Crimean-Congo haemorrhagic fever

doi:10.1016/S1473-3099(06)70435-2

The Lancet Infectious Diseases

Volume 6, Issue 4, April 2006, Pages 203-214

https://doi.org/10.1016/S1473-3099(06)70435-2 Get rights and content

Summary

Crimean-Congo haemorrhagic fever (CCHF) is an often fatal viral infection described in about 30 countries, and it has the most extensive geographic distribution of the medically important tickborne viral diseases, closely approximating the known global distribution of Hyalomma spp ticks. Human beings become infected through tick bites, by crushing infected ticks, after contact with a patient with CCHF during the acute phase of infection, or by contact with blood or tissues from viraemic livestock. Clinical features commonly show a dramatic progression characterised by haemorrhage, myalgia, and fever. The levels of liver enzymes, creatinine phosphokinase, and lactate dehydrogenase are raised, and bleeding markers are prolonged. Infection of the endothelium has a major pathogenic role. Besides direct infection of the endothelium, indirect damage by viral factors or virus-mediated host-derived soluble factors that cause endothelial activations and dysfunction are thought to occur. In diagnosis, enzyme-linked immunoassay and real-time reverse transcriptase PCR are used. Early diagnosis is critical for patient therapy and prevention of potential nosocomial infections. Supportive therapy is the most essential part of case management. Recent studies suggest that ribavirin is effective against CCHF, although definitive studies are not available. Health-care workers have a serious risk of infection, particularly during care of patients with haemorrhages from the nose, mouth, gums, vagina, and injection sites. Simple barrier precautions have been reported to be effective.

Introduction

Crimean-Congo haemorrhagic fever (CCHF) is a fatal viral infection described in parts of Africa, Asia, eastern Europe, and the middle east.1, 2 The virus belongs to the genus Nairovirus in the Bunyaviridae family and causes severe diseases in human beings, with a reported mortality rate of 3–30%.2, 3 The geographic range of CCHF virus is the most extensive one among the medically important tickborne viruses (figure 1). Human beings become infected through tick bites, by contact with a patient with CCHF during the acute phase of infection, or by contact with blood or tissues from viraemic livestock.⁴ The clinical features show common dramatic progression characterised by haemorrhage, myalgia, and fever, with some differences among different regions suggested but not well studied. Treatment with ribavirin has not yet been approved in many countries. However, there are reports that indicate the drug may be beneficial. The widespread geographic distribution of CCHF virus, its ability to produce severe human disease with high mortality rates, and fears about its intentional use as a bioterrorism agent⁵ make the virus an important human pathogen. Moreover, ecological complexity of vectorborne diseases, therapeutic controversy, and human-to-human transmission of a zoonotic infection make CCHF an interesting topic for research.

There has been a substantial increase in reports on CCHF virus over the past 5 years. Here I review published work on CCHF, with an emphasis on the recent outbreak in Turkey. CCHF virus-infected cases were first reported in Turkey in 2002,3, 6, 7, 8 although epidemics have been reported from neighbouring countries since the 1970s. Between 2002 and 2005, 500 cases were reported to Turkish Ministry of Health, and 26 (5·2%) of these cases died.⁹

Section snippets

Historical background

In the 12th century, a haemorrhagic syndrome was described in present day Tajikistan. The signs were presence of blood in the urine, rectum, gums, vomitus, sputum, and abdominal cavity.¹ The arthropod that caused the disease was said to be tough, small, related to a louse or tick, and normally parasitising a black bird. In the modern era, Crimean haemorrhagic fever was first described as a clinical entity in 1944–45, when about 200 Soviet military personnel were infected while assisting

Epidemiology

The geographic range of CCHF virus is the most extensive among the tickborne viruses that affect human health, and the second most widespread of all medically important arboviruses, after dengue viruses (figure 1).²

The history of reported outbreaks is summarised in table 1. Before 1970, most cases were reported from the former Soviet Union (Crimea, Astrakhan, Rostov, Uzbekistan, Kazakhstan, Tajikistan)1, 2 and Bulgaria,1, 2 as well as virus circulation in parts of Africa such as the Democratic

The microbiology and the life cycle of the virus

CCHF is a member of the Nairovirus genus of the family Bunyaviridae. Other genera within the family include Orthobunyavirus, Hantavirus, Phlebovirus, and Tospovirus. The Nairovirus genus includes 34 described viruses and is divided into seven different serogroups.⁵⁶ The most important groups are the CCHF group, which includes CCHF virus and Hazara virus, and the Nairobi sheep disease group, which includes the Nairobi sheep disease and Dugbe viruses.⁴ CCHF virus, Dugbe virus, and Nairobi sheep

Phylogenetic studies and worldwide diversity

In 1970, when the virus was first named as CCHF virus,¹⁵ the antigenic structures of the viruses from various geographic regions were thought to be indistinguishable. However, the development of nucleic acid sequence analysis techniques revealed extensive genetic diversity. Most nucleic acid sequence analyses are based on the S segment of the genome, although some recent studies were done on the M RNA segment. According to these studies, there are eight genetically distinct clades.¹⁵

Because of

Vertebrate reservoir hosts

CCHF virus circulates in an enzootic tick–vertebrate–tick cycle, and there is no evidence that the virus causes disease in animals. CCHF viral infection has been commonly demonstrated among smaller wildlife species—eg, hares and hedgehogs—that act as hosts for the immature stages of the tick vectors.1, 2 Antibodies against CCHF virus have been detected in the sera of horses, donkeys, goats, cattle, sheep, and pigs in various regions of Europe, Asia, and Africa.² It must be borne in mind that

Risk factors for infection among human beings

Epidemiologically, CCHF cases are distributed mainly among actively working age groups exposed to tick populations. The major at-risk group are farmers living in endemic areas; most of the affected cases deal with agriculture and/or animal husbandry. Almost 90% of the cases in the recent outbreak in Turkey were farmers.3, 6, 7 Although there is no evidence that the virus causes disease in animals, CCHF virus-infected individuals were reported after skin contact with livestock and other animals.1

Course of infection and clinical features

Human beings are the only known host of CCHF virus in which disease is manifested.2, 4 In one Russian study⁸⁴ the probability of developing CCHF for people who had been infected was found to be 0·215—ie, one of every five infected people develops CCHF.

The typical course of CCHF infection has four distinct phases: incubation, prehaemorrhagic, haemorrhagic, and convalescence periods (figure 3).¹ The incubation period that follows a tick bite is usually short—3–7 days—but it is difficult to obtain

Pathogenesis

The pathogenesis of CCHF is not well described. A common pathogenic feature of haemorrhagic fever viruses is their ability to disable the host immune response by attacking and manipulating the cells that initiate the antiviral response.⁸⁸ This damage is characterised by marked replication of the virus together with dysregulation of the vascular system and lymphoid organs.⁸⁹

Infection of the endothelium has an important role in CCHF pathogenesis.90, 91 The endothelium can be targeted in two

Diagnosis

Early diagnosis is critical both for patient survival and for the prevention of potential nosocomial infections and transmission in the community. Suspected cases should be evaluated and their management carefully planned, including supportive care, particularly haematological support (panel). The differential diagnosis list differs according to geographic location, and includes bacterial, viral, and non-infectious causes (table 3).

Treatment

Supportive therapy is the most essential part of case management, and includes the administration of thrombocytes, fresh frozen plasma, and erythrocyte preparations. Replacement therapy with these blood products should be done after checking the patient's complete blood count, which should be done once or twice a day. Potential bleeding foci should be considered and conservative measures taken—eg, the use of histamine receptor blockers for peptic ulcer patients, avoidance of intramuscular

Prevention

People living in endemic areas should use personal protective measures that include the avoidance of areas where tick vectors are abundant, particularly when they are active; regular examination of clothing and skin for ticks, and their removal; and the use of repellents.¹⁰⁵ People who are exposed to potentially viraemic animal blood should take practical measures to protect themselves, including the use of repellents on the skin and clothing and wearing gloves or other protective clothing to

Future research areas

The dynamics of the enzootic environment and transmission cycle of the CCHF virus need to be further detailed. The role of climatic factors, reservoir hosts, and vectors should be described. These studies need multidisciplinary team work, including entomologists, microbiologists, epidemiologists, veterinarians, and clinicians. New data on viral replication offers substantial potential for the development of new drugs. Further studies on the pathogenesis of viral haemorrhagic fevers will shed

Search strategy and selection criteria

Data for this review were identified by searches of PubMed, Google, and references from relevant articles, using the search terms “Crimean Congo haemorrhagic fever”, “viral haemorrhagic fever”, and “ribavirin”. No date limits were set; only the abstracts of non-English language papers were included.

References (112)

WhitehouseCA
Crimean-Congo hemorrhagic fever
Antivir Res
(2004)
OzkurtZ et al.
Crimean-Congo hemorrhagic fever in Eastern Turkey: clinical features, risk factors and efficacy of ribavirin therapy
J Infect
(2006)
SheikhAS et al.
Bi-annual surge of Crimean-Congo haemorrhagic fever (CCHF): a five-year experience. Int
J Infect Dis
(2005)
El-AzazyOM et al.
Crimean-Congo haemorrhagic fever virus infection in the western province of Saudi Arabia
Trans R Soc Trop Med Hyg
(1997)
SaluzzoJF et al.
Haemorrhagic fever caused by Crimean Congo haemorrhagic fever virus in Mauritania
Trans R Soc Trop Med Hyg
(1985)
SaluzzoJF et al.
Isolation of Crimean-Congo haemorrhagic fever and Rift Valley fever viruses in Upper Volta
Lancet
(1984)
HonigJE et al.
Crimean-Congo hemorrhagic fever virus genome L RNA segment and encoded protein
Virology
(2004)
KinsellaE et al.
Sequence determination of the Crimean-Congo hemorrhagic fever virus L segment
Virology
(2004)
MorikawaS et al.
Genetic diversity of the M RNA segment among Crimean-Congo hemorrhagic fever virus isolates in China
Virology
(2002)
Estrada-PenaA
Forecasting habitat suitability for ticks and prevention of tick-born diseases
Vet Parasitol
(2001)

RandolphSE

Evidence that climate change has caused ‘emergence’ of tick-borne diseases in Europe?

Int J Med Microbiol

(2004)

ShepherdAJ et al.

Field and laboratory investigation of Crimean-Congo haemorrhagic fever virus (Nairovirus, family Bunyaviridae) infection in birds

Trans R Soc Trop Med Hyg

(1987)

CelikbasA et al.

Crimean Congo hemorrhagic fever infection simulating acute appendicitis

J Infect

(2005)

DrostenC et al.

Molecular diagnostics of viral hemorrhagic fevers

Antiviral Res

(2003)

CharrelRN et al.

Tick-borne virus diseases of human interest in Europe

Clin Microbiol Infect

(2004)

HoogstraalH

The epidemiology of tick borne Crimean-Congo hemorrhagic fever in Asia, Europe, and Africa

J Med Entomol

(1979)

WattsDM et al.

Crimean-Congo hemorrhagic fever

ErgonulO et al.

The characteristics of Crimean-Congo hemorrhagic fever in a recent outbreak in Turkey and the impact of oral ribavirin therapy

Clin Infect Dis

(2004)

Bioterrorism agents/diseases

KartiSS et al.

Crimean-Congo hemorrhagic fever in Turkey

Emerg Infect Dis

(2004)

BakirM et al.

Crimean-Congo haemorrhagic fever outbreak in Middle Anatolia: a multicentre study of clinical features and outcome measures

J Med Microbiol

(2005)

Ministry of Health Turkey. Reports of the Communicable Diseases Department, Ankara, 2005 (in...

SimpsonDIH et al.

Congo virus: a hitherto undescribed virus occuring in Africa. Human isolations-clinical notes

East Afr Med J

(1967)

CasalsJ

Antigenic similarity between the virus causing Crimean hemorrhagic fever and Congo virus

Proc Soc Exp Biol Med

(1969)

BegumF et al.

Tick-borne viruses of west Pakistan. IV. Viruses similar to or identical with, Crimean hemorrhagic fever (Congo-Semunya), Wad Medani and Pak Argas 461 isolated from ticks of the Changa Manga Forest, Lahore District, and of Hunza, Gilgit Agency, W. Pakistan

Am J Epidemiol

(1970)

WoodallJP et al.

Congo virus: a hitherto undescribed virus occurring in Africa. II. Identification studies

East Afr Med J

(1967)

CauseyOR et al.

Congo virus from domestic livestock, African hedgehog, and arthropods in Nigeria

Am J Trop Med Hyg

(1970)

CasalsJ et al.

A review of Soviet viral hemorrhagic fevers, 1969

J Infect Dis

(1970)

PapaA et al.

Crimean-Congo hemorrhagic fever in Bulgaria

Emerg Infect Dis

(2004)

PapaA et al.

Crimean-Congo hemorrhagic fever in Albania, 2001

Eur J Clin Microbiol Infect Dis

(2002)

PapaA et al.

Genetic detection and isolation of Crimean-Congo hemorrhagic fever virus, Kosovo, Yugoslavia

Emerg Infect Dis

(2002)

PapaA et al.

Genetic characterization of the M RNA segment of Crimean Congo hemorrhagic fever virus strains, China

Emerg Infect Dis

(2002)

BurneyMI et al.

Nosocomial outbreak of viral hemorrhagic fever caused by Crimean hemorrhagic fever-Congo virus in Pakistan, January 1976

Am J Trop Med Hyg

(1980)

SmegoRA et al.

Crimean-Congo hemorrhagic fever: Prevention and control limitations in a resource poor country

Clin Infect Dis

(2004)

SuleimanMN et al.

Congo/Crimean haemorrhagic fever in Dubai. An outbreak at the Rashid hospital

Lancet

(1980)

SchwarzTF et al.

Clinical features of Crimean-Congo haemorrhagic fever in the United Arab Emirates

Infection

(1997)

Al-TikritiSK et al.

Congo/Crimean haemorrhagic fever in Iraq

Bull World Health Organ

(1981)

TantawiHH et al.

Crimean-Congo haemorrhagic fever virus in Iraq: isolation, identification and electron microscopy

Acta Virol

(1980)

WilliamsRJ et al.

Crimean-Congo haemorrhagic fever: a seroepidemiological and tick survey in the Sultanate of Oman

Trop Med Int Health

(2000)

MardaniM et al.

The efficacy of oral ribavirin in the treatment of crimean-congo hemorrhagic fever in Iran

Clin Infect Dis

(2003)

AntoniadisA et al.

Serological evidence of human infection with Congo-Crimean hemorrhagic fever virus in Greece

Am J Trop Med Hyg

(1982)

DunsterL et al.

First documentation of human Crimean-Congo hemorrhagic fever, Kenya

Emerg Infect Dis

(2002)

YenYC et al.

Characteristics of Crimean-Congo hemorrhagic fever virus (Xinjiang strain) in China

Am J Trop Med Hyg

(1985)

GearJH et al.

Congo-Crimean haemorrhagic fever in South Africa. Report of a fatal case in the Transvaal

S Afr Med J

(1982)

SwanepoelR et al.

Crimean-congo hemorrhagic fever in South Africa

Am J Trop Med Hyg

(1983)

SwanepoelR et al.

Investigations following initial recognition of Crimean-Congo haemorrhagic fever in South Africa and the diagnosis of 2 further cases

S Afr Med J

(1985)

SwanepoelR et al.

A common-source outbreak of Crimean-Congo haemorrhagic fever on a dairy farm

S Afr Med J

(1985)

van EedenPJ et al.

A nosocomial outbreak of Crimean-Congo haemorrhagic fever at Tygerberg Hospital. Part I. Clinical features

S Afr Med J

(1985)

van EedenPJ et al.

A nosocomial outbreak of Crimean-Congo haemorrhagic fever at Tygerberg Hospital. Part II. Management of patients

S Afr Med J

(1985)

JoubertJR et al.

A nosocomial outbreak of Crimean-Congo haemorrhagic fever at Tygerberg Hospital. Part III. Clinical pathology and pathogenesis

S Afr Med J

(1985)

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Crimean-Congo hemorrhagic fever virus prevalence in livestock of Jabalpur, Madhya Pradesh, Central India and its implications for public health
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The rise of Crimean-Congo Hemorrhagic Fever (CCHF), poses a significant global health challenge, urging immediate action and continuous surveillance. With no available vaccines, monitoring pathogen presence is critical to identify at-risk areas promptly. A study was designed to assess the incidence of CCHF virus in goats and cattle using commercial ELISA IgG kits in tribal-dominated regions. Overall, 16% of the samples (n = 63/393) were positive for CCHF virus-specific IgG antibodies, whereas sero-prevalence detected in cattle 11.6% [95% CI:7–17.7] and in goats 18.9% [95% CI: 13.76–24.01], respectively. Statistically, Animal gender and age didn't significantly affect prevalence (p-value >0.05). Our finding indicates unnoticed CCHF virus circulation. Notably, lack of public awareness about zoonotic diseases in the study region was recorded. To combat this emerging tick-borne disease effectively, it's crucial to screen individuals with hemorrhagic manifestations in healthcare settings and active surveillance of ticks to prevent unwarranted public health outbreaks and design preventive interventions.
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Both mathematics and science exhibit a reciprocally advantageous and close relationship. The undeniable significance of mathematics in diverse scientific fields, including electrical engineering, physics, biology, and medicine, is beyond dispute. Due to the multitude of applications of mathematical biology in the present era, scholars have demonstrated a marked intrigue in this specific realm. In the past few years, there has been a discernible rise in the application of different fractional operators as a method of expressing the given problem. The utilization of this approach has gained significant acceptance as a customary technique for examining the propagation of epidemics. The current investigation explores innovative fractional operators in the framework of a model for an infectious disease. The mechanical characteristics of the model with fractional orders are established by employing diverse numerical methods and adjusting parameters related to time fractional components. To substantiate the theoretical discoveries, computational simulations are implemented for the suggested approach over a variety of fractional orders, displaying the outcomes of both fractional and fractal orders. We employed a highly efficient numerical methodology to obtain solutions for both the model and simulations. Additionally, we provide the criteria for the existence of a solution to the proposed epidemic model, and we determine the reproductive number under specific state conditions of the analyzed dynamic system. A fractional-order model of infectious disease is proposed to be analyzed through simulations, aiming to ascertain the possible efficacy of disease transmission within the community. These aspects are tackled through the application of the Banach contraction principle. Moreover, we have proposed future research directions incorporating the utilization of a novel hybrid fractional operator. Fractional calculus emerges as a significant area of investigation within applied mathematics, offering valuable tools for problem-solving across diverse fields such as medicine, science, and engineering. Recent scholars have emphasized the importance of mathematical techniques, especially those related to fractional and integer calculus modeling, as extremely advantageous when examining the dynamics of different disease models. The utilization of the fractional operator allows for the investigation of the dynamic impact of diseases on society, providing valuable insights for analysis, decision-making, and disease control.
Third International Conference on Crimean-Congo Hemorrhagic Fever in Thessaloniki, Greece, September 19–21, 2023
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The Third International Conference on Crimean-Congo Hemorrhagic Fever (CCHF) was held in Thessaloniki, Greece, September 19–21, 2023, bringing together a diverse group of international partners, including public health professionals, clinicians, ecologists, epidemiologists, immunologists, and virologists. The conference was attended by 118 participants representing 24 countries and the World Health Organization (WHO). Meeting sessions covered the epidemiology of CCHF in humans; Crimean-Congo hemorrhagic fever virus (CCHFV) in ticks; wild and domestic animal hosts; molecular virology; pathogenesis and animal models; immune response related to therapeutics; and CCHF prevention in humans. The concluding session focused on recent WHO recommendations regarding disease prevention, control strategies, and innovations against CCHFV outbreaks. This meeting report summarizes lectures by the invited speakers and highlights advances in the field.
Mapping the risk of exposure to Crimean-Congo haemorrhagic fever virus in the Iberian Peninsula using Eurasian wild boar (Sus scrofa) as a model
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Crimean-Congo haemorrhagic fever (CCHF) virus (CCHFV) is a tick-borne zoonotic pathogen that can cause a lethal haemorrhagic disease in humans. Although the virus appears to be endemically established in the Iberian Peninsula, CCHF is an emerging disease in Spain. Clinical signs of CCHFV infection are mainly manifested in humans, but the virus replicates in several animal species. Understanding the determinants of CCHFV exposure risk from animal models is essential to predicting high-risk exposure hotspots for public health action. With this objective in mind, we designed a cross-sectional study of Eurasian wild boar (Sus scrofa) in Spain and Portugal. The study analysed 5,291 sera collected between 2006 and 2022 from 90 wild boar populations with a specific double-antigen ELISA to estimate CCHFV serum prevalence and identify the main determinants of exposure probability. To do so, we statistically modelled exposure risk with host- and environment-related predictors and spatially projected it at a 10 × 10 km square resolution at the scale of the Iberian Peninsula to map foci of infection risk. Fifty-seven (63.3 %) of the 90 populations had at least one seropositive animal, with seroprevalence ranging from 0.0 to 88.2 %. Anti-CCHFV antibodies were found in 1,026 of 5,291 wild boar (19.4 %; 95 % confidence interval: 18.3–20.5 %), with highest exposure rates in southwestern Iberia. The most relevant predictors of virus exposure risk were wild boar abundance, local rainfall regime, shrub cover, winter air temperature and soil temperature variation. The spatial projection of the best-fit model identified high-risk foci as occurring in most of western and southwestern Iberia and identified recently confirmed risk foci in eastern Spain. The results of the study demonstrate that serological surveys of CCHFV vector hosts are a powerful, robust and highly informative tool for public health authorities to take action to prevent human cases of CCHF in enzootic and emergency settings.
Dynamics of Crimean-Congo hemorrhagic fever virus in two wild ungulate hosts during a disease-induced population collapse
2023, One Health
Identifying the role that host species play in pathogen transmission and maintenance is crucial for disease control, but it is a difficult task, in particular for vector-borne and multi-host pathogens, and especially when wildlife species are involved. This is the case for a Crimean-Congo hemorrhagic fever virus (CCHFV) hotspot in north-eastern Spain, where Iberian ibex (Capra pyrenaica) and wild boar (Sus scrofa) are involved, but their roles in disease transmission are unclear. In this context, we studied the dynamics of CCHFV transmission in these two species during the collapse of an Iberian ibex population due to a sarcoptic mange outbreak. We carried out a repeated cross-sectional study measuring the trends of CCHFV seroprevalence in Iberian ibex and wild boar and their abundances. In addition, we identified the tick species present in this area on the vegetation and on wild boars, and evaluated relevant meteorological factors. Results show that while the trends in CCHFV seroprevalence in Iberian Ibex and density of wild boars remained constant (p = 1.0 and p = 0.8, respectively), both the trends in Iberian ibex census and CCHFV seroprevalence in wild boars decreased significantly (p = 0.003 and p = 0.0001, respectively), and were correlated (Spearman's rank, 0.02 < p-adjusted<0.05). The correlation between the patterns of reduction of Iberian ibex abundance and the decrease of seroprevalence in wild boars suggests some sort of shared transmission cycle between the two species. Data from tick species in the area suggest a possible role of Rhipicephalus bursa in CCHFV transmission. The dynamics of CCHFV were unlikely caused by changes in meteorological variables such as temperature or water vapor pressure deficit. Further studies will be needed to confirm these hypotheses.
Spatial prediction of Crimean Congo hemorrhagic fever virus seroprevalence among livestock in Uganda
2023, One Health
Crimean-Congo Hemorrhagic Fever (CCHF) is a viral disease that can infect humans via contact with tick vectors or livestock reservoirs and can cause moderate to severe disease. The first human case of CCHF in Uganda was identified in 2013. To determine the geographic distribution of the CCHF virus (CCHFV), serosampling among herds of livestock was conducted in 28 Uganda districts in 2017. A geostatistical model of CCHF seroprevalence among livestock was developed to incorporate environmental and anthropogenic variables associated with elevated CCHF seroprevalence to predict CCHF seroprevalence on a map of Uganda and estimate the probability that CCHF seroprevalence exceeded 30% at each prediction location. Environmental and anthropogenic variables were also analyzed in separate models to determine the spatially varying drivers of prediction and determine which covariate class resulted in best prediction certainty. Covariates used in the full model included distance to the nearest croplands, average annual change in night-time light index, percent sand soil content, land surface temperature, and enhanced vegetation index. Elevated CCHF seroprevalence occurred in patches throughout the country, being highest in northern Uganda. Environmental covariates drove predicted seroprevalence in the full model more than anthropogenic covariates. Combination of environmental and anthropogenic variables resulted in the best prediction certainty. An understanding of the spatial distribution of CCHF across Uganda and the variables that drove predictions can be used to prioritize specific locations and activities to reduce the risk of future CCHF transmission.

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ReviewCrimean-Congo haemorrhagic fever

Summary

Introduction

Section snippets

Historical background

Epidemiology

The microbiology and the life cycle of the virus

Phylogenetic studies and worldwide diversity

Vertebrate reservoir hosts

Risk factors for infection among human beings

Course of infection and clinical features

Pathogenesis

Diagnosis

Treatment

Prevention

Future research areas

Search strategy and selection criteria

Antivir Res

J Infect

J Infect Dis

Trans R Soc Trop Med Hyg

Trans R Soc Trop Med Hyg

Lancet

Virology

Virology

Virology

Vet Parasitol

Int J Med Microbiol

Trans R Soc Trop Med Hyg

J Infect

Antiviral Res

Clin Microbiol Infect

The epidemiology of tick borne Crimean-Congo hemorrhagic fever in Asia, Europe, and Africa

J Med Entomol

Crimean-Congo hemorrhagic fever

The characteristics of Crimean-Congo hemorrhagic fever in a recent outbreak in Turkey and the impact of oral ribavirin therapy

Clin Infect Dis

Bioterrorism agents/diseases

Crimean-Congo hemorrhagic fever in Turkey

Emerg Infect Dis

Crimean-Congo haemorrhagic fever outbreak in Middle Anatolia: a multicentre study of clinical features and outcome measures

J Med Microbiol

Congo virus: a hitherto undescribed virus occuring in Africa. Human isolations-clinical notes

East Afr Med J

Antigenic similarity between the virus causing Crimean hemorrhagic fever and Congo virus

Proc Soc Exp Biol Med

Tick-borne viruses of west Pakistan. IV. Viruses similar to or identical with, Crimean hemorrhagic fever (Congo-Semunya), Wad Medani and Pak Argas 461 isolated from ticks of the Changa Manga Forest, Lahore District, and of Hunza, Gilgit Agency, W. Pakistan

Am J Epidemiol

Congo virus: a hitherto undescribed virus occurring in Africa. II. Identification studies

East Afr Med J

Congo virus from domestic livestock, African hedgehog, and arthropods in Nigeria

Am J Trop Med Hyg

A review of Soviet viral hemorrhagic fevers, 1969

J Infect Dis

Crimean-Congo hemorrhagic fever in Bulgaria

Emerg Infect Dis

Crimean-Congo hemorrhagic fever in Albania, 2001

Eur J Clin Microbiol Infect Dis

Genetic detection and isolation of Crimean-Congo hemorrhagic fever virus, Kosovo, Yugoslavia

Emerg Infect Dis

Genetic characterization of the M RNA segment of Crimean Congo hemorrhagic fever virus strains, China

Emerg Infect Dis

Nosocomial outbreak of viral hemorrhagic fever caused by Crimean hemorrhagic fever-Congo virus in Pakistan, January 1976

Am J Trop Med Hyg

Crimean-Congo hemorrhagic fever: Prevention and control limitations in a resource poor country

Clin Infect Dis

Congo/Crimean haemorrhagic fever in Dubai. An outbreak at the Rashid hospital

Lancet

Clinical features of Crimean-Congo haemorrhagic fever in the United Arab Emirates

Infection

Congo/Crimean haemorrhagic fever in Iraq

Bull World Health Organ

Crimean-Congo haemorrhagic fever virus in Iraq: isolation, identification and electron microscopy

Acta Virol

Crimean-Congo haemorrhagic fever: a seroepidemiological and tick survey in the Sultanate of Oman

Trop Med Int Health

The efficacy of oral ribavirin in the treatment of crimean-congo hemorrhagic fever in Iran

Clin Infect Dis

Serological evidence of human infection with Congo-Crimean hemorrhagic fever virus in Greece

Am J Trop Med Hyg

Review
Crimean-Congo haemorrhagic fever