Crimean-Congo Haemorrhagic Fever

Crimean-Congo haemorrhagic fever (CCHF) is a severe viral haemorrhagic disease caused by CCHF virus (Nairovirus), transmitted by Hyalomma ticks and through contact with blood or tissues of infected livestock or patients.

• Endemic in Africa (Uganda, Kenya, Sudan, Senegal), the Middle East, southeastern Europe, Turkey, and Central Asia.
• Risk groups: farmers, abattoir workers, veterinarians, and healthcare workers (nosocomial outbreaks).
• Case fatality 10 to 40%.

• Incubation 1 to 3 days after tick bite, 5 to 6 days after contact with blood.
• Pre-haemorrhagic phase: abrupt fever, myalgia, headache, dizziness, nausea, vomiting, and diarrhoea.
• Haemorrhagic phase (days 3 to 6): petechiae, ecchymoses, epistaxis, melena, haematuria, and hepatic involvement, with thrombocytopenia, leukopenia, and elevated transaminases, CK, and LDH.
• Death from multiorgan failure, shock, and bleeding in the second week; survivors recover slowly.

• RT-PCR (blood) is the main diagnostic test in the first 5 days; IgM and IgG ELISA later; virus isolation requires BSL-4.
• Blood: thrombocytopenia (under 50 x 10^9/L), prolonged PT and aPTT, raised AST greater than ALT, CK, and creatinine; fibrinogen.
• Exclude Ebola, Marburg, Lassa, Rift Valley fever, dengue, malaria, leptospirosis, typhoid, meningococcaemia, and rickettsioses.
• Notify public health authorities immediately.

• Supportive care is the mainstay: fluid resuscitation, electrolyte correction, platelet transfusion (for counts under 20 x 10^9/L or bleeding), fresh frozen plasma, cryoprecipitate, and red cell transfusion.
• Ribavirin (off label, evidence limited; most useful early): IV 30 mg/kg loading dose, then 16 mg/kg every 6 hours for 4 days, then 8 mg/kg every 8 hours for 6 days; or oral 2 g loading dose, then 1 g every 6 hours for 4 days, then 500 mg every 6 hours for 6 days.
• Favipiravir is under evaluation. Corticosteroids and IVIG have been used with unproven benefit.
• Infection control: strict barrier nursing, PPE (including N95 or FFP3 respirators), safe laboratory handling, and safe burial practices.
• Post-exposure prophylaxis with oral ribavirin 500 mg every 6 hours for 7 days for high risk exposures (needlestick).
• Prevention: tick avoidance, protective clothing, and animal husbandry practices.