Treatment Of Crimean-Congo Hemorrhagic Fever Research Articles

Knowledge, attitudes, and practices regarding Crimean-Congo hemorrhagic fever in a high-prevalence suburban community, southeast of Iran

Crimean Congo Hemorrhagic Fever (CCHF) is a zoonotic viral disease with a high mortality rate. The World Health Organization has classified it as a high-priority pathogen due to its severity. To manage this disease, knowledge, attitude, and practices (KAP) of the community play an important role. This study was conducted in a suburban area in southeastern Iran, an endemic region with a high occurrence of CCHF. A cross-sectional study was performed among 176 livestock farmers in Zahedan suburb, and data were collected through an interviewer-administered questionnaire. Single-factor and multi-factor analysis of variance was used to identify factors related to participants’ knowledge, attitude, and risk of CCHF. All statistical analyses were conducted using SPSS 24, and a significance level of p ≤ 0.05 was adopted to determine statistical significance. Overall, the knowledge level about CCHF was moderate. Participants demonstrated a better understanding of high-risk occupations compared to the transmission routes and symptoms of CCHF. Conversely, their knowledge about the prevention and treatment of CCHF was found to be inadequate. The participants exhibited a good attitude towards CCHF prevention; most considered it a dangerous disease, believed in the effectiveness of preventive measures, and demonstrated the ability to address perceived obstacles. High-frequency engagement in high-risk behaviors related to CCHF was observed among the study participants. In the multi-factor model, the most critical factors associated with knowledge were age (p = 0.044), CCHF infection (p = 0.047), and CCHF education (p = 0.004). Income (p = 0.001), keeping livestock at home (p = 0.028), and receiving CCHF education (p = 0.012) were the most critical factors associated with attitude toward the risk of CCHF. The most important factors related to CCHF high-risk behavior were age (p = 0.045), gender (p = 0.028), and handling livestock (p < 0.001). These findings emphasize the need for maintaining health educational efforts on CCHF.

Crimean-Congo hemorrhagic fever: A pediatric case responding to plasmapheresis treatment

Crimean-Congo hemorrhagic fever (CCHF) is a life-threatening tick-borne viral infection. The most important step in the treatment of CCHF is supportive therapy. Ribavirin is the recommended antiviral agent for infected patients. We present a case of a child who presented to our pediatric intensive care unit due to CCHF and was treated with plasmapheresis and ribavirin. A previously healthy seven-month-old male infant presented to the emergency room with a fever of 39.5 °C, nosebleed, cough, vomiting, and weakness. We decided to apply plasmapheresis treatment due to multiple organ failure associated with thrombocytopenia, acute liver failure, and a family history of death from the disease. Plasmapheresis was performed in three sessions. By the sixth day of his admission to the intensive care unit, the patient’s clinical condition had improved and his laboratory values had returned to normal, so he was transferred to the infectious diseases service in stable condition.

Treatment of Crimean-Congo Haemorrhagic Fever by Favipiravir in a Patient with Novel Coronavirus Co-Infection.

Crimean-Congo haemorrhagic fever (CCHF) is a lethal zoonotic disease caused by an RNA virus that is a member of the Nairovirus genus in the Bunyaviridae family from the arbovirus group. CCHF is transmitted by Hyalomma ticks through direct contact with the blood and other bodily fluids of patients or infected animals. A 65-year-old man was admitted to the emergency unit with dry cough, myalgia and fever. He was treated with favipiravir. He had disseminated intravascular coagulopathy with thrombocytopenia in the setting of COVID-19 infection. He tested positive for both COVID-19 and CCHF. By the end of the fifth day of treatment, his laboratory parameters and clinical symptoms had normalized. Favipiravir is currently on the market for treating COVID-19 infection worldwide. It has also been used to treat CCHF in laboratory animals. To the best of our knowledge this is the first report of CCHF successfully treated with favipiravir, which could be a key drug for treating human CCHF. Clinicians should be alert for concomitant viral infections such as Crimean-Congo haemorrhagic fever, which share similar clinical and laboratory findings to COVID-19.The effectiveness of favipiravir for viral infections other than influenza and COVID-19, such as Crimean-Congo haemorrhagic fever, should be elucidated.

Scoping Review of Crimean-Congo Hemorrhagic Fever (CCHF) Literature and Implications of Future Research

Crimean-Congo hemorrhagic fever (CCHF) is one of the severe forms of high-fatality hemorrhagic fever transmitted by bite of infected ticks or body fluids of infected individuals. Lack of sufficient research and endemic potential of the disease is posing serious threats to public health. The aim of this review was to explore the current status of Crimean-Congo hemorrhagic fever virus (CCHFV) related research and to identify knowledge gaps and the areas that are yet to be explored. An interpretative scoping review methodology was followed to systematically characterize the most recent literature. Literature survey was conducted using electronic databases: PubMed, Scopus, ScienceDirect and Google Scholar. This comprehensive research yielded more than 300 records, but we excluded 100 articles based on our inclusion criteria and duplicates removal. All articles (n=85) that have been published currently were discussed in this scoping review. From a total of 303 documents retrieved, 85 met the criteria. All the documents (case studies, review articles, systematic reviews, meta-analysis, case control studies, cohort studies, randomised control trials, and longitudinal studies) were included in the study. The articles mainly cover different areas such as epidemiology, prevalence, diagnosis, pathogenesis, clinical outcomes, molecular basis, phylogenetics, transmission and treatment of CCHF. Treatment and prevention related knowledge is limited; therefore, future research should focus the development of therapeutics to mitigate the increasing risk of CCHF. Priority future goal should be studies on the molecular basis and treatment of CCHFV infection because several knowledge gaps have been identified in these areas.

Crimean-Congo Hemorrhagic Fever.

Crimean-Congo hemorrhagic fever virus (CCHFV) is a member of the Bunyaviridae family and Nairovirus genus. The viral genome consists of 3 RNA segments of 12 kb (L), 6.8 kb (M), and 3 kb (S). Crimean-Congo hemorrhagic fever (CCHF) is the most widespread tickborne viral infection worldwide: it has been reported in many regions of Africa, the Middle East, and Asia. The geographical distribution of CCHFV corresponds most closely with the distribution of members of the tick genera, and Hyalomma ticks are the principal source of human infection. In contrast to human infection, CCHFV infection is asymptomatic in all species. Treatment options for CCHF are limited; immunotherapy and ribavirin are effective in the treatment of CCHF; the efficacy of ribavirin in the treatment of CCHF has not yet been proven. This article reviews the history, epidemiology, clinical symptoms, pathogenesis, diagnosis, and treatment of CCHFV, as well as the development of a vaccine against it.

Do We Really Need Ribavirin in the Treatment of Crimean-Congo Hemorrhagic Fever?

The role of ribavirin in the treatment of Crimean-Congo hemorrhagic fever (CCHF) is scarce. We retrospectively reviewed treatment features of 81 hospitalized patients with laboratory confirmed CCHF between January 2007 and December 2010. The median age of the patients was 45 years and 47 were male. Out of 81 patients, 6 received ribavirin. Demographic characteristics and laboratory findings of the patients who received ribavirin were not different from the patients who did not receive antiviral. There were no statistically significant difference in duration of symptoms before admission (P = 0·47) between the two groups. Of the patients, 29 who did not receive ribavirin and four from the ribavirin treated group had severe disease based on the Swanpoel criteria (P = 0·22). Two patients from each group died. There was no statistically significant difference in case fatality (P = 0·14) and duration of hospitalization (P = 0·11). Treatment of CCHF without ribavirin seems to be safe based on the findings of this study.

European Monitoring Plans for the management of Outbreak of Crimean Congo Haemorrhagic Fever (CCHF)

The Crimean Congo Haemorrhagic Fever (CCHF) is a viral infection caused by the CCHF virus (CCHFV), a member of the family Bunyaviridae, genus Nairovirus. This virus is transmitted by ticks of the genus Hyalomma and has been reported in more than 30 countries in Africa, Asia, South-East Europe and the Middle East [1] arising considerable public health concern in many regions of the world. The first case of CCHF was probably described by a Physician in Tajikistan in 1110 DC in a patient with hemorrhagic manifestations [2]. More recently, CCHF was described for the first time as a proper clinical entity in 1944-45 when about 200 Soviet soldiers were infected while providing assistance to farmers in the Crimea during the Second World War [3]. However the virus was first isolated from a Patient in the Democratic Republic of the Congo only in 1956 [4]. The disease is currently reported in Asia (China, Kazakhstan, Tajikistan, Pakistan, Afghanistan, Iraq, Iran, UAE, Oman, Yemen, southern Saudi Arabia), Africa (Mauritania, Senegal, Burkina Faso, Congo, Uganda, Kenya, Tanzania, Namibia, South Africa) [5] and Europe [6]. H. marginatum, the main vector of CCHF virus in Europe, is located in Albania, Bulgaria, Cyprus, France, Greece, Italy, Kosovo, Moldova, Portugal, Romania, Russia, Serbia, Spain, Turkey and Ukraine. In 2006 it was isolated for the first time in the Netherlands and in southern Germany [7,8]. As evidenced by a recent study (Estrada-Pena, 2012), favorable climate and ecological conditions present in several European countries bordering the Mediterranean Sea, could ensure a CCHFV expansion in the near future. The risk of infection is particularly high in Italy due to the presence of concomitant factors such as the wild ecological heterogeneity that characterizes its territory, and the peculiar position in the middle of the Mediterranean area. Besides, the recent raising of the average seasonal temperatures in south European countries could increase the colonization by vector populations that were not naive [9]. Typically CCHF’s clinical manifestations are high fever, malaise, severe headache and gastrointestinal symptoms. Extensive bleeding may occur in an advanced stage of the disease, with mortality rates ranging from 5% to 50%. CCHF is a disease of immediate communication to the public health authorities [4]. During the last decade the CCHFV has emerged and / or re-emerged in several countries of the Balkans, Turkey, in the regions of the south-west of the Russian Federation and Ukraine, with a significantly high mortality rates. The reasons for the re-emergence of CCHFV include climate and anthropogenic factors such as changes in agricultural practices or hunting activities and cattle movement. These factors can influence the dynamics of host-tick-virus. In the light of the dangerousness of this disease an International surveillance for the management of an outbreak of CCHF is needed. This should be carry out with an integrated approach among the countries at risk of infection in the Mediterranean area in order to design measures for prevention and control of this disease, mapping of endemic areas and assessing risk of CCHF transmission. In addition, the areas at risk of further expansion of CCHF should be identified also oversight [6]. Different elements concerning diagnosis, monitoring and treatment of CCHF should be considered in order to increase the surveillance in Europe defining appropriate measures for prevention and control. Currently there are no standard definitions regarding how to notify CCHF infection and how “contact tracing” must be carry out in different European countries. Recent cases of nosocomial infection of health care workers infected by CCHFV have been documented. These cases stress the needing for a focused education, with particular regard to transmission pathways and to preventive measures; it is also crucial providing adequate resources on contrasting the diffusion of this disease [6]. Besides, in many countries at risk of infection, standard collaboration procedures and protocols for data exchange are not settled between human and animal health services. Therefore designing and creating a surveillance system for these vector-transmitted diseases should be aimed to develop common procedures and protocols for data exchange. References

Ribavirin is not effective against Crimean–Congo hemorrhagic fever: observations from the Turkish experience

SummaryCrimean–Congo hemorrhagic fever (CCHF) is a viral infection associated with a high mortality rate. Ribavirin is the only drug used in the treatment of this disease. Studies investigating the effectiveness of ribavirin in CCHF have been retrospective and to date have included only a small number of cases. In recent years, due to climate changes, the number of cases of CCHF in Turkey has increased, and experience in the treatment of CCHF has improved. Several studies have evaluated the efficacy of ribavirin in Turkey, including one randomized controlled trial and two studies with a large number of cases. In these studies, ribavirin therapy was not shown to decrease mortality rates; the mortality rate was 2–9% in patients treated with ribavirin and 5.6–11% in those who were not treated with this drug. These findings suggest that patients with CCHF should be followed with supportive care only until randomized controlled trials with larger groups have been conducted.

The Treatment of Crimean-Congo Hemorrhagic Fever With High-dose Methylprednisolone, Intravenous Immunoglobulin, and Fresh Frozen Plasma

Crimean-Congo hemorrhagic fever (CCHF) is an acute tick-borne disease caused by Nairovirus, and it is sometimes characterized by reactive hemophagocytic histiocytosis (HLH). The reasons for reactive HLH are macrophage-activating syndrome and disseminated intravascular coagulation due to cytokine storm, liver dysfunction, and endothelial damage by the virus. In this study, the effectiveness of high-dose methylprednisolone (HDMP) (5 to 30 mg/kg/d), fresh frozen plasma (FFP), and intravenous immunoglobulin (IVIG) was investigated in patients with CCHF associated with reactive HLH. Twelve patients with CCHF in association with reactive HLH were included in the study. The patients were successfully treated with HDMP to suppress the macrophage activation, FFP to treat disseminated intravascular coagulation, and IVIG to treat severe thrombocytopenia. No patients received ribavirin. Fever reduced in 1.6 ± 0.8 days, WBC count increased above 4.500/µL in 4.0 ± 2.4 days, platelet count increased above 150.000/µL in 8.5 ± 2.5 days, and D-dimer level decreased under 1 mcg/dL in 5.8 ± 3.6 days. Consequently, HDMP, FFP, and IVIG may be effective in patients with CCHF associated with reactive HLH during hemorrhagic period of the disease.

Re-Evaluation of 400 Crimean-Congo Hemorrhagic Fever Cases in an Endemic Area: Is Ribavirin Treatment Suitable?

Crimean-Congo hemorrhagic fever (CCHF) is a tick-borne viral disease, seen in various regions around the world, leading to death following a clinical syndrome of hemorrhagic fever. This trial was conducted in Tokat State Hospital that is located in an endemic area. Four hundred patients referring to hospital between 2007 and 2009 and diagnosed as having CCHF with RT-PCR were enrolled in this trial. Ribavirin was not administered to any patient. Epidemiological, clinical, and laboratory findings of CCHF and factors affecting mortality were evaluated. Twenty patients (5%) died and 380 patients recovered (95%). It was found that mean age, white blood cells (WBC), active tromboplastine time (aPTT), alanine aminotransferase (ALT), and aspartate aminotransferase (AST) values were significantly higher in patients who died, as compared with recovered cases and the difference was significant. Platelet values were significantly lower in patients who died, as compared with recovered cases. Age, male gender, high levels of ALT, AST, WBC aPTT values, platelet levels, and decrease in these values during follow-up are indicative of a poor prognosis. Use of ribavirin is not required in treatment of CCHF.

Ribavirin for patients with Crimean–Congo haemorrhagic fever: a systematic review and meta-analysis

Crimean-Congo haemorrhagic fever (CCHF) is a potentially fatal tick-borne infection. The virus is widely distributed around the world and reports of sporadic cases and outbreaks have recently increased significantly. Some authors have proposed that ribavirin improves survival in CCHF and this view appears to be widely accepted. We evaluated the efficacy of ribavirin in reducing mortality by conducting a systematic review and meta-analysis. We included randomized controlled trials and observational studies that compared the outcomes of CCHF patients who were treated with ribavirin with those of patients that were not treated. The main endpoint we assessed was survival. We also evaluated secondary endpoints, i.e. adverse events, length of stay in the hospital, time taken for laboratory values to return to normal and requirement for blood products. A pooled estimate of the relative risks for survival from each study was obtained by using random effects models. One randomized controlled trial and seven observational studies met our inclusion criteria. Most observational studies suffered from different types of bias due to inappropriate selection of controls. Compilation of data from all included studies showed that ribavirin did not improve survival in CCHF (relative risk 1.06, 95% confidence interval 0.97-1.16). Analysis of secondary endpoints did not suggest a clinically significant beneficial effect either. Our systematic review and meta-analysis revealed that the available data in the literature are inadequate to support a claim of efficacy of ribavirin in CCHF. We believe a real uncertainty exists over the benefit of ribavirin in the treatment of CCHF, which necessitates the urgent conduct of a randomized placebo-controlled trial.

Recent Progress in the Treatment Of Crimean–Congo Hemorrhagic Fever and Future Perspectives

Crimean–Congo hemorrhagic fever (CCHF) caused by the CCHF virus, a member of the family Bunyaviridae, genus Nairovirus, is a tick-borne acute viral hemorrhagic fever with a high case–fatality rate. Ribavirin has been used as a treatment for patients with CCHF. Although the efficacy of ribavirin in the treatment of CCHF has not yet been proven conclusively, its use in the early stage of the disease is recommended. A number of clinical and virological insights into CCHF have been revealed. Virus-associated hemophagocytic syndrome has been found to contribute to the exacerbation of CCHF in some patients, and the administration of methylprednisolone at high doses was observationally undertaken in patients with CCHF and virus-associated hemophagocytic syndrome, with promising results. It is expected that effective therapeutics and preventive measures will be developed in the future.

Kırım-Kongo kanamalı ateşi’nin kan merkezi iş yüküne etkisi

Ozet Amac. Kirim-Kongo Kanamali Atesi (KKKA) tedavisinde kan urunleri (trombosit suspansiyonu, taze donmus plazma, eritrosit suspansiyonu) onemlidir. Bu arastirmada kan merkezimizde hazirlanan ve hastanemizde yatan hastalara uygulanan kan urunleri geriye yonelik olarak incelenmistir. Amacimiz, tuketilen kan urunlerinin aylara ve kliniklere gore dagilimini incelemek ve KKKA'nin goruldugu Ilkbahar ve Yaz aylarinda kan merkezimizin is yukunun artip artmadigini belirlemekti. Yontem. Ocak-Aralik 2009 tarihleri arasindaki bir yillik surede kan merkezimiz bilgisayar kayitlari incelenerek kliniklerce tuketilen kan urunleri her klinik icin unite/ay olmak uzere kaydedilerek analiz edildi. Bulgular. Bir yillik calisma suresince hastanemizde aylik ortalama 940 (min: 699; max: 1260) unite kan urununun kliniklerce kullanilmis oldugu gozlendi. Hastanemizde KKKA hastalarinin takip edildigi Nisan-Eylul aylari arasindaki 6 aylik surede ortalama 1080 unite, takip edilmedigi diger 6 aylik sure icinde ise aylik ortalama 806 unite kan urununun tuketildigi ve bu iki donem arasinda %34'luk fark oldugu gozlendi. Infeksiyon Hastaliklari ve Klinik Bakteriyoloji Klinigi'nde 6 aylik KKKA doneminde toplam 206 KKKA hastasinin izlenerek tedavi edildigi ve bu donemde ortalama 135 unite/ay, diger donemde ise ortalama 16 unite/ay kan urununun kullanildigi, iki donem arasinda 8.4 katlik bir farkin oldugu bulundu. Hastanemizin diger kliniklerinde Nisan-Eylul 2009 doneminde aylik ortalama 972 unite, diger donemde ise aylik ortalama 790 unite kan urunu kullanilmis olup, iki donem arasinda %23'luk bir fark oldugu belirlendi. Buna gore hastanemizde kan merkezimizin is yukunun Ilkbahar ve Yaz aylarinda, Sonbahar ve Kis aylarina gore %34 oraninda artmis oldugu ve bu artisin %11'lik kisminin KKKA'dan kaynaklandigini gozlemledik. Sonuc. Bulgularimizin KKKA icin endemik olan bolgelerdeki kan merkezlerinin yapilandirilmasinda, fiziksel kosullarin iyilestirilmesinde ve kan merkezi personellerinin egitiminde goz onunde bulundurulmasi gerektigini dusunuyoruz. Anahtar sozcukler: Kirim-Kongo kanamali atesi, kan urunleri, kan merkezi is yuku Abstract Aim. Blood products (platelet suspension, fresh frozen plasma, packed red blood cells) are important in the treatment of Crimean-Congo Hemorrhagic Fever (CCHF). In this study, administered blood products prepared by our blood transfusion center to the hospitalized patients at our hospital were examined retrospectively. Our aim was to examine the distribution of utilized blood products according to months and clinics and to determine whether the workload of the blood transfusion center was increased in seasons which CCHF is frequently encountered such as the spring and summer. Methods. Data were obtained from our blood transfusion center . Computer records of consumed blood products by clinics between January to December 2009 were recorded as unit/month for each clinic and were analyzed. Results. Within this one year period, it was observed that the average units of blood products of utilized by clinics was 940 (min: 699, max: 1260 units). Average blood product consumption of our hospital in a 6-month period between the months of April to September, in which CCHF patients were followed was 1080 units, and it was 806 units in the other 6 months. We found 34% difference between these two periods. A total of 206 CCHF patients were treated and followed in Infectious Diseases and Clinical Bacteriology Clinic during this 6 month of CCHF period. In this period, an average of 135 units/month of blood products were used, while in the other period, an average of 16 units/month of blood products were used and 8.4-fold difference between the two periods were found. During the 6-month CCHF period, an average of 972 units/month of blood products were used in the other clinics of our hospital, while in the other 6 months period, an average of 790 units/month blood products were used, and there was a 23% of difference between the two periods. Accordingly, we observed that the workload of hospital blood center increased to 33% in the spring and summer months with respect to autumn and winter months, and 11% portion of this increase was due to CCHF. Conclusion. We think that our findings should be considered for configuration and improvement of the physical conditions regarding blood transfusion centers and in education of blood transfusion center staff in CCHF endemic areas. Key words: Crimean-Congo hemorrhagic fever, blood products, blood transfusion center workload

Early Use of Ribavirin in the Treatment of Crimean-Congo Haemorrhagic Fever

Early Use of Ribavirin in the Treatment of Crimean-Congo Haemorrhagic Fever

The efficacy of ribavirin in the treatment of Crimean-Congo hemorrhagic fever in Eastern Black Sea region in Turkey

Background The efficiency of ribavirin for treatment of Crimean-Congo hemorrhagic fever (CCHF) is unknown. In the literature, prospective randomized studies investigating the efficacy of ribavirin are not found. Objectives To investigate the efficacy of ribavirin in treatment of patients with CCHF. Study design In this prospective randomized cohort study 136 cases were included between June 2004 and August 2007. The diagnosis was confirmed in the CCHF reference laboratory of Refik Saydam National Hygiene Central Institute of the Turkish Ministry of Health. Patients either received ribavirin plus supportive treatment (Group A) ( n = 64) or only supportive treatment (Group B) ( n = 72). For the evaluation of efficacy of ribavirin, various parameters were compared between Group A and Group B. Results As well as the similarity of demographic features between the two groups, there were no statistical differences in incubation time; hospitalization time; patients requiring platelet replacement therapy; the time taken for platelet levels to return to normal levels and mortality. In Group B, the rate of tick contact was higher ( p = 0.03). In Group A, leukocyte levels took longer to return to the normal levels ( p = 0.02). Conclusion In our study, there was no positive effect determined on clinical or laboratory parameters in CCHF patients treated with ribavirin, also it was observed that leukocyte levels took longer to return to normal ( p = 0.02) and, while not statistically significant, the longer period of hospitalization ( p = 0.09) needed was observed as a negative effect. Because of these reasons, it is thought that the use of ribavirin makes no significant contribution to the prognosis of the CCHF disease.

Crimean-Congo Hemorrhagic Fever: A Global Perspective

Preface: Onder Ergonul and Chris A. Whitehouse Section I: Introduction and Historical Perspectives 1. Introduction: Onder Ergonul and Chris A. Whitehouse 2. A Historical Perspective of Infectious Diseases with Reference to Crimean-Congo Hemorrhagic Fever: Berna Arda and Ahmet Aciduman 3. Personal Reflections: Jack Woodall Section II: Etiologic agent 4. Molecular Biology of the Crimean-Congo Hemorrhagic Fever Virus: Ramon Flick 5. Molecular Epidemiology, Genomics, and Phylogeny of the Crimean-Congo Hemorrhagic Fever Virus: Roger Hewson Section III: Epidemiology and ecology 6. Crimean-Congo Hemorrhagic Fever in Turkey: Zati Vatansever, Ramazan Uzun, Agustin Estrada-Pena, Onder Ergonul 7. Crimean-Congo Hemorrhagic Fever in the Balkans: Tatjana Avsic-Zupanc 8. Crimean-Congo Hemorrhagic Fever in Iran: Sadegh Chinikar 9. Crimean-Congo Hemorrhagic Fever in Russia and the Former Soviet Union: A.M. Butenko and G.G. Karganova 10. Crimean-Congo Hemorrhagic Fever CCHF in the Xinjiang Uygur Autonomous Region of Western China: Masayuki Saijo 11. Crimean-Congo Hemorrhagic Fever in South Africa: Felicity J. Burt and Robert Swanepoel 12. Role of Ticks in the Transmission of Crimean-Congo Hemorrhagic Fever Virus: Mike Turell 13. Infection among Animals: Aysegul Nalca and Chris A. Whitehouse 14. Ecology of Disease and the Role of Climate Change: Sarah Randolph and David J. Rogers 15. Predicative Models of Infection: Ben Cooper Section IV: Clinical Features and Pathogenesis 16. Clinical and Pathologic Features of Crimean-Congo Hemorrhagic Fever: Onder Ergonul 17. Pathogenesis of Crimean-Congo Hemorrhagic Fever and Correlation with other Viral Hemorragic Fevers: Mike Bray 18. Laboratory Diagnosis of Crimean-Congo Hemorrhagic Fever: Herve Zeller 19. Treatment of Crimean-Congo Hemorrhagic Fever 19.1. Current Therapy: Ribavirin Use and Hematological Support: Onder Ergonul 19.2. Old and New Treatment Strategies: Ali Mirazimi 19.3. Antibodies to CCHFV for Prophylaxis And Treatment: Mitko Dimitrov Section V: Prevention and Control 20. Risk Groups and Control of Tick Vectors: Chris A. Whitehouse 21. Estimates and Prevention of Crimean Congo Hemorrhagic Fever Risks for Health Care Workers: Arnaud Tarantola, Onder Ergonul, Pierre Tattevin 22. International Surveillance and Control of Crimean-Congo Hemorrhagic Fever Outbreaks: Pierre Formenty, Glenn Schnepf , Fernando Gonzalez-Martin, and Zhenqiang Bi Section VI: Remaining questions and future research Future Research: Onder Ergonul and Chris A. Whitehouse Frequently Asked Questions Index

Treatment of Crimean-Congo hemorrhagic fever

Crimean-Congo hemorrhagic fever (CCHF) has the most extensive geographic range of the medically significant tick-borne viruses, occurring from western China across southern Asia to eastern Europe and South Africa. The causative agent is a negative-sense, single-stranded RNA virus in the genus Nairovirus, family Bunyaviridae. In published reports, the case fatality rate has generally ranged from 10% to 50%. Sporadic cases and outbreaks of the disease have increased during the past decade across the endemic region. CCHF was first diagnosed in Turkey in 2002, but since then more than 1100 cases have been confirmed by IgM serology or RT-PCR, with a fatality rate of just over 5%. Simple methods are available for the in vitro evaluation of antiviral drugs, but because CCHF virus does not cause disease in its reservoir species or in laboratory animals other than suckling mice, methods are lacking for in vivo efficacy testing. Intravenous or oral ribavirin has been used in several countries to treat the disease for more than 20 years. Evidence of its efficacy is limited to observational studies, and placebo-controlled trials may be impossible to perform for ethical reasons. However, careful analysis of properly stratified observational studies can be used to assess the effects of treatment. This article reviews current approaches to the treatment of CCHF, focusing on the use of ribavirin and hematological support, and discusses prospects for future research.