CCHF is endemic to Eastern Europe and the Crimea, the Middle East, western China, Pakistan, Iraq, and Africa. An outbreak of CCHF was confirmed by the WHO in 2022 when the health authorities of the Republic of Iraq were notified of 212 cases between January 1 and May 22, 2022 (97 cases were laboratory confirmed in 2022 versus only 33 lab confirmed cases in 2021). Eighty percent of these cases were reported in April and May 2022, and there were 27 deaths.
CCHF is acquired by direct contact with infected animal tissues and body fluids, bites from infected ticks, and by aerosol inhalation. Documented transmission has occurred from one infected human to another by contact with infectious blood or body fluids and, in health care settings, through improper sterilization of medical supplies and equipment and reuse of injection needles.
After an incubation period of 1-3 days following a tick bite or 5-6 days after exposure to infected blood, CCHF produces an initial illness with sudden onset of fever, weakness, malaise, and back pain lasting 2-7 days. It often does not progress beyond this phase, but when it does, it may progress to fulminant hepatitis, jaundice, disseminated intravascular coagulation (DIC), hemorrhage, shock, and death. Asymptomatic and mild infections occur often, but the mortality rate of the hemorrhagic form is 20%-50%.
At present, no vaccine is available.
People at higher risk for contracting CCHF include workers from the livestock and agricultural industries, slaughterhouse workers, veterinarians, hunters, campers, hikers, and farmers.
The WHO recommends reducing the risk of tick-to-human, animal-to-human, and human-to-human transmission by:
- Enforcing relevant preventive measures during slaughtering, butchering, and culling procedures.
- Quarantining animals before they enter slaughterhouses or routinely treating animals with pesticides 2 weeks prior to slaughtering them.
- Ensuring that health care workers implement infection prevention-control measures when taking care of CCHF cases.
