Everything about Crimean-congo Hemorrhagic Fever totally explained
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Crimean-Congo hemorrhagic fever (CCHF) is a widespread
tick-borne
viral disease, a
zoonosis of
domestic animals and
wild animals, that may affect humans. The
pathogenic
virus, especially common in
East and
West Africa, is a member of the
Bunyaviridae family of
RNA viruses. Clinical
disease is rare in
infected mammals, but commonly severe in infected
humans, with a 30%
mortality rate.
Outbreaks of illness are usually attributable to handling infected animals or people.
Epidemiology
Sporadic infection of people is usually caused by
Hyalomma tick bite. Clusters of illness typically appear after people treat, butcher or eat infected
livestock, particularly
ruminants and
ostriches. Outbreaks have occurred in clinical facilities where health workers have been exposed to infected
blood and
fomites.
The causative organism is found in
Asia,
Eastern Europe, the
Middle East, a belt across central
Africa and
South Africa and
Madagascar (
see map (External Link
)) The main environmental reservoir for the virus is small mammals (particularly
European hare, Middle-African
hedgehogs and
multimammate rats). Ticks carry the virus to domestic animal stock.
Sheep,
goats and
cattle develop high titers of virus in blood, but tend not to fall ill.
Birds are generally resistant with the exception of ostriches.
Manifestations
Typically, after a 1–3 day
incubation period following a tick bite (5–6 days after exposure to infected blood or tissues),
flu-like
symptoms appear, which may resolve after one week. In up to 75% of cases, however, signs of
hemorrhage appear within 3–5 days of the onset of
illness: first
mood instability,
agitation,
mental confusion and throat
petechiae, then soon
nosebleeds,
bloody urine and
vomiting, and
black stools. The
liver becomes
swollen and painful.
Disseminated intravascular coagulation may occur as well as acute
kidney failure and
shock, and sometimes
acute respiratory distress syndrome.
Patients usually begin to recover after 9–10 days from symptom onset, but 30% die in the second week of illness.
Public health measures
Where mammal and tick infection is common agricultural regulations require de-ticking farm animals before transportation or delivery for
slaughter. Personal tick avoidance measures are recommended, such as use of
insect repellents, adequate clothing and body inspection for adherent ticks.
When feverish patients with evidence of bleeding require
resuscitation or
intensive care,
body substance isolation precautions should be taken.
The
United States armed forces maintain special stocks of
ribavirin to protect personnel deployed to
Afghanistan and
Iraq from CCHF.
Treatment
Treatment is primarily symptomatic and supportive, as there's no established specific treatment.
Ribavirin is effective
in vitro and has been used during outbreaks, but there's no trial evidence to support its use.
Notable outbreaks
During the summers of
1944 and
1945 over 200 cases of an acute, hemorrhagic, febrile illness occurred in
Soviet troops rescuing the harvest following the
ethnic cleansing of the
Crimean Tatars. Virus was discovered in blood samples of patients and in the tick
Hyalomma marginatum marginatum. Researchers soon recognized that a similar disease had been occurring in the
Central Asian Republics. In
1969 analysis of a preserved blood sample collected from a febrile child in
Zaire in
1956 showed the same virus. This finding gave rise to the present name of the disease.
On
July 28,
2005 authorities reported 41 cases of CCHF in
Turkey's
Yozgat Province, with one death.
Further Information
Get more info on 'Crimean-congo Hemorrhagic Fever'.
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