seroprevalence ranging from 0.0 to 88.2 %. Anti-CCHFV antibodies were found in 1,026 of 5,291 wild boar (19.4 %; 95 % confidence interval: 18.3–20.5 %), with highest exposure rates in southwestern Iberia. The most relevant predictors of virus exposure risk were wild boar abundance, local rainfall regime, shrub cover, winter air temperature and soil temperature variation. The spatial projection of the best-fit model identified high-risk foci as occurring in most of western and southwestern Iberia and identified recently confirmed risk foci in eastern Spain. The results of the study demonstrate that serological surveys of CCHFV vector hosts are a powerful, robust and highly informative tool for public health authorities to take action to prevent human cases of CCHF in enzootic and emergency settings.

Implementation and expansion of laboratory capacity for molecular diagnostics in response to COVID-19 and preparedness for other emerging infectious diseases in the Islamic Emirate of Afghanistan.

Afghanistan experienced various outbreaks before and during the Covid-19 pandemic, including dengue, Crimean Congo hemorrhagic fever (CCHF), measles, and acute watery diarrhea (AWD). Diagnostic and surveillance support was limited, with only the Central Public Health Laboratory equipped to handle outbreak responses. This article highlights initiatives taken to improve diagnostic capabilities for COVID-19 and other outbreaks of public health concern encountered during the pandemic. The World Health Organization (WHO) Afghanistan Country Office collaborated with the WHO Eastern Mediterranean Regional Office (EMRO), Central Public Health Laboratory (CPHL), and National Influenza Center (NIC) to enhance COVID-19 diagnostic capacity at national and subnational facilities. To alleviate pressure on CPHL, a state-of-the-art laboratory was established at the National Infectious Disease Hospital (NIDH) in Kabul in 2021-2022, while WHO EMRO facilitated the regionalization of testing to subnational facilities for dengue, CCHF, and AWD in 2022-2023. COVID-19 testing capacity expanded nationwide to 34 Biosafety Level II labs, improving diagnosis time. Daily testing rose from 1000 in 2020 to 9200 in 2023, with 848,799 cumulative tests. NIDH identified 229 CCHF cases and 45 cases nationally. Dengue and CCHF testing, decentralized to Nangarhar and Kandahar labs, identified 338 dengue and 18 CCHF cases. AWD testing shifted to NIDH and five subnational facilities (Kandahar, Paktia, Balkh, Herat, and Nangarhar labs), while measles testing also decentralized to nine subnational facilities. Afghanistan implemented a remarkable, multisectoral response to priority pathogens. The nation now possesses diagnostic expertise at national and subnational levels, supported by genomic surveillance. Future efforts should concentrate on expanding and sustaining this capacity to enhance public health responses.

An Evaluation of the Hitit Index in Differential Diagnosis of Crimean-Congo Hemorrhagic Fever in the Emergency Department.

Background and Objectives: Crimean-Congo Hemorrhagic Fever (CCHF) is a viral zoonotic infection, which is seen over a wide geographic area. The mortality rate is in inverse proportion to the ability of patients to access healthcare services. Therefore, early identification of patients is extremely important. The aim of this study was to test the sensitivity and specificity of the Hitit Index in the differentiation of CCHF cases at the time of presentation at the Emergency Department and to evaluate the agreement of this index with molecular (CCHFV RNA) and/or serological diagnostic tests (ELISA-CCHF IgM). Materials and Methods: The patients included were those who presented at the Emergency Department (ED) with the complaint of a tick bite or those identified as potential CCHF cases as a result of complaints and/or laboratory findings. For cases that met the study inclusion criteria, the Hitit Index score was calculated automatically from the parameters included in the index formula uploaded to the automation system in the ED at the time of presentation. Through comparisons of the agreement of the Hitit Index with the CCHFV-RNA and/or IgM results the power of the Hitit Index for differentiation of CCHF cases in ED was evaluated. Results: The data of 273 patients were analyzed. There was a history of tick bite in 236 (86%) cases. Of the evaluated cases, 110 (40.2%) were hospitalized; CCHF positivity was determined in 72 (26.4%). The Hitit Index values calculated in ED and at 24 h after hospitalization were determined to be significant in the prediction of the CCHF cases (p < 0.001, AUC = 0.919 (0.887-0.951); p < 0.001, AUC = 0.902 (0.841-0.962). For a cut-off point of 0 of the Hitit Index evaluated in ED, the classification success was found to have a sensitivity of 75% and specificity of 88% (PPV-NPV). For a cut-off point of 0 of the Hitit Index evaluated at 24 h after hospitalization, the classification success was found to have a sensitivity of 79.7% and specificity of 84% (PPV-NPV). Conclusions: The defined form of the Hitit Index can be used in the differentiation of CCHF cases in ED with high sensitivity and specificity levels. Just as evaluation with the Hitit Index prevents unnecessary hospitalization, it can also contribute to reducing mortality rates with the early identification of CCHF cases.

Environmental Analysis of Hemorrhagic Fever in Iraq Using Machine Learning

Crimean-Congo Hemorrhagic Fever (CCHF) is a viral disease with rising prevalence in Iraq. This research focused on investigating factors influencing CCHF spread in Dhi Qar Governorate, which has seen a substantial surge in cases. The problem was to uncover which environmental and climatic factors correlate with CCHF outbreaks. Meteorological data, rodent populations, vegetation indices, and epidemiological records were analyzed using data preprocessing techniques like interpolation and ARIMA modeling. Pearson correlation analysis was applied to quantify associations between CCHF cases and factors like temperature, humidity, rodent prevalence, and vegetation lushness. Results showed strong positive correlations of CCHF with rodent populations, temperature, solar radiation, and evapotranspiration. Negative correlations were found with humidity and vegetation health. The conclusions indicate environmental factors significantly influence CCHF outbreaks in Dhi Qar. This can inform prevention strategies targeting ecological and climatic drivers of the disease.

The Spatial Distribution of Crimean-Congo Haemorrhagic Fever and Its Potential Vectors in Europe and Beyond.

Crimean-Congo haemorrhagic fever (CCHF) is considered to be spreading across the globe, with many countries reporting new human CCHF cases in recent decades including Georgia, Türkiye, Albania, and, most recently, Spain. We update a human CCHF distribution map produced in 2015 to include global disease occurrence records to June 2022, and we include the recent records for Europe. The predicted distributions are based on long-established spatial modelling methods and are extended to include all European countries and the surrounding areas. The map produced shows the environmental suitability for the disease, taking into account the distribution of the most important known and potential tick vectors Hyalomma marginatum and Hyalomma lusitanicum, without which the disease cannot occur. This limits the disease's predicted distribution to the Iberian Peninsula, the Mediterranean seaboard, along with Türkiye and the Caucasus, with a more patchy suitability predicted for inland Greece, the southern Balkans, and extending north to north-west France and central Europe. These updated CCHF maps can be used to identify the areas with the highest probability of disease and to therefore target areas where mitigation measures should currently be focused.

Cytokine release syndrome in Crimean-Congo hemorrhagic fever: can IL-1 receptor antagonist levels be a guide in its treatment?

Crimean-Congo Hemorrhagic Fever (CCHF) is a potentially fatal zoonotic viral disease involving fever and hemorrhage. Our aim was to investigate the relationship between interleukin (IL)-1 and IL-1 receptor antagonist (RA) levels in patients with CCHF and the course of the disease and mortality, as well as to contribute to the literature at a time when new therapeutic protocols are being investigated. Sixty-one patients with CCHF were admitted to our hospital's infectious diseases ward between March and September 2022, and 40 healthy people were included in the control group in our study. The patients were divided into mild/moderate (n=35) and severe (n=26) CCHF groups depending on the clinical course. The patients with CCHF were also divided into surviving and exitus groups. IL-1 and IL-1RA levels were measured from blood specimens using the ELISA method. Significant elevation in IL-1 and IL-1RA levels was observed in CCHF cases with a severe manifestation compared to those with moderate disease. Both patient groups' IL-1 and IL-1RA levels were also significantly higher than those of the control group. In addition, IL-1 and IL-1RA levels were significantly higher among the exitus patients compared to the surviving CCHF patients. The laboratory values of lactate dehydrogenase (LDH), aspartate aminotransferase (AST), alanine aminotransferase (ALT), creatinine phosphokinase (CK), platelet count, prothrombin time (PT), and activated partial thromboplastin time (aPTT) were also significantly higher among the patients with severe manifestations compared to the moderate severity patient group, and in the exitus patients compared to the survivors. However, platelet count and fibrinogen levels were lower in the patients with a severe manifestation compared to the moderate severity group and in the exitus patients compared to the survivors. White blood cells (WBC) were higher in exitus patients than in survivors. IL-1 and IL-1RA levels were elevated in all the CCHF patients, while the higher values in patients with a fatal course suggest that the inflammatory process is very severe and that IL-1 receptor antagonists may be needed in the treatment.

Temporal tendency, seasonality and relationship with climatic factors of Crimean-Congo Hemorrhagic Fever cases (East of Turkey: 2012–2021)

Crimean-Congo Hemorrhagic Fever continues to be an important public health problem by expanding its borders. To evaluate the temporal trend, seasonality, and relationship with the climatic factors of Crimean-Congo Hemorrhagic Fever. Study data included cases treated in two different tertiary healthcare institutions between 2012 and 2021. The demographic characteristics of the cases and the dates of admission to the hospital were determined, and they were matched with the average of the measurements (temperature, cumulative precipitation, relative humidity, wind speed) of two different meteorology stations in the study area. By calculating the crude incidence rates, the trend in years was investigated. Estimates were created by removing the incidence rates, seasonality, and trend components using the additive decomposition technique. The temporal relationship between incidence rates and climatic factors was evaluated with the help of the Autoregressive Distributed Lag Bound Test. Toda Yamamoto test was used for causality verification. The mean age of the cases (n = 974) included in the study was 47.6 ± 17.7 years, and the majority (57.3%) were in the group above 45 years of age. 56.6% of the cases were male and there was a male predominance in all age groups. Incidence rates ranged from 5.5 to 23.1/100,000 over the ten-year period and there was a significant upward trend (R2 = 0.691, p = 0.003). Cases of Crimean-Congo Hemorrhagic Fever that started in March, peaked in July and ended in October, showed a clear seasonality. A cointegration relationship was observed between case incidence rates and air temperature, cumulative precipitation, and relative humidity (p < 0.05 for all). Climatic factors can only indirectly affect the occurrence of Crimean-Congo Hemorrhagic Fever cases. However, climatic conditions that become progressively more favorable for vector ticks lead to the spread of the disease. The control measures to be taken should be prepared by considering the changing climatic conditions and prioritizing the risk groups. There is a need for information and awareness-raising studies about climate change and the growing dangers associated with it, also outside of endemic regions.

Cases of Crimean-Congo haemorrhagic fever in North Macedonia, July to August 2023.

The last report of Crimean-Congo haemorrhagic fever (CCHF) in North Macedonia was more than 50 years ago in the northwest. We report on a fatal CCHF case following a Hyalomma tick bite in the east of the country in July 2023. Tracing of 67 contacts identified CCHF in one healthcare worker (HCW) providing care for the patient. Monitoring of contacts is concluded (including further 11 HCW contacts), thus far 28 days after the death of the case no additional cases were identified.

Pediatric Crimean–Congo Hemorrhagic Fever Experience during the COVID-19 Pandemic

Abstract Objective Crimean–Congo hemorrhagic fever (CCHF) is a zoonotic disease that is mainly transmitted by tick bites. During the COVID-19 pandemic, a change of notifications has been reported for most infectious diseases. We aimed to compare CCHF in pediatric patients during the COVID-19 pandemic and before the pandemic period with demographic, clinical, and laboratory features. Methods Overall, 18 CCHF patients were evaluated and divided into two groups: those admitted from May 2014 to February 2020 were placed in the “prepandemic” group and those admitted from March 2020 to August 2021 were placed in the “pandemic” group. Patients were diagnosed as CCHF with polymerase chain reaction (PCR) and immunoglobulin M (IgM) antibody positivity in the blood samples. Results Pediatric CCHF cases were more frequent during the 2 years of the COVID-19 pandemic period compared with the 6 years before the pandemic (10 cases and 8 cases, respectively). There were no demographic and clinically significant differences between the two groups. Prepandemic patients had lower platelet (PLT) levels than pandemic patients (p = 0.021). Two CCHF patients in the pandemic group were hospitalized with a preliminary diagnosis of multisystem inflammatory syndrome in children (MIS-C). Seventeen patients (94.4%) were treated with ribavirin. All the patients recovered. Conclusion The frequency of CCHF appeared to have been increased during the COVID-19 pandemic. But there was no difference between the prepandemic and pandemic groups from a demographic and clinical finding point of view of patients diagnosed with CCHF.

Evaluation of choroidal thickness and choroidal vascularity index in patients with Crimean-Congo hemorrhagic fever.

This study aimed to compare choroidal thickness parameters between patients diagnosed with Crimean-Congo hemorrhagic fever (CCHF) and healthy individuals using spectral domain optical coherence tomography. The right eyes of 27 individuals diagnosed with CCHF and 27 healthy subjects were included in this study. CCHF cases were assessed based on a history of tick bites and hospitalization. Choroidal thickness was measured using enhanced depth imaging optical coherence tomography. Measurements of choroidal thickness were taken at 5 different points, including the subfoveal quadrant and the fovea up to 2000μm with 1000μm intervals in the temporal and nasal quadrants. Choroidal vascular index (CVI) was calculated as the ratio of luminal area (LA) to total choroidal area (TCA) at the macula's total area and at 1500μm from the center (CVI and CVI1500). Choroidal thickness in the CCHF group was found to be thicker in each quadrant compared to the control group, with the subfoveal and nasal quadrants showing significantly greater thickness. TCA, stromal area, and LA were significantly higher in the CCHF group, while no significant difference was observed in CVI and CVI1500. The findings of this study suggest that CCHF disease may have an impact on the choroidal structure.