CRIMEAN-CONGO HEMORRHAGIC FEVER - GEORGIA, FIRST CASE
***********************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>
Date: Fri 11 Sep 2009
Source: Rustavi 2 News [edited]
<http://www.rustavi2.com/news/news_text. ... &ct=0&wth=>
The National Center of Disease Control says the 1st case of the
lethal virus -- Crimean-Congo hemorrhagic fever (CCHF) -- has been
confirmed in Georgia. The health condition of the 31-year-old man
infected by the virus is very poor. He has been connected to a
breathing apparatus in the resuscitation department of the Hospital
of Tbilisi infectious diseases hospital. Initial symptoms of
Crimean-Congo hemorrhagic fever are instant shock, internal bleeding,
also hemorrhages on the body. The infected man was taken to hospital
with the mentioned symptoms.
CCHF is caused by infection with a tick-borne virus (genus
_Nairovirus_ of the family _Bunyaviridae_. The disease was 1st
characterized in the Crimea in 1944 and given the name Crimean
hemorrhagic fever. It was then later recognized in 1969 as the cause
of illness in the Congo, thus resulting in the current name of the
disease. This is the 1st case of CCHF virus infection in Georgia.
Until now, the virus was present in the Krasnodar Oblast of Russia,
Iran and Turkey. [In fact CCHFV is widespread in Africa, the Middle
East and Asia. It has also been found in many parts of Europe,
including southern portions of the former USSR (Crimea, Astrakhan,
Rostov, Uzbekistan, Kazakhstan, Tajikistan), Turkey, Bulgaria,
Greece, Albania and Kosovo province of the former Yugoslavia. Limited
serological evidence suggests that CCHFV might also occur in parts of
Hungary, France and Portugal. - Mod.CP]
In case of infection, the probability of the patient's death is 60
percent. Ixodid (hard) ticks, especially those of the genus,
_Hyalomma_, 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 amplifying hosts for the virus. Transmission to
humans occurs through contact with infected animal blood or ticks.
CCHF virus can be transmitted from one infected human to another by
contact with infectious blood or body fluids
The head of the national center, Paata Imnadze, says the infected
person is a young man who is undergoing intensive treatment in
hospital. He said the Health Care Ministry would completely cover the
treatment expenditures. The man has been presumably infected by an
ixodid tick. Blood tests will be conducted on his family members as well.
--
Communicated by:
ProMED-mail Rapporteur Susan Baekeland
[For further information, see the WHO Factsheet at:
<http://www.who.int/mediacentre/factshee ... index.html>.
A map of Georgia showing the location of the capital Tbilisi can be
found at:
<http://www.worldatlas.com/webimage/coun ... ope/ge.htm>. - Mod.CP]
Krim-Kongo Hämorrhagisches Fieber
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Re: Krim-Kongo Hämorrhagisches Fieber
CRIMEAN-CONGO HEMORRHAGIC FEVER - TURKEY (08 )
***********************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>
Date: Mon 14 Sep 2009
Source: Today's Zaman [edited]
<http://www.todayszaman.com/tz-web/news- ... onths.html>
As the summer comes to a close, ticks, a seasonal menace, continue to
cause illness and death around the country, with 6 people dying last
week of tick-borne Crimean-Congo Hemorrhagic Fever (CCHF), thus
bringing the year-to-date tally of CCHF victims to 61.
According to data from the Ministry of Health, between 1 Jan and 31
Aug 2009, 274 cases of CCHF were detected, 61 of which were fatal,
whereas 1298 cases were diagnosed in the same period of 2008, and only
59 lost their lives.
Efforts to eradicate ticks, which can be found in almost 1200 Turkish
villages, continue at full speed. Ministry of Health officials carry
out education and awareness campaigns, distribute tick repellent and
spray for ticks in affected areas. Officials warn, however, that many
citizens do not take necessary precautions to avoid tick bites and
their resulting illnesses.
--
Communicated by:
ProMED-mail Rapporteur Susan Baekeland
***********************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>
Date: Mon 14 Sep 2009
Source: Today's Zaman [edited]
<http://www.todayszaman.com/tz-web/news- ... onths.html>
As the summer comes to a close, ticks, a seasonal menace, continue to
cause illness and death around the country, with 6 people dying last
week of tick-borne Crimean-Congo Hemorrhagic Fever (CCHF), thus
bringing the year-to-date tally of CCHF victims to 61.
According to data from the Ministry of Health, between 1 Jan and 31
Aug 2009, 274 cases of CCHF were detected, 61 of which were fatal,
whereas 1298 cases were diagnosed in the same period of 2008, and only
59 lost their lives.
Efforts to eradicate ticks, which can be found in almost 1200 Turkish
villages, continue at full speed. Ministry of Health officials carry
out education and awareness campaigns, distribute tick repellent and
spray for ticks in affected areas. Officials warn, however, that many
citizens do not take necessary precautions to avoid tick bites and
their resulting illnesses.
--
Communicated by:
ProMED-mail Rapporteur Susan Baekeland
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Re: Krim-Kongo Hämorrhagisches Fieber
Iran - Krim-Kongo hämorrhagisches Fieber (CCHF)
14.09.2009
Laut offiziellen Angaben des Gesundheitsministeriums sind 2009 bisher 63 Menschen an CCHF erkrankt und 8 verstorben. Vermutlich besteht eine hohe Dunkelziffer. Zeckenschutz beachten. / Quelle: crm
14.09.2009
Laut offiziellen Angaben des Gesundheitsministeriums sind 2009 bisher 63 Menschen an CCHF erkrankt und 8 verstorben. Vermutlich besteht eine hohe Dunkelziffer. Zeckenschutz beachten. / Quelle: crm
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Re: Krim-Kongo Hämorrhagisches Fieber
CRIMEAN-CONGO HEMORHAGGIC FEVER, FATAL: IMPORTED ex AFGHANISTAN
***************************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>
Date: Thu 17 Sep 2009
Source: Andalusia Star-News.com [edited]
<http://www.andalusiastarnews.com/news/2 ... l-soldier/>
Virus claims soldier: Infection came from Afghanistan tick bite
---------------------------------------------------------------
A United States Army soldier from Covington County, Alabama, died
Wednesday [16 Sep 2009] in Landstuhl, Germany, after succumbing to a
virus he contracted from a tick [bite] while serving in Afghanistan.
The 22-year-old sergeant from River Falls, Alabama, was stationed
close to Afghanistan's capital of Kabul when the tick bit him, said a
relative in Andalusia. "As far as we know, he was bitten by a tick
that carried a virus," said his relative, who has been in contact with
the soldier's family in Germany. "It put him into a coma for 5 days
and they had him on a dialysis machine. He had a heart attack and
passed away Wednesday morning [16 Sep 2009] at (approximately 8:30
p.m. Tuesday night, Alabama time)."
His relative said doctors determined the soldier contracted the rare
Crimean-Congo hemorrhagic fever (CCHF) virus, which has been recorded
in Africa, Asia and the Middle East. According to the World Health
Organization's (WHO) Factfile, the mortality rate for the CCHF virus
is 30 percent [see
<http://www.who.int/mediacentre/factshee ... index.html>
and comment below. - Mod.CP]
The soldier's relative said that he may have been the 1st U.S. soldier
to contract the virus in Afghanistan. "We have heard that he was going
out into the countryside with some goat herdsmen, and he picked it up
there."
The virus has a 3-week incubation period, and then once it comes out
of incubation, it starts to attack. [According to the WHO Web site:
Following infection via tick bite, the incubation period is usually
one to 3 days, with a maximum of 9 days. The incubation period
following contact with infected blood or tissues is usually 5 to 6
days, with a documented maximum of 13 days. - Mod.CP]. The soldier
started hemorrhaging on Sunday [13 Sep 2009], and the doctors gave him
2 units of packed red-blood cells and platelets.
"Tuesday, they gave him another dose of platelets, and administered a
feeding tube. By that point, we were told his [probability of
survival] had dropped from 50 percent to 5 percent. I was talking to
his sister (on Wed 16 Sep 2009) and the doctors were going to take him
for a CAT scan, but the heart attack hit before they could do that."
The deceased soldier 1st enlisted in the U.S. Army more than 4 years
ago in Montgomery. He was assigned to Fort Lewis in Pierce County,
Washington, and became a member of the 5th Stryker Brigade Combat
Team, 2nd Infantry Division, which was sent to Afghanistan in July
[2009]. He had recently re-enlisted with the U.S. Army for 6 more
years, and his late father had also served in the military. "He had
come home for a visit in August," his relative said. "The military was
his life. The only thing he wanted to do was go into service. He was
very honored to serve his country."
The relative said funeral arrangements have not been finalized, and
the immediate family is still in Germany. The body will undergo an
autopsy in Atlanta, Georgia, prior to a funeral.
[Byline: Justin Schuver]
--
Communicated by:
ProMED-mail
<promed@promedmail.org>
[The geographical distribution of CCHF, like that of its tick vector,
is widespread. Evidence of CCHF virus has been found in Africa, Asia,
the Middle East and Eastern Europe. Health care workers in endemic
areas should be aware of the illness and the correct infection control
procedures to protect themselves and their patients from the risk of
nosocomial (hospital-acquired) infection. Humans who become infected
with CCHF acquire the virus from direct contact with blood or other
infected tissues from livestock during this time, or they may become
infected from a tick bite. The majority of cases have occurred in
those involved with the livestock industry, such as agricultural
workers, slaughterhouse workers and veterinarians.
According to the WHO Web site, general supportive therapy is the
mainstay of patient management in CCHF. Intensive monitoring to guide
volume and blood component replacement is required. The antiviral drug
ribavirin has been used in treatment of established CCHF infection
with apparent benefit. Both oral and intravenous formulations seem to
be effective. The value of immune plasma from recovered patients for
therapeutic purposes has not been demonstrated, although it has been
employed on several occasions. No vaccine is currently available, but
as this incident indicates there is an urgent need for development of
a prophylactic vaccine. - Mod.CP]
[CCHF virus infection was originally reported from a 1944 outbreak
affecting 200 Soviet military who were assisting peasants in the
war-devastated Crimean peninsula of the Ukraine. Only about 5000 cases
of CCHF virus infection have been recorded since then in the
literature, and given the relatively small number of people at risk
for contracting the disease, large-scale development and production of
a vaccine to modern regulatory standards seems unlikely. Ref: Ergonul
O & Whitehouse CA 2007 Crimean-Congo Hemorrhagic Fever, Springer. -
Mod.JW]
***************************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>
Date: Thu 17 Sep 2009
Source: Andalusia Star-News.com [edited]
<http://www.andalusiastarnews.com/news/2 ... l-soldier/>
Virus claims soldier: Infection came from Afghanistan tick bite
---------------------------------------------------------------
A United States Army soldier from Covington County, Alabama, died
Wednesday [16 Sep 2009] in Landstuhl, Germany, after succumbing to a
virus he contracted from a tick [bite] while serving in Afghanistan.
The 22-year-old sergeant from River Falls, Alabama, was stationed
close to Afghanistan's capital of Kabul when the tick bit him, said a
relative in Andalusia. "As far as we know, he was bitten by a tick
that carried a virus," said his relative, who has been in contact with
the soldier's family in Germany. "It put him into a coma for 5 days
and they had him on a dialysis machine. He had a heart attack and
passed away Wednesday morning [16 Sep 2009] at (approximately 8:30
p.m. Tuesday night, Alabama time)."
His relative said doctors determined the soldier contracted the rare
Crimean-Congo hemorrhagic fever (CCHF) virus, which has been recorded
in Africa, Asia and the Middle East. According to the World Health
Organization's (WHO) Factfile, the mortality rate for the CCHF virus
is 30 percent [see
<http://www.who.int/mediacentre/factshee ... index.html>
and comment below. - Mod.CP]
The soldier's relative said that he may have been the 1st U.S. soldier
to contract the virus in Afghanistan. "We have heard that he was going
out into the countryside with some goat herdsmen, and he picked it up
there."
The virus has a 3-week incubation period, and then once it comes out
of incubation, it starts to attack. [According to the WHO Web site:
Following infection via tick bite, the incubation period is usually
one to 3 days, with a maximum of 9 days. The incubation period
following contact with infected blood or tissues is usually 5 to 6
days, with a documented maximum of 13 days. - Mod.CP]. The soldier
started hemorrhaging on Sunday [13 Sep 2009], and the doctors gave him
2 units of packed red-blood cells and platelets.
"Tuesday, they gave him another dose of platelets, and administered a
feeding tube. By that point, we were told his [probability of
survival] had dropped from 50 percent to 5 percent. I was talking to
his sister (on Wed 16 Sep 2009) and the doctors were going to take him
for a CAT scan, but the heart attack hit before they could do that."
The deceased soldier 1st enlisted in the U.S. Army more than 4 years
ago in Montgomery. He was assigned to Fort Lewis in Pierce County,
Washington, and became a member of the 5th Stryker Brigade Combat
Team, 2nd Infantry Division, which was sent to Afghanistan in July
[2009]. He had recently re-enlisted with the U.S. Army for 6 more
years, and his late father had also served in the military. "He had
come home for a visit in August," his relative said. "The military was
his life. The only thing he wanted to do was go into service. He was
very honored to serve his country."
The relative said funeral arrangements have not been finalized, and
the immediate family is still in Germany. The body will undergo an
autopsy in Atlanta, Georgia, prior to a funeral.
[Byline: Justin Schuver]
--
Communicated by:
ProMED-mail
<promed@promedmail.org>
[The geographical distribution of CCHF, like that of its tick vector,
is widespread. Evidence of CCHF virus has been found in Africa, Asia,
the Middle East and Eastern Europe. Health care workers in endemic
areas should be aware of the illness and the correct infection control
procedures to protect themselves and their patients from the risk of
nosocomial (hospital-acquired) infection. Humans who become infected
with CCHF acquire the virus from direct contact with blood or other
infected tissues from livestock during this time, or they may become
infected from a tick bite. The majority of cases have occurred in
those involved with the livestock industry, such as agricultural
workers, slaughterhouse workers and veterinarians.
According to the WHO Web site, general supportive therapy is the
mainstay of patient management in CCHF. Intensive monitoring to guide
volume and blood component replacement is required. The antiviral drug
ribavirin has been used in treatment of established CCHF infection
with apparent benefit. Both oral and intravenous formulations seem to
be effective. The value of immune plasma from recovered patients for
therapeutic purposes has not been demonstrated, although it has been
employed on several occasions. No vaccine is currently available, but
as this incident indicates there is an urgent need for development of
a prophylactic vaccine. - Mod.CP]
[CCHF virus infection was originally reported from a 1944 outbreak
affecting 200 Soviet military who were assisting peasants in the
war-devastated Crimean peninsula of the Ukraine. Only about 5000 cases
of CCHF virus infection have been recorded since then in the
literature, and given the relatively small number of people at risk
for contracting the disease, large-scale development and production of
a vaccine to modern regulatory standards seems unlikely. Ref: Ergonul
O & Whitehouse CA 2007 Crimean-Congo Hemorrhagic Fever, Springer. -
Mod.JW]
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Re: Krim-Kongo Hämorrhagisches Fieber
Türkei - Krim-Kongo hämorrhagisches Fieber (CCHF)
21.09.2009
Inzwischen stieg die Zahl der Todesfälle in diesem Jahr auf 61 an. Die Erkrankung geht mit Fieber, schweren Allgemeinerscheinungen und gelegentlich Blutungen einher und tritt besonders in der warmen Jahreszeit auf. Der Erreger, ein Virus, kommt vor allem im zentralen, nördlichen und östlichen Anatolien mit den Provinzen Samsun, Corum, Tokat, Amasya sowie Gumushane, Sivas, Bayburt, Cankin, Yozgat, Karabuk, Kastamonu, Erzurum und Erzincan vor; aus den Urlaubsgebiete im Süden der Türkei wurden bisher keine Fälle berichtet. Die Übertragung erfolgt gewöhnlich durch Zecken, gelegentlich aber auch von Mensch zu Mensch. Schutz vor Zeckenstichen beachten, Kontakt mit Kranken meiden. / Quelle: crm
21.09.2009
Inzwischen stieg die Zahl der Todesfälle in diesem Jahr auf 61 an. Die Erkrankung geht mit Fieber, schweren Allgemeinerscheinungen und gelegentlich Blutungen einher und tritt besonders in der warmen Jahreszeit auf. Der Erreger, ein Virus, kommt vor allem im zentralen, nördlichen und östlichen Anatolien mit den Provinzen Samsun, Corum, Tokat, Amasya sowie Gumushane, Sivas, Bayburt, Cankin, Yozgat, Karabuk, Kastamonu, Erzurum und Erzincan vor; aus den Urlaubsgebiete im Süden der Türkei wurden bisher keine Fälle berichtet. Die Übertragung erfolgt gewöhnlich durch Zecken, gelegentlich aber auch von Mensch zu Mensch. Schutz vor Zeckenstichen beachten, Kontakt mit Kranken meiden. / Quelle: crm
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Re: Krim-Kongo Hämorrhagisches Fieber
CRIMEAN-CONGO HEMORRHAGIC FEVER - PAKISTAN (ABOTTABAD): REQUEST FOR INFORMATION
*******************************************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>
Date: Sun 27 Sep 2009
Source: Daily time [edited]
<http://www.dailytimes.com.pk/default.as ... 009_pg11_6>
One patient tests negative for CCHF and another tests positive
--------------------------------------------------------------
A suspected Crimean-Congo hemorrhagic fever (CCHF) patient was
admitted to the Pakistan Institute of Medical Sciences (PIMS) on
Saturday [26 Sep 2009], but after laboratory test it was confirmed
that he had not contracted the virus, Dr Waseem Khawaja, the
hospital's spokesman, told the Daily Times.
Dr Khawaja said a 65-year-old man, a resident of Haripur, was brought
to hospital on Saturday with suspected symptoms of CCHF. "He was
brought here bleeding from his eyes, nose and other parts of body.
Immediately, he was shifted to an isolation ward and samples of his
blood dispatched to the National Institute of Health (NIH). After
laboratory test, the NIH confirmed that the patient was not suffering
from CCHF," Dr Khawaja said.
He said that the PIMS administration had already placed the hospital
under emergency and established an isolation ward for treatment of
swine flu and CCHF patients. He said CCHF [was a viral hemorrhagic
fever]. Viral hemorrhagic fevers refer to a group of illnesses that
are caused by several distinct families of viruses. "In general, the
term 'viral hemorrhagic fever' is used to describe a severe
multi-system syndrome. Characteristically, overall vascular system is
damaged, and the body's ability to regulate itself is impaired in
this disease," he said. He said its symptoms often included marked
fever, fatigue, dizziness, muscle aches, loss of strength, and
exhaustion. "Patients with severe cases of VHF often show signs of
bleeding under the skin, in internal organs, or from body orifices
like the mouth, eyes, or ears. They may bleed from many sites around
the body but these patients rarely die because of blood loss," Dr
Khawaja said. He said the patients received supportive t!
herapy and there was no other treatment or established cure for VHF.
"Ribavirin, an anti-viral drug, has been effective in treating some
individuals with Lassa fever or HFRS [hemorrhagic fever with renal
syndrome], but it is very expensive and not everyone in Pakistan can
afford it," he said.
Earlier, on Friday [25 Sep 2009], a 58-year-old resident of Abottabad
was admitted to the PIMS bleeding from his nose, eyes, and other
parts of body. After laboratory test, he was confirmed as a case of
CCHF.
[Byline: Mahtab Bashir]
--
Communicated by:
ProMED-mail
<promed@promedmail.org>
[One patient has been confirmed by laboratory testing as a case of
CCHF, whereas another displaying symptoms of hemorrhagic fever has
tested negative. Further information would be welcomed regarding the
circumstances of the exposure of the 2 patients and the final
diagnosis in the case of the CCHF-negative patient.
Abottabad can be located using the HealthMap/ProMEDmail interactive map at:
<http://healthmap.org/promed/en?name=Abb ... 5,73.202,5>.
- Mod.CP]
*******************************************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>
Date: Sun 27 Sep 2009
Source: Daily time [edited]
<http://www.dailytimes.com.pk/default.as ... 009_pg11_6>
One patient tests negative for CCHF and another tests positive
--------------------------------------------------------------
A suspected Crimean-Congo hemorrhagic fever (CCHF) patient was
admitted to the Pakistan Institute of Medical Sciences (PIMS) on
Saturday [26 Sep 2009], but after laboratory test it was confirmed
that he had not contracted the virus, Dr Waseem Khawaja, the
hospital's spokesman, told the Daily Times.
Dr Khawaja said a 65-year-old man, a resident of Haripur, was brought
to hospital on Saturday with suspected symptoms of CCHF. "He was
brought here bleeding from his eyes, nose and other parts of body.
Immediately, he was shifted to an isolation ward and samples of his
blood dispatched to the National Institute of Health (NIH). After
laboratory test, the NIH confirmed that the patient was not suffering
from CCHF," Dr Khawaja said.
He said that the PIMS administration had already placed the hospital
under emergency and established an isolation ward for treatment of
swine flu and CCHF patients. He said CCHF [was a viral hemorrhagic
fever]. Viral hemorrhagic fevers refer to a group of illnesses that
are caused by several distinct families of viruses. "In general, the
term 'viral hemorrhagic fever' is used to describe a severe
multi-system syndrome. Characteristically, overall vascular system is
damaged, and the body's ability to regulate itself is impaired in
this disease," he said. He said its symptoms often included marked
fever, fatigue, dizziness, muscle aches, loss of strength, and
exhaustion. "Patients with severe cases of VHF often show signs of
bleeding under the skin, in internal organs, or from body orifices
like the mouth, eyes, or ears. They may bleed from many sites around
the body but these patients rarely die because of blood loss," Dr
Khawaja said. He said the patients received supportive t!
herapy and there was no other treatment or established cure for VHF.
"Ribavirin, an anti-viral drug, has been effective in treating some
individuals with Lassa fever or HFRS [hemorrhagic fever with renal
syndrome], but it is very expensive and not everyone in Pakistan can
afford it," he said.
Earlier, on Friday [25 Sep 2009], a 58-year-old resident of Abottabad
was admitted to the PIMS bleeding from his nose, eyes, and other
parts of body. After laboratory test, he was confirmed as a case of
CCHF.
[Byline: Mahtab Bashir]
--
Communicated by:
ProMED-mail
<promed@promedmail.org>
[One patient has been confirmed by laboratory testing as a case of
CCHF, whereas another displaying symptoms of hemorrhagic fever has
tested negative. Further information would be welcomed regarding the
circumstances of the exposure of the 2 patients and the final
diagnosis in the case of the CCHF-negative patient.
Abottabad can be located using the HealthMap/ProMEDmail interactive map at:
<http://healthmap.org/promed/en?name=Abb ... 5,73.202,5>.
- Mod.CP]
-
Birgitt
- Moderator
- Beiträge: 35430
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- Wohnort: NRW / Südl. Rheinland
- Kontaktdaten:
Re: Krim-Kongo Hämorrhagisches Fieber
CRIMEAN-CONGO HEMORRHAGIC FEVER - PAKISTAN (02): ex SAUDI ARABIA, SUSPECTED
***********************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>
Date: Sat 10 Oct 2009
Source: The International News [edited]
<http://www.thenews.com.pk/print1.asp?id=202474>
A 32-year-old Pakistani, who had been working as a driver in Saudi
Arabia, returned to Islamabad on Friday [9 Oct 2009] with symptoms of
Crimean-Congo hemorrhagic fever (CCHF). The patient, who had been
under treatment in a private hospital in Saudi Arabia, got himself
admitted to the Pakistan Institute of Medical Sciences (PIMS), where
he was driven straight from the Benazir Bhutto International Airport.
According to PIMS spokesman Dr. Waseem Khwaja, the patient is
suspected as suffering from CCHF and has been moved to the isolation
ward, where barrier nursing protocols are being strictly adhered to.
Relevant samples of the patient have been dispatched to the National
Institute of Health (NIH). "The patient is bleeding from the nose and
gums and has high fever and body rash," Dr. Waseem said, terming him
"critical."
An endemic tick-borne viral disease, CCHF is transferred to humans
through tick bite or through direct contact with blood or other
infected tissues from livestock infected with the virus. Symptoms
include fever, aching muscles, dizziness, neck pain and stiffness,
backache, headache, sore eyes and sensitivity to light. Other
clinical signs that may emerge include fast heart rate, dramatic drop
in platelet and white blood cell counts, bleeding from the upper
bowel, blood in the urine, nosebleeds, and bleeding from the gums.
The severely ill may develop liver and kidney failures after the 5th
day of illness. In patients who recover, improvement generally begins
on the 9th or 10th day after the onset of illness.
[Byline: Shahina Maqbool]
--
Communicated by:
ProMED-mail <promed@promedmail.org>
[Although Crimean-Congo hemorrhagic fever (CCHF) has not been
confirmed by laboratory analysis, CCHF is treated frequently in
Pakistani hospitals, and it is likely that the preliminary diagnosis
will be confirmed.
Information on the likely place and time of exposure in Saudi Arabia
would be welcomed. In view of the critical condition of the patient,
there could be some risk of transmission of infection to the
patient's fellow travellers during transit from Saudi Arabia to
Pakistan if the patient was already hemorrhaging during that time. - Mod.CP]
***********************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>
Date: Sat 10 Oct 2009
Source: The International News [edited]
<http://www.thenews.com.pk/print1.asp?id=202474>
A 32-year-old Pakistani, who had been working as a driver in Saudi
Arabia, returned to Islamabad on Friday [9 Oct 2009] with symptoms of
Crimean-Congo hemorrhagic fever (CCHF). The patient, who had been
under treatment in a private hospital in Saudi Arabia, got himself
admitted to the Pakistan Institute of Medical Sciences (PIMS), where
he was driven straight from the Benazir Bhutto International Airport.
According to PIMS spokesman Dr. Waseem Khwaja, the patient is
suspected as suffering from CCHF and has been moved to the isolation
ward, where barrier nursing protocols are being strictly adhered to.
Relevant samples of the patient have been dispatched to the National
Institute of Health (NIH). "The patient is bleeding from the nose and
gums and has high fever and body rash," Dr. Waseem said, terming him
"critical."
An endemic tick-borne viral disease, CCHF is transferred to humans
through tick bite or through direct contact with blood or other
infected tissues from livestock infected with the virus. Symptoms
include fever, aching muscles, dizziness, neck pain and stiffness,
backache, headache, sore eyes and sensitivity to light. Other
clinical signs that may emerge include fast heart rate, dramatic drop
in platelet and white blood cell counts, bleeding from the upper
bowel, blood in the urine, nosebleeds, and bleeding from the gums.
The severely ill may develop liver and kidney failures after the 5th
day of illness. In patients who recover, improvement generally begins
on the 9th or 10th day after the onset of illness.
[Byline: Shahina Maqbool]
--
Communicated by:
ProMED-mail <promed@promedmail.org>
[Although Crimean-Congo hemorrhagic fever (CCHF) has not been
confirmed by laboratory analysis, CCHF is treated frequently in
Pakistani hospitals, and it is likely that the preliminary diagnosis
will be confirmed.
Information on the likely place and time of exposure in Saudi Arabia
would be welcomed. In view of the critical condition of the patient,
there could be some risk of transmission of infection to the
patient's fellow travellers during transit from Saudi Arabia to
Pakistan if the patient was already hemorrhaging during that time. - Mod.CP]
-
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- Beiträge: 35430
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- Kontaktdaten:
Re: Krim-Kongo Hämorrhagisches Fieber
CRIMEAN-CONGO HEMORRHAGIC FEVER - IRAN (05): ABATTOIR WORKERS
*************************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>
Date: Sun 1 Nov 2009
From: Sadegh Chinikar <sadeghchinikar@yahoo.com>
In ProMED post 20091018.3582 Crimean-Congo hem. fever - Iran (04):
abattoir workers, official veterinarian Dr Hamid Ebrahimzadeh wrote:
"Iran has more than 50 autonomous abattoirs comprising modern meat
processing facilities for halal slaughter, emergency slaughter,
refrigeration, condemned meat disposal, hide and skin storage, offal
disposal, edible fat collection, meat trimming rooms, changing rooms,
and veterinary offices. ... I wish to point out that the CCHF virus,
and nairoviruses in general, are sensitive to pH changes.
Consequently, when rigor mortis ensues (pH about 5.8 ), the carcasses
of cattle in particular will be free of virus infectivity. Thus, the
lapse of time between slaughter and consumption ensures that the meat
will be free of infectivity and is an important factor in risk
management."
[A study by Dr Sadegh Chinikar (in Ergonul O & Whitehouse CA (eds)
2007 Crimean-Congo Hemorrhagic Fever: A Global Perspective, OUP NY)
found that only 16/233 cases of CCHF in Iran were in slaughterhouse
workers, compared with 38 in butchers, raising the question as to why
butchers were at higher risk when presumably they would be receiving
meat from the slaughterhouse with low pH, which would therefore be
non-infectious. ProMED asked for further details, and Dr Chinikar
replied as follows]
In reply to your question about the high number of butchers affected
by CCHF, if butchers used only correctly slaughtered commercial
livestock, they would be at lesser risk of CCHF infection than
slaughterhouse workers. But when we check their history in the rural
areas, some butchers sacrifice livestock themselves in addition to
using commercially slaughtered livestock; this issue should not be
forgotten. Those butchers would certainly increase their CCHF
infection risk this way. The virus can persist in livestock liver for
about 40 days because the pH in the liver does not drop at the same
rate as in muscle, and some people eat uncooked liver.
--
Dr. Sadegh Chinikar
Head of Arbovirus & Viral Haemorrhagic Fever Laboratory
(National Reference Laboratory)
Pasteur Institute of Iran
69 Pasteur Ave.
Tehran, Iran
<sadeghchinikar@yahoo.com>
*************************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>
Date: Sun 1 Nov 2009
From: Sadegh Chinikar <sadeghchinikar@yahoo.com>
In ProMED post 20091018.3582 Crimean-Congo hem. fever - Iran (04):
abattoir workers, official veterinarian Dr Hamid Ebrahimzadeh wrote:
"Iran has more than 50 autonomous abattoirs comprising modern meat
processing facilities for halal slaughter, emergency slaughter,
refrigeration, condemned meat disposal, hide and skin storage, offal
disposal, edible fat collection, meat trimming rooms, changing rooms,
and veterinary offices. ... I wish to point out that the CCHF virus,
and nairoviruses in general, are sensitive to pH changes.
Consequently, when rigor mortis ensues (pH about 5.8 ), the carcasses
of cattle in particular will be free of virus infectivity. Thus, the
lapse of time between slaughter and consumption ensures that the meat
will be free of infectivity and is an important factor in risk
management."
[A study by Dr Sadegh Chinikar (in Ergonul O & Whitehouse CA (eds)
2007 Crimean-Congo Hemorrhagic Fever: A Global Perspective, OUP NY)
found that only 16/233 cases of CCHF in Iran were in slaughterhouse
workers, compared with 38 in butchers, raising the question as to why
butchers were at higher risk when presumably they would be receiving
meat from the slaughterhouse with low pH, which would therefore be
non-infectious. ProMED asked for further details, and Dr Chinikar
replied as follows]
In reply to your question about the high number of butchers affected
by CCHF, if butchers used only correctly slaughtered commercial
livestock, they would be at lesser risk of CCHF infection than
slaughterhouse workers. But when we check their history in the rural
areas, some butchers sacrifice livestock themselves in addition to
using commercially slaughtered livestock; this issue should not be
forgotten. Those butchers would certainly increase their CCHF
infection risk this way. The virus can persist in livestock liver for
about 40 days because the pH in the liver does not drop at the same
rate as in muscle, and some people eat uncooked liver.
--
Dr. Sadegh Chinikar
Head of Arbovirus & Viral Haemorrhagic Fever Laboratory
(National Reference Laboratory)
Pasteur Institute of Iran
69 Pasteur Ave.
Tehran, Iran
<sadeghchinikar@yahoo.com>
-
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- Moderator
- Beiträge: 35430
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- Wohnort: NRW / Südl. Rheinland
- Kontaktdaten:
Re: Krim-Kongo Hämorrhagisches Fieber
CRIMEAN-CONGO HEMORRHAGIC FEVER - IRAN (06): ABATTOIR WORKERS
*************************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>
Date: Tue 3 Nov 2009
From: Shamsudeen Fagbo <oloungbo@yahoo.com>
I have followed the interesting current Crimean-Congo hemorrhagic fever
(CCHF) thread and have some comments to make. Dr Chinikar's study (though I
could not access the full text online) and ProMED-mail's postings are
indeed interesting and, more importantly, relevant to risk assessment and
animal health surveillance efforts for the impending Haj pilgrimage in
Saudi Arabia, where CCHF is endemic [El-Azazy OME, Scrimgeour EM.
Crimean-Congo haemorrhagic fever virus infection in the Western Province of
Saudi Arabia. Trans R Soc Trop Med Hyg 1997; 91(3): 275-8, abstract
available at <http://www.ncbi.nlm.nih.gov/pubmed/9231193>; also see
ProMED-mail Crimean-Congo hem. fever - Iran (03): update 20090908.3172] and
the massive slaughter of livestock will take place within a very short
period. Such slaughter will be replicated elsewhere as well.
Dr Chinikar asserts that butchers slaughtering animals outside government
approved commercial slaughterhouses seem to be more at risk of CCHF
infection. The value of this information would be better enhanced if more
details were provided. Are we to assume that it is the enhanced
pre-slaughter inspection, normally routine in the commercial establishments
but lacking with the butchers, that is responsible for the disparity? This
will be difficult to prove as CCHF infected animals are normally
asymptomatic. Or are the animals pre-tested for CCHF? -- this would be
laborious and costly. Was the observation of the slaughterhouse workers and
the butchers well controlled for confounders such that the observation is
really true?
It is possible, as Dr Chinikar did mention in passing, that the butchers
ate raw livers and the slaughterhouse workers did not. But is this really
the case? We also cannot determine if there is a statistical significance
in the difference observed with the limited data given. As an example,
there are cases and some are documented in the El-Azazy & Scrimgeour study
from Jeddah, Saudi Arabia. Knowing the exact risk factors would be
beneficial and add value to this ProMED-mail post.
Merritt Clifton [Crimean-Congo hem. fever - Iran (02): (KV) abattoir
workers 20090908.316] somewhat implies that the halal method may contribute
to CCHF infection risk while also conceding his personal preference or
bias. Such bias goes against the sound epidemiological principles that
characterize modern evidence-based public health: his comments are not
accompanied by any ascertained data.
If one were to look at just the study by Dr Sadegh Chinikar (referred to
earlier in the previous posting in this thread), 16 cases out of 223
slaughterhouse workers gives you a low incidence of 7 per cent. This is far
from what would be expected if the fears of blood flying around were truly
having an effect on CCHF incidence.
In addition, it is pertinent to note that over 1 billion people, a large
number of whom live in CCHF endemic countries in Africa, Asia, and Europe,
adhere to this halal method. The expected high incidence of CCHF relative
to Merritt's argument is simply non existent.
In contrast, modern health promotion and epidemiology takes into cognisance
working around and not belittling local practices that may interplay in
infectious disease processes.
--
Shamsudeen Fagbo, DVM
Jeddah
Saudi Arabia
<oloungbo@yahoo.com>
[Among other matters Shamsudeen Fagbo has drawn attention to the fact that
CCHF virus-infected domestic livestock are normally asymptomatic, a
circumstance which will complicate risk assessment and animal health
surveillance efforts during the impending Haj pilgrimage in Saudi Arabia.
With this contribution the thread is now cut. - Mod.CP]
*************************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>
Date: Tue 3 Nov 2009
From: Shamsudeen Fagbo <oloungbo@yahoo.com>
I have followed the interesting current Crimean-Congo hemorrhagic fever
(CCHF) thread and have some comments to make. Dr Chinikar's study (though I
could not access the full text online) and ProMED-mail's postings are
indeed interesting and, more importantly, relevant to risk assessment and
animal health surveillance efforts for the impending Haj pilgrimage in
Saudi Arabia, where CCHF is endemic [El-Azazy OME, Scrimgeour EM.
Crimean-Congo haemorrhagic fever virus infection in the Western Province of
Saudi Arabia. Trans R Soc Trop Med Hyg 1997; 91(3): 275-8, abstract
available at <http://www.ncbi.nlm.nih.gov/pubmed/9231193>; also see
ProMED-mail Crimean-Congo hem. fever - Iran (03): update 20090908.3172] and
the massive slaughter of livestock will take place within a very short
period. Such slaughter will be replicated elsewhere as well.
Dr Chinikar asserts that butchers slaughtering animals outside government
approved commercial slaughterhouses seem to be more at risk of CCHF
infection. The value of this information would be better enhanced if more
details were provided. Are we to assume that it is the enhanced
pre-slaughter inspection, normally routine in the commercial establishments
but lacking with the butchers, that is responsible for the disparity? This
will be difficult to prove as CCHF infected animals are normally
asymptomatic. Or are the animals pre-tested for CCHF? -- this would be
laborious and costly. Was the observation of the slaughterhouse workers and
the butchers well controlled for confounders such that the observation is
really true?
It is possible, as Dr Chinikar did mention in passing, that the butchers
ate raw livers and the slaughterhouse workers did not. But is this really
the case? We also cannot determine if there is a statistical significance
in the difference observed with the limited data given. As an example,
there are cases and some are documented in the El-Azazy & Scrimgeour study
from Jeddah, Saudi Arabia. Knowing the exact risk factors would be
beneficial and add value to this ProMED-mail post.
Merritt Clifton [Crimean-Congo hem. fever - Iran (02): (KV) abattoir
workers 20090908.316] somewhat implies that the halal method may contribute
to CCHF infection risk while also conceding his personal preference or
bias. Such bias goes against the sound epidemiological principles that
characterize modern evidence-based public health: his comments are not
accompanied by any ascertained data.
If one were to look at just the study by Dr Sadegh Chinikar (referred to
earlier in the previous posting in this thread), 16 cases out of 223
slaughterhouse workers gives you a low incidence of 7 per cent. This is far
from what would be expected if the fears of blood flying around were truly
having an effect on CCHF incidence.
In addition, it is pertinent to note that over 1 billion people, a large
number of whom live in CCHF endemic countries in Africa, Asia, and Europe,
adhere to this halal method. The expected high incidence of CCHF relative
to Merritt's argument is simply non existent.
In contrast, modern health promotion and epidemiology takes into cognisance
working around and not belittling local practices that may interplay in
infectious disease processes.
--
Shamsudeen Fagbo, DVM
Jeddah
Saudi Arabia
<oloungbo@yahoo.com>
[Among other matters Shamsudeen Fagbo has drawn attention to the fact that
CCHF virus-infected domestic livestock are normally asymptomatic, a
circumstance which will complicate risk assessment and animal health
surveillance efforts during the impending Haj pilgrimage in Saudi Arabia.
With this contribution the thread is now cut. - Mod.CP]
-
Birgitt
- Moderator
- Beiträge: 35430
- Registriert: Di 2. Aug 2005, 22:52
- Wohnort: NRW / Südl. Rheinland
- Kontaktdaten:
Re: Krim-Kongo Hämorrhagisches Fieber
CRIMEAN-CONGO HEMORRHAGIC FEVER, FATAL - GERMANY EX AFGHANISTAN (02)
********************************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>
Date: Fri 6 Nov 2009
Source: The Washington Times [edited]
<http://www.washingtontimes.com/news/200 ... to-troops/>
Rare virus poses new threat to troops
-------------------------------------
US military officials sent a medical team to a remote outpost in southern
Afghanistan this week [week of 2 Nov 2009] to take blood samples from
members of an Army unit after a soldier in the unit died from an Ebola-like
[that is, hemorrhagic fever] virus [infection]. Dr Jim Radike, an expert in
internal medicine and infectious diseases at the Role 3 Trauma Hospital at
Kandahar Air Field, told The Washington Times that a 22 year old sergeant
from River Falls, Alabama, died on 16 Sep 2009 from what turned out to be
Crimean-Congo hemorrhagic fever [CCHF] after he was bitten by a tick. The
virus is transmitted by infected blood and can be carried by ticks,
according to the Centers for Disease Control and Prevention (CDC). Dr
Radike, who is with the Navy, said the medical team "will be taking blood
samples and the results may take several weeks to get back." He called it
"a precautionary measure." Dr Radike did not say how many individuals would
be tested or why the military had waited until now to act. The unit
involved is the 5th Stryker Brigade, 2nd Infantry division, A-Company 2-1
Infantry.
Dr Radke said the [CCHF] hemorrhagic fever is similar to Ebola [hemorrhagic
fever] "in that the end there is internal degeneration and external
bleeding. From the Black Sea to upper Turkey, you'll see a dozen or more
cases a year. Afghanistan falls right in the middle." The disease was first
reported in the Crimea in 1944, then in the Congo in 1956, according to the
World Health Organization. An outbreak was reported 8 years ago in Quetta,
the capital of Pakistan's Baluchistan province, which borders Afghanistan.
Symptoms of CCHF include sudden fever, dizziness, neck pain, aching
muscles, soreness in the eyes, and sensitivity to light. Early on, nausea,
vomiting, and sore throat occur. The virus incubation period depends on how
the virus was acquired. If the infection is via tick bite, the incubation
period is roughly 1 to 3 days, with a maximum of 9 days, Dr Radike said. If
the illness is not caught early, it is often fatal, he said. The mortality
rate is 30 per cent, according to CDC.
Lt Col Jeffrey French, the sergeant's battalion commander, told The Times
from Forward Operating Base Ramrod, to the west of Kandahar City, that the
soldier's death "was a tragic loss for everyone." It started out as a small
bite on the foot, Col French said.
[byline: Sara A Carter]
--
communicated by:
Terry Allen <tallen@igc.org>
[The United States Army soldier identified in this report is the 22 year
old sergeant from Covington County, Alabama, who died on Wed 16 Sep 2009 in
Landstuhl, Germany, after succumbing to CCHF contracted from a tick bite
while serving in Afghanistan. For additional information see the
ProMED-mail report archived as: Crimean-Congo hem. fever, fatal - Germany
ex Afghanistan 20090919.3286.
Further information regarding CCHF can be obtained from WHO's fact sheet at
<http://www.who.int/mediacentre/factshee ... index.html>. - Mod.CP
The HealthMap/ProMED-mail interactive map of Afghanistan is available at
<http://healthmap.org/r/00Qr>. - Sr.Tech.Ed.MJ]
********************************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>
Date: Fri 6 Nov 2009
Source: The Washington Times [edited]
<http://www.washingtontimes.com/news/200 ... to-troops/>
Rare virus poses new threat to troops
-------------------------------------
US military officials sent a medical team to a remote outpost in southern
Afghanistan this week [week of 2 Nov 2009] to take blood samples from
members of an Army unit after a soldier in the unit died from an Ebola-like
[that is, hemorrhagic fever] virus [infection]. Dr Jim Radike, an expert in
internal medicine and infectious diseases at the Role 3 Trauma Hospital at
Kandahar Air Field, told The Washington Times that a 22 year old sergeant
from River Falls, Alabama, died on 16 Sep 2009 from what turned out to be
Crimean-Congo hemorrhagic fever [CCHF] after he was bitten by a tick. The
virus is transmitted by infected blood and can be carried by ticks,
according to the Centers for Disease Control and Prevention (CDC). Dr
Radike, who is with the Navy, said the medical team "will be taking blood
samples and the results may take several weeks to get back." He called it
"a precautionary measure." Dr Radike did not say how many individuals would
be tested or why the military had waited until now to act. The unit
involved is the 5th Stryker Brigade, 2nd Infantry division, A-Company 2-1
Infantry.
Dr Radke said the [CCHF] hemorrhagic fever is similar to Ebola [hemorrhagic
fever] "in that the end there is internal degeneration and external
bleeding. From the Black Sea to upper Turkey, you'll see a dozen or more
cases a year. Afghanistan falls right in the middle." The disease was first
reported in the Crimea in 1944, then in the Congo in 1956, according to the
World Health Organization. An outbreak was reported 8 years ago in Quetta,
the capital of Pakistan's Baluchistan province, which borders Afghanistan.
Symptoms of CCHF include sudden fever, dizziness, neck pain, aching
muscles, soreness in the eyes, and sensitivity to light. Early on, nausea,
vomiting, and sore throat occur. The virus incubation period depends on how
the virus was acquired. If the infection is via tick bite, the incubation
period is roughly 1 to 3 days, with a maximum of 9 days, Dr Radike said. If
the illness is not caught early, it is often fatal, he said. The mortality
rate is 30 per cent, according to CDC.
Lt Col Jeffrey French, the sergeant's battalion commander, told The Times
from Forward Operating Base Ramrod, to the west of Kandahar City, that the
soldier's death "was a tragic loss for everyone." It started out as a small
bite on the foot, Col French said.
[byline: Sara A Carter]
--
communicated by:
Terry Allen <tallen@igc.org>
[The United States Army soldier identified in this report is the 22 year
old sergeant from Covington County, Alabama, who died on Wed 16 Sep 2009 in
Landstuhl, Germany, after succumbing to CCHF contracted from a tick bite
while serving in Afghanistan. For additional information see the
ProMED-mail report archived as: Crimean-Congo hem. fever, fatal - Germany
ex Afghanistan 20090919.3286.
Further information regarding CCHF can be obtained from WHO's fact sheet at
<http://www.who.int/mediacentre/factshee ... index.html>. - Mod.CP
The HealthMap/ProMED-mail interactive map of Afghanistan is available at
<http://healthmap.org/r/00Qr>. - Sr.Tech.Ed.MJ]
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Birgitt
- Moderator
- Beiträge: 35430
- Registriert: Di 2. Aug 2005, 22:52
- Wohnort: NRW / Südl. Rheinland
- Kontaktdaten:
Re: Krim-Kongo Hämorrhagisches Fieber
CRIMEAN-CONGO HEMORRHAGIC FEVER, CURRENT SITUATION - EUROPE
***********************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>
Date: Thu 11 Mar 2010
Source: Eurosurveillance, Volume 15, Issue 10 [edited]
<http://www.eurosurveillance.org/ViewArt ... leId=19504>
Crimean-Congo hemorrhagic fever in Europe: current situation calls
for preparedness
------------------------------
By H C Maltezou 1, L Andonova2, R Andraghetti3, M Bouloy4, O
Ergonul5, F Jongejan6, N Kalvatchev7, S Nichol8, M Niedrig9, A
Platonov10, G Thomson11, K Leitmeyer12, H Zeller12 At: 1 Hellenic
Center for Diseases Control and Prevention, Athens, Greece, 2 Medical
University, Sofia, Bulgaria, 3 World Health Organization, Copenhagen,
Denmark, 4 Institut Pasteur, Paris, France, 5 Marmara University,
Istanbul, Turkey, 6 Utrecht Centre for Tick- borne Diseases, Utrecht
University, Utrecht, the Netherlands, 7 National Centre of Infectious
and Parasitic Diseases, Sofia, Bulgaria, 8 Centers of Disease Control
and Prevention, Atlanta, United States, 9 Robert Koch Institute,
Berlin, Germany, 10 Central Research Institute of Epidemiology,
Moscow, Russian Federation, 11 Health Protection Agency, London,
United Kingdom, 12 European Centre for Disease Control and
Prevention, Stockholm, Sweden
Summary:
During the last decade, Crimean-Congo hemorrhagic fever (CCHF)
emerged and/or re-emerged in several Balkan countries, Turkey,
southwestern regions of the Russian Federation, and the Ukraine, with
considerable high fatality rates. Reasons for re-emergence of CCHF
include climate and anthropogenic factors such as changes in land
use, agricultural practices or hunting activities, movement of
livestock that may influence host-tick-virus dynamics. In order to be
able to design prevention and control measures targeted at the
disease, mapping of endemic areas and risk assessment for CCHF in
Europe should be completed. Furthermore, areas at risk for further
CCHF expansion should be identified and human, vector and animal
surveillance be strengthened.
Introduction:
CCHF is an acute, highly-contagious viral zoonosis transmitted to
humans mainly by ticks of the genus _Hyalomma_, but also through
direct contact with blood or tissues of viraemic hosts. In humans
CCHF typically presents with high fever of sudden onset, malaise,
severe headache and gastrointestinal symptoms. Prominent hemorrhages
may occur in late stages of the disease with published fatality rates
ranging from 10 percent to 50 percent [1,2]. The disease is endemic
in parts of Africa, Asia, the Middle East and eastern Europe. Main
animal hosts include a number of domestic animals such as cattle,
sheep, goats, and hares. CCHF [virus] has the potential to cause
community and nosocomial outbreaks. Due to the high case fatality
rates and difficulties in treatment, prevention, and control, CCHF is
a disease which should be notified immediately to public health
authorities in the European Union (EU). CCHF virus is also in the
list of agents for which the Revised International Health Regulations
of 2005 call for implementation of the decision algorithm for risk
assessment and possible notification to the World Health Organization
(WHO) [3].
In Europe, CCHF is currently only endemic in Bulgaria, however during
the last decade an increased number of CCHF cases and outbreaks have
been recorded in other countries in the region such as Albania,
Kosovo, Turkey, and the Ukraine as well as south-western regions of
the Russian Federation [4-9]. In June 2008, the 1st case was
registered in Greece [10]. In response to this situation, the
European Centre for Disease Prevention and Control (ECDC) invited a
group of CCHF experts to review the situation of CCHF in Europe and
to consult on interventions necessary to strengthen preparedness and
response at the European level [11]. This article provides an update
on the current situation of CCHF in Europe and emphasises existing
prevention and control capacities within the EU. Aspects relevant to
strengthen preparedness for CCHF are also discussed.
CCHF situation in Europe:
CCHF is endemic in Bulgaria since the 1950s, when a large outbreak
occurred from 1954 to 1955 with 487 notified cases mainly in the
Shumen area in north-east Bulgaria. In total, 1568 CCHF cases were
notified in Bulgaria from 1953 to 2008, with an overall case fatality
rate of 17 percent [4]. Endemic areas are confined to the vicinity of
Shumen, Razgrad, Veliko Tarnovo, Plovdiv, Pazardjik, Haskovo,
Kardjali, and Bourgas; however in April 2008 a cluster of 6 probable
cases occurred in Gotse Delchev in the south-western province
Blagoevgrad near the border with Greece, an area considered of low
CCHF endemicity until recently [5]. During the last decade, CCHF
outbreaks have also been noted in Albania in 2001 and 2003, and in
Kosovo in 2001 [6,7].
In Turkey, the 1st symptomatic human CCHF cases were noted in 2002;
however, serologic evidence of enzootic CCHF virus circulation as
well as limited evidence of CCHF infections among humans (2.4 percent
among 1100 tested humans) has been found since the 1970's [4].
Starting in 2003, Turkey has experienced an expanding outbreak with
increasing numbers of notified cases and associated fatalities (2002:
17/0; 2003: 133/6; 2004: 249/13; 2005: 266/13; 2006: 438/27; 2007:
713/33; 2008: 1315/63; 2009: 1300/62) [4,12]. Overall, there are more
than 4400 recorded laboratory confirmed CCHF cases in this country,
mainly among residents in rural areas in north-central and north-east
Anatolia [4,8,12]. Within the CCHF endemic areas, there are
hyperendemic areas where one out of every 5 residents and one out of
every 2 residents with a history of tick bite has antibodies against
CCHF virus [13]. A predictive map model using satellite-based climate
data and high-resolution vegetation images from Turkey from 2003 to
2006 revealed that areas with higher CCHF reporting were
significantly associated with zones of high climate suitability for
_Hyalomma_ ticks and high rate of fragmentation of agricultural land
[13].
In Greece, a serosurvey conducted between 1981 and 1988 among 3388
rural residents from across the country showed one percent
seroprevalence rate against CCHF virus [4]. More than 400 cases with
a CCHF compatible clinical syndrome have tested negative for CCHF
virus in this country since 1982, therefore, the seroprevalence rate
of one percent was attributed to the non-pathogenic AP-92 strain and
not to the pathogenic Balkan CCHF virus strain. A number of the cases
tested for CCHF were finally diagnosed as hemorrhagic fever with
renal syndrome (HFRS), leptospirosis and ricketsial infections. Other
diagnoses were meningococcal meningitis and unspecified bacterial
sepsis. The 1st CCHF case was recorded in June 2008 in a woman with a
tick bite working in agriculture near the city of Komotini in
north-eastern Greece [10]. This town is situated within a few
kilometres distance from there, where the Bulgarian cluster occurred
in 2008 [5]. A seroepidemiological study for CCHF virus among local
population and animals are underway in northern Greece.
After nearly 27 years without any human cases, CCHF re-emerged in the
south-western regions of the Russian Federation in 1999. Outbreaks
have been reported in Astrakhan, Rostov and Volgograd Provinces,
Krasnodar and Stavropol Territories, Kalmykia, Dagestan and
Ingushetia Republics. Between 2000 and 2009 more than 1300 clinical
cases were diagnosed in the Russian Federation with an overall
fatality rate of 3.2 percent for the period from 2002-2007 [4]. Most
cases occurred among residents of rural areas in the Southern Federal
Distinct. The largest number of cases was registered in Stavropol
Territory, Kalmykia Republic and Rostov Province, where the mean
annual CCHF incidence rate was 1.7, 10.1, and 0.7 cases per 100 000
population, respectively. During 2008 alone, the incidence in
Stavropol Territory increased by 1.3 times, and was the highest
recorded in this region during the last decade [4,9,14]. In 2009,
CCHF cases were also reported from Georgia, Kazakhstan, Tajikistan,
Iran, and Pakistan [15].
CCHF emergence and/or re-emergence in south-eastern Europe and
neighboring countries is attributed to climate and ecologic changes
and anthropogenic factors such as changes in land use, agricultural
practices, hunting activities, and movement of livestock, that may
have an impact on ticks and hosts and accordingly on CCHF
epidemiology [1,2]. The geographic distribution of CCHF coincides
with that of _Hyalomma_ ticks. _H. marginatum_, the main CCHF virus
vector in Europe, is found in Albania, Bulgaria, Cyprus, France,
Greece, Italy, Kosovo, Moldavia, Portugal, Romania, Russia, Serbia,
Spain, Turkey, and the Ukraine. In 2006 it was detected for the 1st
time in the Netherlands and in southern Germany [16,17]. Given the
wide distribution of its vector, the numerous animals that can serve
as hosts, and the favorable climate and ecologic conditions in
several European countries bordering the Mediterranean Sea, it is
possible that the occurrence of CCHF will expand in the future. A
model that studied various climate scenarios on the habitat areas of
different ticks, showed that a rise in temperature and a decrease in
rainfall in the Mediterranean region will result in a sharp increase
in the suitable habitat areas for _H. marginatum_ and its expansion
towards the north, with the highest impact noted at the margins of
its current geographic range [18].
Current prevention and control in Europe:
Several elements relating to laboratory diagnosis, surveillance and
therapy of CCHF should be addressed in order to increase preparedness
capacity in Europe and to design appropriate prevention and control
measures.
Laboratory diagnosis -- In 2008 there were 20 laboratories with
diagnostic capacities for CCHF virus in Europe: 14 in EU Member
States, 8 in the endemic regions of the Russian Federation, and one
in Turkey. Most of them used immunofluorescence assays (IFA), ELISA,
and/or molecular methods to diagnose CCHF whereas 8 among them were
also able to isolate CCHF virus [11], a BSL-4 containment agent.
Surveillance -- Currently, there are no standardised case definitions
for CCHF notification and contact tracing within European countries
[19]. Recent cases of nosocomial acquisition of CCHF in health care
workers were well documented [6,8,20]. These cases underline the need
for educating health-care workers about the modes of getting infected
with CCHF virus and for strict implementation of infection control
measures within health-care facilities, and the importance of
providing adequate resources to do so [1,2].
Therapy -- The World Health Organization (WHO) recommends ribavirin
for the treatment of CCHF cases [21,22]. Ribavirin appears to be more
effective when introduced early in the course of illness [23].
Evidence of its efficacy is based on in vitro data and on limited
observations in humans [24-26]. Randomised controlled trials have not
been conducted so far, and ethical issues concerning the use of a
control group remain a major obstacle for this [27]. Severity of
infection, duration of illness prior to initiation of therapy, and
route of administration may impact the clinical outcome of CCHF
cases. On individual country level, recommendations for treatment of
CCHF cases with ribavirin existed in 2008 in Turkey, Russia,
Bulgaria, and Greece. In Bulgaria, in addition, specific hyperimmune
globulin collected from convalescent CCHF cases is used for
prophylaxis and treatment and an inactivated suckling mouse brain
vaccine is in use since the 1970s for high-risk groups living in CCHF
endemic regions [28]. There is no vaccine against CCHF licensed in
any other EU Member State.
Conclusions:
CCHF is a disease with a high fatality rate and the potential to
cause outbreaks. The vector for CCHF, the _Hyalomma tick is present
in southeastern and southern Europe. Climate factors may contribute
to a further spread of the vector and to a consecutive extension of
the geographic range of CCHF, which may further expand to European
countries bordering the Mediterranean Sea, with the highest risk in
neighbouring areas with already established endemicity. This
highlights the need for strengthening human, vector, and veterinary
surveillance, especially in areas where CCHF is expected to occur in
the future. Together with the implementation of standardised case
definitions for CCHF this will allow an estimate of the CCHF burden
and of epidemiologic trends in various areas and countries. Guidance
for contact tracing and the establishment of early detection and
response systems will allow prompt interventions at patient,
community, and hospital level. Considering the high case fatality
rate of CCHF, ribavirin efficacy should be assessed through
well-designed clinical protocols and in endemic areas general public
and health-care workers should be aware about modes of CCHF
transmission and prophylactic measures. Climate and environmental
factors and human behavior that may influence CCHF epidemiology and
spread should be further studied. Mapping of endemic areas and risk
assessment for CCHF in Europe should be completed and areas at risk
for CCHF expansion should be identified and finally, appropriate
tick-control strategies including public education should be
implemented. All these measures should be undertaken as part of a
multidisciplinary collaboration at interregional and international
level and link ARBO-ZOONET [29]. In accordance with an ECDC-initiated
assessment on the importance of vector-borne diseases in 2008, CCHF
has been identified as a priority disease for the EU [12].
References:
[Interested readers should refer to the original text for details of
the 29 literature references accompanying this article.]
--
Communicated by:
ProMED-mail <promed@promedmail.org
[This excellent survey documents the recent expansion of CCHF in
Europe and its apparent resurgence in its original Crimean home. The
situation in Greece together with studies of seroprevalence and
tick-bite analysis in Turkey suggest that strains of CCHF virus of
differing pathogenicity for humans may be circulating in the European
region.
Climatic change in the form of a rise in temperature and a decrease
in rainfall in the Mediterranean region and beyond may provide
additional suitable habitats for the _Hyalomma marginatum_ vector of
CCHF and facilitate an expansion towards the north, with greatest
impact at the margins of its current geographic range.
Images of _Hyalomma marginatum_ ticks can be viewed at:
<http://webpages.lincoln.ac.uk/fruedisue ... _adult.htm>.
The HealthMap/ProMED-mail interactive map of Europe can be accessed
at: <http://healthmap.org/r/019->. - Mod.CP]
***********************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>
Date: Thu 11 Mar 2010
Source: Eurosurveillance, Volume 15, Issue 10 [edited]
<http://www.eurosurveillance.org/ViewArt ... leId=19504>
Crimean-Congo hemorrhagic fever in Europe: current situation calls
for preparedness
------------------------------
By H C Maltezou 1, L Andonova2, R Andraghetti3, M Bouloy4, O
Ergonul5, F Jongejan6, N Kalvatchev7, S Nichol8, M Niedrig9, A
Platonov10, G Thomson11, K Leitmeyer12, H Zeller12 At: 1 Hellenic
Center for Diseases Control and Prevention, Athens, Greece, 2 Medical
University, Sofia, Bulgaria, 3 World Health Organization, Copenhagen,
Denmark, 4 Institut Pasteur, Paris, France, 5 Marmara University,
Istanbul, Turkey, 6 Utrecht Centre for Tick- borne Diseases, Utrecht
University, Utrecht, the Netherlands, 7 National Centre of Infectious
and Parasitic Diseases, Sofia, Bulgaria, 8 Centers of Disease Control
and Prevention, Atlanta, United States, 9 Robert Koch Institute,
Berlin, Germany, 10 Central Research Institute of Epidemiology,
Moscow, Russian Federation, 11 Health Protection Agency, London,
United Kingdom, 12 European Centre for Disease Control and
Prevention, Stockholm, Sweden
Summary:
During the last decade, Crimean-Congo hemorrhagic fever (CCHF)
emerged and/or re-emerged in several Balkan countries, Turkey,
southwestern regions of the Russian Federation, and the Ukraine, with
considerable high fatality rates. Reasons for re-emergence of CCHF
include climate and anthropogenic factors such as changes in land
use, agricultural practices or hunting activities, movement of
livestock that may influence host-tick-virus dynamics. In order to be
able to design prevention and control measures targeted at the
disease, mapping of endemic areas and risk assessment for CCHF in
Europe should be completed. Furthermore, areas at risk for further
CCHF expansion should be identified and human, vector and animal
surveillance be strengthened.
Introduction:
CCHF is an acute, highly-contagious viral zoonosis transmitted to
humans mainly by ticks of the genus _Hyalomma_, but also through
direct contact with blood or tissues of viraemic hosts. In humans
CCHF typically presents with high fever of sudden onset, malaise,
severe headache and gastrointestinal symptoms. Prominent hemorrhages
may occur in late stages of the disease with published fatality rates
ranging from 10 percent to 50 percent [1,2]. The disease is endemic
in parts of Africa, Asia, the Middle East and eastern Europe. Main
animal hosts include a number of domestic animals such as cattle,
sheep, goats, and hares. CCHF [virus] has the potential to cause
community and nosocomial outbreaks. Due to the high case fatality
rates and difficulties in treatment, prevention, and control, CCHF is
a disease which should be notified immediately to public health
authorities in the European Union (EU). CCHF virus is also in the
list of agents for which the Revised International Health Regulations
of 2005 call for implementation of the decision algorithm for risk
assessment and possible notification to the World Health Organization
(WHO) [3].
In Europe, CCHF is currently only endemic in Bulgaria, however during
the last decade an increased number of CCHF cases and outbreaks have
been recorded in other countries in the region such as Albania,
Kosovo, Turkey, and the Ukraine as well as south-western regions of
the Russian Federation [4-9]. In June 2008, the 1st case was
registered in Greece [10]. In response to this situation, the
European Centre for Disease Prevention and Control (ECDC) invited a
group of CCHF experts to review the situation of CCHF in Europe and
to consult on interventions necessary to strengthen preparedness and
response at the European level [11]. This article provides an update
on the current situation of CCHF in Europe and emphasises existing
prevention and control capacities within the EU. Aspects relevant to
strengthen preparedness for CCHF are also discussed.
CCHF situation in Europe:
CCHF is endemic in Bulgaria since the 1950s, when a large outbreak
occurred from 1954 to 1955 with 487 notified cases mainly in the
Shumen area in north-east Bulgaria. In total, 1568 CCHF cases were
notified in Bulgaria from 1953 to 2008, with an overall case fatality
rate of 17 percent [4]. Endemic areas are confined to the vicinity of
Shumen, Razgrad, Veliko Tarnovo, Plovdiv, Pazardjik, Haskovo,
Kardjali, and Bourgas; however in April 2008 a cluster of 6 probable
cases occurred in Gotse Delchev in the south-western province
Blagoevgrad near the border with Greece, an area considered of low
CCHF endemicity until recently [5]. During the last decade, CCHF
outbreaks have also been noted in Albania in 2001 and 2003, and in
Kosovo in 2001 [6,7].
In Turkey, the 1st symptomatic human CCHF cases were noted in 2002;
however, serologic evidence of enzootic CCHF virus circulation as
well as limited evidence of CCHF infections among humans (2.4 percent
among 1100 tested humans) has been found since the 1970's [4].
Starting in 2003, Turkey has experienced an expanding outbreak with
increasing numbers of notified cases and associated fatalities (2002:
17/0; 2003: 133/6; 2004: 249/13; 2005: 266/13; 2006: 438/27; 2007:
713/33; 2008: 1315/63; 2009: 1300/62) [4,12]. Overall, there are more
than 4400 recorded laboratory confirmed CCHF cases in this country,
mainly among residents in rural areas in north-central and north-east
Anatolia [4,8,12]. Within the CCHF endemic areas, there are
hyperendemic areas where one out of every 5 residents and one out of
every 2 residents with a history of tick bite has antibodies against
CCHF virus [13]. A predictive map model using satellite-based climate
data and high-resolution vegetation images from Turkey from 2003 to
2006 revealed that areas with higher CCHF reporting were
significantly associated with zones of high climate suitability for
_Hyalomma_ ticks and high rate of fragmentation of agricultural land
[13].
In Greece, a serosurvey conducted between 1981 and 1988 among 3388
rural residents from across the country showed one percent
seroprevalence rate against CCHF virus [4]. More than 400 cases with
a CCHF compatible clinical syndrome have tested negative for CCHF
virus in this country since 1982, therefore, the seroprevalence rate
of one percent was attributed to the non-pathogenic AP-92 strain and
not to the pathogenic Balkan CCHF virus strain. A number of the cases
tested for CCHF were finally diagnosed as hemorrhagic fever with
renal syndrome (HFRS), leptospirosis and ricketsial infections. Other
diagnoses were meningococcal meningitis and unspecified bacterial
sepsis. The 1st CCHF case was recorded in June 2008 in a woman with a
tick bite working in agriculture near the city of Komotini in
north-eastern Greece [10]. This town is situated within a few
kilometres distance from there, where the Bulgarian cluster occurred
in 2008 [5]. A seroepidemiological study for CCHF virus among local
population and animals are underway in northern Greece.
After nearly 27 years without any human cases, CCHF re-emerged in the
south-western regions of the Russian Federation in 1999. Outbreaks
have been reported in Astrakhan, Rostov and Volgograd Provinces,
Krasnodar and Stavropol Territories, Kalmykia, Dagestan and
Ingushetia Republics. Between 2000 and 2009 more than 1300 clinical
cases were diagnosed in the Russian Federation with an overall
fatality rate of 3.2 percent for the period from 2002-2007 [4]. Most
cases occurred among residents of rural areas in the Southern Federal
Distinct. The largest number of cases was registered in Stavropol
Territory, Kalmykia Republic and Rostov Province, where the mean
annual CCHF incidence rate was 1.7, 10.1, and 0.7 cases per 100 000
population, respectively. During 2008 alone, the incidence in
Stavropol Territory increased by 1.3 times, and was the highest
recorded in this region during the last decade [4,9,14]. In 2009,
CCHF cases were also reported from Georgia, Kazakhstan, Tajikistan,
Iran, and Pakistan [15].
CCHF emergence and/or re-emergence in south-eastern Europe and
neighboring countries is attributed to climate and ecologic changes
and anthropogenic factors such as changes in land use, agricultural
practices, hunting activities, and movement of livestock, that may
have an impact on ticks and hosts and accordingly on CCHF
epidemiology [1,2]. The geographic distribution of CCHF coincides
with that of _Hyalomma_ ticks. _H. marginatum_, the main CCHF virus
vector in Europe, is found in Albania, Bulgaria, Cyprus, France,
Greece, Italy, Kosovo, Moldavia, Portugal, Romania, Russia, Serbia,
Spain, Turkey, and the Ukraine. In 2006 it was detected for the 1st
time in the Netherlands and in southern Germany [16,17]. Given the
wide distribution of its vector, the numerous animals that can serve
as hosts, and the favorable climate and ecologic conditions in
several European countries bordering the Mediterranean Sea, it is
possible that the occurrence of CCHF will expand in the future. A
model that studied various climate scenarios on the habitat areas of
different ticks, showed that a rise in temperature and a decrease in
rainfall in the Mediterranean region will result in a sharp increase
in the suitable habitat areas for _H. marginatum_ and its expansion
towards the north, with the highest impact noted at the margins of
its current geographic range [18].
Current prevention and control in Europe:
Several elements relating to laboratory diagnosis, surveillance and
therapy of CCHF should be addressed in order to increase preparedness
capacity in Europe and to design appropriate prevention and control
measures.
Laboratory diagnosis -- In 2008 there were 20 laboratories with
diagnostic capacities for CCHF virus in Europe: 14 in EU Member
States, 8 in the endemic regions of the Russian Federation, and one
in Turkey. Most of them used immunofluorescence assays (IFA), ELISA,
and/or molecular methods to diagnose CCHF whereas 8 among them were
also able to isolate CCHF virus [11], a BSL-4 containment agent.
Surveillance -- Currently, there are no standardised case definitions
for CCHF notification and contact tracing within European countries
[19]. Recent cases of nosocomial acquisition of CCHF in health care
workers were well documented [6,8,20]. These cases underline the need
for educating health-care workers about the modes of getting infected
with CCHF virus and for strict implementation of infection control
measures within health-care facilities, and the importance of
providing adequate resources to do so [1,2].
Therapy -- The World Health Organization (WHO) recommends ribavirin
for the treatment of CCHF cases [21,22]. Ribavirin appears to be more
effective when introduced early in the course of illness [23].
Evidence of its efficacy is based on in vitro data and on limited
observations in humans [24-26]. Randomised controlled trials have not
been conducted so far, and ethical issues concerning the use of a
control group remain a major obstacle for this [27]. Severity of
infection, duration of illness prior to initiation of therapy, and
route of administration may impact the clinical outcome of CCHF
cases. On individual country level, recommendations for treatment of
CCHF cases with ribavirin existed in 2008 in Turkey, Russia,
Bulgaria, and Greece. In Bulgaria, in addition, specific hyperimmune
globulin collected from convalescent CCHF cases is used for
prophylaxis and treatment and an inactivated suckling mouse brain
vaccine is in use since the 1970s for high-risk groups living in CCHF
endemic regions [28]. There is no vaccine against CCHF licensed in
any other EU Member State.
Conclusions:
CCHF is a disease with a high fatality rate and the potential to
cause outbreaks. The vector for CCHF, the _Hyalomma tick is present
in southeastern and southern Europe. Climate factors may contribute
to a further spread of the vector and to a consecutive extension of
the geographic range of CCHF, which may further expand to European
countries bordering the Mediterranean Sea, with the highest risk in
neighbouring areas with already established endemicity. This
highlights the need for strengthening human, vector, and veterinary
surveillance, especially in areas where CCHF is expected to occur in
the future. Together with the implementation of standardised case
definitions for CCHF this will allow an estimate of the CCHF burden
and of epidemiologic trends in various areas and countries. Guidance
for contact tracing and the establishment of early detection and
response systems will allow prompt interventions at patient,
community, and hospital level. Considering the high case fatality
rate of CCHF, ribavirin efficacy should be assessed through
well-designed clinical protocols and in endemic areas general public
and health-care workers should be aware about modes of CCHF
transmission and prophylactic measures. Climate and environmental
factors and human behavior that may influence CCHF epidemiology and
spread should be further studied. Mapping of endemic areas and risk
assessment for CCHF in Europe should be completed and areas at risk
for CCHF expansion should be identified and finally, appropriate
tick-control strategies including public education should be
implemented. All these measures should be undertaken as part of a
multidisciplinary collaboration at interregional and international
level and link ARBO-ZOONET [29]. In accordance with an ECDC-initiated
assessment on the importance of vector-borne diseases in 2008, CCHF
has been identified as a priority disease for the EU [12].
References:
[Interested readers should refer to the original text for details of
the 29 literature references accompanying this article.]
--
Communicated by:
ProMED-mail <promed@promedmail.org
[This excellent survey documents the recent expansion of CCHF in
Europe and its apparent resurgence in its original Crimean home. The
situation in Greece together with studies of seroprevalence and
tick-bite analysis in Turkey suggest that strains of CCHF virus of
differing pathogenicity for humans may be circulating in the European
region.
Climatic change in the form of a rise in temperature and a decrease
in rainfall in the Mediterranean region and beyond may provide
additional suitable habitats for the _Hyalomma marginatum_ vector of
CCHF and facilitate an expansion towards the north, with greatest
impact at the margins of its current geographic range.
Images of _Hyalomma marginatum_ ticks can be viewed at:
<http://webpages.lincoln.ac.uk/fruedisue ... _adult.htm>.
The HealthMap/ProMED-mail interactive map of Europe can be accessed
at: <http://healthmap.org/r/019->. - Mod.CP]
-
Birgitt
- Moderator
- Beiträge: 35430
- Registriert: Di 2. Aug 2005, 22:52
- Wohnort: NRW / Südl. Rheinland
- Kontaktdaten:
Re: Krim-Kongo Hämorrhagisches Fieber
CRIMEAN-CONGO HEMORRHAGIC FEVER - KAZAKHSTAN: (SOUTH KAZAKHSTAN)
****************************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>
Date: Sat 17 Apr 2010
Source: Central Asia Online [edited]
<http://www.centralasiaonline.com/cocoon ... wsbrief-05>
Two patients recently died of Crimean-Congo hemorrhagic fever in the
Southern Kazakh Oblast, [according to] the Ministry for Emergencies press
service, Kazakhstan Today reported on Sat 17 Apr 2010.
A 21 year old woman died on Thu 15 Apr 2010 in the perinatal treatment
centre in [the city of] Turkestan. A 36 year old man died on Thu 15 Apr
2010 in a hospital in the Kazgurt District.
The fever is transmitted by ticks and is found in the former Soviet Union,
including Central Asia, according to the US Centers for Disease Control and
Prevention.
[byline: Stan Rogers]
--
communicated by:
Shamsudeen Fagbo, DVM
<oloungbo@yahoo.com>
[Crimean-Congo haemorrhagic fever (CCHF) is the most widely distributed of
the viral haemorrhagic fevers. Although primarily a zoonosis, sporadic
cases and outbreaks of CCHF affecting humans occur frequently. The disease
is endemic in Kazakhstan (for example, see the ProMED-mail archived reports
below) and many countries in Africa, Europe, and Asia. The disease was
first described in the Crimea in 1944 and given the name Crimean
haemorrhagic fever. In 1969 it was recognized that the pathogen causing
Crimean haemorrhagic fever was the same as that responsible for an illness
identified in 1956 in the Congo, and linkage of the 2 place names resulted
in the current name for the disease and the virus. CCHF is a severe disease
in humans, with a high mortality rate (about 30 per cent). Fortunately,
human illness occurs infrequently, although infection of livestock is common.
The geographical distribution of CCHF virus is determined by the
distribution of its tick vector -- predominantly ticks belonging to the
genus _Hyalomma_. Healthcare and hospital staff in endemic areas should be
aware of the illness and the correct infection control procedures to
protect themselves and their patients from the risk of nosocomial
(person-to-person) infection. There is no protective vaccine, but the
antiviral drug ribavirin has been used in treatment of established CCHF
infection with apparent benefit.
A map showing the location of the district of Kazgurt in the Oblast of
South Kazakhstan can be accessed at
<http://en.wikipedia.org/wiki/Kazygurt_District>. The city of Turkestan,
which is located in the Kazgurt district, can be found at
<http://en.wikipedia.org/wiki/Hazrat-e_Turkestan>. The
HealthMap/ProMED-mail interactive map of Kazakhstan is available at
<http://healthmap.org/r/01de>. - Mod.CP]
****************************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>
Date: Sat 17 Apr 2010
Source: Central Asia Online [edited]
<http://www.centralasiaonline.com/cocoon ... wsbrief-05>
Two patients recently died of Crimean-Congo hemorrhagic fever in the
Southern Kazakh Oblast, [according to] the Ministry for Emergencies press
service, Kazakhstan Today reported on Sat 17 Apr 2010.
A 21 year old woman died on Thu 15 Apr 2010 in the perinatal treatment
centre in [the city of] Turkestan. A 36 year old man died on Thu 15 Apr
2010 in a hospital in the Kazgurt District.
The fever is transmitted by ticks and is found in the former Soviet Union,
including Central Asia, according to the US Centers for Disease Control and
Prevention.
[byline: Stan Rogers]
--
communicated by:
Shamsudeen Fagbo, DVM
<oloungbo@yahoo.com>
[Crimean-Congo haemorrhagic fever (CCHF) is the most widely distributed of
the viral haemorrhagic fevers. Although primarily a zoonosis, sporadic
cases and outbreaks of CCHF affecting humans occur frequently. The disease
is endemic in Kazakhstan (for example, see the ProMED-mail archived reports
below) and many countries in Africa, Europe, and Asia. The disease was
first described in the Crimea in 1944 and given the name Crimean
haemorrhagic fever. In 1969 it was recognized that the pathogen causing
Crimean haemorrhagic fever was the same as that responsible for an illness
identified in 1956 in the Congo, and linkage of the 2 place names resulted
in the current name for the disease and the virus. CCHF is a severe disease
in humans, with a high mortality rate (about 30 per cent). Fortunately,
human illness occurs infrequently, although infection of livestock is common.
The geographical distribution of CCHF virus is determined by the
distribution of its tick vector -- predominantly ticks belonging to the
genus _Hyalomma_. Healthcare and hospital staff in endemic areas should be
aware of the illness and the correct infection control procedures to
protect themselves and their patients from the risk of nosocomial
(person-to-person) infection. There is no protective vaccine, but the
antiviral drug ribavirin has been used in treatment of established CCHF
infection with apparent benefit.
A map showing the location of the district of Kazgurt in the Oblast of
South Kazakhstan can be accessed at
<http://en.wikipedia.org/wiki/Kazygurt_District>. The city of Turkestan,
which is located in the Kazgurt district, can be found at
<http://en.wikipedia.org/wiki/Hazrat-e_Turkestan>. The
HealthMap/ProMED-mail interactive map of Kazakhstan is available at
<http://healthmap.org/r/01de>. - Mod.CP]
-
Birgitt
- Moderator
- Beiträge: 35430
- Registriert: Di 2. Aug 2005, 22:52
- Wohnort: NRW / Südl. Rheinland
- Kontaktdaten:
Re: Krim-Kongo Hämorrhagisches Fieber
CRIMEAN-CONGO HEMORRHAGIC FEVER - KAZAKHSTAN (02): (SOUTH KAZAKHSTAN)
*********************************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>
Date: Thu 22 Apr 2010
Source: Epidemiolog.ru [in Russian, trans. corr.ATS, edited]
<http://www.epidemiolog.ru/news/detail.p ... NT_ID=9317>
CCHF: 7 cases and 2 deaths in South Kazakhstan
----------------------------------------------
As of Tue 20 April 2010 there have been 7 confirmed cases of
Crimean-Congo hemorrhagic fever (CCHF) in the South Kazakhstan Oblast
[region]. The regional public health authority announced that more
than 1500 people had sought medical care after receiving tick bites
during the period 30 Mar to 20 Apr 2010. Of the 7 CCHF cases 2 died,
whereas the remaining 5 cases experienced mild to moderate illness.
About 127 of the contacts of these 7 are now under medical surveillance.
Some settlements have recorded higher numbers of tick bites probably
because of denser tick populations or inadequate tick control
measures. More than 266 000 individuals who may be at risk are being
contacted daily by healthcare workers, in order to encourage tick
avoidance behavior and to check for suspicious symptoms and signs.
Farm livestock are being treated with acaricides.
--
Communicated by:
ProMED-RUS
<promed-rus@promedmail.org>
[There were 22 CCHF cases (and 8 fatalities) in the South Kazakhstan
region last year (2009), including 5 fatalities in a hospital
nosocomial outbreak. The 7 fatalities and 2 deaths recorded during
the 1st 4 months of 2010 are a cause for concern. Treatment of farm
animals to reduce tick infestation and information and education of
the local population are immediate priorities. All patients with
fever and thrombocytopenia who may be at risk of infection should be
tested for CCHF virus infection. - Mod.NP]
[It is likely, but not certain from the information provided above,
that the 2 fatalities listed are the same 2 fatal cases described in
detail in the previous ProMED-mail report: "Crimean-Congo hem. fever
- Kazakhstan: (SK) 20100419.1273".
A map and description of the South Kazakhstan region of Kazakhstan
can be accessed at
<http://aboutkazakhstan.com/South_Kazakh ... last.shtml>.
The HealthMap/ProMED-mail interactive map of Kazakhstan is available at
<http://healthmap.org/r/01de>. - Mod.CP]
*********************************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>
Date: Thu 22 Apr 2010
Source: Epidemiolog.ru [in Russian, trans. corr.ATS, edited]
<http://www.epidemiolog.ru/news/detail.p ... NT_ID=9317>
CCHF: 7 cases and 2 deaths in South Kazakhstan
----------------------------------------------
As of Tue 20 April 2010 there have been 7 confirmed cases of
Crimean-Congo hemorrhagic fever (CCHF) in the South Kazakhstan Oblast
[region]. The regional public health authority announced that more
than 1500 people had sought medical care after receiving tick bites
during the period 30 Mar to 20 Apr 2010. Of the 7 CCHF cases 2 died,
whereas the remaining 5 cases experienced mild to moderate illness.
About 127 of the contacts of these 7 are now under medical surveillance.
Some settlements have recorded higher numbers of tick bites probably
because of denser tick populations or inadequate tick control
measures. More than 266 000 individuals who may be at risk are being
contacted daily by healthcare workers, in order to encourage tick
avoidance behavior and to check for suspicious symptoms and signs.
Farm livestock are being treated with acaricides.
--
Communicated by:
ProMED-RUS
<promed-rus@promedmail.org>
[There were 22 CCHF cases (and 8 fatalities) in the South Kazakhstan
region last year (2009), including 5 fatalities in a hospital
nosocomial outbreak. The 7 fatalities and 2 deaths recorded during
the 1st 4 months of 2010 are a cause for concern. Treatment of farm
animals to reduce tick infestation and information and education of
the local population are immediate priorities. All patients with
fever and thrombocytopenia who may be at risk of infection should be
tested for CCHF virus infection. - Mod.NP]
[It is likely, but not certain from the information provided above,
that the 2 fatalities listed are the same 2 fatal cases described in
detail in the previous ProMED-mail report: "Crimean-Congo hem. fever
- Kazakhstan: (SK) 20100419.1273".
A map and description of the South Kazakhstan region of Kazakhstan
can be accessed at
<http://aboutkazakhstan.com/South_Kazakh ... last.shtml>.
The HealthMap/ProMED-mail interactive map of Kazakhstan is available at
<http://healthmap.org/r/01de>. - Mod.CP]
-
Birgitt
- Moderator
- Beiträge: 35430
- Registriert: Di 2. Aug 2005, 22:52
- Wohnort: NRW / Südl. Rheinland
- Kontaktdaten:
Re: Krim-Kongo Hämorrhagisches Fieber
CRIMEAN-CONGO HEMORRHAGIC FEVER - SUDAN: 2008, NOSOCOMIAL
*********************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>
Date: Thu 29 Apr 2010
Source: Emerging Health Threats [edited]
<http://www.eht-forum.org/news.html?file ... from=forum>
Outbreaks of suspected Crimean-Congo haemorrhagic fever (CCHF) have been
occurring in the Kordufan region of Sudan over the past 2 years, but
scientists could not say for sure whether the CCHF virus circulates in the
country. Molecular tests on blood samples taken from patients during an
outbreak affecting 12 people in 2008 have identified the virus for the 1st
time in the country. The results of the analysis are published in the May
2010 edition of Emerging Infectious Diseases [IE Aradaib, BR Erickson, ME
Mustafa, ML Khristova, NS Saeed, RM Elageb, et al. Nosocomial outbreak of
Crimean-Congo hemorrhagic fever, Sudan. Emerg Infect Dis 2010; 16(5-May)
<http://www.cdc.gov/eid/content/16/5/837.htm>. - Mod.CP].
CCHF is fatal for around 30 per cent of people who contract it. It can be
spread by the bite of an infected _Hyalmmoma_ tick. The ticks pick up the
virus from infected animals and live in many parts of Africa, Asia, and
southern Europe. The incidence of the disease is rising in some parts of
the world, including south eastern Europe and Turkey, where scientists
recently suggested that changes in the way land is used are behind the
trend. They say the ticks can travel farther when natural habitats are
separated by patches of bush left behind by human activity, and this
enables the virus to circulate in a wider area.
The Sudanese outbreak was probably triggered when a butcher from Al-Fulah,
a town in the central region of the country, picked up the CCHF virus from
infected meat he handled, according to Aradaib and colleagues. He died
after being admitted to the local hospital.
The virus spread to 2 nurses and 2 family members who cared for the man,
the man's sister and a nurse who cared for her, say the authors. It also
spread to 3 other people linked to the hospital. "No protective gloves or
antiseptic products were available at the hospital," they added.
A further 3 probable cases of the disease were spotted in the local
community, and in total, 9 people died in the outbreak. Laboratory tests
confirmed the CCHF virus was behind the illness in 8 cases, but it is not
clear how many patients were included in the analysis.
"Genetic analysis of the viruses showed that the strain involved was
similar to strains found in South Africa, Mauritania, and Nigeria," write
Aradaib and colleagues. Understanding the lineages of the CCHF virus
circulating in Sudan will help scientists to track the movement of the
virus in the region and identify areas at risk of the disease, they add.
[byline: Rita Willaert]
--
communicated by:
ProMED-mail <promed@promedmail.org>
[Crimean-Congo hemorrhagic fever virus (CCHFV; family _Bunyaviridae_, genus
_Nairovirus_) is a tickborne virus. Its tripartite RNA genome consists of
small (S), medium, and large segments. The virus is distributed throughout
much of Africa, Asia, and southern Europe. In some regions, the virus is
responsible for annual outbreaks of haemorrhagic fever with high case
fatality rates; in others, it causes sporadic cases only. The distribution
of CCHF largely mirrors that of its Ixodid tick hosts, particularly those
of the genus _Hyalomma_.
People become infected when bitten by virus-infected ticks or after contact
with blood or tissue from viremic livestock or other people. Outbreaks
often involve people in rural communities, such as shepherds,
slaughterhouse workers, or medical staff of resource-poor hospitals.
Despite presence of _Hyalomma_ tick vectors in Sudan, no CCHF cases had
been confirmed there prior to the investigation reported above. However, in
the past 2 years since 2008, suspected CCHF outbreaks and sporadic cases in
the Kordufan region of Sudan have been reported.
Nosocomial transmission of CCHF virus infection is a recognised hazard for
health care personnel, and procedures must be adapted accordingly.
The HealthMap/ProMED-mail interactive map of Sudan can be accessed at
<http://healthmap.org/r/01g_>. - Mod.CP]
*********************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>
Date: Thu 29 Apr 2010
Source: Emerging Health Threats [edited]
<http://www.eht-forum.org/news.html?file ... from=forum>
Outbreaks of suspected Crimean-Congo haemorrhagic fever (CCHF) have been
occurring in the Kordufan region of Sudan over the past 2 years, but
scientists could not say for sure whether the CCHF virus circulates in the
country. Molecular tests on blood samples taken from patients during an
outbreak affecting 12 people in 2008 have identified the virus for the 1st
time in the country. The results of the analysis are published in the May
2010 edition of Emerging Infectious Diseases [IE Aradaib, BR Erickson, ME
Mustafa, ML Khristova, NS Saeed, RM Elageb, et al. Nosocomial outbreak of
Crimean-Congo hemorrhagic fever, Sudan. Emerg Infect Dis 2010; 16(5-May)
<http://www.cdc.gov/eid/content/16/5/837.htm>. - Mod.CP].
CCHF is fatal for around 30 per cent of people who contract it. It can be
spread by the bite of an infected _Hyalmmoma_ tick. The ticks pick up the
virus from infected animals and live in many parts of Africa, Asia, and
southern Europe. The incidence of the disease is rising in some parts of
the world, including south eastern Europe and Turkey, where scientists
recently suggested that changes in the way land is used are behind the
trend. They say the ticks can travel farther when natural habitats are
separated by patches of bush left behind by human activity, and this
enables the virus to circulate in a wider area.
The Sudanese outbreak was probably triggered when a butcher from Al-Fulah,
a town in the central region of the country, picked up the CCHF virus from
infected meat he handled, according to Aradaib and colleagues. He died
after being admitted to the local hospital.
The virus spread to 2 nurses and 2 family members who cared for the man,
the man's sister and a nurse who cared for her, say the authors. It also
spread to 3 other people linked to the hospital. "No protective gloves or
antiseptic products were available at the hospital," they added.
A further 3 probable cases of the disease were spotted in the local
community, and in total, 9 people died in the outbreak. Laboratory tests
confirmed the CCHF virus was behind the illness in 8 cases, but it is not
clear how many patients were included in the analysis.
"Genetic analysis of the viruses showed that the strain involved was
similar to strains found in South Africa, Mauritania, and Nigeria," write
Aradaib and colleagues. Understanding the lineages of the CCHF virus
circulating in Sudan will help scientists to track the movement of the
virus in the region and identify areas at risk of the disease, they add.
[byline: Rita Willaert]
--
communicated by:
ProMED-mail <promed@promedmail.org>
[Crimean-Congo hemorrhagic fever virus (CCHFV; family _Bunyaviridae_, genus
_Nairovirus_) is a tickborne virus. Its tripartite RNA genome consists of
small (S), medium, and large segments. The virus is distributed throughout
much of Africa, Asia, and southern Europe. In some regions, the virus is
responsible for annual outbreaks of haemorrhagic fever with high case
fatality rates; in others, it causes sporadic cases only. The distribution
of CCHF largely mirrors that of its Ixodid tick hosts, particularly those
of the genus _Hyalomma_.
People become infected when bitten by virus-infected ticks or after contact
with blood or tissue from viremic livestock or other people. Outbreaks
often involve people in rural communities, such as shepherds,
slaughterhouse workers, or medical staff of resource-poor hospitals.
Despite presence of _Hyalomma_ tick vectors in Sudan, no CCHF cases had
been confirmed there prior to the investigation reported above. However, in
the past 2 years since 2008, suspected CCHF outbreaks and sporadic cases in
the Kordufan region of Sudan have been reported.
Nosocomial transmission of CCHF virus infection is a recognised hazard for
health care personnel, and procedures must be adapted accordingly.
The HealthMap/ProMED-mail interactive map of Sudan can be accessed at
<http://healthmap.org/r/01g_>. - Mod.CP]
-
Birgitt
- Moderator
- Beiträge: 35430
- Registriert: Di 2. Aug 2005, 22:52
- Wohnort: NRW / Südl. Rheinland
- Kontaktdaten:
Re: Krim-Kongo Hämorrhagisches Fieber
CRIMEAN-CONGO HEMORRHAGIC FEVER - KOSOVO
****************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>
Date: Wed 9 Jun 2010
Source: Balkan Insight [edited]
<http://www.balkaninsight.com/en/main/news/28638/>
A patient suffering from Crimean Congo haemorrhagic fever died Tuesday
evening [8 Jun 2010] at the infectious disease clinic in Pristina
hospital, the 4th person in Kosovo to succumb to the disease this year
[2010]. The patient, aged 50, was from the Gjakova municipality.
The clinic has registered some 357 patients this year [2010] who
complained of tick bites, but only 72 of them required further
treatment in hospital. Crimean Congo haemorrhagic fever, CCHF, is a
tick-borne disease.
"The patients come from a region in Kosovo where there is evidence of
the haemorrhagic fever," Prof Dr Shemsedin Dreshaj, the director of
the infectious disease clinic, told Balkan Insight. He added that for
the past 15 years an area that covers 4 municipalities has been the
region where the highest number of infected people has been found. In
2009, 13 persons were confirmed to be infected with CCHF virus, of
whom 2 persons died.
Explaining the situation in 2010, Dreshaj said: "75 patients either
had clinical signs or were bitten by a tick from the endemic region."
The affected region covers Suhareke municipality, Podrime region,
Malisevo municipality, and reaches to Istog municipality.
Dreshaj confirmed that there are no patients currently in danger. On a
daily basis the infectious disease clinic receives individuals
complaining of tick bites but after treatment they are discharged from
hospital. "There are ticks that are not infected [with the virus],
therefore people are not kept in hospital," Dreshaj stressed.
The youngest victim to succumb to the disease this year was an
11-year-old boy from Malisevo municipality who passed away on 21 May
2010.
Dreshaj said that the Ministry of Agriculture and Ministry of Health
had conducted decontamination activities in the affected areas.
"Disinfection starts in early spring but this does not eliminate all
infected ticks," Dreshaj explained. He added that ticks lay the eggs
50 to 70 centimetres [20-28 in] under the ground, making it difficult
to eliminate the disease. "This makes the process a bit difficult."
[But see comment below].
Dreshaj recommends that people who live in affected regions avoid
areas where ticks are plentiful and wear long clothes [long sleeves
and pants] when working outside.
[Byline: Petrit Collaku]
--
Communicated by:
ProMED-mail
<promed@promedmail.org>
[The bit about ticks laying eggs 2 ft underground is nonsense. Female
ixodid ticks, the vectors of CCHF virus, lay their eggs in a
gelatinous mass stuck to their body, then die and stay on the surface.
For details of CCHF and its epidemiology see ProMED-mail posting
Crimean-Congo hem. fever, current situation - Europe below, and an
article by ProMED's own Arnon Shimshony at
<http://www.infectiousdiseasenews.com/article/64303.aspx>.
There were cases reported from Kosovo last year(2009) -- see last
ProMED archive listed below.
Tick life cycle:
<http://www.dpd.cdc.gov/dpdx/images/Para ... eCycle.gif>.
Locator maps of Kosovo:
<http://www.globalsecurity.org/military/ ... region.gif> and
<http://healthmap.org/r/01w0>. - Mod.JW]
****************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>
Date: Wed 9 Jun 2010
Source: Balkan Insight [edited]
<http://www.balkaninsight.com/en/main/news/28638/>
A patient suffering from Crimean Congo haemorrhagic fever died Tuesday
evening [8 Jun 2010] at the infectious disease clinic in Pristina
hospital, the 4th person in Kosovo to succumb to the disease this year
[2010]. The patient, aged 50, was from the Gjakova municipality.
The clinic has registered some 357 patients this year [2010] who
complained of tick bites, but only 72 of them required further
treatment in hospital. Crimean Congo haemorrhagic fever, CCHF, is a
tick-borne disease.
"The patients come from a region in Kosovo where there is evidence of
the haemorrhagic fever," Prof Dr Shemsedin Dreshaj, the director of
the infectious disease clinic, told Balkan Insight. He added that for
the past 15 years an area that covers 4 municipalities has been the
region where the highest number of infected people has been found. In
2009, 13 persons were confirmed to be infected with CCHF virus, of
whom 2 persons died.
Explaining the situation in 2010, Dreshaj said: "75 patients either
had clinical signs or were bitten by a tick from the endemic region."
The affected region covers Suhareke municipality, Podrime region,
Malisevo municipality, and reaches to Istog municipality.
Dreshaj confirmed that there are no patients currently in danger. On a
daily basis the infectious disease clinic receives individuals
complaining of tick bites but after treatment they are discharged from
hospital. "There are ticks that are not infected [with the virus],
therefore people are not kept in hospital," Dreshaj stressed.
The youngest victim to succumb to the disease this year was an
11-year-old boy from Malisevo municipality who passed away on 21 May
2010.
Dreshaj said that the Ministry of Agriculture and Ministry of Health
had conducted decontamination activities in the affected areas.
"Disinfection starts in early spring but this does not eliminate all
infected ticks," Dreshaj explained. He added that ticks lay the eggs
50 to 70 centimetres [20-28 in] under the ground, making it difficult
to eliminate the disease. "This makes the process a bit difficult."
[But see comment below].
Dreshaj recommends that people who live in affected regions avoid
areas where ticks are plentiful and wear long clothes [long sleeves
and pants] when working outside.
[Byline: Petrit Collaku]
--
Communicated by:
ProMED-mail
<promed@promedmail.org>
[The bit about ticks laying eggs 2 ft underground is nonsense. Female
ixodid ticks, the vectors of CCHF virus, lay their eggs in a
gelatinous mass stuck to their body, then die and stay on the surface.
For details of CCHF and its epidemiology see ProMED-mail posting
Crimean-Congo hem. fever, current situation - Europe below, and an
article by ProMED's own Arnon Shimshony at
<http://www.infectiousdiseasenews.com/article/64303.aspx>.
There were cases reported from Kosovo last year(2009) -- see last
ProMED archive listed below.
Tick life cycle:
<http://www.dpd.cdc.gov/dpdx/images/Para ... eCycle.gif>.
Locator maps of Kosovo:
<http://www.globalsecurity.org/military/ ... region.gif> and
<http://healthmap.org/r/01w0>. - Mod.JW]