Crimean-Congo Hemorrhagic Fever Overview
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Questions and Answers

What is the primary mode of transmission for Crimean-Congo haemorrhagic fever?

  • Consumption of contaminated food and water
  • Direct contact with contaminated surfaces
  • Airborne particles from infected individuals
  • Tick bites and contact with infected animal fluids (correct)

Which animal is NOT listed as a host for the CCHF virus?

  • Pigs (correct)
  • Sheep
  • Cattle
  • Goats

What is the estimated case fatality rate of Crimean-Congo haemorrhagic fever?

  • 5–15%
  • 40–70%
  • 10–40% (correct)
  • 1–5%

Which genus of ticks is primarily associated with the transmission of the CCHF virus?

<p>Hyalomma (C)</p> Signup and view all the answers

In which geographical regions is Crimean-Congo haemorrhagic fever considered endemic?

<p>Africa, the Balkans, Middle East, and parts of Asia (C)</p> Signup and view all the answers

Which of the following groups of people is at the highest risk for contracting CCHF?

<p>Veterinarians and slaughterhouse workers (D)</p> Signup and view all the answers

What kind of virus causes Crimean-Congo haemorrhagic fever?

<p>Nairovirus (B)</p> Signup and view all the answers

What factor contributes to the continuation of the tick-animal-tick cycle for CCHF?

<p>Infected animals can transmit the virus for weeks after infection (C)</p> Signup and view all the answers

What is a recognized avenue for human-to-human transmission of CCHF?

<p>Contact with blood and bodily fluids of infected persons (C)</p> Signup and view all the answers

What contributes to hospital-acquired infections of CCHF?

<p>Improper sterilization of medical equipment (A)</p> Signup and view all the answers

What is the main strategy for reducing the risk of CCHF infection in humans when no vaccine is available?

<p>Increasing awareness and education on preventive measures (A)</p> Signup and view all the answers

Which of the following measures is NOT recommended to reduce tick-to-human transmission?

<p>Avoiding physical examination of skin for ticks (D)</p> Signup and view all the answers

What should be done with animals before they enter slaughterhouses to minimize CCHF transmission risk?

<p>Quarantine them or treat with pesticides (D)</p> Signup and view all the answers

Which practice is essential for healthcare workers dealing with suspected CCHF cases?

<p>Implementing strict hand hygiene and personal protective measures (B)</p> Signup and view all the answers

To effectively reduce the risk of human-to-human transmission of CCHF, individuals should:

<p>Avoid close contact and wear protective equipment when caring for the sick (B)</p> Signup and view all the answers

Which of the following is NOT a recommended community engagement strategy for CCHF?

<p>Providing inaccurate health information (D)</p> Signup and view all the answers

What type of clothing is advised to help in detecting ticks effectively?

<p>Light-colored clothing (A)</p> Signup and view all the answers

Why is the implementation of basic hand hygiene critical in healthcare settings dealing with CCHF?

<p>To reduce the risk of CCHF transmission (B)</p> Signup and view all the answers

Which approach is suggested for limiting tick infestations on animals?

<p>Regular application of pesticides (B)</p> Signup and view all the answers

Which of the following statements regarding CCHF infection is accurate?

<p>Infection risk can be minimized through awareness and preventive measures. (C)</p> Signup and view all the answers

What was the total number of Crimean-Congo Hemorrhagic Fever cases reported in Iraq from January to May 2022?

<p>212 (B)</p> Signup and view all the answers

What percentage of the reported Crimean-Congo Hemorrhagic Fever cases in Iraq were laboratory-confirmed as of May 2022?

<p>46% (A)</p> Signup and view all the answers

What is the incubation period following infection from a tick bite for Crimean-Congo Hemorrhagic Fever?

<p>One to three days (C)</p> Signup and view all the answers

What proportion of the confirmed cases of Crimean-Congo Hemorrhagic Fever in Iraq were male?

<p>62% (C)</p> Signup and view all the answers

Which symptom is not typically associated with the onset of Crimean-Congo Hemorrhagic Fever?

<p>Lethargy (D)</p> Signup and view all the answers

What is the estimated mortality rate for Crimean-Congo Hemorrhagic Fever?

<p>30% (B)</p> Signup and view all the answers

What age group accounted for just over half of the confirmed cases of Crimean-Congo Hemorrhagic Fever?

<p>15 to 44 years (C)</p> Signup and view all the answers

What clinical sign is characterized by small, pinpoint hemorrhages often seen in patients with Crimean-Congo Hemorrhagic Fever?

<p>Petechiae (C)</p> Signup and view all the answers

Which of the following symptoms may appear after two to four days of illness in Crimean-Congo Hemorrhagic Fever?

<p>Sleepiness and depression (C)</p> Signup and view all the answers

What is one common mode of transmission for Crimean-Congo Hemorrhagic Fever among confirmed cases?

<p>Direct contact with infected animals (C)</p> Signup and view all the answers

When do patients who recover from Crimean-Congo hemorrhagic fever typically begin to show improvement?

<p>On the ninth or tenth day (A)</p> Signup and view all the answers

Which of the following is a laboratory test used to diagnose Crimean-Congo hemorrhagic fever virus infection?

<p>Polymerase chain reaction (PCR) assay (A)</p> Signup and view all the answers

What is the main approach to treating Crimean-Congo hemorrhagic fever?

<p>General supportive care (D)</p> Signup and view all the answers

Which symptom was NOT reported in the 37-year-old man's presentation of Crimean-Congo hemorrhagic fever?

<p>Cough (B)</p> Signup and view all the answers

What was the outcome for the patient after starting ribavirin treatment for Crimean-Congo hemorrhagic fever?

<p>Dramatic improvement in condition (A)</p> Signup and view all the answers

What is a significant challenge in controlling Crimean-Congo hemorrhagic fever infection in animals?

<p>Infection in domestic animals is often asymptomatic (C)</p> Signup and view all the answers

Which of the following laboratory tests was highlighted as part of the diagnosis for Crimean-Congo hemorrhagic fever?

<p>Serum neutralization (B)</p> Signup and view all the answers

Why is tick control with acaricides primarily effective in well-managed livestock production facilities?

<p>The tick-animal-tick cycle is more manageable in these facilities (C)</p> Signup and view all the answers

Which symptom is considered the most common manifestation of Crimean-Congo hemorrhagic fever based on the patient case?

<p>Epistaxis (D)</p> Signup and view all the answers

What was the patient’s primary complaint upon presentation for Crimean-Congo hemorrhagic fever?

<p>Fever and malaise (C)</p> Signup and view all the answers

Flashcards

Crimean-Congo haemorrhagic fever (CCHF)

A widespread viral disease caused by a tick-borne virus (Nairovirus) of the Bunyaviridae family, causing severe hemorrhagic fever outbreaks.

Transmission (CCHF)

Primarily transmitted by tick bites, or through contact with infected animal blood, tissues (during/after slaughter), and human-to-human contact via bodily fluids.

Vector (CCHF)

Ticks of the Hyalomma genus are the main carriers of the CCHF virus.

Reservoir (CCHF)

Animals, like cattle, sheep, and goats, carry the virus.

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Endemic Regions (CCHF)

CCHF is prevalent in Africa, the Balkans, the Middle East, and some Asian countries.

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Case Fatality Rate (CCHF)

The percentage of CCHF cases that result in death, ranging from 10-40%.

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Viral Haemorrhagic Fever

A broad category of diseases caused by certain viruses (e.g., Lassa fever, Crimean-Congo haemorrhagic fever, Ebola, Yellow fever).

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Human-to-human Transmission (CCHF)

Transmission of CCHF between people through close contact with infected bodily fluids, like blood or secretions.

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Hospital-acquired infections (CCHF)

Transmission of CCHF within a hospital or healthcare setting through improper sterilization and reuse of medical equipment or contaminated supplies.

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Tick Genera

Different types of ticks can be infected by CCHF virus, but the Hyalomma genus is the main one.

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Crimean-Congo Hemorrhagic Fever (CCHF) cases in Iraq (2022)

From January 1st to May 22nd, 2022, Iraq reported 212 suspected and confirmed CCHF cases, with 27 deaths; the number of cases was significantly higher than 2021.

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CCHF Transmission via Animals

Most confirmed CCHF cases in Iraq had direct contact with animals, particularly livestock breeders and butchers.

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CCHF Age Range

Over half of confirmed CCHF cases in Iraq were aged 15–44, with a majority being male.

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Incubation Period (Tick Bite)

Following a tick bite, CCHF incubation is typically 1-3 days (max 9 days).

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Incubation Period (Blood/Tissue Contact)

CCHF incubation after blood/tissue contact is usually 5-6 days (max 13 days).

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Initial CCHF Symptoms

Sudden fever, muscle pain, dizziness, neck pain, backache, headache, sore eyes, photophobia, nausea, vomiting, diarrhea, and abdominal pain.

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Later CCHF Symptoms

Mood swings, confusion, sleepiness, depression, and localized abdominal pain (upper right quadrant) with liver enlargement can occur.

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Additional CCHF Signs

Tachycardia (fast heartbeat), swollen lymph nodes (lymphadenopathy), and skin rashes (petechiae, ecchymoses) developing on mucosal surfaces and skin are common in advanced stages.

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CCHF Complications

CCHF can lead to hepatitis, kidney failure, liver failure, and/or lung failure after 5 days.

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CCHF Mortality Rate

CCHF has an approximate 30% mortality rate, with death typically occurring during the second week of the illness.

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CCHF Symptoms

CCHF (Crimean-Congo hemorrhagic fever) causes large ecchymoses (bruising) and other hemorrhages like hematuria, melena, gingival bleeding, and epistaxis (nosebleeds). It also often involves fever, malaise, body aches, nausea, vomiting, and abdominal pain.

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CCHF Diagnosis

CCHF infection is diagnosed using lab tests like ELISA (enzyme-linked immunosorbent assay), antigen detection, serum neutralization, RT-PCR (reverse transcriptase polymerase chain reaction), or virus isolation by cell culture.

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CCHF Treatment

Treatment mostly focuses on supportive care (managing symptoms) and the antiviral drug ribavirin, both oral and intravenous forms.

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CCHF Recovery Time

If a patient recovers, symptoms usually start improving around 9-10 days after the illness begins.

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CCHF Prevention (Animals)

Preventing CCHF in animals is difficult due to the hidden tick-animal-tick cycle and lack of accessible animal vaccines. Tick control is possible in well-managed livestock facilities.

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Ribavirin

An antiviral drug used to treat CCHF infection. It can be given orally or intravenously.

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Patient Presentation (CCHF)

Typical CCHF symptoms include fever, body aches, abdominal pain, and a pattern of hemorrhages (internal bleeding).

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Clinical Signs (CCHF)

Physical symptoms observed in a CCHF patient may include tenderness, and chest x-ray showing lower/mid-zone haziness with obliterated costophrenic angles. Abdominal ultrasound shows fluid collection and obstructed portal veins.

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Ecchymoses

Large areas of bruising.

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Hemorrhages (CCHF)

Internal bleeding, resulting in various symptoms like nosebleeds, blood in urine, in vomit, from gums.

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CCHF Prevention: What's the Biggest Challenge?

Currently, there's no widely available vaccine for CCHF. This means the primary way to prevent infections is by taking steps to reduce exposure to the virus.

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How Do You Prevent Transmission Through Ticks?

To avoid tick bites, wear protective clothing, use insect repellent, and regularly check clothes for ticks. Also, try to stay away from areas where ticks are common during peak seasons.

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Handling Animals Safely: What to Avoid?

When working with animals in areas where CCHF is common, wear protective clothing, especially when handling blood or tissues during slaughter.

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The Importance of Quarantine

To decrease the risk of CCHF spreading, quarantine animals before they enter slaughterhouses. This can help prevent the virus spreading to other animals and eventually to humans.

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Human-to-Human Transmission: How Can It Happen?

CCHF can spread through close contact with an infected person's bodily fluids, such as blood or secretions.

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Important Precautions for Healthcare Workers

Healthcare workers caring for patients with suspected CCHF should use standard infection control measures, including protective equipment and safe burial practices.

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What to Do with CCHF Samples?

Specimens from individuals suspected of having CCHF should be handled by trained staff in specialized laboratories to minimize the spread of the virus.

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How Can Communities Help?

Engaging communities to promote safe practices, provide timely information, and encourage awareness about CCHF is crucial for prevention.

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CCHF and Slaughterhouses: Why Are They Linked?

Slaughterhouses can become hotspots for CCHF transmission due to potential contact with infected animals' blood or tissues during the slaughtering process.

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What is the Role of Pesticides in CCHF Control?

Treating animals with pesticides prior to slaughter can help reduce the risk of CCHF transmission by killing ticks that may carry the virus.

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Study Notes

Haemorrhagic Fevers

  • Viral hemorrhagic fevers (VHFs) are diseases caused by various viruses, including those from the Arenaviridae, Bunyaviridae, Filoviridae, and Flaviviridae families.
  • Crimean-Congo hemorrhagic fever (CCHF) is a widespread disease, caused by a tick-borne virus (Nairovirus) of the Bunyaviridae family.
  • CCHF is endemic in Africa, the Balkans, the Middle East, and parts of Asia.
  • The case fatality rate of CCHF is 10-40%.
  • CCHF viruses are hosted by wild and domestic animals, such as cattle, sheep, and goats.

Crimean-Congo Haemorrhagic Fever

  • CCHF is a tick-borne viral disease.
  • The virus is transmitted to humans via tick bites or contact with infected animal blood/tissue during or immediately after slaughter.
  • Animals infected with CCHF virus, have the virus in their bloodstream for approximately one week.
  • The main vector for CCHF virus is the Hyalomma tick.
  • Human-to-human transmission is possible from close contact with blood, secretions, organs or other bodily fluids of infected individuals.
  • Hospital-acquired infections can arise from improper sterilization of medical equipment.

Epidemiology

  • CCHF is endemic in Africa, the Balkans, the Middle East, and some Asian countries.
  • The geographical limit of the primary tick vector is roughly 50th parallel north.
  • Iraq was first diagnosed with CCHF in 1979.
  • Between January 1 and May 22, 2022, Iraq reported 212 cases of CCHF.

Epidemiology of the Disease

  • CCHF is endemic in Africa and in parts of Asia, the Middle East, and the Balkans.
  • Iraq is one of the eastern Mediterranean countries where CCHF is endemic.
  • CCHF cases have been reported in Iraq since 1979.
  • In Iraq, six cases were reported between 1989 and 2009, 11 in 2010.
  • Three fatal cases were reported in 2018.
  • A total confirmed cases of 33 cases, including 13 deaths in 2021 (with a fatality rate of 39%).

Burden of Crimean-Congo Haemorrhagic Fever

  • Approximately 3 billion people are at risk of CCHF.
  • There are an estimated 10,000 to 15,000 CCHF infections each year.
  • Approximately 500 deaths from CCHF are estimated each year.

Incubation Period

  • The incubation period of CCHF varies based on the mode of infection.
  • Tick bite infection: 1-3 days, with a maximum of 9 days.
  • Contact with infected blood/tissue: 5-6 days, with a documented maximum of 13 days.

Signs and Symptoms

  • The onset of symptoms is typically sudden, characterized by fever, myalgia, dizziness, neck pain and stiffness, backache, headache, sore eyes, photophobia, nausea.
  • Early symptoms may include abdominal pain, sore throat, vomiting and diarrhoea.
  • Severe cases may progress to mood swings, confusion, sleepiness, depression, lassitude.
  • Abdominal pain may localize to the upper right quadrant, with detectable hepatomegaly.
  • Other signs may include tachycardia, lymphadenopathy, and petechial rashes on internal mucosal surfaces.

Skin Manifestations

  • Crimean-Congo hemorrhagic fever virus-infected patients commonly present with a striking pattern of large ecchymoses which are not seen in other viral hemorrhagic fevers.

Diagnosis

  • Diagnosis of CCHF infection relies on various laboratory tests, including enzyme-linked immunosorbent assay (ELISA), antigen detection, serum neutralization, reverse transcriptase polymerase chain reaction (RT-PCR) assay, and virus isolation by cell culture.

Treatment

  • General supportive care and symptom treatment is the main approach for managing CCHF.
  • Ribavirin, an antiviral drug, shows some benefit when used in the treatment of CCHF infections.
  • Oral and intravenous formulations of Ribavirin have both been used effectively.

Prevention

  • CCHF prevention is challenging because the tick-animal-tick cycle often goes unnoticed.
  • Acaricides (chemicals to kill ticks) are an effective option at animal facilities, however, not universally available.
  • No effective vaccines are currently available for use in animals.
  • For human CCHF prevention, measures focus on raising public awareness and educating people about risk factors, exposure to the virus.

Prevention and Control of CCHF in Humans

  • Tick-to-human transmission: Wearing protective clothing like long sleeves and long trousers, with light coloured clothing to detect ticks easily. Use approved acaricides on clothing; approved repellent on the skin and clothing, examine clothes and skin regularly for ticks, remove safely. Avoid areas where ticks are abundant.
  • Animals-to-human transmission: Wear gloves and protective clothing when handling animals or tissues in endemic areas during slaughtering and butchering procedures. Quarantin animals for at least two weeks prior to slaughter.
  • Human-to-human transmission: Avoid close physical contact with infected people. Wear gloves and protective equipment when caring for infected people; regularly wash hands.

Community Engagement

  • Engage communities in health practices and behaviors.
  • Provide communities with regular and accurate information on the disease.

CCHF Outbreak Strategy

  • Conduct social and cultural assessments
  • Engage with key community members (e.g., women, youth associations, traditional healers).
  • Communicate effectively with the community, formally and informally.
  • Address community concerns.
  • Control vectors and reservoirs of the virus.
  • Active case finding, contact tracing and epidemiological investigation
  • Implement surveillance measures.
  • Provide proper management for suspected and confirmed cases.
  • Coordinate efforts among all relevant agencies.
  • Implement ethical considerations in all aspects of the outbreak response.
  • Staff should use appropriate protective equipment to reduce risks, while caring for suspected and confirmed cases.

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This quiz covers key information about Crimean-Congo hemorrhagic fever (CCHF), a serious viral disease transmitted by ticks. Participants will learn about the virus's characteristics, transmission methods, and its impact in various regions. Test your knowledge on this critical public health issue and its epidemiology.

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