What is Crimean-Congo Hemorrhagic Fever?
Crimean-Congo Hemorrhagic Fever (CCHF) is one of the viral hemorrhagic fevers caused from the bite of the tick. This is a widespread disease, endemic in the Balkans, Africa, Asia and the Middle East. The virus that causes Crimean–Congo Hemorrhagic Fever belongs to the member of the Bunyaviridae family. Crimean–Congo Hemorrhagic Fever is a zoonotic disease, which means that the carriers of this disease include various domestic and wild animals. The clinical disease of Crimean–Congo Hemorrhagic Fever is rare in the infected animals, but this disease is very severe in humans who get infected. The mortality rate of Crimean–Congo Hemorrhagic Fever in human beings is about 10 to 40%. Outbreaks of Crimean–Congo Hemorrhagic Fever are often from Hyalomma tick bites or from coming in contact with infected humans or animals. Crimean–Congo Hemorrhagic Fever is likely a cause of future epidemic as recognized by the WHO.
Signs & Symptoms of Crimean-Congo Hemorrhagic Fever
The symptoms of Crimean–Congo Hemorrhagic Fever are sudden in nature and consist of:
- Initial symptoms consist of headache, back pain, high fever, pain in the joints, vomiting and abdominal pain.
- Other common symptoms are: Red eyes, flushed face, redness of the throat, and petechiae or red spots on the palate.
- Other symptoms, which may occur include jaundice.
- In severe cases, the patient may have changes in sensory perception and in his/her moods.
- As there is worsening of Crimean-Congo Hemorrhagic Fever, the patient has large portions of severe bruising, uncontrolled bleeding at injection sites and severe nosebleeds. This can occur on fourth day of illness and can persist up to two weeks.
- Patients hospitalized with Crimean-Congo Hemorrhagic Fever have mortality rates ranging from 10% to 50%.
Risk Factors of Crimean-Congo Hemorrhagic Fever
- People who herd goats, slaughterhouse workers, livestock workers in endemic regions are at an increased risk for contracting Crimean-Congo Hemorrhagic Fever.
- Healthcare workers in these regions are also vulnerable for this infection from unprotected contact with infectious body fluids and infectious blood of the patient.
- International travelers who come into contact with livestock in endemic regions can also contract CCHF.
Diagnosis of Crimean-Congo Hemorrhagic Fever
There are different laboratory tests available for diagnosing Crimean-Congo Hemorrhagic Fever:
- Enzyme-Linked Immunosorbent Assay (ELISA).
- Serum neutralization test.
- Antigen detection test.
- Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) test.
- Virus isolation by cell culture.
Patients in the initial stages of this disease and the patients who are suffering from a severe case of Crimean-Congo Hemorrhagic Fever will usually not develop a sufficient antibody response. In such cases, the diagnosis can be made by virus or RNA detection in tissue or blood.
Treatment for Crimean-Congo Hemorrhagic Fever
- The primary treatment is managing and alleviating the symptoms along with general supportive care of the patient.
- Ribavirin is an antiviral drug, which has shown to be effective in treating Crimean-Congo Hemorrhagic Fever. Ribavirin can be given both intravenously and orally.
- Supportive treatment of Crimean-Congo Hemorrhagic Fever consists of maintaining the fluid balance, oxygenation, correcting electrolyte abnormalities, and hemodynamic support.
- Treatment of secondary infections if present should be started.
Recovery from Crimean-Congo Hemorrhagic Fever
It is not determined what the long-term effects or complications of Crimean-Congo Hemorrhagic are, as sufficient studies are not available. The recovery from Crimean-Congo Hemorrhagic Fever is very slow.
Vaccine for Crimean-Congo Hemorrhagic Fever
Currently, there is no safe and effective vaccine available for human use. Research is still going on for development of potential vaccines along with determining the efficacy of different treatments including ribavirin and other antiviral medicines. Vaccines are also not available for animals.
Prevention of Crimean-Congo Hemorrhagic Fever
Prevention of Tick-To-Human Transmission
- Agricultural workers people who work with animals should always apply insect repellent on the exposed areas of the body. It is also important to wear gloves and protective clothing when going outside for work.
- Always wear clothes which are light in color, as this makes it easier to detect ticks on the clothes.
- The clothes and skin should be regularly examined for ticks and then removed carefully.
- Acaricides should be used on clothing.
- People should avoid areas which are abundant in ticks and also those seasons in which the ticks are active.
Prevention of Animal-to-Human Transmission
- Gloves and other protective clothing should be worn by people who are handling animals or tissues of animals in endemic areas, especially during butchering, slaughtering, culling process.
- Contact with the infected body and blood fluids of humans and livestock should be avoided.
- Always quarantine the animals before moving them to slaughterhouses. It is also important to regularly treat animals with pesticides about 15 days before slaughtering them.
Prevention of Human-to-Human Transmission
- Close physical contact with individuals who are infected with Crimean-Congo Hemorrhagic Fever should be avoided.
- Proper infection control precautions should be taken by healthcare workers.
- Healthcare workers should wear gloves and other protective equipment when looking after patients who are infected with this condition.
- Healthcare workers should always wash hands after visiting or when caring for patients.
- Safe injection practices and safe burial practices should be followed.
- Blood or other fluid samples taken from CCHF infected or suspected patients should be handled by trained healthcare workers in appropriately equipped laboratories.