Crimean-Congo Hemorrhagic Fever

Crimean-Congo Hemorrhagic Fever (CCHF)

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Take an infection that is spread by ticks, that can cause bleeding and a high fatality rate, and distribute it widely in many parts of the world and you, unfortunately, have Crimean-Congo Hemorrhagic Fever (CCHF).

What does it cause? 

Those affected may have a high fever, muscle aches, lightheadedness, abdominal pain and vomiting as well as bleeding. They may develop light sensitivity and later develop mood swings and become confused or aggressive.

The disease usually involves a sudden febrile illness occurring 2-7 days after exposure (possibly 2-14 days) with neurologic changes (confusion or aggression), hemorrhagic manifestations, and kidney and liver failure. Death, if it occurs, happens 5-14 days after symptoms begin with bleeding in the brain, fluid in the lungs, or generalized organ failure to blame.

How bad is it?

The disease can cause severe outbreaks, with up to 2 in 5 infected patients dying. Some see only 1 in 10 die.

It's rare, fortunately.

Because the disease often occurs where testing may be harder to obtain and resources are more limited, not all cases are likely diagnosed. Outbreaks are usually counted in single or double digits, rarely reaching 200 cases. 

This is not a disease found in the US. 

Where is it?

It is found in Eastern Europe, Africa, Middle East, and Asia. It is not found in the US. As the name implies, the disease can be found from the Democratic Republic of the Congo through other parts of Africa, from Senegal to South Africa to Egypt, to the Ukraine and parts of Russia, as well as Iran, Afghanistan, Kazakhstan, Georgia, Turkey, Croatia, and Bulgaria.

It is also found in Pakistan and western parts of India and China.

Where does it come from?

It can be found in many farm animals and wild animals. Infected animals include cattle, goats, sheep, rabbits. Birds are usually not infected, but ostriches can be, and are often a source of infection.

Transmission can occur from ticks infected by eating from these animals.

Infections can be transmitted directly from the blood from infected animals, such as during butchering. Many of those infected work in slaughterhouses or as veterinarians - both groups vulnerable to CCHf.

The disease may also spread within hospitals or ambulances. Infections can occur when healthcare staff come in contact with blood or other body fluids leading to infection. This can also occur where medical equipment may be reused or staff may not have access to gloves and other supplies to prevent exposures. 

Is there a vaccine?

There is no vaccine.

Is there treatment?

There isn't a specific treatment for this virus. Ribavirin, a drug used in other viruses, seems to have a benefit, but this hasn't been proven; it also is not curative. Formal studies in humans have not been conducted. Opinion on treatment is based on observation and of cases, not on Randomized Trials, as well as lab studies of animals. Given the remote areas and sudden outbreaks in diverse parts of the world, it has been difficult to establish a randomized trial for the study of this disease.

Other drugs have also been evaluated.

Care is largely supportive. This involves support for respiration, for kidney function, for blood pressure, and treatment of any secondary infections. 

Can it spread to health care providers?

Yes, after a US soldier was infected in Afghanistan, 2 of his caregivers developed the infection, despite prophylaxis with ribavirin. Likely either from bagging for ventilation or bronchoscopy or else from routine care with insufficient PPE protocols

It is a biosafety level-4 pathogen.

What sort of virus is it?

The Crimean-Congo Hemorrhagic Fever virus comes from the family Bunyaviridae, genus Nairovirus. This family includes Rift Valley Virus and Hantavirus.

Why does it have its name?

The disease was noticed hundreds of years before. It wasn't identified until in 1944 Soviet troops were infected in Crimea. It was later noticed that the same virus was found in Uganda and what was then called the Congo virus.

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