Recent Progress in the Treatment of Crimean–Congo Hemorrhagic Fever and Future Perspectives

Masayuki Saijo; Shigeru Morikawa; Ichiro Kurane


Future Virology. 2010;5(6):801-809. 

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Epidemiology of CCHF

Crimean–Congo hemorrhagic fever has been reported in Africa, Eastern Europe, the Middle East and Central and Southern Asia.[7,13,15,17,19–45] CCHF has been confirmed in Abu Dhabi, Afghanistan, Albania, Bulgaria, China (Xinjiang Uygur Autonomous Region), Democratic Republic of Congo, Dubai, Greece, Iran, Iraq, Kazakhstan, Mauritania, Namibia, Oman, Pakistan, Russia, Saudi Arabia, Senegal, Serbia/Yugoslavia, South Africa, Tajikistan, Turkey, UAE and Uganda. The virus has also been isolated in Nigeria, Central African Republic, Kenya, Upper Volta, Madagascar and Ethiopia. The actual number of patients with CCHF is believed to be far higher than that reported, because the disease usually occurs in remote areas. CCHF usually occurs in the spring and early summer in endemic countries in the Northern hemisphere. The outbreak seasonality might be associated with tick density and activity, and with the increase in viral load in animals in the regions. It is noteworthy that, although CCHF had been recognized as a viral disease in the early 1940s in the Crimea Peninsula, Russia, the first case of CCHF in Turkey was identified in 2002, but the number of the patients exceeded 1820 by 2007.[43] The geographic distribution of CCHF is closely associated with that of ixodid ticks, which are the natural reservoir of CCHFV. Possible causes for the emergence or re-emergence of CCHF are climate changes, which may have a significant impact on the reproduction rate of the vector ticks, and changes in human occupational and agricultural activities.[45]

To date, two cases of CCHF imported from Africa to Europe have been reported: one was from Zimbabwe to the UK[101] and the other was from Senegal to France.[102] CCHF outbreaks have been reported commonly among agricultural and abattoir workers and shepherds, all of whom handle livestock, such as sheep, goats and ostriches.[15,35,46–48] The animals responsible for CCHFV transmission to humans in the Northern hemisphere were mainly sheep, while, in South Africa they were also ostriches, and in Namibia, pigs.[103]


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