Crimean Congo Hemorrhagic Fever (CCHF) in Afghanistan, Iraq and Mauritania
Afghanistan
From the beginning of the year through November 18, the total number of reported suspected CCHF cases and associated deaths are 1,219 and 114, respectively (CFR 9.4%).
The good news is a decreasing trend in the number of suspected CCHF cases since 3rd week of September 2023 is being reported. This decline could be attributed to seasonal changes towards winter.
The CCHF-associated deaths were reported from 15 provinces, more than half of which were reported from 2 provinces: Kabul (52, 45.6%) and Balkh (16, 14.0%).
The vast majority of cases have been reported in people older than 5 years of age (99.8%).
Iraq
In Iraq, the Ministry of Health reports over 545 confirmed cases of CCHF in Iraq during the current year of 2023, including 70 deaths.
Iraq has had a history of sporadic cases of CCHF since 1979, and CCHF virus was first isolated in 1981 from a limited outbreak of eight patients and two health workers. Sporadic CCHF outbreaks occurred from the 1980s till 2010, with zero to six confirmed cases reported between 1998 and 2009. The suspected number of CCHF cases increased to 28, with 11 laboratory-confirmed cases in 2010. Most small outbreaks were limited to the same province. CCHFV infections have recently increased from 33 cases in 2021 to a 6-fold increase in the first half of 2022.
Researchers say cases spiked during holidays, suggesting cultural practices contribute to spread. Other outbreak linked factors include vector movement, climate change, and free animal trade.
Mauritania
Two Crimean-Congo hemorrhagic fever (CCHF) cases were confirmed in Mauritania since the beginning of 2023.
The first case was a 58-year-old male from Tevarett district of Nouakchott North region who had reportedly been infected in the Ouad Naga district of Trarza region and developed a febrile illness on 17 July 2023. He was tested and died in Dakar, Senegal, on 26 July 2023. His results returned positive for CCHF on 27 July 2023.
The second case is a 23-year-old female from Libheir locality in Barkeol district of Assaba region with date of symptom onset as of 5 September 2023. She tested positive for CCHF by RT-PCR on 9 September 2023.
No epidemiological link was established between the two confirmed cases.
Crimean-Congo hemorrhagic fever (CCHF)
Congo Hemorrhagic Virus was first isolated and described from patient blood samples in Congo in 1967. An antigenic similar virus was identified in Crimea in 1969, called Crimean-Congo Hemorrhagic Fever virus (CCHFV).
CCHFV is transmitted by a Hyalomma sp and since its discovery has spread to more than 30 countries. CCHFV is an endemic in Africa, the Middle East, Eastern Europe, and Central Asia. Recently, CCHFV was also detected in Spain and Southwest Europe and the sequencing analysis showed they were closely genetically related to CCHFV isolates from West Coast of Africa, Mauritania, and Senegal.
CCHF is asymptomatic in 60–80% of cases, and the remaining 20–40% of cases usually suffer from initial fever, headache and malaise followed by gastrointestinal symptoms; severe cases can experience bleeding, shock and multi-organ system failure.
CCHF represents a major challenge to public health due to its burden on social and economic well-being, as well as its effects on the health of individuals. Despite the presence of public health measures to control and prevent the spread of CCHF, there has been an increase in its occurrence worldwide, including in the Eastern Mediterranean region, over the last decade due to the nature of the disease, human behavior, environmental and ecological factors, and improvements in diagnostic methods.
