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Crimean-Congo hemorrhagic fever

Author
Hakan Leblebicioglu, MD
Section Editor
Martin S Hirsch, MD
Deputy Editor
Elinor L Baron, MD, DTMH

INTRODUCTION

Crimean-Congo hemorrhagic fever (CCHF) is a zoonotic disease transmitted by ticks and characterized by fever and hemorrhage [1,2]. It was first described in Soviet soldiers in the Crimea in 1944 and was named Crimean fever. In 1956, the virus was isolated from a child with similar symptoms and was named Congo virus [3]. The causative agent of both illnesses was shown to be the same virus, which was subsequently termed Crimean-Congo hemorrhagic fever virus (CCHFV) [4]. CCHF infects a range of animals; humans are the only known host that develops disease.

EPIDEMIOLOGY

Crimean-Congo hemorrhagic fever (CCHF) is an emerging infectious disease given the expanding distribution of its main vector, ticks of the genus Hyalomma. Each year, more than 1000 human cases are reported from southeastern Europe and western Asia [5,6]. The primary means of transmission to humans is via tick bites.

Geography and season — CCHF is endemic in parts of Africa, the Middle East, Asia, and southeastern Europe [5,6]. CCHF virus has been observed in over 30 countries, including in Africa (Democratic Republic of Congo, South Africa, Nigeria, Senegal, Uganda, Tanzania, Mauritania, Kenya), Asia (Pakistan, Afghanistan, Tajikistan, Uzbekistan, Kazakhstan, China), the Middle East (Iran, Iraq, United Arab Emirates, Saudi Arabia, Oman), and southeastern Europe (the Russian Federation, Bulgaria, Albania, Kosovo, Turkey, Greece) (figure 1) [5,7,8]. Emergence of CCHF in India was reported in 2011 [9]. Between 1998 and 2013, CCHF occurred most frequently in Turkey, Russia, Iran, Pakistan, and Afghanistan [10].

In the Northern Hemisphere, transmission of CCHF virus (CCHFV) is common between May and September, with a peak incidence in June and July [11]. In Pakistan, CCHF has biannual peaks between March and May and between August and October [12]. In Turkey, there is peak transmission in early summer months and a strong association with living at altitude greater than 836.5 m [13]. Seasonal transmission at moderate altitudes, typically around 1000 m, has been reported in other studies, presumably reflecting optimum conditions for tick populations [14,15].

Ticks — CCHFV is primarily transmitted via hard-bodied Hyalomma ticks of the family Ixodes, particularly Hyalomma marginatum [16]. The geography of CCHF infection reflects the distribution of Hyalomma ticks, which have a northern geographic limit of 48° north latitude [17]. CCHFV has also been isolated from Rhipicephalus, Boophilus, and Dermacentor spp, which may also transmit the virus [18].

                

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