Krim-Kongo Hämorrhagisches Fieber

[Birgitt]

CRIMEAN-CONGO HEMORRHAGIC FEVER - SOUTH AFRICA (02): BACKGROUND
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Date: Wed 16 Jan 2013
Source: GIDEON (Global Infectious Disease & Epidemiology Network) [edited]
http://www.gideononline.com


Crimean-Congo hemorrhagic fever - South Africa: background
----------------------------------------------------------
The following background data are abstracted from the Gideon database <www.GideonOnline.com> and the Gideon e-book series. [1,2]

Time and place
--------------
The 1st indigenous case of Crimean-Congo hemorrhagic fever (CCHF) in South Africa was reported in 1981 -- fatal infection acquired in Transvaal. At the time of the report, 7 percent of persons in the area were found to be seropositive.
- Highest incidence is reported in the Karoo, the Western Free State, the Northern Cape and North West Province.
- Most patients are farmers, farm laborers, hunters, or abattoir workers.
- 101 cases were reported during 1981 to 1992; 81 during 1993 to 2010.
- 16 outbreaks were reported among animals during 1981 to 1986.
- Imported cases were reported in 1985 (from Democratic Republic of Congo) and 1986 (from Tanzania).

CCHF: reported cases and deaths per year - see graph [3]:
http://cdn.gideononline.com/wp/wp-conte ... CHF-SA.png

Seroprevalence surveys
----------------------
100 percent of giraffe (_Giraffa camelopardalis_), 54 percent of rhinoceros (_Ceratotherium simum_ and _Diceros bicornis_), 46 percent of eland (_Taurotragus oryx_), 19.5 percent of buffalo (_Syncerus caffer_), 22 percent of kudu (_Tragelaphus strepsiceros_), 17 percent of zebra (_Equus burchelli_), 6.0 percent of domestic dogs, 13.7 percent of hares, 1.7 percent of rodents, and 0 percent of primates (South Africa and Zimbabwe, 1987 publication), 28 percent of cattle (1987 publication)

Vectors
-------
- The principal vector is _Hyalomma truncatum_.
- _H. marginatum rufipes_ and _H. m. turanicum_ have also been incriminated.

Notable outbreaks
-----------------
1984: an outbreak (5 cases, 1 fatal) of Crimean-Congo hemorrhagic fever was reported in Orange Free State [currently, Free State].
1985: an outbreak (6 cases, 1 fatal) was reported at a hospital near Cape Town, among health-care workers who had contact with an index patient or his secretions.
1996: an outbreak (32 suspect cases, 17 confirmed; one fatal) was reported at an ostrich abattoir in Oudtshoorn (Western Cape).

References
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1. Berger SA: Infectious Diseases of South Africa, 2012. 436 pages, 95 graphs, 1942 references. Gideon e-books, http://www.gideononline.com/ebooks/coun ... th-africa/.
2. Berger SA: Crimean-Congo Hemorrhagic Fever: Global Status. 2012. 36 pages, 18 graphs, 505 references. Gideon e-books, http://www.gideononline.com/ebooks/dise ... al-status/.
3. Gideon Graph Tool, see tutorial at http://www.GIDEONonline.com/wp/wpconten ... Graphs.pps.

--
Communicated by:
Dr Steve Berger
Geographic Medicine
Tel Aviv Medical Center
Israel
<mberger@post.tau.ac.il>

[ProMED-mail thanks Steve Berger for provision of these background data quantitating the prevalence of Crimean-Congo hemorrhagic fever throughout the whole of South Africa. - Mod.CP

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/4SvZ.]

[Birgitt]

CRIMEAN-CONGO HEMORRHAGIC FEVER - TURKEY: (TOKAT) FATAL
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Date: Mon 29 Apr 2013
Source: World Bulletin/News Desk [edited]
http://www.worldbulletin.net/?aType=hab ... eID=107692


A man died as a result of Crimean-Congo hemorrhagic fever (CCHF), a sometimes fatal viral disease contracted from a tick bite, in the Black Sea province of Tokat on Sat 27 Apr 2013. He had been bitten by a tick while taking care of his animals in the fields on 17 Apr 2013. He extracted the tick by himself and did not immediately seek professional attention. He was taken to Tokat State Hospital and later transferred to the Gaziosmanpasa University Research and Treatment Hospital when his condition deteriorated.

Doctors at the Gaziosmanpasa hospital stated that the man is the 1st person to die due to CCHF this year [2013] in Turkey; however, there are some patients who are currently receiving treatment for the disease in other hospitals. According to data released by the Ministry of Health, 174 people died as a result of CCHF in Turkey between 2002 and 2012.

The number of tick bite cases increases as the weather gets warmer and people engage in more activities outdoors. Experts say people who come into contact with a tick should be carefully monitored for 10 days following contact and seek professional medical care if symptoms of fever, headache, nausea, vomiting, or diarrhea present themselves.

--
communicated by:
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[Crimean-Congo haemorrhagic fever (CCHF) is a widespread disease caused by a tickborne virus (genus _Nairovirus_, family _Bunyaviridae_). CCHF virus causes severe viral haemorrhagic fever outbreaks, with a case fatality rate of 10-40 per cent. CCHF is endemic in Africa, the Balkans, the Middle East, and Asian countries south of the 50th parallel north -- the geographical limit of the principal tick vector.

The following information has been extracted from a recent review in The Lancet by Talha Khan Burki (Lancet 2012; 380(9857): 1897-8. doi:10.1016/S0140-6736(12)62097-2). In its immature form, the tick feeds on small mammals. Later, the adult tick attaches itself to cattle, sheep, goats, or human beings. Livestock show no overt signs of disease, and farmers and slaughterhouse workers have little idea they have been infected until they start expressing symptoms: dizziness, muscular pain, and stiffness, and of course the signature bleeding. Whereas infection in birds mostly tends to be abortive, ostriches are important hosts. In the mid 1990s, South Africa saw a CCHF outbreak at an ostrich abattoir. About 30 countries in Africa, Asia, and Europe have reported CCHF. The tick ventures no further than 50 deg north latitude, which cuts across Russia, Ukraine, central Europe, and France; the latter 2 regions are not considered to be at any immediate risk, the _Hyalomma_ spp ticks are present but there is no serological evidence of CCHF. The distribution of known cases across the Middle East and Africa is patchy -- ticks are present in the whole of this region but in many countries it seems harmless. In Africa, only South Africa, and from time to time Mauritania, face ongoing outbreaks; countries such as Tanzania and Uganda have not reported any recent outbreaks; and countries such as Angola and Algeria seem not to be at risk.

Changing patterns of agriculture and flood control may also have played a part. In Turkey affected parts of central Anatolia had been more or less abandoned in the late 1990s due to terrorist activity. Hunting and farming resumed in 2001, and ticks were able to fasten onto the influx of cattle and sheep. The following year [2002], Turkey confirmed its 1st case of CCHF and numbers have steadily increased ever since (which may simply be due to the increased surveillance).

Only 4 countries report more than 50 cases per year: Iran, Russia, Turkey, and Uzbekistan (although, it could easily be the case that these countries simply have particularly efficient surveillance systems backed by proper diagnostics). A few other nations report 5 to 49 cases per year. Most of the time, CCHF outbreaks affect a small handful of people. Turkey is responsible for most of the burden. According to the Turkish Ministry of Health, 2008 and 2009 both saw in excess of 1200 cases of CCHF; numbers dropped in 2010, but exceeded 1100 last year (no figures for 2012 have been released). Turkish mortality from CCHF hovers at around 5 per cent. But it can be considerably higher, particularly if there are delays in obtaining treatment (and this is a disease that mainly affects rural areas). There is a good deal about the vector, the virus, and its expression that remains unclear. Variation in mortality is just one of these issues -- it could be related to the alacrity with which supportive therapy and treatment are started, but viral properties (there are several distinct strains of CCHF virus) and genetics may also play a part.

Only one drug is used to treat CCHF: ribavirin. "It's a good treatment option but it needs to be given early on -- as soon as the disease is diagnosed -- I don't think there's much hope once the clinical picture is dominated by the host inflammatory responses," according to one authority.

For now, the best way to minimise infection would be to ensure at-risk communities take precautions. Wearing protective clothing, insect repellent, and spraying livestock with insecticide would be very effective and could have a knock-on effect on other diseases. Health professionals must be assiduous in ensuring that safety measures are adhered to within hospitals, most crucially when they encounter haemorrhaging patients.

Meanwhile, experts need to be enlisted to map the behaviour of the tick. In studying this, Turkey should be expected to lead the way. If it can be established why its burden of CCHF is higher than elsewhere, whether it is the environment, the virus, a genetic factor, or something to do with the tick, then other countries might be able to draw conclusions relevant to their own experience. - Mod.CP

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/6E1D.]

[Birgitt]

CRIMEAN-CONGO HEMORRHAGIC FEVER - BULGARIA: (KURDZHALI)
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Date: Fri 28 Jun 2013
Source: FluTrackers.com [edited]
http://www.flutrackers.com/forum/showth ... post502583


Two cases of Crimean-Congo hemorrhagic fever (CCHF), the latter reported yesterday [27 Jun 2013], were admitted to the Infectious Disease Department of "Dr. Atanas Dafovski" Hospital in Kardzhali [Kurdzhali Province - CopyEd.MSP]. Both were referred for treatment to the Plovdiv Hospital, as the 1st hospital lacked facilities to treat contagious diseases such as CCHF, according to the head of the department, Dr. Magdalena Marinova.

The patients had been bitten by ticks, which disseminated the disease. This year [2013], the [tick] population is particularly high due to periods of heavy rainfall. According to Dr. Marinova, people bitten by a tick should immediately seek medical attention and not try to remove the tick themselves because of the risk of the tick remaining attached to the patient's body.

The [initial] symptoms of Crimean-Congo hemorrhagic fever can be treated with hyper-immune gamma globulin, but if the disease is in an advanced stage, there is risk of death, warned Dr. Magdalena Marinova. In practice, over 15 percent of Crimean-Congo hemorrhagic fever patients do not recover.

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[A map of Bulgaria showing Kardzhali [Kurdzhali] in the southeast of Bulgaria close to the border with Greece is available at: http://get.info.bg/visit/images/Bulgari ... ed_Map.gif.

Crimean-Congo hemorrhagic fever is caused by infection with a tick-borne virus (belonging to the 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 designation of the disease. Crimean-Congo hemorrhagic fever is found in Eastern Europe, particularly in the southern parts of the former Soviet Union. It is also distributed throughout the Mediterranean, in northwestern China, central Asia, southern Europe, Africa, the Middle East, and the Indian subcontinent.

The following information has been extracted from a recent review in The Lancet by Talha Khan Burki (Lancet 2012; 380(9857): 1897-8. doi:10.1016/S0140-6736(12)62097-2):

In its immature form, the tick feeds on small mammals. Later, the adult tick attaches itself to cattle, sheep, goats, or human beings. Livestock show no overt signs of disease, and farmers and slaughterhouse workers have little idea they have been infected until they start expressing symptoms: dizziness, muscular pain, and stiffness, and of course the signature bleeding. Whereas infection in birds mostly tends to be abortive, ostriches are important hosts. In the mid 1990s, South Africa saw a CCHF outbreak at an ostrich abattoir. About 30 countries in Africa, Asia, and Europe have reported CCHF. The tick ventures no further than 50 degrees north latitude, which cuts across Russia, Ukraine, central Europe, and France; the latter 2 regions are not considered to be at any immediate risk. The _Hyalomma_ spp. ticks are present, but there is no serological evidence of CCHF. Changing patterns of agriculture and flood control may also have played a part. In Turkey, affected parts of central Anatolia had been more or less abandoned in the late 1990s due to terrorist activity. Hunting and farming resumed in 2001, and ticks were able to fasten onto the influx of cattle and sheep. The following year [2002], Turkey confirmed its 1st case of CCHF, and numbers have steadily increased ever since (which may simply be due to the increased surveillance). Only 4 countries report more than 50 cases per year: Iran, Russia, Turkey, and Uzbekistan (although it could easily be the case that these countries simply have particularly efficient surveillance systems backed by proper diagnostics). There is a good deal unknown about the vector, the virus, and its spread. Variation in mortality is just one of these issues; it could be related to the alacrity with which supportive therapy and treatment are started, but viral properties (there are several distinct strains of CCHF virus) and genetics may also play a part. - Mod.CP

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/1HTY.]

[Birgitt]

CRIMEAN-CONGO HEMORRHAGIC FEVER - KOSOVO REGION: TRAVEL ALERT
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Date: Mon 24 Jun 2013
Source: OSAC [abbreviated & edited]
https://www.osac.gov/Pages/ContentRepor ... ?cid=14190


The U.S. Embassy, Pristina advises U.S. citizens that Kosovo is experiencing a cyclical outbreak of Crimean-Congo hemorrhagic fever (CCHF), which is endemic to this area. National Institute of Public Health of Kosovo (NIPH) has recently reported 5 fatal cases of CCHF in the Malisheva/Malishevo, Rahovec/Orahovac and Gjakova/Gjakovica municipalities. Those most at risk are individuals with contact with livestock in endemic regions.

CCHF is a tick-borne disease in humans with a high mortality rate. Fortunately, human illness occurs infrequently. A map of areas in Kosovo where the outbreaks are occurring is attached. In addition, please see instructions from the CDC website about CCHF.

Signs and symptoms of the disease include: Sudden onset of high fever, headache, backache, and abdominal pain, small hemorrhages of the eyes, a type of rash in the mouth and on the trunk of the body [and evidence of a current tick-bite]. There is no safe and effective vaccine widely available for human use. People living in endemic regions should avoid areas where there are many ticks, particularly in the spring and summer. The following safety precautions are also recommended:
- Wear light-colored clothing that covers legs and arms;
- If living in an infested area, check your whole body regularly for ticks, remove ticks gently but promptly;
- Examine clothes regularly for ticks;
- Use tick repellents on skin and clothing;
- Tuck trousers into socks, and keep sleeves rolled down;
- Clean areas well where food is prepared or served so as not to attract ticks [?];
- Maintain neatness and cleanliness;
- Check your pets frequently for fleas and ticks, and use flea and tick collars and shampoos.

For health issues, include the following: obtain Centers for Disease Control and Prevention (CDC) travel notices, call the CDC at 1-800-CDC-INFO (1-800-232-4636) from within the United States or 1-404-639-3534 from overseas, or visit the CDC website at http://www.cdc.gov/travel.

We strongly recommend that U.S. citizens traveling to or residing in Kosovo enroll in the Department of State's Smart Traveler Enrollment Program (STEP). STEP enrollment gives you the latest security updates, and makes it easier for the U.S. embassy or nearest U.S. consulate to contact you in an emergency. If you don't have Internet access, enroll directly with the nearest U.S. embassy or consulate.

Regularly monitor the State Department's website, where you can find current Travel Warnings, Travel Alerts, and the Worldwide Caution. Read the Country Specific Information for Kosovo.

For additional information, refer to "A Safe Trip Abroad" on the State Department's website. The U.S. Embassy, Pristina is located at 30 Nazim Hikmet St. Arberia/Dragodan, 10 000 Pristina and is open between 8 AM-5 PM, (381) 38-5959-3000.

--
Communicated by:
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<promed@promedmail.org>

[CCHF 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. CCHF is found in Eastern Europe, particularly in the former Soviet Union. It is currently distributed throughout the Balkans, northwestern China, central Asia, southern Europe, Africa, the Middle East, and the Indian subcontinent.

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 can be transmitted from one infected human to another by contact with infectious blood or body fluids. Documented spread of CCHF has also occurred in hospitals due to improper sterilization of medical equipment, reuse of injection needles, and contamination of medical supplies.

In humans, the length of the incubation period for the illness appears to depend on the mode of acquisition of the virus. 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 5-6 days, with a documented maximum of 13 days. The mortality rate from CCHF is approximately 30 percent, with death occurring in the 2nd week of illness. Therefore, the 5 deaths recorded in Kosovo imply that there may have been more than 15 cases in total.

In those patients who recover, improvement generally begins on the 9th or 10th day after the onset of illness. General supportive therapy is the mainstay of patient management in CCHF infections. Intensive monitoring to guide blood volume and 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. (Further information can be obtained from the WHO Fact Sheet at: http://www.who.int/mediacentre/factshee ... index.html.

A map of Kosovo can be accessed at: http://goeasteurope.about.com/od/introt ... Kosovo.htm. - Mod.CP

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/3uhY.]

[Birgitt]

CRIMEAN-CONGO HEMORRHAGIC FEVER - SOUTH AFRICA (03): (MPUMALANGA), FARMER
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Date: Mon 8 Jul 2013
Source: IOL News [edited]
http://www.iol.co.za/news/south-africa/ ... dxp9j54bVS


A farmer who has been diagnosed with Crimean-Congo hemorrhagic fever [CCHF], a life-threatening disease, has been admitted to a Pretoria hospital.

On Sunday [7 Jul 2013], Dr Lucille Blumberg, from the National Institute for Communicable Diseases (NICD), confirmed that the man, who is in his 40s, was diagnosed with CCHF. She said the man was transferred from a hospital in Mpumalanga on Friday [5 Jul 2013] before the tests confirmed that he had the disease. Tests had been run while he was still in Mpumalanga because it was suspected he had CCHF. Commenting on the patient's condition, Blumberg said: "He is in a stable condition, and he is improving." Blumberg said the man had a fever, headache, muscle pain and bleeding gums.

3 other cases of CCHF have been reported in South Africa this year [2013] -- one in North West, while the other 2 patients were from the Free State. According to the
1 Jan 2013 communique on the NICD website, a 31-year-old man working as a game warden on a private game ranch near Jagersfontein in the Free State presented with clinical symptoms suggestive CCHF. A 2nd case of CCHF was confirmed on 12 Jan 2013, after a 44-year-old man was taken to hospital in Bloemfontein. He had been on a farm in Pomfret, North West (about 5 km from the Botswana border), where he was bitten by a tick; 3 days later, he developed symptoms and presented with fever, rash, conjunctivitis and pharyngitis. Blumberg said: "They were all doing very well and have long been discharged."

[Byline: Solly Maphumulo]

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[Crimean-Congo haemorrhagic fever (CCHF) is a widespread disease caused by a tick-borne virus (genus _Nairovirus_, family _Bunyaviridae_). CCHF virus causes severe viral haemorrhagic fever outbreaks, with a case fatality rate of 10-40 percent.

CCHF is endemic in Africa, the Balkans, the Middle East and Asian countries south of the 50th parallel north, the geographical limit of the principal tick vector. Although a number of tick genera are capable of becoming infected with CCHF virus, ticks of the genus _Hyalomma_ are the principal vector.

CCHF virus is transmitted to people either by tick bites or through contact with infected animal blood or tissues during and immediately after slaughter. The majority of cases have occurred in people involved in the livestock industry, such as agricultural workers, slaughterhouse workers and veterinarians. The length of the incubation period depends on the mode of acquisition of the virus. Following infection by a tick bite, the incubation period is usually 1-3 days, with a maximum of 9 days. The incubation period following contact with infected blood or tissues is usually 5-6 days, with a documented maximum of 13 days.

Onset of symptoms is sudden, with fever, myalgia, (muscle ache), dizziness, neck pain and stiffness, backache, headache, sore eyes and photophobia (sensitivity to light). There may be nausea, vomiting, diarrhoea, abdominal pain and sore throat early on, After 2-4 days, the agitation may be replaced by sleepiness, depression and lassitude, and the abdominal pain may localize to the upper right quadrant, with detectable hepatomegaly [WHO Factsheet http://www.who.int/mediacentre/factshee ... index.html].

Mortality rate from CCHF is approximately 30 percent, with death occurring in the 2nd week of illness. In patients who recover, improvement generally begins on the 9th or 10th day after the onset of illness. General supportive care with treatment of symptoms is the main approach to managing CCHF in people. The antiviral drug ribavirin has been used to treat CCHF infection with apparent benefit. Both oral and intravenous formulations seem to be effective.

All 4 South African patients appear to be responding well to treatment in hospital, and it would be generally useful if the treatment protocols could be publicised.

A map of the provinces of South Africa showing the location of Mpumalanga can be accessed at: http://www.nationsonline.org/oneworld/m ... s_map2.htm. - Mod.CP

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/1EPe.]

[Birgitt]

CRIMEAN-CONGO HEMORRHAGIC FEVER - INDIA: (GUJARAT)
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[1]
Date: Mon 15 Jul 2013
Source: The Times of India, Rajkot [edited]
http://timesofindia.indiatimes.com/city ... 077424.cms


State Health Department officials, along with a team [from the] Pune-based National Institute of Virology (NIV), are camping in Kariyana village in Babra taluka of Amreli district [in Gujarat state] after a virology report that 4 persons who died last week [week of 7 Jul 2013] tested positive for Crimean-Congo hemorrhagic fever (CCHF). According to [local] sources, 7 people had lost their lives in fever a week ago [around 8 Jul 2013] in Kariyana village. Later on, the blood samples were sent to NIV for laboratory testing. Sources said that the sudden deaths scared villagers and they started moving out from the village to live on the outskirts of the village. "The health department teams carried out [a] survey and all preventive measures are being taken. Samples of all those persons who came into contact with CCHF-positive people [have been] sent to Pune," said Dr. B N Desani, Block Health Officer, Babra.

Sources said that more than 10 people from the village have been taking treatment at various hospitals in Rajkot and Ahmedabad. "We have taken blood samples of all people who complained of fever in the village and are monitoring them constantly," Dr Desani said. The village has around 5000 population and their main occupation is animal husbandry and agriculture. Officials said that symptoms characterizing the initial stage of CCHF include mood instability, agitation and mental confusion. Other signs are nose bleeding, bloody urine, vomiting, and black stools. Sources said that after an incubation period of 1 to 3 days following a tick bite, flu-like symptoms appear which may resolve in a week. In up to 75 per cent of cases, however, signs of hemorrhage appear 3 to 5 days after the onset of the illness if it is not contained properly.

--
Communicated by:
Ronan Kelly
<ronankelly@comcast.net>

******
[2]
Date: Mon 15 Jul 2013
Source: Press Trust of India [edited]
http://ptinews.com/news/3804415_Seven-d ... n-one-week


As many as 7 people died of Crimean-Congo hemorrhagic fever (CCHF) in Amreli district of Gujarat over the last week, while 6 others were undergoing treatment at the civil hospital, officials said here today. Teams from the State Health Department and the Pune-based National Institute of Virology have reached Kariyana town in the district to control the outbreak. Many inhabitants of Kariyana have [left the village] after onset of the disease, according to [local] sources.

--
Communicated by:
Ronan Kelly
<ronankelly@comcast.net>

[Cases of Crimean-Congo hemorrhagic fever (CCHF) have been reported from rural areas of Gujarat in the north-west of India in previous years, despite the fact that it is one of the most industrialised regions of India. The development of the outbreak and progress on its control can be followed by accessing the ongoing FluTrackers thread at: http://www.flutrackers.com/forum/showth ... p?t=208849.

Crimean-Congo hemorrhagic fever (CCHF) is a viral hemorrhagic fever caused by a nairovirus. Although primarily a zoonosis, sporadic cases and outbreaks of CCHF affecting humans occur. The disease is endemic in many countries in Africa, Europe and Asia. Crimean-Congo hemorrhagic fever virus is present (and probably endemic) throughout northern India.

The mortality rate from CCHF is approximately 30 percent, with death occurring in the 2nd week of illness. In those patients who recover, improvement generally begins on the 9th or 10th day after the onset of illness. When patients with CCHF are admitted to hospital, there is a risk of nosocomial spread of infection.

CCHF virus may infect a wide range of domestic and wild animals. Animals become infected with CCHF from the bite of infected ticks. A number of tick genera are capable of becoming infected with CCHF virus, but the most efficient and common vectors for CCHF appear to be members of the genus _Hyalomma_. Trans-ovarial (transmission of the virus from infected female ticks to offspring via eggs) and venereal transmission have been demonstrated amongst some vector species, indicating one mechanism which may contribute to maintaining the circulation of the virus in nature. However, the most important source for acquisition of the virus by ticks is believed to be infected small vertebrates on which immature _Hyalomma_ ticks feed. Once infected, the tick remains infected through its developmental stages, and the mature tick may transmit the infection to large vertebrates, such as livestock. Domestic ruminant animals, such as cattle, sheep and goats, are viraemic for around one week after becoming infected.

Disease management in humans consists of general supportive therapy. The antiviral drug ribavirin has been used in treatment of established CCHF infection with some apparent benefit. There is no protective vaccine. (For further information, see: http://www.who.int/mediacentre/factshee ... index.html).

A map showing the location of Amreli district in the state of Gujarat can be viewed at http://www.mapsofindia.com/maps/gujarat/gujarat.htm. The HealthMap/ProMED-mail interactive map of India can be accessed at http://healthmap.org/r/27Ix. - Mod.CP]

[Birgitt]

CRIMEAN-CONGO HEMORRHAGIC FEVER - PAKISTAN (02): (KHYBER PAKHTUNKHWA) SUSPECTED
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Date: Sat 20 Jul 2013
Source: Central Asia Online [edited]
http://centralasiaonline.com/en_GB/arti ... wsbrief-14


The Khyber Pakhtunkhwa (KP) Health Department has ordered the establishment of isolation wards to cope with a possible outbreak of Crimean-Congo haemorrhagic fever (CCHF), a frequently deadly tickborne disease, officials said.

"We made this decision after discovering 2 people reportedly died from the virus [disease]," Dr Muhammad Zafar, director-general of health services, told Central Asia Online on Fri 19 Jul 2013. "The [presence of the] virus was not confirmed in the victims, but the government is not taking any chances." The virus also has killed about a dozen in Karachi, he said.

[byline: Ashfaq Yusufzai]

--
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[Crimean-Congo hemorrhagic fever outbreaks have a case fatality rate of up to 40 per cent. The virus is primarily transmitted to people from ticks and livestock animals. Human-to-human transmission can occur resulting from close contact with the blood, secretions, organs, or other bodily fluids of infected people. CCHF is endemic in Africa, the Balkans, the Middle East, and Asia, in countries south of the 50th parallel north. There is no vaccine, and protection depends on better education of the population regarding the adverse consequences of tick bites.

The hosts of the CCHF virus include a wide range of wild and domestic animals such as cattle, sheep, and goats. Many birds are resistant to infection, but ostriches are susceptible and may show a high prevalence of infection in endemic areas, where they have been at the origin of human cases. There is no apparent disease in these animals. Animals become infected by the bite of infected ticks, and the virus remains in their bloodstream for about one week after infection, allowing the tick-animal-tick cycle to continue when another tick bites. Although a number of tick genera are capable of becoming infected with CCHF virus, ticks of the genus _Hyalomma_ are the principal vector. Following infection by a tick bite, the incubation period is usually 1-3 days, with a maximum of 9 days. The incubation period following contact with infected blood or tissues is usually 5-6 days, with a documented maximum of 13 days. - Mod.CP

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/1iGJ.]

[Birgitt]

CRIMEAN-CONGO HEMORRHAGIC FEVER - INDIA (02): (GUJARAT), HUMAN DEATHS
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Date: Tue 30 Jul 2013
Source: FAO EMPRES-AH - Animal Disease Daily Update [edited]


In the Amreli District [Gujarat state], 6 human cases [of Crimean-Congo hemorrhagic fever (CCHF)] were confirmed (2 deaths) between 23 Jun 2013 and 10 Jul 2013. Several cattle, goats, and sheep were found positive for CCHF as well.

All cases occurred among [the] cattle grazing-community living in houses with mounds of cow dung and other garbage nearby. Cattle were living along with humans. [National Authorities; 14 Jul 2013: Integrated Disease Surveillance Project].

--
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[Crimean-Congo hemorrhagic fever (CCHF) virus is primarily transmitted to people by ticks carried by livestock. Human-to-human transmission can occur resulting from close contact with the blood, secretions, organs or other bodily fluids of infected persons. CCHF is endemic in Africa, the Balkans, the Middle East and Asia, in countries south of the 50th parallel north. There is no vaccine available for either people or animals. Livestock is relatively unharmed by CCHF virus infection.

Amreli district is one of the 26 administrative districts of the state of Gujarat in western India. The district headquarters are located at Amreli. The district occupies an area of 6760 square km and has a population of 1 393 918, of which 22.45 percent were urban (as of 2001). - Mod.CP

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/1pSH.]

[Birgitt]

CRIMEAN-CONGO HEMORRHAGIC FEVER - UGANDA: (AGAGO) FATAL
*******************************************************
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Date: Fri 16 Aug 2013
Source: World Bulletin [edited]
http://www.worldbulletin.net/?aType=hab ... eID=115240


The Ugandan Health Ministry said on Friday [16 Aug 2013] that 3 people have died in northern Uganda from a suspected outbreak of a highly infectious hemorrhagic fever. A male farmer is still being treated as a confirmed case of Crimean-Congo hemorrhagic fever (CCHF), and the 3 other deaths are being investigated, junior health minister Elioda Tumwesigye told a news conference.

Doctors at 1st suspected the farmer had Ebola [hemorrhagic fever], the highly contagious and lethal viral fever, after falling ill on 8 Aug [2013], with sudden headache, bleeding, high fever, joint muscle pain, vomiting, red eyes, back pain, and stomach pain.

Subsequent tests showed it was CCHF. Caused by a tickborne virus, it is highly infectious and is endemic in livestock in Africa. It kills 40 per cent of all the people it infects, according to the Health Ministry. The ministry said it was tracking 6 other people who had come into contact with the sick farmer, being treated at Kalongo Hospital in Agago district, 450 km [280 miles] north of the capital Kampala, and that an isolation facility had been set up.

Uganda has suffered several episodes of Ebola [hemorrhagic fever] and Marburg [hemorrhagic fever] since 2000. The most recent case was in October last year [2012] in Kabale, near the Democratic Republic of Congo, when Marburg virus killed 5 people. The largest outbreak of Ebola [hemorrhagic] fever in the country was in 2000 in the north of the country, which infected 425 people and killed more than half of them. Health services in Uganda are severely underfunded and understaffed with leading referral hospitals lacking basic medical supplies.

The Ministry advised people to avoid close physical contact with animals and suspected infected people.

--
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[CCHF is a zoonotic disease whose usual hosts are wild animals or livestock. It is transmitted to humans though tick bites (usually of the genus _Hyalomma_) or through contact with blood of infected animals during slaughtering or contact with infected fluids of an infected human case.

Following infection via a tick bite, the incubation period is usually 1 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.

Cases present with acute fevers, headache, muscle pains, abdominal pains, petechiae [small red or purple spots caused by broken capillaries], jaundice, and other bleeding manifestations. Mortality may be as high as 30 per cent but can be reduced with supportive treatment and administration of ribavirin.

People who live in endemic areas should use personal protective measures which include avoidance of areas where tick vectors are abundant and times when they are active; regular examination of clothing and skin for ticks, and their removal; and use of repellents. (For further information, see http://www.who.int/mediacentre/factshee ... index.html.)

A map showing the districts of Uganda can be seen at http://en.wikipedia.org/wiki/Districts_of_Uganda, and the HealthMap/ProMED-mail interactive map of the country can be seen at http://healthmap.org/r/3Lpc. - Mod.JFW]

[Birgitt]

CRIMEAN-CONGO HEMORRHAGIC FEVER - INDIA (03): (GUJARAT) FATAL
*************************************************************
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Date: Sat 17 Aug 2013
Source: The Times of India [edited]
http://timesofindia.indiatimes.com/city ... 869823.cms


The dreaded Crimean-Congo haemorrhagic fever is suspected to have claimed lives of 3 men in Barvalataluka in Ahmedabad district [Gujarat state]. Following this, the health department has asked medical and veterinary teams to undertake fogging [fogging would be more appropriate for flying vectors rather than ticks - Mod.CP] operations to contain the virus, which spreads through ticks found on the cattle.

Regional deputy director of health at Civil Hospital Dr Neelam Patel said that 3 men were reported dead in Kundal village in Barwala due to haemorrhagic fever suspected to be caused by Crimean-Congo haemorrhhagic fever virus. Moreover, 2 relatives of the victims, including a woman, have also been admitted to the Bhavnagar Government Hospital. The victims belong to Bharwad families staying in the same locality.

District health officer Dr Shilpa Jadhav said that the teams of health department and animal husbandry department have been sent to the village to carry out extensive antiviral operations and undertake cleanliness drives. The ticks, which are known to carry Crimean-Congo virus, are being plucked from the cattle. The officials said that the cleanliness drive has been undertaken in a 5 km [about 3 mile] radius of the village.

Earlier, 4 people of Kariyana village in Babra taluka of Amreli district [Gujarat state] had died of confirmed Crimean-Congo haemorrhagic fever as their clinical samples had tested positive for Crimean-Congo haemorrhagic fever.

In India, Crimean-Congo haemorrhagic fever virus 1st surfaced in Gujarat in January 2011 when a woman from Kolat village in Sanand died of the virus infection.

--
communicated by:
ProMED-mail rapporteur Kunihiko Iizuka

[Crimean-Congo haemorrhagic fever (CCHF) outbreaks have a case fatality rate of up to 40 per cent. The virus is primarily transmitted to people from ticks harboured by livestock animals. Human-to-human transmission can occur resulting from close contact with the blood, secretions, organs, or other bodily fluids of those infected. Infected domestic animals do not usually show signs of infection, which may contribute to the general lack of awareness of the disease even in endemic areas and a toleration of tick bites.

CCHF is endemic in Africa, the Balkans, the Middle East and Asia, in countries south of the 50th parallel north. There is no vaccine available for either people or animals.

A map of the states and territories of India showing the location of Gujarat in the north west can be accessed at http://www.mapsofindia.com/maps/india/i ... al-map.gif. - Mod.CP

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/27Ix.]

[Birgitt]

CRIMEAN-CONGO HEMORRHAGIC FEVER - UGANDA (02): (AGAGO), CONFIRMED CASE
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Date: Fri 16 Aug 2013
Source: Ugandan Ministry of Health Press Release [edited]


The Ministry of Health informs the general public that a hemorrhagic fever outbreak has been confirmed in Omot sub-county, Agago district. Following tests done by the Uganda Virus Research Institute (UVRI), Entebbe, the samples obtained from one person have tested positive for Crimean-Congo hemorrhagic fever (CCHF) [virus infection].

CCHF is a zoonotic disease that is caused by a tick-borne virus (genus _Nairo-Virus_) of the family _Bunyaviridae_. This virus causes severe viral hemorrhagic fever outbreaks; it is highly infectious and kills about 40 percent of people infected. It is endemic in livestock in Africa, e.g. cattle, goats and sheep. This virus is transmitted to human beings through bites of infected ticks. The ticks pick up their infection from wild or domestic animals like sheep, cattle and goats, among others. The signs and symptoms of the disease range from sudden headache, high fever, back pain, joint muscle pain, stomach pain, vomiting, red eyes, a flushed face, a red throat, and bleeding from some body parts. The infection has a short incubation period of 3-5 days.

The confirmed case of CCHF is a male adult farmer from Baroma village, Atece Parish in Omot Sub-county in Agago District. His illness started on 8 Aug 2013 presenting with a high fever, general body weakness, muscle pains, and bleeding from some body parts. He was admitted at Kalongo Hospital on 10 Aug 2013 and is still undergoing supportive treatment. We are also investigating 3 other deaths in Omot sub-county in relation to the outbreak [i.e. this case].

In response to the outbreak, the Ministry of Health has reactivated the task force to coordinate all responses. A district task force has, in addition, been organised to coordinate the local responses.

--
Communicated by:
Permanent Secretary's Office
The Republic of Uganda Ministry of Health
P.O. Box 7272
Plot 6, Lourdel Road
Wandegeya
Kampala
Uganda

[The following addendum is from Dr. Elioda Tumwesigye, Minister of State for Health (General Duties); Vishnu-Priya Snellers, CDC-Uganda:

"A technical team from the Ministry of Health and other partners will today [16 Aug 2013] be dispatched to the district to conduct further investigations and support the response on ground. Surveillance teams in the district have intensified their activities to trace and identify contacts. So far, 6 contacts from Omot sub-county have been identified and are all under strict surveillance.

A temporary isolation section has been identified at Kalongo Hospital to accommodate any suspected cases. Health workers at Kalongo Hospital have been briefed to enhance their infection and prevention control. The public in the affected areas is, therefore, advised to observe the following:
1. Avoid close physical contact with suspected/infected people or their body fluids.
2. Report to a nearby health facility in case of showing the above symptoms and signs.
3. Wear long sleeved, light coloured clothing when dealing with livestock so as to identify ticks quickly and avoid tick bites.
4. Avoid direct contact with animals (e.g. slaughtering) without protective wear.
5. Report to the Ministry of Health Hotline at 0750996034."

In a Reuters report previously posted in ProMED-mail (Crimean-Congo hem. fever - Uganda: (AG) fatal 20130816.1885056), it was stated that 3 patients had died as a result of Crimean-Congo haemorrhagic fever. The official ministry statement posted above indicates that only the currently surviving farmer is a confirmed case of Crimean-Congo haemorrhagic fever. The 3 deceased patients are suspected to have died as a result of Crimean-Congo haemorrhagic fever, but this has not yet been confirmed.

A map showing the districts of Uganda can be seen at http://en.wikipedia.org/wiki/Districts_of_Uganda, and the HealthMap/ProMED-mail interactive map of the country can be seen at http://healthmap.org/r/3Lpc. - Mod.CP]

[Birgitt]

CRIMEAN-CONGO HEM. FEVER - UGANDA (03): (AG) FATAL
**************************************************
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Date: Wed 21 Aug 201
Source: AllAfrica, The New Vision report [edited]
http://allafrica.com/stories/201308220130.html


Mulago hospital in Uganda confirms their 1st [fatal?] case of Crimean-Congo haemorrhagic fever (CCHF). The ministry of health has confirmed that the CCHF has claimed the life of one female, aged 27. The deceased was admitted at Mulago Hospital. Dr Jane Ruth Aceng, the Director-General of health services, said the patient was admitted on 16 Aug 2013 with severe anaemia, vomiting, headaches, and inter-menstrual bleeding.

Aceng said the Ministry would intensify its response to the disease. The statement said this is the 1st confirmed death since the outbreak of the disease was announced on 16 Aug 2013 [see ProMED-mail post Crimean-Congo hem. fever - Uganda (02): (AG) conf. case 20130819.1888823].

After confirmation of the disease in Kampala, Mulago Hospital has reopened its isolation facility to admit suspected cases in and around Kampala. "Currently, there are no admissions at the isolation facility. A burial team has been instituted to co-ordinate the burials of suspected and confirmed cases," Aceng said. She said there is only one confirmed case admitted in Agago at Kalongo Hospital. The Ministry of Health has delivered drugs and other health supplies to the hospital.

The ministry has also intensified its surveillance activities in Kampala and Agago districts to trace cases of the disease. The 36 people who [had] contact with the confirmed cases have been listed and are being monitored for signs and symptoms of the disease. Samples have been collected from humans and sent to the Uganda Virus Research Institute to aid the investigations into the disease.

Working with the Ministry of Agriculture, 50 samples have been collected from sheep, goats, cows, and dogs in Agago district to trace the source of the disease.

[Byline: John Odyek]

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[On 16 Aug 2013 the Ugandan Ministry of Health reported that a case of CCHF has been confirmed in Omot sub-county, Agago district, following testing at the Uganda Virus Research Institute in Entebbe. The confirmed case of CCHF is a male adult farmer from Baroma village, Atece Parish in Omot Sub-county in Agago District. His illness started on 8 Aug 2013 presenting with a high fever, general body weakness, muscle pains, and bleeding from some body parts. He was admitted at Kalongo Hospital on 10 Aug 2013 and is still undergoing supportive treatment.

Another 3 deaths related to the case in Omot Sub-county have been reported and are being investigated (see Crimean-Congo hem. fever - Uganda (02): (AG) conf. case 20130819.1888823).

Clarification of whether the patient who was admitted on 16 Aug 2013 with severe anaemia, vomiting, headaches, and inter-menstrual bleeding and who subsequently died, is the 2nd confirmed case in Agago District, is awaited.

A map showing the districts of Uganda can be seen at http://en.wikipedia.org/wiki/Districts_of_Uganda, and the HealthMap/ProMED-mail interactive map of the country can be seen at http://healthmap.org/r/85xZ. - Mod.CP]

[Birgitt]

CRIMEAN-CONGO HEMORRHAGIC FEVER - PAKISTAN (03): (KHYBER-PAKHTUNKHWA) FATALITIES
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Date: Sat 14 Sep 2013
Source: The International News [edited]
http://www.thenews.com.pk/Todays-News-2 ... -in-Hazara


Hazara Division Commissioner Abid Ali Khan has directed various line departments of all the districts in Hazara Division [Khyber-Pakhtunkhwa province] to provide free medical treatment and take precautionary measures for protection against Crimean-Congo hemorrhagic fever (CCHF) infection, which has claimed the lives of 2 people hailing from Havelian, a suburb of Abbottabad. An emergency meeting, headed by the Hazara commissioner, has alerted the district administrations of all the six districts and Health and Livestock Departments to take the remedial steps to cope with the deadly disease and asked the provincial government to declaring Hazara division as an affected area.

CCHF is a viral disease that occurs primarily in animals but humans are also susceptible to it. The disease is indigenous to many African, European, and Asian countries. Being a tickborne disease, the majority of the people who contract the virus are involved in the livestock industry. The meeting, attended by Deputy Speaker National Assembly Murtaza Javed Abbassi, Abbottabad deputy commissioner, Combined Military Hospital commandant, medical superintendents of the Ayub Teaching Hospital and district Headquarter Hospital and representative of Livestock Department, was briefed by Abbottabad District Health Officer Dr Zafeer.

Livestock officials were asked to check the animals from the entry points of every district and butchers would be asked to use special masks and gloves during the cutting of animals. The movement of the animals in the district would be banned in all the districts for which section 144 is also imposed in all the districts. Officials of the WHO were asked to provide the special kits and medicines to be used for the treatment of CCHF virus patients.

It may be recalled here that 2 patients who had contracted CCHF previously died in Abbottabad including a serving doctor about 2 years ago. Dr Hasnain Shah, a resident medical officer (RMO) at the Ayub Teaching Hospital, also died due to the deadly CCHF.

[Byline: Syed Kosar Naqvi]

--
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[CCHF outbreaks are often associated with a change in situation such as war, population and animal movements, or climatic and vegetation changes which produce more ground cover for small mammals which act as hosts for ticks. The incubation period of CCHF appears to vary according to the mode of acquisition of the virus. If a patient has been infected by a tick bite, the incubation period is usually 1-3 days and up to 9 days. Infection via contact with infected blood or tissues leads to an incubation period of 5-6 days, and the maximum recorded incubation period is 13 days.

The illness begins abruptly, with fever, muscle aches, dizziness, neck pain and stiffness, backache, headache, sore eyes and photophobia (sensitivity to light). Nausea, vomiting, and sore throat may also occur, with diarrhoea and abdominal pain. Over the next few days, the patient may experience mood swings, confusion and aggression, followed by sleepiness, depression, and liver enlargement. More severe symptoms may follow, including petechial rash (a rash caused by bleeding into the skin), bruising and generalised bleeding of the gums and orifices. In severe cases, patients develop failure of the liver, kidneys, and lungs and become drowsy and comatose after 5 days. Approximately 30 percent of cases are fatal. General supportive therapy is given, including replacement of blood components, balancing fluids and electrolytes, and maintaining oxygen status and blood pressure. There is evidence that CCHF responds to treatment with the antiviral drug ribavirin, in both oral and intravenous formulations.

Persons living in or visiting endemic areas should use personal protective measures to avoid contact with ticks. This includes avoiding areas where ticks are abundant at times when they are active, using tick repellents, and carefully checking clothing and skin for ticks. Those who work with livestock or other animals in endemic areas should protect themselves by using tick repellents on their skin and clothing and wearing gloves or other protective clothing to prevent skin coming into contact with infected tissue or blood. (For more detailed information, see http://www.hpa.org.uk/Topics/Infectious ... formation/.)

Ticks of the genus _Hyalomma_ are the principal vector of CCHF virus. It is difficult to prevent or control CCHF infection in animals and ticks as the tick-animal-tick cycle usually goes unnoticed and the infection in domestic animals is usually not apparent. Furthermore, the tick vectors are numerous and widespread, so tick control with acaricides (chemicals intended to kill ticks) is only a realistic option for well-managed livestock production. Currently, there is no protection vaccine available for either livestock or humans.

An interactive HealthMap of Pakistan can be accessed at http://healthmap.org/r/8qmc. Hazara is a region in the eastern part of the Khyber-Pakhtunkhwa province of Pakistan. It is located east of the Indus River and comprises 6 districts: Abbottabad, Battagram, Haripur, Mansehra, Kohistan, and Torghar. A map of Hazara region can be accessed at http://www.pakimag.com/files/2011/06/Ha ... on-Map.gif. - Mod.CP]

[Birgitt]

CRIMEAN-CONGO HEM. FEVER - PAKISTAN (04): (KHYBER-PAKHTUNKHWA) UPDATE
*********************************************************************
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Date: Fri 13 Sep 2013
Source: The International News [edited]
http://www.thenews.com.pk/Todays-News-6 ... -dies-at-P


A man from Abbottabad [Khyber-Pakhtunkhwa province] has died of Crimean-Congo haemorrhagic fever (CCHF) at the Pakistan Institute of Medical Sciences (PIMS), while his father and brother have been admitted to the hospital after succumbing to the same tick-borne zoonotic viral disease.

One of the deceased's brothers had already lost his life to CCHF, which, according to World Health Organisation [WHO], has a high fatality rate (10-40 per cent). They all are butchers by profession. Dr Ayesha Isani Majeed, spokesperson for PIMS, told 'The (International) News' on Thursday [12 Sep 2013] that a 60-year-old man and his 21- and 28-year-old sons had been moved from the Combined Military Hospital in Abbottabad, 1st to the Military Hospital in Rawalpindi and then to the PIMS on Wednesday [11 Sep 2013] in critical condition. Dr Majeed said that the 3 were found to be infected with CCHF [virus] and immediately admitted to an isolation ward and given antiviral treatment (Ribavirin tablets) without delay. "[The 21-year-old] breathed his last at 11:35 p.m. (Wednesday, 11 Sep 2013) despite all resuscitative measures, while the 60-year-old father and his 28-year-old other son were shifted to an intensive care unit, where they are receiving the best possible treatment," she said.

Earlier this year [2013], the PIMS treated 2 other CCHF patients, a local woman and a man from Saudi Arabia.

According to a WHO expert, CCHF is a viral haemorrhagic fever transmitted by ticks; it can be responsible for severe outbreaks in humans, but it is not pathogenic for ruminants, their amplifying host. "CCHF spreads to humans either by tick-bites, or through contact with viraemic animal tissues during and immediately post-slaughter." The WHO expert said that CCHF outbreaks constituted a threat to public health services because of its epidemic potential, its high case fatality ratio (10-40 per cent), its potential for nosocomial outbreaks and the difficulties in treatment and prevention. He said CCHF was endemic in all of Africa, the Balkans, the Middle East and Asia.

--
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[Since the previous report (see: Crimean-Congo hem. fever - Pakistan (03): (KP) fatalities, archive no. 20130914.1944511), the number of CCHF victims has been increased to 3 (a father and his 2 sons all working as butchers). The youngest of the 3 has now died and the father and his elder son are in serious condition. CCHF virus is transmitted to people either by tick bites or through contact with infected animal blood or tissues during and immediately after slaughter. The majority of cases have occurred in people involved in the livestock industry, such as agricultural workers, slaughterhouse workers and veterinarians. As the father and his 2 sons worked as butchers, it is likely that they became infected in the course of their work rather than as result of tick bites.

The length of the incubation period depends on the mode of acquisition of the virus. Following infection by a tick bite, the incubation period is usually 1 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.

General supportive care with treatment of symptoms is the main approach to managing CCHF in people. The antiviral drug ribavirin has been used to treat CCHF infection with apparent benefit. Both oral and intravenous formulations seem to be effective.

An interactive HealthMap of Pakistan can be accessed at http://healthmap.org/r/8qmc. - Mod.CP]

[Birgitt]

CRIMEAN-CONGO HEMORRHAGIC FEVER - UGANDA (05): (AGAGO, KAMPALA)
***************************************************************
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Date: Wed 11 Sep 2013
Source: The New Vision (Uganda) [edited]
http://www.newvision.co.ug/news/647099- ... -govt.html


Crimean-Congo hemorrhagic fever under control
---------------------------------------------
All cases of suspected Crimean-Congo hemorrhagic fever (CCHF) have been discharged from hospital. The suspected cases were admitted at Mulago National hospital [in Kampala] and in Agago at Kalongo hospital temporary isolation facility. Speaking in an interview the assistant Commissioner Health at the Ministry of Health Dr Christopher Oleke said, "Crimean-Congo hemorrhagic fever is under control and so far no new cases have been reported."

Recently a 27-year-old woman died of CCHF at Mulago National Referral Hospital. This was the 1st confirmed death since the outbreak was announced on 16 Aug 2013. The deceased was admitted on 16 Aug 2013 with febrile illness, severe anemia, vomiting blood, headaches, and inter-menstrual bleeding.

Crimean-Congo hemorrhagic fever is a zoonotic disease that is caused by a tickborne virus (belonging to the genus _Nairovirus_) of the family _Bunyaviridae_ . This virus causes severe viral hemorrhagic fever outbreaks, it is highly infectious, and kills about 40 percent of people infected. In Africa it is endemic in livestock such as cattle, goats, and sheep. This virus is transmitted to human beings through bites of infected ticks. The ticks pick up their infection from wild or domestic animals like sheep, cattle, and goats among others.

[Byline: Violet Nabatanzi]

--
Communicated by:
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[According to the report above, the Crimean-Congo hemorrhagic fever outbreak in Uganda is reported to be under control with no human cases admitted in any of the designated isolation facilities in Kampala and Agago districts. However, sustainable prevention of new human cases will rely on initiation of adequate measures for tick control in endemic areas in the country. One-Health approaches prioritizing interventions for minimising human exposure to ticks, viraemic animals, and individuals are therefore highly recommended.

A map showing the districts of Uganda can be seen at http://en.wikipedia.org/wiki/Districts_of_Uganda, and the HealthMap/ProMED-mail interactive map of the country can be seen at http://healthmap.org/r/1wa6. - Mod.JFW]

[It would seem that Uganda is currently free of human cases of Crimean-Congo hemorrhagic fever. It is likely that the fatality reported in this press report is the case previously described in the ProMED-mail archived reports listed below who contracted infection from her husband, a trader working out of Sudan. - Mod.CP]