Crimean-Congo Hemorrhagic Fever (CCHF) Situation Report: Cases Reported in Iraq, Georgia, and Spain

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Crimean-Congo Hemorrhagic Fever Outbreaks

Crimean-Congo Hemorrhagic Fever (CCHF) is found in Eastern Europe, particularly in the former Soviet Union, throughout the Mediterranean, in northwestern China, central Asia, southern Europe, Africa, the Middle East, and the Indian subcontinent. In recent months, cases of CCHF have been reported in Iraq, Georgia, and Spain.

Unprecedented Case Numbers in Iraq

According to the World Health Organization (WHO), as of August 11, 2022, 1,085 suspected cases of Crimean-Congo Hemorrhagic Fever have been reported in Iraq (https://iraq.un.org/index.php/en/194395-who-situation-report-iraq-week-31, Accessed August 2022).

Of that number, 287 have been confirmed, and 52 people have died, representing an 18% case fatality rate. The majority of cases in Iraq occurred in individuals who were in close contact with livestock.

CCHF on the Rise in Georgia

Additionally, over the past seven months there have been 42 confirmed cases and two deaths in the country of Georgia (https://promedmail.org/promed-post/?id=8704893, “Accessed August 15, 2022; page no longer available”). This represents a dramatic increase in case numbers since the first outbreak of CCHF in Georgia in 2009.

Sporadic Cases of CCHF in Spain

The Spanish Ministry of Health has confirmed two cases of Crimean-Congo Hemorrhagic Fever, with no epidemiological link, in the Bierzo region of León. The first case is a 49-year-old man with a history of tick bites. On July 12, 2022, he started exhibiting symptoms, including headache, fever, and gastrointestinal symptoms, and remains hospitalized in a biocontainment unit.

The second case was a 51-year-old man without a history of tick bites who died on June 19 and was retrospectively diagnosed with CCHF a month later via autopsy.

There have been sporadic cases of CCHF reported in Spain every year since 2010.

Advice for Health Care Professionals in the U.S.

While Crimean-Congo Hemorrhagic Fever is uncommon in non-endemic countries, health care workers in the U.S. should be alert for patients with signs and symptoms consistent with CCHF. Learn more about the signs and symptoms (CDC, https://www.cdc.gov/vhf/crimean-congo/symptoms/index.html, Accessed 8/15/2022).

Identify, Isolate, Inform

• If a patient presents with symptoms of CCHF, follow the identify, isolate, and inform strategy to reduce viral transmission in your health care facility. Watch NETEC’s webinar on identify, isolate, and inform for Lassa fever, another viral hemorrhagic fever (VHF). 

• When screening a new patient for possible exposure to CCHF virus, take a through travel and exposure history, including travel to endemic areas, contact with sick people or animals, and other risk factors. See the Nebraska Medicine screening guide for viral hemorrhagic fevers in emergency departments. If the patient has recently returned from travel, follow the CDC’s CALM algorithm to assess VHF risk (CDC, https://www.cdc.gov/vhf/abroad/assessing-vhf-returning-traveler.html, Accessed 8/15/2022).

• The risk of human-to-human transmission in hospitals can be drastically reduced through timely identification of CCHF virus, and implementation of barrier-protection and patient-isolation practices. See NETEC’s matrix for determining the personal protective equipment (PPE) and precautions necessary to use when managing a patient suspected or confirmed to be infected with any viral hemorrhagic fever, including CCHF.

• Promptly notify appropriate internal and external stakeholders, including your infection prevention and public health professionals.

Diagnostic Testing for CCHF

Laboratory tests on patient samples present a high risk of transmission. Testing for CCHF is performed by the CDC and you must contact and receive approval from the CDC prior to sending specimens. See NETEC’s flyer with laboratory resources related to Crimean-Congo Hemorrhagic Fever.