Situation Report: Global Outbreaks of Crimean-Congo Hemorrhagic Fever

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Crimean-Congo Hemorrhagic Fever (CCHF) is the most widespread tick-borne viral disease affecting humans. According to the European Centre for Disease Prevention and Control (ECDC), it is estimated that three billion people are at risk of infection globally, and 10,000 to 15,000 infections — 500 of them fatal — occur every year.

CCHF Transmission

CCHF is caused by infection with a virus carried by ticks. These ticks primarily infest livestock animals, however, human infections (CDC, https://www.cdc.gov/vhf/crimean-congo/transmission/index.html, Accessed 9/13/2023) can occur through contact with the blood, bodily fluids, and tissues of infected animals or through the bite of an infected tick. Additionally, person-to-person transmission can occur via direct contact with the blood or bodily fluids of an infected individual, especially in health care settings.

Global Outbreaks of CCHF

CCHF is endemic in Africa, the Balkans, the Middle East, and Asia. Countries in these regions have reported unusually high case numbers since January 2023. Additionally, the country of Georgia and the Republic of North Macedonia have reported outbreaks in 2023. See the most recent ECDC Communicable Disease Threats Report from August 18, 2023, for an overview of the cases in North Macedonia. While uncommon in non-endemic countries, health care workers in the U.S. should be on the lookout for patients with symptoms of CCHF (CDC, https://www.cdc.gov/vhf/crimean-congo/symptoms/index.html, Accessed 9/13/2023) and recent travel history.

Health Care Recommendations

The potential for continued outbreaks and the lack of specific antiviral treatment make preparedness and surveillance crucial. Health care workers should follow strict infection prevention and control measures, including the use of personal protective equipment, to prevent nosocomial infections. Access the PPE and precautions for viral hemorrhagic fevers matrix.

Rapid diagnosis and isolation of suspected cases can prevent further transmission within health care facilities and communities. The CDC uses the CALM algorithm to assess the risk of VHF in a returning traveler (CDC, https://www.cdc.gov/vhf/abroad/assessing-vhf-returning-traveler.html, Accessed 9/13/2023).

NETEC has developed the Health Care Facility Viral Hemorrhagic (VHF) Preparedness Checklist for health care facilities to assess their readiness to identify, isolate, inform, and provide initial treatment for patients suspected or confirmed to be infected with CCHF or another VHF. 

The WHO course, Crimean-Congo Hemorrhagic Fever (CCHF): Introduction, provides a general introduction to CCHF and is intended for frontline responders engaged in preventing and managing outbreaks.