Crimean-Congo Hemorrhagic Fever Cases Research Articles

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 haemorrhagic fever among healthcare workers in Iran 2000-2023, a report of National Reference Laboratory.

Crimean-Congo haemorrhagic fever (CCHF) is a lethal acute viral zoonosis with a case fatality rate of 5-50%. Due to the potential of human-to human transmission of the disease, healthcare workers (HCWs) are at risk of occupational exposure to CCHF virus. Little is known about CCHF virus route of transmission and risks in Iranian HCWs. Therefore this study was designed to identify the routes of exposure to the CCHF virus among Iranian HCWs. From Oct 2000 to Feb 2023, 96 CCHF suspected healthcare workers referred to national reference laboratory were tested for CCHF virus infection by the use of RT-PCR and IgM Capture Enzyme-Linked Immunosorbent Assay (MAC-ELISA) and exposure history of cases were investigated to determine the CCHF virus routes of transmission in nosocomial settings. Twelve CCHF confirmed cases were identified including seven nurses and five physicians, with the median age of 32.5 years (range 23-53 years) and the median incubation period of 6.8 days (range from 1 to 22 days). None of the cases reported a history of tick bite or close contact with tissues or animal blood. The cases were from Razavi Khorasan (seven cases), Sistan and Baluchistan (two cases), Isfahan (one case), South Khorasan (one case) and Fars (one case). Percutaneous exposure (needle stick) (three cases), mucosal exposure (blood splash in to face) (three cases) and skin contact with blood (three cases) constituted the most prevalent routes of transmission. Since 2013, no CCHF cases have been identified among Iranian HCWs. In healthcare settings, physicians and nurses are at risk of nosocomial CCHF virus infection. The routes of transmission mainly include direct exposures via needle-stick, mucosal or direct contact with the skin to infected blood. Continuous education and implementation of infection prevention and control measures are key factors to minimize the incidence of healthcare related CCHF.

Determinants of crimean-congo hemorrhagic fever (cchf) outbreaks: a retrospective analysis

Abstract Introduction Crimean-Congo Hemorrhagic Fever (CCHF), a viral tick-borne zoonotic disease with high mortality rates, poses a particular threat in Pakistan during religious event of Eid-ul-Azha as increased livestock contact. This study aims to analyze CCHF cases from three outbreaks, to identify transmission and disease patterns. Understanding these patterns can inform targeted interventions for future outbreaks. Methods A retrospective cross-sectional study was conducted to examine three CCHF outbreak investigations between July 2nd and August 12th, 2023 in Khyber Pakhtunkhwa, Pakistan. Multisectoral teams, including human and animal health departments, investigated these outbreaks. Data was collected through semi-structured case investigation tools. The healthcare providers, patients and family were subjects. During active case surveillance, 41 probable contacts were traced. Results Among positive cases, male predominance (71.4%) was observed. The highest proportion of cases occurred in the 15-29 year age group (42.9%, n = 6). Individuals involved in animal handling professions had the highest prevalence (50%, n = 7), followed by students (21.4%, n = 3). Common clinical manifestations included high-grade fever (100%), muscle pain (92.9%), and bleeding symptoms (85.7%), with 64.3% of cases reporting vomiting blood. The average recovery time was 7.1 days, while fatal cases had an average of 6.8 days from symptom onset to death. Recovery was observed in 64.3% of cases, with a mortality rate of 35.7%. Chi-square analysis showed significant associations between gender, occupation, and disease outcome (p < 0.05). Conclusions This study identified a higher risk of CCHF in males, young adults, and individuals involved in animal handling during outbreaks. Public health interventions targeting occupations, demographics, particularly education and protective measures for animal handlers during Eid-ul-Azha days, are crucial to mitigate future outbreaks Key messages • Young male adults, and individuals involved in animal handling are on greater risk of higher risk of CCHF infections in Khyber Pakhtunkhwa, Pakistan. • One Health community can leverage these findings to develop better prevention and control strategies through collaboration between human and animal health sectors.

Crimean-Congo hemorrhagic fever in Herat province of Afghanistan, 2007-2021

Crimean-Congo hemorrhagic fever (CCHF) is a geographically widespread tick-borne hemorrhagic diseasecaused by the Crimean-Congo hemorrhagic fever virus (CCHFV). In Afghanistan, the first case of CCHF wasdetected in Takhar province in 1998, after which no additional cases were reported for ten years. The aim ofthis study is to report the analyses of the clinical and epidemiological features of confirmed CCHF cases thatwere recorded in Herat province between 2007 and 2021. This prospective case series study was conducted atHerat Regional Hospital between January 2007 and December 2021. Demographic and clinical data werecollected for each patient; all patients were hospitalized. Biochemical and hematological laboratoryexamination, and the detection of CCHV IgM and viral RNA was performed for all patients. Statistical analyseswere performed in IBM SPSS Statistics (version 26). A total of 252 confirmed CCHF cases including 160(63.5%) males and 91 (36.5%) females, with a mean age of 33.37±14.1 years were included in the study. Themajority of patients were in 11-50 age category, 32.9% were housewife, 38.4% were farmers, shephard, andbutchers. The most prevalent clinical presentations were fever (100%), headache (98.8%), body pain (96.4%),Ecchymosis (48.0%), epistaxis (44.8%) and gum bleeding (33.3%). The majority of cases occurred betweenApril and October. The case fatality rate of CCHF in this study was 2.8%. Considering the significant social,economic and health burden CCHF places on the community, enhanced public health measures are necessaryto control CCHF in Herat province and neighboring regions.

Crimean-Congo hemorrhagic fever cases diagnosed during an outbreak of Sudan virus disease in Uganda, 2022-23.

In September 2022, Uganda experienced an outbreak of Sudan virus disease (SVD), mainly in central Uganda. As a result of enhanced surveillance activities for Ebola disease, samples from several patients with suspected viral hemorrhagic fever (VHF) were sent to the VHF Program at Uganda Virus Research Institute (UVRI), Entebbe, Uganda, and identified with infections caused by other viral etiologies. Herein, we report the epidemiologic and laboratory findings of Crimean-Congo hemorrhagic fever (CCHF) cases that were detected during the SVD outbreak response. Whole blood samples from VHF suspected cases were tested for Sudan virus (SUDV) by real-time reverse transcription-polymerase chain reaction (RT-PCR); and if negative, were tested for CCHF virus (CCHFV) by RT-PCR. CCHFV genomic sequences generated by metagenomic next generation sequencing were analyzed to ascertain strain relationships. Between September 2022 and January 2023, a total of 2,626 samples were submitted for VHF testing at UVRI. Overall, 13 CCHF cases (including 7 deaths; case fatality rate of 53.8%), aged 4 to 60 years, were identified from 10 districts, including several districts affected by the SVD outbreak. Four cases were identified within the Ebola Treatment Unit (ETU) at Mubende Hospital. Most CCHF cases were males engaged in livestock farming or had exposure to wildlife (n = 8; 61.5%). Among confirmed cases, the most common clinical symptoms were hemorrhage (n = 12; 92.3%), fever (n = 11; 84.6%), anorexia (n = 10; 76.9%), fatigue (n = 9; 69.2%), abdominal pain (n = 9; 69.2%) and vomiting (n = 9; 69.2%). Sequencing analysis showed that the majority of identified CCHFV strains belonged to the Africa II clade previously identified in Uganda. Two samples, however, were identified with greater similarity to a CCHFV strain that was last reported in Uganda in 1958, suggesting possible reemergence. Identifying CCHFV from individuals initially suspected to be infected with SUDV emphasizes the need for comprehensive VHF testing during filovirus outbreak responses in VHF endemic countries. Without expanded testing, CCHFV-infected patients would have posed a risk to health care workers and others while receiving treatment after a negative filovirus diagnosis, thereby complicating response dynamics. Additionally, CCHFV-infected cases could acquire an Ebola infection while in the ETU, and upon release because of a negative Ebola virus result, have the potential to spread these infections in the community.

Epidemiological analysis of event-based surveillance data of Crimean-Congo Hemorrhagic Fever (CCHF) outbreaks across Balochistan Province, Pakistan, from 2000 to August 2021

Background Crimean-Congo hemorrhagic fever (CCHF) is endemic in Balochistan, caused by the Bunyaviridae family’s tick-borne virus (Nairovirus). The CCHF virus leads to severe viral hemorrhagic fever outbreaks with a fatality rate of 10–40%. This study aims to describe the epidemiological trend of CCHF in Balochistan and provide recommendations for controlling current and future outbreaks. Methods A descriptive approach was adopted for data analysis, utilizing the standard case definition of the Vector-Borne Diseases (VBD) program. “Any person of any age and gender residing in Balochistan from 2000 until August 10, 2021, presenting with the acute onset of illness, featuring a high-grade fever (38.5°C) persisting for more than 3 days but less than 10 days. Individuals should also exhibit any two of the following symptoms: hemorrhagic or purpuric rash, nosebleed, blood in vomit/sputum/stool, or other hemorrhagic symptoms. Moreover, there should be no known predisposing factors for hemorrhagic manifestations, and individuals must have had contact with a confirmed patient or engaged in handling animals and raw animal products.” The study covered cases identified from 2000 to August 10, 2021, and the descriptive study was conducted at the Provincial Disease Surveillance and Response Unit (PDSRU) in Quetta. Frequencies were calculated, and Excel 2016 was used to generate tables and graphs. Results Based on the case definition, 1418 laboratory-confirmed cases of CCHF were identified out of 2542 reported cases from 2000 to August 10, 2021. Most cases (89%, n = 1262) were found to be males. The case fatality rate increased from 5% to 13% over the last decade. The highest number of CCHF cases occurred in 2017 (n = 172), followed by 2005 (n = 108) and 2004 (n = 107). Direct animal contact was reported in 61% of cases, with 22% being butchers and farmers each. CCHF poses a significant public health issue in Balochistan. Conclusion This study provides a detailed overview of CCHF in Balochistan over the last 21 years, recommending the declaration of CCHF as a public health emergency. Establishing a comprehensive tick surveillance system, ecological studies, and health education sessions in collaboration with the livestock department is crucial to prevent future outbreaks.

Crimean-Congo haemorrhagic fever in Iraq.

Crimean-Congo haemorrhagic fever (CCHF) is the most common tick-borne viral disease worldwide. Its incidence has increased rapidly in the Eastern Mediterranean countries and has been endemic in Iraq since it was first identified in 1979. To describe the sociodemographic, epidemiologic and clinical characteristics of CCHF patients in Iraq. This cross-sectional study was conducted using data from the national surveillance system of the Communicable Diseases Control Centre, Baghdad, Iraq, for the period 2021-2023. We included all confirmed cases and analysed the data using SPSS version 27. A total of 986 cases of CCHF were identified during the period, mean age 36 ± 15.4 years, male 58.9%. The majority of cases were reported in the southern provinces and during the summer months. Animal contact was reported by 52.8% and slaughtering by 45.7% of the patients. Bleeding from injection site was observed in 26.6% of the patients, while 24.8% had ecchymosis. Case fatality rate was 16.8%. The number of CCHF cases was very high during the study period. We recommend actions to intensify tick control in Iraq, including the control of slaughtering, movement of livestock in and out of Iraq, in addition to health promotion and health education activities especially among high-risk groups.

Large-Scale Serological Survey of Crimean-Congo Hemorrhagic Fever Virus and Rift Valley Fever Virus in Small Ruminants in Senegal.

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.

Upsurge of Crimean-Congo Hemorrhagic Fever During Eid-Al-Adha Period 2023 in Iraq

Background: Crimean-Congo Hemorrhagic Fever (CCHF) is a tick-borne zoonotic disease. It has a case fatality rate of up to 40%. Animal sacrifices during the Eid-Al-Adha period are a common religious tradition in the country. Since 2021, Iraq has been plagued by a continuous epidemic. Objectives: To investigate the upsurge of CCHF cases during the Eid-Al-Adha period in 2023 and determine the times of high incidence and related risk factors. Methods: A cross-sectional study was conducted using data derived from the Communicable Disease Control Center in Iraq during the period from June 19 to July 30, 2023, and included all laboratory-confirmed cases during the study period. The studied variables were categorized according to before, during and after the Eid period. The chi-square test and regression analysis were used to analyze the variables. Results: CCHF cases increased during the Eid period (118, compared to 63 before and 23 after). Slaughtering activities during the Eid period increased by more than 45%. Being a butcher and participating in slaughtering activities significantly contributed to the increase in cases during the Eid period. The only significant predictor identified was the presence of slaughtering activities before and after Eid, compared to the Eid period itself. Conclusions: CCHF cases increased during the Eid-Al-Adha period, which may be due to animal sacrifice activities during this Islamic festival.

First Broad-Range Serological Survey of Crimean-Congo Hemorrhagic Fever among Hungarian Livestock.

(1) Background: Crimean-Congo hemorrhagic fever (CCHF) is an emerging tick-borne disease endemic in Africa, Asia, the Middle East, and the Balkan and Mediterranean regions of Europe. Although no human CCHF cases have been reported, based on vector presence, serological evidence among small vertebrates, and the general human population, Hungary lies within high evidence consensus for potential CCHF introduction and future human infection. Thus, the aim of our pilot serosurvey was to assess CCHF seropositivity among cattle and sheep as indicator animals for virus circulation in the country. (2) Methods: In total, 1905 serum samples taken from free-range cattle and sheep in 2017 were tested for the presence of anti-CCHF virus IgG antibodies using commercial ELISA and commercial and in-house immunofluorescent assays. (3) Results: We found a total of eleven reactive samples (0.58%) from five administrative districts of Hungary comprising 8 cattle and 3 sheep. The most affected regions were the south-central and northwestern parts of the country. (4) Conclusions: Based on these results, more extended surveillance is advised, especially in the affected areas, and there should be greater awareness among clinicians and other high-risk populations of the emerging threat of CCHF in Hungary and Central Europe.

Epidemiologic Features and Risk Factors for Crimean-Congo Hemorrhagic Fever in Dhi Qar Province, Iraq.

Crimean-Congo hemorrhagic fever virus (CCHFV) is endemic in Iraq, where recurrent epidemics have been constantly observed during the last five years. The present study aimed to determine the factors associated with Crimean-Congo hemorrhagic fever (CCHF) cases in Dhi Qar province during the year 2022. A test-negative case-control design was used to analyze 621 CCHF patients, of which 162 were confirmed and 459 were suspected cases. To identify the confirmed and suspected cases, reverse transcriptase polymerase chain reaction (RT-PCR) was used. Suspected patients whose PCR test results were negative were selected as the control group. Data on potential risk factors for CCHF were collected as existing data for previous years for the same geographical locations in Dhi Qar province. Logistic regression analyses were used to determine the correlation between probable risk factors and confirmed CCHF cases. The incidence rate of CCHF was 6.8% per 100,000 people. The total number of deaths was 48 for patients with a case fatality rate of 7.7%. The patients' ages ranged from one year to 65 years, with an overall mean ± SD of 36.08 ± 18.29 years. A total of 98.2% of the patients were between 15 and 65 years of age; 58% of the reported patients were male, and the male-to-female ratio was 1.4:1. Additionally, contact with raw meat, animal contact, and tick bite had the highest percentages for CCHF positivity cases. Male gender, high-risk jobs like housewives, health staff, shepherds, butchers, animal dealers, slaughterhouse workers, veterinary staff, and farmers, tick bites, and contact with raw meat were statistically significant predictors for increasing CCHF incidence in Dhi Qar province during the year 2022.

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.

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.

Evaluation of epidemiological, clinical, laboratory and treatment characteristics of Crimen Congo hemorrhagic fever patients: Results of a 10-year analysis.

Crimean-Congo hemorrhagic fever (CCHF) is a viral zoonosis transmitted by ticks and may have an acute and severe course with fever, bleeding, muscle aches, headache, diarrhea, weakness, and similar non-specific symptoms. This study aimed to determine the distribution of CCHF cases in Amasya province, which is endemic for this disease, according to districts, epidemiological, clinical, laboratory, and treatment characteristics. The characteristics of 88 CCHF cases over 18 who were admitted to our clinic and treated between January 2013 and January 2023 were evaluated retrospectively. Demographic data such as age, gender, occupation, district of residence, history of tick contact, the incubation period of the disease, period of development of the disease (months, years), length of hospital stay, symptoms, physical examination and laboratory findings, blood product replacement therapies applied, recovery and mortality status of the patients were reached by scanning the patient files. The mean age (±standard deviation) of 88 cases was 48±18 years, and 53 (60.2%) were male. Of the patients, 68 (77.3%) were engaged in farming and animal husbandry, and 79 (89.7%) lived in villages and hamlets. Tasova district had the highest frequency of cases, with 29 (32.9%) patients. June was the most common month for the disease, with 31 (35.2%) cases. The most common symptom on admission was fatigue, with a rate of 93%. Other symptoms included myalgia and arthralgia (83.2%), fever (65%), headache (64.4%), nausea-vomiting (43.5%), conjunctival hyperemia (35.2%), and diarrhea (21.7%). In clinical follow-up, bleeding was missed in 15 (17.04%) patients. On admission to the hospital, there were elevated levels of thrombocytopenia (92%), leukopenia (84.1%), aspartate aminotransferase and alanine aminotransferase (86.3%), creatinine phosphokinase (71.6%), and lactate dehydrogenase (76.1%). None of the patients were given ribavirin treatment. Our mortality rate was 3.40% with three patients. Amasya is an endemic area for CCHF with all its districts. In our province's spring and summer months, tick contact history and the farming-livestock profession should be questioned in patients with fever complaints in clinic admissions, especially emergency services. In the case of the detection of thrombocytopenia in these patients, CCHF should be kept in mind.

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.