Clinical Updates
30 July 2008
Crimean Congo haemorrhagic fever - update
Crimean Congo haemorrhagic fever (CCHF) is endemic in many countries in eastern Europe, the Middle East, Africa, and Asia. Outbreaks have recently been recorded in Russia, Turkey, Bulgaria, Kazakhstan, and South Africa. In June 2008, the first human case was reported in northern Greece. It is rarely reported in travellers.
Russia
Since the last Clinical Update of 27 June 2008, media reports have suggested that human cases of CCHF have continued to occur in the Southern Federal District. Since March 2008 and as of 16 July, 53 cases have been reported in the Rostov Oblast; the Orlov, Martinov, and Zimovnikov districts have been most affected [1]. In 2008, as of 15 July, 61 cases were reported in Stavropol Krai, compared to 64 reported in the whole of 2007 [2].
Turkey
Since the last Clinical Update of 27 June 2008, media reports suggest that cases and deaths from CCHF have continued to occur in western and northern provinces of Turkey. As of 4 July 2008, more than 550 cases had been reported [3], and as of 25 July, 41 people have died from CCHF [4] with deaths recently reported in Bursa, Canakkale, and Samsun provinces [3]. In Bolu province, one death occurred in a nurse that is suspected to have resulted from nosocomial transmission [4].
Bulgaria
Between 20 March and 10 April 2008, six probable CCHF cases were reported by the Bulgarian Ministry of Health [5]. The six cases were reported in the Gotse Delchev municipality, in the Blagoevgrad district of Bulgaria, which borders Greece and Macedonia, an area known to be endemic for CCHF. Four of the cases had removed ticks from cattle and the other two (one a healthcare worker) both had known contact with bodily fluids of one of the CCHF patients.
Greece
On 25 June 2008, a woman died from CCHF after working in fields in Komotini, a town close to Alexandroupoli in northeastern Greece, close to the border with Bulgaria and Turkey [6,7]. It was the first human case to be reported in Greece to date.
Kazakhstan
An increase in reports of CCHF has been seen in the Southern Kazakhstan region, where there is a usual seasonal rise between June and August. One death has been reported in a man who was bitten by a tick at the end of June 2008 [8].
South Africa
As of July 2008, five cases of CCHF have been reported including two deaths. Between 23 June and 21 July, two cases were reported. The first case was in a 38 year old woman who lived on a farm in Bloemfontein, Free State Province. The second case was in a 39 year old male farmer who was bitten by a tick during a hunting trip to Paterson in the Eastern Cape province. Between five and 25 cases are reported in South Africa each year; most cases are reported in Karoo, the Western Free State, the Northern Cape and North West province, and are associated with farm or abattoir workers and hunters. Cases usually occur in the summer months and therefore these two recent cases are somewhat unseasonal [9].
Advice for travellers
CCHF is a serious, viral disease transmitted by the bite of an infected tick. It is a zoonosis (acquired from animals) that infects a range of domestic and wild animals.
There is no vaccine to protect against CCHF. Travellers to affected areas are advised to take measures to minimise their exposure to ticks. These include:
- Wear long sleeved clothing and long trousers. Trousers should be tucked into socks when walking in tick infested areas.
- Apply insect repellent to exposed skin.
- Use a permethrin based insecticide on clothing.
- Inspect for ticks and remove them immediately with tweezers or tick removers.
- Animal handlers should take precautions to avoid exposure to blood and tissues.
Outbreaks of CCHF are listed in the NaTHNaC Outbreak Surveillance Database.
Further information about CCHF can be found in the Clinical Update of 27 June 2008 or on the Health Protection Agency website.
References
1. ProMED-mail. Crimean Congo haemorrhagic fever – Russia (08), 23 July 2008. [Accessed 29 July 2008]. Available at: http://apex.oracle.com/pls/otn/f?p=2400:1001:81396618477193
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2. ProMED-mail. Crimean Congo haemorrhagic fever – Russia (07), 18 July 2008. [Accessed 29 July 2008]. Available at: http://apex.oracle.com/pls/otn/f?p=2400:1001:81396618477193
9::NO::F2400_P1001_BACK_PAGE,F2400_P1001_PUB_MAIL_
3. ProMED-mail. Crimean Congo haemorrhagic fever – Turkey (11), 18 July 2008. [Accessed 29 July 2008]. Available at: http://apex.oracle.com/pls/otn/f?p=2400:1001:41520509797831
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4. ProMED-mail. Crimean Congo haemorrhagic fever – Turkey (13), 18 July 2008. [Accessed 29 July 2008]. Available at: http://apex.oracle.com/pls/otn/f?p=2400:1001:7896885022416::
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5. Kunchev A, Kojouharvoa M. Probable cases of Crimean Congo haemorrhagic fever in Bulgaria: A preliminary report. EuroSurveillance, 2008; 13 (17). [Accessed 29 July 2008]. Available at: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=18845
6. ProMED-mail. Crimean Congo haemorrhagic fever – Greece, 3 July 2008. [Accessed 29 July 2008]. Available at: http://apex.oracle.com/pls/otn/f?p=2400:1001:28033947766352
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7. ProMED-mail. Crimean Congo haemorrhagic fever – Greece (02), 5 July 2008. [Accessed 29 July 2008]. Available at: http://apex.oracle.com/pls/otn/f?p=2400:1001:813966184771939
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8. ProMED-mail. Crimean Congo haemorrhagic fever – Kazakhstan, Russia, 13 June 2008. [Accessed 29 July 2008]. Available at: http://apex.oracle.com/pls/otn/f?p=2400:1001:81396618477193
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9. South African National Institute for Communicable Disease. Communique, July 2008. [Accessed 29 July 2008]. Available at: http://www.nicd.ac.za/pubs/communique/2008/NICDCommJuly0
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