Crimean-Congo Hemorrhagic Fever case in Portugal
The Directorate-General for Health (DGS) reported on August 14, 2024, the first laboratory-confirmed case of Crimean-Congo Hemorrhagic Fever (CCHF) was identified in Portugal.
CCHF is a disease transmitted by ticks infected by the virus, namely those of the species Hyalomma lusitanicum and Hyalomma marginatum, which are found in different municipalities of the country.
The case, in an individual over 80 years of age, of Portuguese nationality and birthplace, resident in the district of Bragança, who carried out agricultural activities during the incubation period, had symptoms on the onset of July 11, 2024, having been admitted to the Hospital de Bragança due to nonspecific symptoms and ended up dying.
The biological samples were tested, post mortem, for several agents, including the CCHF virus, with positive results on 8/14/2024, by the national reference laboratory - Instituto Nacional de Saúde Doutor Ricardo Jorge (INSA).
In response to the alert, the Health Authorities began an epidemiological investigation and implemented appropriate measures, including contact tracing. The epidemiological investigation revealed that the case had no history of travel outside the country, having participated in some outdoor activities in the area where he lived. No contacts with possible symptoms or additional cases of the disease were identified. Reinforced entomological investigations to collect ticks in the district where the case lived are still ongoing, in conjunction with the Health Authorities and INSA, as well as a study on the possible detection of ticks infected with the FHCC virus.
Given the detection of this case, the importance of adopting measures to prevent tick bites is highlighted, therefore, when carrying out activities in nature in areas prone to the risk of exposure to ticks, it is recommended:
Wearing light-colored clothing so that ticks can be seen and removed more easily;
Wear long-sleeved clothing, long trousers and closed shoes;
It may also be possible to consider using insect repellent on clothing and protecting the skin with products containing DEET (N,N-diethyl-m-toluamide) in risk areas;
When walking in the countryside, if possible, walk along the central part of the paths to avoid contact with vegetation, and check your clothes and body for ticks after activities in nature.
Inspect your clothing, skin and scalp when returning from field activities and remove any ticks. If they are attached, you should seek medical attention so that they can be removed properly and be alert to the appearance of signs and symptoms, and call SNS24 to be directed to health services with prior notification.
The detection of CCHF cases in Europe has been increasing in recent years, especially in the context of rising average temperatures in southern Europe and Portugal, which are conducive to the multiplication of vectors. In Spain, cases of CCHF have been identified since 2013, with 16 cases confirmed since then, the last two in April and June 2024, in communities bordering Portugal. In 2020, Hyalomma lusitanicum and Hyalomma marginatum ticks with the CCHF virus had been detected in Spain. In France (Perineus), in 2023, H. marginatum ticks infected with the CCHF virus were detected.
The DGS, committed to transparency and timely communication, clarifies that there is no risk of an outbreak or person-to-person transmission, highlighting that this is a rare and sporadic event. The virus that causes Crimean-Congo Hemorrhagic Fever (CCHF) has not been detected, to date, in ticks in the REVIVE entomological surveillance network, which indicates that the risk to the population is low. The DGS and its partners remain vigilant and will continue to monitor the evolution of the situation and update technical guidelines for health professionals at the level of public health units and care services to improve detection, diagnosis, therapeutic approach and protection of contacts of suspected cases.