Krim-Kongo Hämorrhagisches Fieber

[Birgitt]

CRIMEAN-CONGO HEMORRHAGIC FEVER - TURKEY: (ANATOLIA), HUMAN FATALITIES
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Date: Wed 16 May 2012
Source: World News UPI.com [edited]
http://www.upi.com/Top_News/World-News/ ... t=hs&or=tn


5 people have died in the Black Sea region of Turkey of a disease that can be transmitted by tick bites, officials said; 3 residents of Kastamonu province in northern Turkey were taken to the Ankara Numune Hospital on Tuesday 15 May 2012 and died that day from Crimean-Congo hemorrhagic fever, today's [16 May 2012] Zaman [newspaper] reported. A shepherd from Tokat district in Tokat province and a farmer from Corum province also died of the disease Tuesday.

The disease, which affects mainly farm and slaughterhouse workers in the countryside and in the central Anatolia and Black Sea regions, is normally transmitted by bites from infected ticks or through direct contact with infected blood tissue in livestock. Transmission between humans through exposure to contaminated blood is rare.

As a result of global warming, ticks carrying the virus are multiplying faster, scientists said. The disease, for which there is no vaccine, causes hemorrhage, high fever, muscle pain, and vomiting. In severe cases, the disease can cause a body rash, bleeding from the bowels and gums and renal failure.

The disease, which has a mortality rate of about 30 percent, was 1st identified in the Crimea in 1944 and later appeared in the Congo.

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[In rural parts of central and northern Turkey, Crimean-Congo hemorrhagic fever (CCHF) is an occupational hazard for some types of agricultural workers. CCHF is caused by infection with a tick-borne virus classified in the genus _ Nairovirus_ in 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. CCHF is found in Eastern Europe, particularly in 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.

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. 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. 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.

An image of a _Hyalomma_ app. tick can be viewed at: http://www.cdc.gov/ncidod/dvrd/spb/mnpa ... s/cchf.htm).

The provinces of Corum, Kastamonu, and Tokat can be located in the map of the provinces of Turkey at http://www.mapsofworld.com/turkey/turke ... l-map.html. - Mod.CP

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

[Birgitt]

CRIMEAN-CONGO HAEMORRHAGIC FEVER - TURKEY (02): (KASTAMONU), HUMAN FATALITIES
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Date: Fri 18 May 2012
Source: Daily News, Doğan News Agency [edited]
http://www.hurriyetdailynews.com/3-die- ... sCatID=341


3 die in Crimean-Congo fever strikes in Black Sea Coast province
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KASTAMONU: 3 people have died in the Black Sea province of Kastamonu due to Crimean-Congo hemorrhagic fever, a tick-borne viral disease, the governor of the province said yesterday (Thu 17 May 2012] in a joint press conference with other local officials; 7 people in 5 different provinces have died of the disease in the last 2 weeks following tick bites, and dozens of others have been discharged after receiving treatment at hospitals.

“This tick-borne curse has once more become an issue along with the warming weather. The viral Crimean-Congo hemorrhagic fever has again reared its head. We have lost 3 [people] due to [this illness] as of today. We have quite a large number of patients receiving treatment for the disease. Some have been discharged, while others are still under treatment due to a positive diagnosis,” Kastamonu Gov. Erdoğan Bektaş said. “It is spring, and our citizens are going outside [more]. Therefore we need to caution our citizens. This is no joke: Death is the price that is on the line. We have lost 3 citizens. Taking the [necessary] precautions is not difficult,” Bektaş said. 7 patients have already been treated and discharged from hospital as of now, Dr. Yılmaz said, adding that the disease does not have to be fatal if the tick bite can be detected early on and the victim taken to hospital in short order. “Turkey first saw Crimean-Congo hemorrhagic fever in 2002. This is an undesirable situation that could [arise] across the whole of Turkey, although it is more prevalent in certain areas,” Dr. Yılmaz said.

Crimean-Congo hemorrhagic fever mainly affects animals. Ticks that live on sheep and cattle can sometimes pass the virus on to people. It is an Ebola-like [i.e. haemorrhagic] fever and patients can bleed to death if they are not treated quickly. [Ebola virus and Crimean-Congo haemorrhagic fever virus are not related viruses. - Mod.CP], Those infected can transmit the virus through their blood or saliva. The disease is endemic in parts of Africa, Asia and Europe.

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ProMED-mail correspondent Susan Baekeland

[The vector of Crimean-Congo haemorrhagic fever (CCHF) is the tick _Hyalomma marginatum_ which is present throughout Asia, Southern Europe and Africa. Some records from North western Europe relate to immature stages traveling on birds. This species has two hosts and the tick's life cycle lasts 14 weeks (minimum) from egg to adult. Adults target domestic animals: sheep, cattle, dogs, deer, camels, horses, whereas the nymphs and larvae target small wild mammals, lizards and birds. Humans are mostly attacked by the adult stage.

Education of the population to recognise and promptly remove these ticks will be the most relevant strategy for control of CCFV infection in Turkey. Images of the tick vector can be viewed at: http://www.google.co.uk/search?q=hyalom ... 08&bih=404.

The increasing CCHF mortality currently being reported in the Black Sea and Anatolian regions of Turkey may be indicative of an increasing abundance of the tick vector, or a lack of appreciation of the hazards associated with tick-bites.

The province of Kastamonu can be located in the map of the provinces of Turkey at http://www.mapsofworld.com/turkey/turke ... l-map.html>. - Mod.CP]

[Birgitt]

CRIMEAN-CONGO HEMORRHAGIC FEVER - IRAN
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Date: Sun 10 Jun 2012
Source: Payvand Iran News, Radio Zamaneh report [edited]
http://www.payvand.com/news/12/jun/1077.html


Rising number of CCHF infections in Iranian provinces
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Iranian media report that 7 people in the country have died after contracting Crimean-Congo haemorrhagic fever (CCHF). Most victims of the viral disease have been identified in the eastern provinces, but reports indicate that the virus has been detected in 27 of Iran's 31 provinces.

The Mehr News Agency reports on Sunday [10 Jun 2012] that the head of the Pasteur Institute labs in Tehran announced that since the beginning of the Iranian year in March [2012], 29 people have contracted Crimean Congo haemorrhagic fever and 7 of them have died from it. He confirmed that the virus has been identified in 27 provinces. The Mehr report adds that top Health Ministry officials have so far confirmed that 2 deaths can be attributed to this disease.

Crimean-Congo haemorrhagic fever (CCHF) is a severe viral disease communicated to humans through animals, especially ticks. The 1st signs are flu-like symptoms such as fever, aching muscles, dizziness, neck pain and stiffness, headaches, and soreness of eyes. It may also result in mood swings, depression, confusion, and aggression. Later symptoms are severe bleeding through the skin from a rash or internal bleeding that may lead to death.

Iranian health officials say last year [2011] there were 87 cases of CCHF infection, 15 of which were fatal, and in the previous year, 154 cases were reported and 26 deaths. In recent weeks, after the presence of CCHF was confirmed in Iran's eastern provinces, some cases were also reported in Tehran, with 2 of them turning critical. Despite the reports, health officials stressed that Tehran was not facing an outbreak of CCHF, and the cases reported in the capital had been transferred from other cities for treatment.

Infected livestock entering the country through eastern borders is said to be the main cause of the CCHF outbreak, and spraying them has been suggested as an effective way of halting the spread. Suggested ways to stop the contagion include using gloves when handling meat and keeping meat in a freezer for 48 hours before consumption.

CCHF has no cure, but treatment of the symptoms usually leads to the patient's recovery. The World Health Organization puts the disease's mortality rate at 30 per cent.

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[Crimean-Congo haemorrhagic fever (CCHF) is a viral haemorrhagic fever caused by a member of the genus _Nairovirus_ (family _Bunyaviridae_). Although primarily a zoonosis, sporadic cases and outbreaks of CCHF affecting humans do occur. The disease is endemic in many countries in Africa, Europe, and Asia, and reflects the distribution of the tick vector.

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. Fortunately, human illness occurs infrequently, although animal infection may be more common. The vector is the tick _Hyalomma marginatum_, a good image to which is included in the Payvand Iran News report at the source URL above. Further information about CCHF can be obtained from the WHO website at http://www.who.int/mediacentre/factshee ... index.html.

It is unclear how these statistics relate to the Iranian calendar. According to Wikipedia (http://en.wikipedia.org/wiki/Iranian_calendars): "The modern Iranian calendar (Solar Hejri) is now the official calendar in Iran and Afghanistan. It begins on the vernal equinox as determined by astronomical calculations for the Iran Standard Time meridian (52.5 deg E or GMT+3.5h). This determination of starting moment is more accurate than the Gregorian calendar as far as predicting the date of the vernal equinox is concerned because it uses astronomical calculation rather than mathematical rules, but requires consulting an astronomical almanac. The Iranian year usually begins within a day of 21 March of the Gregorian calendar."

The interactive HealthMap/ProMED-mail map of Iran can be accessed at http://healthmap.org/r/1Cfu. - Mod.CP]

[Birgitt]

CRIMEAN-CONGO HAEMORRHAGIC FEVER - PAKISTAN: (BALUCHISTAN)
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Date: Sat 16 Jun 2012
Source: Dawn.com (Newspaper Urdu edition) [edited]
http://dawn.com/2012/06/15/congo-fever- ... rm-worker/


Farm worker in Balochistan dies of Crimea-Congo Haemorrhagic Fever
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A 57-year-old farm worker from the Dalbandin area in Balochistan (Baluchistan} who was admitted to the Liaquat National Hospital [LNH] in the city with a history of high-grade fever, muscle pain and gum bleed died on Wed 13 Jun 2012 it emerged on Thursday.

Sources at the LNH said that the Pashto-speaking patient was admitted to the hospital on 10 Jun 2012. He tested positive for Crimean-Congo haemorrhagic fever (CCHF) virus infection at a private university hospital laboratory. He became tachypnic [rapid respiration], his oxygen level dropped after midnight and he was declared clinically dead on Wednesday morning [13 Jun 2012].

A trader from Quetta accompanying the patient told Dawn that the dead was a relative of a customer of his and he was a member of a group that came to Karachi. "As I was told, the man kept a cattle herd at his home in a village some 600 kilometres from Quetta and received treatment at a private hospital in Quetta before coming to Karachi," he said.

The deceased was a resident of Gardi Jungle district, near Dalbandin, and was doing different jobs, including feeding goats and cleaning cattle pens, to earn a living. Having symptoms such as low-grade fever, myalgia [muscle pain] and generalised weakness, he continued working before he began bleeding from the nose which became profuse in the next half an hour. The patient was admitted to the LNH in the evening of 10 Jun 2012 and was shifted to the medical ICU.

A total of 3 deaths caused by the CCHF virus infection were reported in 2010, 2 in 2011, including that of a doctor who was believed to have contracted the deadly viral infection during a surgical operation in Quetta, and a young man of Gazdarabad, Ranchhore Line. A source at the Dengue Surveillance [Group] of the Sindh Health Department, which also records CCHF cases reported in the province, said 4 persons had been reported as confirmed CCHF patients by 3 different private health concerns in the city this year. 3 of them, including the latest victim, came from Balochistan, said the source, adding that the death of the patient was the 1st caused by the CCHF in the city this year.

Dr Shobha Luxmi, an infectious disease consultant at the LNH, said the patient had the history of handling livestock as well. CCHF is a tick-transmitted viral haemorrhagic fever and sporadic cases and outbreaks affecting humans did occur in Pakistan, she said, adding that the disease was endemic in many other countries.

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[Balochistan (Baluchistan) is the largest of the 4 provinces of Pakistan, constituting approximately 44 percent of its total land area. It is bordered by Afghanistan to the north and northwest, Iran to the southwest, Punjab and Sindh to the east, and Khyber Pakhtunkhwa and the Federally Administered Tribal Areas to the northeast. The Arabian Sea borders it to the south. The largest city, Quetta, serves as its capital. The main ethnic groups in the province are Balochs, Pashtun and Brahuis, with smaller communities of Hazaras and Sindhis. The name Balochistan means "land of the Baloch." The interactive HealthMap of Balochistan can be accessed at: http://healthmap.org/r/03Bd.

CCHF is endemic in this region. CCHF virus is transmitted from cattle and sheep to humans via a tick vector and can spread also from person to person via infected blood. Cases usually occur singly among shepherds or among small groups of individuals in contact with livestock or animal products. Occasionally, clusters of cases occur as a result of nosocomial transmission in hospitals. Livestock in general are unaffected by CCNF virus infection. In humans mortality can be as high as 40 percent in extreme situations in the absence of treatment, but is normally in the region of 15 percent. The distribution of CCHF follows that of the principal tick vector (_Hyalomma _), and CCHF is maintained both by alternation between mammalian hosts and ticks and by vertical transmission in ticks. A detailed account of the biology of _Hyalomma_ spp. ticks can be found at: http://www.merckvetmanual.com/mvm/index ... /72111.htm. - Mod.CP]

[Birgitt]

CRIMEAN-CONGO HEMORRHAGIC FEVER - IRAN (02): BACKGROUND
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Date: Sun 17 Jun 2012
Source: Trend News Agency [edited]
http://en.trend.az/regions/iran/2037820.html


Congo fever kills 14 in Iran over 2 years
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During the past 2 years, 14 people have died in Iran as a result of sporadic cases of Crimean-Congo haemorrhagic fever (CCHF), the Jam-e Jam Persian language daily reported. The importation of livestock to Iran from eastern borders has been the cause of the spread of the disease, which has [affected] 114 people so far, of whom 14 have died.

The highest number of [cases] has been reported in Sistan-Baluchestan Province. During 1999-2011, some 610 cases of the disease have been reported, which has led to the death of 60 people.

CCHF is a viral disease and it has [affected] Yazd, Fars, and Sistan-Baluchestan provinces so far, he said. CCHF is a widespread tickborne viral disease that affects domestic and wild animals and may also be transmitted to humans.

[Byline: F. Milad]

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[Crimean-Congo haemorrhagic fever (CCHF) is a viral haemorrhagic fever caused by a member of the genus _Nairovirus_ (family _Bunyaviridae_). Although primarily a zoonosis, sporadic cases and outbreaks of CCHF affecting humans do occur. The disease is endemic in many countries in Africa, Europe, and Asia, and reflects the distribution of the tick vector _Hyalomma marginatum_.

In Iran it is most prevalent in the east of the country. Humans who become infected with CCHF acquire the virus from direct contact with blood or other infected tissues from infected livestock, 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.

Iran is subdivided into 31 provinces, each governed from a local centre, usually the largest local city, which is identified as the capital of that province. The provincial authority is headed by a Governor-General who is appointed by the Minister of the Interior subject to approval of the cabinet. A map showing the location of the 31 provinces can be accessed at http://en.wikipedia.org/wiki/Provinces_of_Iran. Sistan-Baluchestan Province, the worst affected province borers the politically unstable northwestern region of Pakistan.

The interactive HealthMap/ProMED-mail map of Iran can be accessed at http://healthmap.org/r/1Cfu. - Mod.CP]

[Birgitt]

CRIMEAN-CONGO HEMORRHAGIC FEVER - INDIA: (GUJARAT) NOSOCOMIAL
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Date: Fri 22 Jun 2012
Source: NDTV, Press Trust of India [edited]
http://www.ndtv.com/article/cities/doct ... ent-235005


Doctor dies of Crimean-Congo haemorrhagic fever after contracting the virus from patient
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A local hospital is on alert as a resident doctor died of the dreaded Crimean-Congo Haemorrhagic Fever (CCHF) in Ahmedabad today [Fri 22 Jun 2012]. A doctor at the V S Hospital, who contracted the virus while treating a patient with an unknown haemorrhagic viral fever, today died at a private hospital.

"We started screening all ward boys, nursing staff and resident doctors as soon as we received the positive report of the doctor's blood sample from the National Institute of Virology, Pune," said Dr Pankaj Patel, the superintendent of the Municipal Corporation-run V S Hospital. "On Wednesday [20 Jun 2012], while the doctor was treating a patient, a splash of patient's blood landed on his face. Next day he complained of high-grade fever, severe headache, and metallic taste in his mouth. He was immediately rushed here. But today he passed away," said Dr Atul Patel, senior consultant at Sterling Hospital, where the deceased doctor was undergoing treatment.

Authorities at the V S Hospital have started checking everybody who was in the medical team with the deceased doctor and given preventive medicines, as were also his colleagues who took him to the private hospital and had stayed with him until he passed away.

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[This report is further confirmation that Crimean-Congo haemarrhagic fever virus is present (and probably endemic) in northern India (see ProMED-mail archived report: Crimean-Congo hemorrhagic fever - India: (GJ) 20110123.0285).

This case is remarkable in the rapidity of onset of the disease, presumably a consequence of the nature of the exposure. The length of the incubation period for CCHF 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 to 6 days, with a documented maximum of 13 days. Onset of symptoms is sudden, with fever, myalgia (aching muscles), dizziness, neck pain and stiffness, backache, headache, sore eyes and photophobia (sensitivity to light). There may be nausea, vomiting and sore throat early on, which may be accompanied by diarrhoea and generalised abdominal pain. Over the next few days, the patient may experience sharp mood swings, and may become confused and aggressive. After 2 to 4 days, the agitation may be replaced by sleepiness, depression and lassitude, and the abdominal pain may localize to the right upper quadrant, with detectable hepatomegaly (liver enlargement).

Other clinical signs which emerge include tachycardia, lymphadenopathy, and a petechial rash (a rash caused by bleeding into the skin), both on internal mucosal surfaces, such as in the mouth and throat, and on the skin. The petechiae may give way to ecchymoses (like a petechial rash, but covering larger areas) and other haemorrhagic phenomena such as melaena (bleeding from the upper bowel, passed as altered blood in the faeces), haematuria (blood in the urine), epistaxis (nosebleeds) and bleeding from the gums. There is usually evidence of hepatitis. The severely ill may develop hepatorenal (i.e., liver and kidney) and pulmonary failure after the 5th day of illness.

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. In the past, serious outbreaks have occurred in this way and it is imperative that adequate infection control measures be observed to prevent this disastrous outcome. Patients with suspected or confirmed CCHF should be isolated and cared for using barrier nursing techniques. Specimens of blood or tissues taken for diagnostic purposes should be collected and handled using universal precautions. Sharps (needles and other penetrating surgical instruments) and body wastes should be safely disposed of using appropriate decontamination procedures.

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. There is no protective vaccine. (From:http://www.who.int/mediacentre/factshee ... index.html).

A map showing the location of Ahmedabad 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/0mRM. - Mod.CP]

[Birgitt]

CRIMEAN-CONGO HEMORRHAGIC FEVER - INDIA (02): (GUJARAT) NOSOCOMIAL
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Date: Sun 24 Jun 2012
Source: Times of India [edited]
http://articles.timesofindia.indiatimes ... agic-fever


When district health officials visited the house of the 1st victim of Crimean-Congo Haemorrhagic Fever (CCHF) in Kochariya village of Bavla taluka [district], they were astonished to find that his house was infested with _Hyalomma_ ticks. The parasite is the main carrier of the nairovirus that causes CCHF. Not only the deceased victim but even his neighbours had severe tick infestation in their homes.

Since the dairy business is the principal occupation in the village, these ticks are in abundance here. CCHF has already claimed the life of this villager and also the doctor who treated this patient at the VS Hospital.

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

[This report identifies the person who died in hospital in Ahmedabad as a resident of Kochariya village in Bavla taluka [district], where he was engaged in dairying (and presumably exposed to frequent tick-bites). His treatment for an unknown haemorrhagic fever resulted in the death of a physician at a municipal VS Hospital in Ahmedabad.

Ticks of the subgenus _Hyalommina_ are found on the Indian subcontinent and Somalia. Each of the 6 species has a 3-host cycle. Immatures parasitize small mammals, especially rodents. Adult host preferences among livestock reflect the wild gazelle, bovine, caprine, or ovine group with which each species evolved. Two species now infest chiefly cattle and the domestic buffalo: _H. brevipunctata_ (India and Pakistan) and _H. kumari_ (India, Pakistan, Afghanistan, northwestern Iran, and Tadzhikistan). Three usually parasitize sheep and goats: _H. hussaini_ (India, Pakistan, Burma), _H. rhipicephaloides_ (Dead Sea and Red Sea areas), and _arabica_ (Yemen and Saudi Arabia). _H. punt_ (Somalia and Ethiopia) feeds on antelope, camels, cattle, sheep, and goats.

The subgenus _Hyalomma_ contains 15 species of veterinary and public health importance. Three of the 15 species have 2, 3, and 4 subspecies, respectively. Chief among these is the 2-host _H. anatolicum anatolicum_, which ranks high among the world's most damaging ticks and has been widely distributed by camels, cattle, and horses in steppe and semidesert environments from central Asia to Bangladesh, the Middle and Near East, Arabia, southeastern Europe, and Africa north of the equator. Immatures and adults generally infest the same kinds of hosts. Nymphs and unfed adults spend the dry and winter season in crevices in stone walls, stables, and weedy or fallow fields. When immatures infest smaller mammals, birds, or reptiles, the life cycle type is 3-host. _H. anatolicum anatolicum_ transmits _Theileria annulata_, _XXXXXX equi_, _B. caballi_, _Anaplasma marginale_, _Trypanosoma theileri_, and at least 5 arboviruses; it is a significant vector of Crimean-Congo haemorrhagic fever virus to humans.

The _H. marginatum_ complex consists of 4 subspecies, each apparently invariably 2-host. Adults parasitize livestock and wild herbivores. Immatures primarily parasitize birds. Rodents are rarely, if ever, parasitized. Hares and hedgehogs are secondary hosts. The subspecies are _H. marginatum marginatum_ (Caspian area of Iran and former USSR to Portugal and northwestern Africa), _H. marginatum rufipes_ (south of the Sahara to South Africa, also Nile Valley and southern Arabia), _H. marginatum turanicum_ (Pakistan, Iran, southern former USSR, Arabia, parts of northeastern Africa, introduced with sheep from Iran to Karoo), and _H. marginatum isaaci_ (Sri Lanka to southern Nepal, Pakistan, northern Afghanistan). _H. marginatum_ subspecies are important vectors of Crimean-Congo haemorrhagic fever virus and also transmit agents of livestock diseases and other viruses that infect wildlife, livestock, and humans [excerpted from the Merck Veterinary Manual: http://www.merckvetmanual.com/mvm/index ... /72111.htm].

A map showing the location of Ahmedabad 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/0mRM. - Mod.CP]

[Birgitt]

CRIMEAN-CONGO HEMORRHAGIC FEVER - PAKISTAN (03): (BALOCHISTAN AND QUETTA), WHO
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Date: Sun 24 Jun 2012
Source: The Express Tribune [edited]
http://tribune.com.pk/story/398275/who- ... ver-cases/


The World Health Organisation (WHO) has expressed concern over the recent outbreak of measles and Crimean-Congo haemorrhagic fever (CCHF) in some parts of the country. According to the WHO Weekly Epidemiological Bulletin, 22 suspected cases of CCHF were reported throughout the country, of which 15 cases were confirmed, leading to 5 deaths this year [2012]. Out of 15 cases reported from Balochistan, 13 cases were in Quetta.

Disease Early Warning System (DEWS) Senior Surveillance Officer at WHO, Dr Musa Rahim, said: "Currently, the situation is not alarming, but it is worrisome, and immediate measures need to be taken to control these outbreaks, which spread rapidly. Cases of CCHF are being reported from Balochistan, and the victims are workers who work in farmhouses or are associated with the leather business," he added.

The WHO DEWS team is working in close coordination with the health department to control the outbreak of CCHF. The district health department has planned a door-to-door distribution of flyers in Quetta to raise awareness on the hazards of exposure to ticks and fresh blood when animals are butchered.

[Byline: Sehrish Wasif]

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

[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. These conditions can lead to explosions in tick populations and allow increased tick/human contact.

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.

Diagnosis of CCHF requires highly specialised, high biosafety level laboratory facilities. Antibodies may be detected in serum by about day 6 of illness. The virus may be isolated from blood or tissue specimens in the 1st 5 days of illness, and grown in cell culture, and nucleic acid detection methods may also be used to detect the viral genome. Patients with fatal disease do not usually develop a detectable antibody response, and in these individuals, and those in the early stages of infection, diagnosis is by virus detection.

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/.)

The interactive HealthMap of Pakistan can be accessed at: http://healthmap.org/r/1iGJ. A map of the provinces of Pakistan can be found at: http://www.mapsofworld.com/pakistan/pak ... l-map.html. - Mod.CP]

[Birgitt]

CRIMEAN-CONGO HEMORRHAGIC FEVER - INDIA (03): (GUJARAT)
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Date: Fri 20 Jul 2011
Source: The Times of India, Ahmedabad [edited]
http://articles.timesofindia.indiatimes ... agic-fever


Congo fever has killed seven in state: Govt
-------------------------------
Crimean-Congo Haemorrhagic Fever (CCHF) has claimed 7 lives in Gujarat. And according to the state government, about 18 people have been affected by CCHF.

Replying to a question from Vadodara City MLA [Member of the Legislative Assembly] Bhupendra Lakhawala, the government said that after an incubation period of one 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 haemorrhage appear 3 to 5 days after the onset of the illness if it is not contained [treated?] properly. Officials said that symptoms characterising the initial stage of CCHF include mood instability, agitation, and mental confusion. Other signs are nosebleed, bloody urine vomiting, and black stools.

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[Crimean-Congo haemorrhagic fever (CCHF) is a viral haemorrhagic 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. This preceding government statement is further confirmation that Crimean-Congo haemorrhagic fever virus is present (and probably endemic) in 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. 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 some apparent benefit. Both oral and intravenous formulations seem to be effective. There is no protective vaccine. (For further information, see: http://www.who.int/mediacentre/factshee ... index.html).

A map showing the location of Ahmedabad 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/0mRM. - Mod.CP]

[Birgitt]

CRIMEAN-CONGO HEMORRHAGIC FEVER - PAKISTAN (04): (BALOCHISTAN)
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Date: Sat 11 Aug 2012
Source: Khaleej Times [edited]
http://www.khaleejtimes.com/displayarti ... ional&col=

Crimean-Congo haemorrhagic fever claims life of live-stock trader
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A 49-year-old patient died at a Karachi Hospital -- the second one this year -- after he was tested positive for the fatal Crimean-Congo haemorrhagic fever (CCHF) virus infection late on Thursday night. The authorities did not give the name of the deceased. The man reported by the media to be a live-stock trader was brought to city's Patel Hospital on 7 Aug 2012 after having gone to Balochistan on business. He was suffering from high fever and bleeding and tested positive for the dreaded disease at another hospital's laboratory.

The Dengue Surveillance Cell of Sindh Health Department, confirmed to the media that so far six confirmed CCHF cases have been reported in the province this year and three of them had gone to Balochistan and probably got infected there.

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[Previously on 24 Jun 2012 it was reported that the World Health Organisation (WHO) had expressed concern over recent outbreaks of Crimean-Congo haemorrhagic fever (CCHF) in some parts of Pakistan For a comprehensive account of the current situation, see ProMED-mail post: "Crimean-Congo hem. fever - Pakistan (03): (BA & QA) WHO 20120625.1180202". According to the WHO Weekly Epidemiological Bulletin, 22 suspected cases of CCHF were reported throughout the country, of which 15 cases were confirmed, leading to 5 deaths this year [2012]. Up to that time 15 cases had originated in Balochistan. The above report from Karachi indicates that the risk of contraction of CCHF infection for people working with live-stock in Balochistan remains high. Furthermore diagnosis and treatment of CCHF in Pakistan remains unsatisfactory.

Balochistan (or Baluchistan) is the largest of the four provinces of Pakistan, constituting approximately 44% of its total land mass, but in terms of population, it's the smallest province of Pakistan. It is bordered by Afghanistan to the north and northwest, Iran to the southwest, Punjab and Sindh to the east, and Khyber Pakhtunkhwa and Federally Administered Tribal Areas to the northeast. The Arabian Sea borders it to the south.The interactive HealthMap of Pakistan can be accessed at: http://healthmap.org/r/1iGJ.

A map of the provinces of Pakistan can be found at: http://www.mapsofworld.com/pakistan/pak ... l-map.html. - Mod.CP]

[Birgitt]

CRIMEAN-CONGO HEMORRHAGIC FEVER - PAKISTAN (05)
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Date: Mon 13 Aug 2012
Source: The International News [edited]
http://www.thenews.com.pk/article-63154 ... in-Karachi


Crimean-Congo haemorrhagic fever kills 5 in Karachi
---------------------------------------------------
With the death of a 42 year old shepherd from Karachi, who recently passed away at a private hospital from Crimean-Congo haemorrhagic fever (CCHF), the number of people who have succumbed to the disease reached 5, health officials said. Prior to his death, 4 other patients -- mainly livestock farmers from Balochistan -- had been brought to the city's private hospitals and had died from CCHF, the deadly viral disease that is transmitted from animals to humans.

The Provincial Dengue Surveillance Cell, which monitors viral disease outbreaks, was reluctant to talk about the disease as they believed it would spread panic among the people. However, its officials said that so far, 5 patients had died at Karachi's hospitals this year, and their laboratory analysis confirmed that they were suffering from CCHF.

Apart from the 42 year old shepherd, a 50 year old man died in the 1st week of January this year 2012], a 17 year old died in April, a 22 year old succumbed to the disease in May, and a 45 year old expired in June. 2 of these patients were admitted to the Aga Khan Hospital and one each to the National Institute of Blood Diseases (NIBD), Liaquat National Hospital (LNH), and Patel Hospital. It is worth mentioning here that only Aga Khan Hospital had the facilities to diagnose CCHF virus through laboratory tests and samples of all the patients were sent for analysis and confirmation. Experts said the viral disease is spread through a tick found on animals and people who deal with dairy farming and livestock were the most likely to catch the deadly virus. Affected patients would become seriously ill from fever, shortness of breath, and hemorrhage and unfortunately, there was no vaccine available to prevent people from falling victim.

Pakistan had been battling with CCHF cases since 2000 and ever since, dozens of patients had died, yet many believed that health authorities were not taking the threat seriously. Experts urged the launch of an awareness campaign about the mode of transmission from animals to humans as thousands of people earned their livelihood through dairy and livestock farming. They added that people needed to be told about precautions that could be taken to protect them from the condition. Similarly, more facilities to diagnose the disease were needed in the provinces of Khyber-Pakhtunkhwa and Balochistan as well as well as specialised centers to manage the patients, who often used traditional methods to overcome the illness due to ignorance and lack of knowledge.

A specialised training program for general practitioners should also be launched in all the provinces of the country so that they could refer patients immediately to tertiary-care hospitals in the country.

[byline: M Waqar Bhatti]

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[The CCHF death toll in Pakistan continues to mount, almost exclusively among people employed in dairying and animal husbandry. It is becoming appreciated that education of those employed in this sector would help to reduce loss of life as a consequence of CCHF infection.

According to the World Health Organization (WHO), CCHF was 1st described in the Crimea in 1944 and given the name Crimean haemorrhagic fever. In 1969 it was recognised 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. The virus which causes CCHF belongs to the genus _Nairovirus_, one of the the 5 genera in the family _Bunyaviridae_. All members of the genus _Nairovirus_ are transmitted by argasid or ixodid ticks. Although primarily a zoonosis, sporadic cases and outbreaks of CCHF affecting humans wherever ticks are prevalent. The disease is now known to be endemic in many countries in Africa, Europe and Asia.

Following infection via tick bite, the incubation period is usually one to 3 days, with a maximum of 9 days and onset of symptoms is sudden, with fever, aching muscles, dizziness, neck pain and stiffness, backache, headache, sore eyes and sensitivity to light. There may be nausea, vomiting and sore throat early on, which may be accompanied by diarrhoea and generalised abdominal pain. Over the next few days, the patient may experience sharp mood swings, and may become confused and aggressive. After 2 to 4 days, the agitation may be replaced by sleepiness, depression and lassitude, and the abdominal pain may localise to the right upper quadrant, with detectable liver enlargement.

The mortality rate from CCHF is about 30 per cent, 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.

A map of Pakistan can be found at http://www.mapsofworld.com/pakistan/pak ... l-map.html. - Mod.CP

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

[Birgitt]

CRIMEAN-CONGO HEMORRHAGIC FEVER - PAKISTAN (05): (PUNJAB), FATAL CASE
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Date: Sun 2 Sep 2012
Source: The International News [edited]
http://www.thenews.com.pk/Todays-News-6 ... d-yet-safe


A confirmed patient with Crimean-Congo hemorrhagic fever (CCHF) expired here at the Holy Family Hospital [HFH] in August 2012. He was confirmed positive for this infection by the National Institute of Health, Islamabad in the afternoon of Thu 30 Aug 2012. The 65-year old male patient was brought to the HFH from a village in the area of Choa Sayden Shah, District Chakwal on 27 Aug 2012 with signs and symptoms of CCHF, while his history of animal handling was positive.

"After suspecting the patient as a case of CCHF, the HFH kept him in isolation while informing the District Health Officer Chakwal Dr. Nasir of his status for surveillance purposes," said the Chairman of the Infection Control Committee at HFH, Dr. Javed Hayat, while talking to The News on Saturday [1 Sep 2012]. He added that the patient's sample was sent to the NIH for confirmation, but he died of the deadly infection on Wednesday [29 Aug 2012].

In answer to a query, Dr. Javed said that the doctors and staff who received and provided initial treatment to the patient, and who may have been exposed to the virus, have been under observation. He added that none of the exposed staff members have developed signs and symptoms of the infection as of yet.

CCHF is caused by a _Nairovirus_ belonging to the family _Bunyaviridae_ transmitted to humans by the bite of the Hyalomma tick, or by direct contact with blood of an infected animal or human. CCHF was 1st described in Crimea in 1944 and identified in 1956 in Congo. The mortality rate of CCHF ranges from 50 to 90 per cent. Persons with CCHF virus infection experience headache, high fever, muscle pain and vomiting along with internal and external bleeding. Studies have revealed that the incubation period is influenced by the route of exposure. Infections acquired via tick bites usually become apparent after one to 3 days; the longest incubation period reported by this route is 9 days. Exposure to blood or tissues usually results in a longer incubation period. Current estimates suggest that these infections become apparent, on average, after 5-6 days, but incubation periods of up to 13 days are also known.

When asked, Dr. Javed said that there were lesser chances of transmission of infection following release of the dead body of the patient to his relatives. The hospital administration [bathed] the dead body of the CCHF patient and handed over his body to his relatives [shrouded] in a plastic bag. "Though the NIH confirmed the patient positive for CCHF a day after his death, the HFH took all necessary preventive measures, treating him as a high suspect," said Dr. Javed Hayat. The HFH on Saturday [1 Sep 2012] formed a committee to examine all contacts of the CCHF patient and to provide recommendations on what preventive measures should be taken by his close relatives and contacts, said Assistant Medical Superintendent Administrator Dr. Tariq Niazi when contacted by The News on Saturday [1 Sep 2012].

[Byline: Muhammad Qasim]

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[In the past, there have been unfortunate incidents of nosocomial transmission of CCHF infection during treatment of patients in Pakistani hospitals. In the present case, appropriate safety procedures appear to have been in place.

Chakwal is a district in Punjab province of Pakistan. Chakwal district was created in 1985; until the year 2000, when divisions were abolished, it was part of Rawalpindi Division. An interactive map of Chakwal District can be accessed at: http://chakwal.dc.lhc.gov.pk/?page_id=1339. A map of the provinces of Pakistan can be found at: http://www.mapsofworld.com/pakistan/pak ... l-map.html. - Mod.CP

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

[Birgitt]

CRIMEAN-CONGO HEMORRHAGIC FEVER - PAKISTAN (06): (PUNJAB) FATAL CASE
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Date: Thu 4 Oct 2012
Source: The Express Tribune [edited]
http://tribune.com.pk/story/446662/rais ... awalpindi/


Virus confirmed from Rawalpindi
-------------------------------
A 2nd case of Crimean-Congo hemorrhagic fever (CCHF) from Rawalpindi was confirmed by the National Institute of Health (NIH) on Wednesday [3 Feb 2012]. Meanwhile, the World Health Organisation (WHO) has warned against the increase in CCHF cases this year if precautionary measures are not taken before Eidul Azha.

This year, 38 confirmed cases of CCHF have been reported from across the country and more are expected after Eidul Azha, according to the WHO. Out of these 38 cases, 14 deaths have been reported so far. This is the 1st time in 8 years that there has been such an increase in the number of CCHF cases in the country. According to the NIH, the case is from Choa Saidan Shah in Chakwal district from where a previous CCHF case was reported which resulted in the patient's death.

The 45-year-old victim was brought to the Holy Family Hospital (HFH) Rawalpindi on 27 Sep 2012 with high-grade fever. His test samples were sent to the NIH where it was confirmed that he was infected with the deadly disease.

Talking to The Express Tribune, HFH Deputy Medical Superintendent (DMS) Dr Javed Hayat said the latest patient is a butcher and is also associated with the leather business. He said his condition was stable and he would soon be discharged. A 65-year-old doctor, who had been brought earlier to the HFH, failed to survive because of massive blood loss. He was also associated with the leather business.

Talking to The Express Tribune, WHO Focal Person for Vector Control, Dr Qutbuddin Kakar said there were chances of an increase in CCHF cases in the country, particularly in high-risk areas, if precautionary measures were not taken to deal with the influx of sacrificial animals in urban areas. Animals from endemic areas like Balochistan should be properly de-ticked before they are moved to from one place to other.

"Considering the recent situation of CCHF cases in Pakistan, we are expecting more cases after Eid ul Azha," he said. Currently, lack of awareness is a major hurdle in combating the disease, Dr Kakar added. People should take precautionary measures while slaughtering sacrificial animals like wearing gloves, properly covering their face, especially eyes and mouth. Those who come into contact with newly-skinned animal hides should also take safety measures.

Patients infected with the virus should be quarantined to prevent its spread through their secretions.

[Byline: Sehrish Wasif]

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[The virus which causes CCHF belongs to the genus _Nairovirus_, one of the 5 genera comprising the family _Bunyaviridae_. All of the 32 members of the genus _Nairovirus_ are transmitted by argasid or ixodid ticks. 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, veterinarians, or in this particular case participants in the leatherwork industry. It is understandable that the health authorities are concerned that there may may be an increase the incidence of human cases CCHFF during the festival of Eid ul Azha (Fri 26 Oct 2012 in Pakistan) when large numbers of domestic animals are sacrificed by the shedding of blood.

Chakwal district is located in the in the Punjab province of Pakistan. Chakwal district can be located in the map of the districts of Pakistan at: http://en.wikipedia.org/wiki/Chakwal_District. - Mod.CP

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

[Birgitt]

Pakistan - Krim-Kongo hämorrhagisches Fieber (CCHF)
09.10.2012

Das erste Mal nach 8 Jahren gibt es in Pakistan wieder eine Zunahme an CCHF-Erkrankungen. Bisher wurden landesweit 38 Fälle registriert, 14 Personen sind verstorben. Nach dem islamischen Opferfest Eidul Azha, das Ende Oktober stattfindet, wird eine weitere Zunahme erwartet. Das CCHF ist eine von Zecken übertragene Viruserkrankung, die durch akut einsetzende grippeähnliche Symptome wie Fieber, Erschöpfung und später hinzutretender Blutungsneigung charakterisiert ist. Das Erregerreservoir sind pflanzenfressende Wild- und Hausiere. Menschliche Infektionen sind relativ selten und treten meistens bei Farmern, Schlachtern und Menschen auf, die mit infektiösem Fleisch in Kontakt waren. / Quelle: crm

Gruß
Birgitt

[Birgitt]

CRIMEAN-CONGO HEMORRHAGIC FEVER - SOUTH AFRICA: (FREE STATE)
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Date: Mon 14 Jan 2013
Source: Health24 [edited]
http://www.health24.com/news/Infectious ... ,78911.asp


Crimean-Congo hemorrhagic fever patient critical
-----------------------------------------
A Bloemfontein businessman is in a critical condition in a Bloemfontein hospital after contracting Crimean-Congo hemorrhagic fever [CCHF], reports Volksblad [newspaper]. He is the 2nd patient to be treated for the virus [infection] in Bloemfontein.

A reserve assistant at the Kalkfontien nature reserve outside Fau-resmith was discharged on Friday [11 Jan 2013]. He was admitted on New Year's eve after contracting CCHF virus infection. Hospital spokesperson Esmarie Cronje yesterday said that businessman showed signs of recovery but is still critical. He remains in hospital and is currently on a ventilator. He was aware of being bitten by a tick on New Year's day, and 1st showed signs of illness on 5 Jan 2013, when he developed a headache and fever.

Crimean-Congo haemorrhagic fever typically appears suddenly within a few days after a tick bite. The patient may have a range of flu-like symptoms, headache, fever, muscle pain, especially lower back pain, cold shivers and hot sweats. Other possible symptoms are nausea, vomiting, diarrhoea and abdominal pain. Generally the patient feels extremely unwell. He or she may appear delirious or confused. After a few days, a measles-like rash may appear, which evolves into one that looks like fine needlepoints which are small areas of bleeding into the skin. The patient may also have nose-bleeds, cough up blood, or pass it through the anus, due to a decrease of platelets. Internal bleeding from other organs may also develop.

Because the disease can pass from one human to another through blood contact, people who have been in contact with CCHF fever patients are closely monitored. The patient's wife told Volksblad she remains optimistic under the circumstances: "There are many people praying for him. At 1st I wasn't positive, but now I feel much better. I have to stay positive."

[Byline: Graig-Lee Smith, Adele Hamilton]

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[Crimean-Congo haemorrhagic fever (CCHF) is a viral haemorrhagic fever caused by a nairovirus. Although primarily a zoonosis, sporadic cases and outbreaks of CCHF affecting humans do occur. The disease is endemic in many countries in Africa, Europe and Asia. The disease was 1st 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. Fortunately, human illness occurs infrequently, although animal infection may be more common.

The virus which causes CCHF is a nairovirus, a group of related viruses forming one of the 5 genera in the _Bunyaviridae_ family of viruses. All of the 32 members of the _Nairovirus_ genus are transmitted by argasid or ixodid ticks, but only 3 have been implicated as causes of human disease: the Dugbe and Nairobi sheep viruses, and CCHF, which is the most important human pathogen amongst them. The CCHF virus may infect a wide range of domestic and wild animals. Many birds are resistant to infection, but ostriches are susceptible and may show a high prevalence of infection in endemic areas. 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 _Hyalomma_ genus. 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.

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 to 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. In those patients who recover, improvement generally begins on the 9th or 10th day after the onset of illness.

Although an inactivated, mouse brain-derived vaccine against CCHF has been developed and used on a small scale in Eastern Europe, there is no safe and effective vaccine widely available for human use. The tick vectors are numerous and widespread and tick control with acaricides (chemicals intended to kill ticks) is only a realistic option for well-managed livestock production facilities.

Persons living in endemic areas should use personal protective measures that include avoidance of areas where tick vectors are abundant and when they are active (Spring to Fall); 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.)

Bloemfontein is the capital city of the Free State Province of South Africa; and, as the judicial capital of the nation, one of South Africa's 3 national capitals -- the other 2 being Cape Town, the legislative capital, and Pretoria, the administrative capital. The interactive ProMED/HealthMap of the Free State can be accessed at: http://healthmap.org/r/4SvZ. - Mod.CP]