What is Crimean-Congo Haemorrhagic Fever?

What is Crimean-Congo Haemorrhagic Fever?

Crimean-Congo hemorrhagic fever (CCHF) is caused by infection with a tick borne virus. First time in 1969 it was recognized as the cause of illness in the Congo, since then the illness is known as Congo fever. Crimean-Congo hemorrhagic fever is found in Eastern Europe, particularly in the former Soviet Union. It is also distributed throughout the Mediterranean, in northwestern China, central Asia, southern Europe, Africa, the Middle East, and the Indian subcontinent.

How Crimean-Congo-Hemorrhagic Fever Spreads?

Hard ticks are both a reservoir and a vector for the CCHF virus. Numerous wild and domestic animals, such as cattle, goats, sheep and hares, serve as hosts for the virus. Transmission to humans occurs through contact with infected animal blood or ticks. CCHF can be transmitted from one infected human to another by contact with infectious blood or body fluids. Documented spread of CCHF has also occurred in hospitals due to improper sterilization of medical equipment, reuse of injection needles, and contamination of medical supplies.

Sign & Symptoms

The onset of CCHF is sudden, with initial signs and symptoms including headache, high fever, back pain, joint pain, stomach pain, and vomiting. Red eyes, a flushed face, a red throat, and petechiae (red spots) on the palate are common. Symptoms may also include jaundice, and in severe cases, changes in mood and sensory perception. As the illness progresses, large areas of severe bruising, severe nosebleeds, and uncontrolled bleeding at injection sites can be seen, beginning on about the fourth day of illness and lasting for about two weeks.

Who is at risk for the disease?

Animal herders, livestock workers, and slaughter houses in endemic areas are at risk of CCHF. Healthcare workers in endemic areas are at risk of infection through unprotected contact with infectious blood and body fluids. Individuals and international travelers with contact to livestock in endemic regions may also be exposed.

Prevention and control

There is no safe and effective vaccine available for human use. The tick vectors are numerous and widespread and tick control with acaricides / Aswinol / Acetellic 25 WP (chemicals intended to kill ticks) is only a realistic option for well managed livestock production facilities.

a. Persons living in endemic areas should use personal protective measures that include avoidance of areas where tick vectors are abundant and when they are active, regular examination of clothing and skin for ticks, and their removal; and use of repellents.

b. Persons who work with livestock or other animals in the endemic areas can take practical measures to protect themselves. These include the use of repellents on the skin (e.g. DEET) and clothing (e.g. permethrin) and wearing gloves or other protective clothing to prevent skin contact with infected tissue or blood.

c. Patients with suspected or confirmed CCHF should be isolated and cared for using barrier nursing techniques. Specimens of blood or tissues taken for diagnostic purposes should be collected and handled using universal precautions. Sharps (needles and other penetrating surgical instruments) and body wastes should be safely disposed of using appropriate decontamination procedures.

d. Healthcare workers are at risk of acquiring infection from sharps injuries during surgical procedures and, in the past, infection has been transmitted to surgeons operating on patients to determine the cause of the abdominal symptoms in the early stages of (at that moment undiagnosed) infection. Healthcare workers who have had contact with tissue or blood from patients with suspected or confirmed CCHF should be followed up with daily temperature and symptom monitoring for at least 14 days after the putative exposure.

e. When patients with CCHF are admitted to hospital, there is a risk of nosocomial spread of infection. In the past, serious outbreaks have occurred in this way and it is imperative that adequate infection control measures be observed to prevent this disastrous outcome.