Crimean-Congo Haemorrhagic Fever
This disease was first identified in 1944 in the Crimea and given the name Crimean haemorrhagic fever. In 1969 it was discovered that the organism causing Crimean haemorrhagic fever was the same as that which caused an illness in in the Congo in 1956. The connection with both places resulted in the current name for the disease and the virus.
The disease is found in many countries in Africa, Europe and Asia, and during 2001, cases or outbreaks were recorded in Kosovo, Albania, Iran, Pakistan, and South Africa.
Crimean-Congo haemorrhagic fever (CCHF) is usually transmitted to man by the bite of an infected tick, by crushing ticks with bare hands and through direct contact with infected blood and tissue from livestock.
Transmission person to person is possible through exposure to blood via injury with contaminated sharp objects or infected blood on broken skin.
The majority of cases occur in individuals involved in the livestock industry e.g. farmers, agricultural workers, slaughterhouse workers and veterinarians.
Healthcare workers are at risk through unprotected contact with infectious blood or body fluids from patients with the illness.
The incubation period varies between 1-13 days.
The onset of illness is sudden, symptoms include fever, weakness, irritability, headache, abdominal pain, joint pain, loss of appetite, and feeling generally unwell. Occasionally vomiting and diarrhoea may occur.
As the illness progresses, mood swings may develop with the patient becoming confused and aggressive. After 2-4 days these symptoms change to drowsiness, lassitude and depression.
Jaundice is usually present.
A rash caused by bleeding under the skin may progress to more severe internal bleeding, generally occurring between 3rd-5th day.
The mortality rate may be around 30%. There is prolonged convalescence in those who survive.
The patient should be cared for in an isolation unit and treatment is supportive, including blood and fluid replacement and treatment of any other infections. The antiviral drug ribavirin has reportedly been used with some benefit.
Recommendations for Travellers
The risk of travellers becoming infected or developing the disease is extremely low, unless there has been direct contact with ticks, infected animals or blood, bodily fluids from an infected person; travellers should avoid this type of exposure. Travellers at increased risk of exposure include those engaging in animal research/work, healthcare workers and others providing care for patients in the community, particularly where outbreaks of CCHF are occurring.
There is no safe and effective vaccine for use in humans. Avoidance of tick bites is the main preventive measure, especially during summer months when they are most active - usually Mar to Oct in the Middle East, Europe and Asia.
Minimise the risk by using insect repellents on the skin and clothing. Use clothing to cover the skin, i.e. long sleeves and long trousers with the bottoms tucked in boots. Inspect the body following possible exposure and remove ticks immediately.
Individuals who have travelled to areas where the disease is present and develop symptoms such as fever, headache or feeling generally unwell, must contact their general practitioner.
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