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Syed MA, Siddiqui MI, Memon IH, Jehandad K, Baloch NN, Jamal H, Hussain A, Memon NM, Syed MH, Ahmed ZA, Fontaine R, Rullán-Oliver P. Risk Factors of Crimean-Congo Hemorrhagic Fever in Sindh Province, Pakistan. Int J Infect Dis 2024:107141. [PMID: 38901728 DOI: 10.1016/j.ijid.2024.107141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 06/04/2024] [Accepted: 06/14/2024] [Indexed: 06/22/2024] Open
Abstract
OBJECTIVES In Sindh Province, Pakistan, confirmed Crimean Congo hemorrhagic fever (CCHF) increased from zero in 2008 to 16 in 2015-2016. To counter this increase, in 2016, we initiated structured CCHF surveillance to improve estimates of risk factors for CCHF in Sindh and to identify potential interventions. METHODS Beginning in 2016, all referral hospitals in Sindh reported all CCHF cases to surveillance agents. We used laboratory-confirmed cases from CCHF surveillance from 2016 to 2020 to compute incidence rates and in a case-control study to quantify risk factors for CCHF. RESULTS For the 5 years, CCHF incidence was 4.2 per million for the Sindh capital, Karachi, (68 cases) and 0.4 per million elsewhere. Each year, the onset of new cases peaked during the 13 days during and after the 3-day Eid al Adha festival, when Muslims sacrificed livestock, accounting for 38% of cases. In Karachi, livestock for Eid were purchased at a seasonal livestock market that concentrated up to 700,000 livestock. CCHF cases were most common (44%) among the general population that had visited livestock markets (odds ratio = 102). CONCLUSIONS Urban CCHF in Sindh province is associated with the general public's exposure to livestock markets in addition to high-risk occupations.
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Affiliation(s)
- Muhammad Asif Syed
- Health Department, Government of Sindh, Karachi, Pakistan; Pakistan Field Epidemiology Training Program, Sindh Province, Pakistan
| | | | - Ishfaque Hussain Memon
- Health Department, Government of Sindh, Karachi, Pakistan; Pakistan Field Epidemiology Training Program, Sindh Province, Pakistan
| | - Kishwar Jehandad
- Health Department, Government of Sindh, Karachi, Pakistan; Pakistan Field Epidemiology Training Program, Sindh Province, Pakistan; Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan
| | - Nayyar Nawaz Baloch
- Health Department, Government of Sindh, Karachi, Pakistan; Pakistan Field Epidemiology Training Program, Sindh Province, Pakistan; Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan
| | - Hamza Jamal
- Health Department, Government of Sindh, Karachi, Pakistan; Pakistan Field Epidemiology Training Program, Sindh Province, Pakistan
| | - Aamir Hussain
- Health Department, Government of Sindh, Karachi, Pakistan; Pakistan Field Epidemiology Training Program, Sindh Province, Pakistan
| | - Naveed Masood Memon
- Health Department, Government of Sindh, Karachi, Pakistan; Pakistan Field Epidemiology Training Program, Sindh Province, Pakistan
| | - Masroor Hussain Syed
- Health Department, Government of Sindh, Karachi, Pakistan; Pakistan Field Epidemiology Training Program, Sindh Province, Pakistan
| | | | - Robert Fontaine
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
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Borhani M, Mohammadi MA, Entezami M, Baneshi MR, Nasibi S, Prada JM, Fasihi Harandi M. Reinfection of farm dogs following praziquantel treatment in an endemic region of cystic echinococcosis in southeastern Iran. PLoS Negl Trop Dis 2024; 18:e0011939. [PMID: 38536863 PMCID: PMC11020379 DOI: 10.1371/journal.pntd.0011939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 04/16/2024] [Accepted: 01/23/2024] [Indexed: 04/18/2024] Open
Abstract
Cystic Echinococcosis (CE) as a prevalent tapeworm infection of human and herbivorous animals worldwide, is caused by accidental ingestion of Echinococcus granulosus eggs excreted from infected dogs. CE is endemic in the Middle East and North Africa, and is considered as an important parasitic zoonosis in Iran. It is transmitted between dogs as the primary definitive host and different livestock species as the intermediate hosts. One of the most important measures for CE control is dog deworming with praziquantel. Due to the frequent reinfection of dogs, intensive deworming campaigns are critical for breaking CE transmission. Dog reinfection rate could be used as an indicator of the intensity of local CE transmission in endemic areas. However, our knowledge on the extent of reinfection in the endemic regions is poor. The purpose of the present study was to determine E. granulosus reinfection rate after praziquantel administration in a population of owned dogs in Kerman, Iran. A cohort of 150 owned dogs was recruited, with stool samples collected before praziquantel administration as a single oral dose of 5 mg/kg. The re-samplings of the owned dogs were performed at 2, 5 and 12 months following initial praziquantel administration. Stool samples were examined microscopically using Willis flotation method. Genomic DNA was extracted, and E. granulosus sensu lato-specific primers were used to PCR-amplify a 133-bp fragment of a repeat unit of the parasite genome. Survival analysis was performed using Kaplan-Meier method to calculate cumulative survival rates, which is used here to capture reinfection dynamics, and monthly incidence of infection, capturing also the spatial distribution of disease risk. Results of survival analysis showed 8, 12 and 17% total reinfection rates in 2, 5 and 12 months following initial praziquantel administration, respectively, indicating that 92, 88 and 83% of the dogs had no detectable infection in that same time periods. The monthly incidence of reinfection in total owned dog population was estimated at 1.5% (95% CI 1.0-2.1). The results showed that the prevalence of echinococcosis in owned dogs, using copro-PCR assay was 42.6%. However, using conventional microscopy, 8% of fecal samples were positive for taeniid eggs. Our results suggest that regular treatment of the dog population with praziquantel every 60 days is ideal, however the frequency of dog dosing faces major logistics and cost challenges, threatening the sustainability of control programs. Understanding the nature and extent of dog reinfection in the endemic areas is essential for successful implementation of control programs and understanding patterns of CE transmission.
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Affiliation(s)
- Mehdi Borhani
- Research Center for Hydatid Disease in Iran, Kerman University of Medical Sciences, Kerman, Iran
- State Key Laboratory for Zoonotic Diseases, Key Laboratory of Zoonosis Research, Ministry of Education, Institute of Zoonosis, College of Veterinary Medicine, Jilin University, Changchun, China
| | - Mohammad Ali Mohammadi
- Research Center for Hydatid Disease in Iran, Kerman University of Medical Sciences, Kerman, Iran
| | - Mahbod Entezami
- School of Veterinary Medicine, University of Surrey, Guildford, United Kingdom
| | - Mohammad Reza Baneshi
- School of Public Health, The University of Queensland Faculty of Medicine, Herston, Australia
- Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Saeid Nasibi
- Research Center for Hydatid Disease in Iran, Kerman University of Medical Sciences, Kerman, Iran
| | - Joaquin M. Prada
- School of Veterinary Medicine, University of Surrey, Guildford, United Kingdom
| | - Majid Fasihi Harandi
- Research Center for Hydatid Disease in Iran, Kerman University of Medical Sciences, Kerman, Iran
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El Ghassem A, Apolloni A, Vial L, Bouvier R, Bernard C, Khayar MS, Cheikh Ahmed M, Fausther-Bovendo H, Beyit AD, Yahya B, Ould El Mamy MB, Elbara A, Bollahi MA, Cêtre-Sossah C, Ould Mohamed Salem Boukhary A. Risk factors associated with Crimean-Congo hemorrhagic fever virus circulation among human, livestock and ticks in Mauritania through a one health retrospective study. BMC Infect Dis 2023; 23:764. [PMID: 37932678 PMCID: PMC10626674 DOI: 10.1186/s12879-023-08779-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 11/01/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND Crimean Congo hemorrhagic fever (CCHF) is endemic in Southern Mauritania where recurrent outbreaks have been constantly observed since the 1980's. The present study is the first to assess CCHFV antibodies and RNA in humans. METHODS A retrospective study was conducted using 263 humans and 1380 domestic animals serum samples, and 282 tick specimens of Hyalomma genus collected from 54 settings in 12 provinces across Mauritania. Antibodies targeting CCHF viral nucleoprotein were detected in animal and human sera using double-antigen ELISA. CCHFV specific RNA was detected in human and animal sera as well as tick supernatants using a CCHFV real time RT-PCR kit. Individual characteristics of sampled hosts were collected at the same time and data were geo-referenced. Satellite data of several environmental and climatic factors, were downloaded from publicly available datasets, and combined with data on livestock mobility, animal and human density, road accessibility and individual characteristics to identify possible risk factors for CCHFV spatial distribution. To this end, multivariate logistic models were developed for each host category (human, small and large ruminants). RESULTS The overall CCHFV antibody prevalence was 11.8% [95% CI: 8.4-16.3] in humans (17.9% in 2020 and 5.4% in 2021; p = 0.0017) and 33.1% (95% CI: 30.1-36.3) in livestock. CCHFV-specific antibodies were detected in 91 (18.1%) out of 502 sheep, 43 (9.0%) out of 477 goats, 144 (90.5%) out of 161 dromedaries and 179 (74.6%) out of 240 cattle. CCHFV RNA was detected in only 2 (0.7%) sera out of 263 animals herders samples from Hodh El Gharbi province and in 32 (11.3%) out of 282 Hyalomma ticks. In humans as well as in animals, seropositivity was not associated with sex or age groups. The multivariate analysis determined the role of different environmental, climatic and anthropic factors in the spatial distribution of the disease with animal mobility and age being identified as risk factors. CONCLUSION Results of the present study demonstrate the potential risk of CCHF for human population in Mauritania primarily those living in rural areas in close vicinity with animals. Future studies should prioritize an integrative human and veterinary approach for better understanding and managing Crimean-Congo hemorrhagic fever.
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Affiliation(s)
- Abdellahi El Ghassem
- Université de Nouakchott, UR GEMI, BP 5026, Nouakchott, Mauritania.
- ONARDEP, BP 167, Nouakchott, Mauritania.
| | - Andrea Apolloni
- CIRAD, UMR ASTRE, Montpellier Cedex, 34398, France.
- ASTRE, University of Montpellier, CIRAD, INRAe, Montpellier, France.
| | - Laurence Vial
- CIRAD, UMR ASTRE, Montpellier Cedex, 34398, France
- ASTRE, University of Montpellier, CIRAD, INRAe, Montpellier, France
| | - Romain Bouvier
- CIRAD, UMR ASTRE, Montpellier Cedex, 34398, France
- ASTRE, University of Montpellier, CIRAD, INRAe, Montpellier, France
| | - Celia Bernard
- CIRAD, UMR ASTRE, Montpellier Cedex, 34398, France
- ASTRE, University of Montpellier, CIRAD, INRAe, Montpellier, France
| | | | | | - Hugues Fausther-Bovendo
- GUARD, Batiscan, QC, G0X 1A0, Canada
- Department of Microbiology and Immunology, The University of Texas Medical Branch, Galveston, United States
| | | | | | | | | | | | - Catherine Cêtre-Sossah
- CIRAD, UMR ASTRE, Montpellier Cedex, 34398, France
- ASTRE, University of Montpellier, CIRAD, INRAe, Montpellier, France
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Golden JW, Fitzpatrick CJ, Suschak JJ, Clements TL, Ricks KM, Sanchez-Lockhart M, Garrison AR. Induced protection from a CCHFV-M DNA vaccine requires CD8 + T cells. Virus Res 2023; 334:199173. [PMID: 37459918 PMCID: PMC10388194 DOI: 10.1016/j.virusres.2023.199173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 07/13/2023] [Accepted: 07/14/2023] [Indexed: 07/28/2023]
Abstract
Crimean-Congo hemorrhagic fever (CCHF) is a World Health Organization prioritized disease because its broad distribution and severity of disease make it a global health threat. Despite advancements in preclinical vaccine development for CCHF virus (CCHFV), including multiple platforms targeting multiple antigens, a clear definition of the adaptive immune correlates of protection is lacking. Levels of neutralizing antibodies in vaccinated animal models do not necessarily correlate with protection, suggesting that cellular immunity, such as CD8+ T cells, might have an important role in protection in this model. Using a well-established IFN-I antibody blockade mouse model (IS) and a DNA-based vaccine encoding the CCHFV M-segment glycoprotein precursor, we investigated the role of humoral and T cell immunity in vaccine-mediated protection in mice genetically devoid of these immune compartments. We found that in the absence of the B-cell compartment (µMT knockout mice), protection provided by the vaccine was not reduced. In contrast, in the absence of CD8+ T cells (CD8+ knockout mice) the vaccine-mediated protection was significantly diminished. Importantly, humoral responses to the vaccine in CD8+ T-cell knockout mice were equivalent to wild-type mice. These findings indicated that CD8+ T-cell responses are necessary and sufficient to promote protection in mice vaccinated with the M-segment DNA vaccine. Identifying a crucial role of the cellular immunity to protect against CCHFV should help guide the development of CCHFV-targeting vaccines.
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Affiliation(s)
- Joseph W Golden
- Virology Division, United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, MD 21702, United States.
| | - Collin J Fitzpatrick
- Virology Division, United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, MD 21702, United States
| | - John J Suschak
- Virology Division, United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, MD 21702, United States
| | - Tamara L Clements
- Diagnostic Systems Division, United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, MD 21702, United States
| | - Keersten M Ricks
- Diagnostic Systems Division, United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, MD 21702, United States
| | - Mariano Sanchez-Lockhart
- Center for Genome Sciences, Molecular Biology Division, United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, MD 21702, United States
| | - Aura R Garrison
- Virology Division, United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, MD 21702, United States.
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Abstract
Crimean-Congo haemorrhagic fever (CCHF) is a severe tick-borne illness with a wide geographical distribution and case fatality rates of 30% or higher. Caused by infection with the CCHF virus (CCHFV), cases are reported throughout Africa, the Middle East, Asia and southern and eastern Europe. The expanding range of the Hyalomma tick vector is placing new populations at risk for CCHF, and no licensed vaccines or specific antivirals exist to treat CCHF. Furthermore, despite cases of CCHF being reported annually, the host and viral determinants of CCHFV pathogenesis are poorly understood. CCHFV can productively infect a multitude of animal species, yet only humans develop a severe illness. Within human populations, subclinical infections are underappreciated and may represent a substantial proportion of clinical outcomes. Compared with other members of the Bunyavirales order, CCHFV has a more complex genomic organization, with many viral proteins having unclear functions in viral pathogenesis. In recent years, improved animal models have led to increased insights into CCHFV pathogenesis, and several antivirals and vaccines for CCHFV have shown robust efficacy in preclinical models. Translation of these insights and candidate therapeutics to the clinic will hopefully reduce the morbidity and mortality caused by CCHFV.
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Aslam M, Abbas RZ, Alsayeqh A. Distribution pattern of Crimean-Congo Hemorrhagic Fever in Asia and the Middle East. Front Public Health 2023; 11:1093817. [PMID: 36778537 PMCID: PMC9909290 DOI: 10.3389/fpubh.2023.1093817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 01/02/2023] [Indexed: 01/27/2023] Open
Abstract
Crimean-Congo Hemorrhagic Fever (CCHF) is one of the most important vector-borne diseases of zoonotic potential that can be acquired following the bite of the Hyalomma species of ticks. It is a highly prevalent disease in Asia and the Middle East. The risk factors of this disease are contact with infected tissue, blood, patient, or livestock in the acute viremic phase, infected tick bites, or the manual removal of ticks. The disease is clinically described as progressive hemorrhages, fever, and pain in musculature. Biochemical tests reveal elevated levels of creatinine phosphokinase, alanine transaminase, aspartate aminotransferase, and lactate dehydrogenase. Clotting time is prolonged in pro-thrombin tests, and pathogenesis is mostly related to the disruption of the epithelium during viral replication and indirectly by secreting cytotoxic molecules. These molecules cause endothelial activation and result in the loss of function. Supportive therapy is given through blood or plasma infusions to treat or manage the patients. According to the most advanced studies, CCHF can be treated by Ribavirin, which is an antiviral drug that shows excellent results in preventing the disease. Health-care staff are more prone to infection. The hemorrhagic phase represents a high risk for accidental exposures. This literature review presents a comprehensive overview of the viral epidemiology, zoonotic perspectives, and significant risk factors of CCHF in various Middle East and Asian countries. Furthermore, the pathophysiology and preventive strategies of CCHF have also been discussed as well as legislation and policies regarding public outreach programs, research, and development aimed at infection prevention and control that are required at a global level.
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Affiliation(s)
- Munazza Aslam
- Department of Pathology, Faculty of Veterinary Science, University of Agriculture, Faisalabad, Pakistan
| | - Rao Zahid Abbas
- Department of Parasitology, Faculty of Veterinary Science, University of Agriculture, Faisalabad, Pakistan
| | - Abdullah Alsayeqh
- Department of Veterinary Medicine, College of Agriculture and Veterinary Medicine, Qassim University, Buraidah, Qassim, Saudi Arabia,*Correspondence: Abdullah Alsayeqh ✉
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Tabassum S, Naeem A, Khan MZ, Mumtaz N, Gill S, Ohadi L. Crimean-Congo hemorrhagic fever outbreak in Pakistan, 2022: A warning bell amidst unprecedented floods and COVID 19 pandemic. Health Sci Rep 2023; 6:e1055. [PMID: 36655141 PMCID: PMC9835039 DOI: 10.1002/hsr2.1055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 12/19/2022] [Accepted: 12/31/2022] [Indexed: 01/15/2023] Open
Abstract
Crimean-Congo hemorrhagic fever (CCHF) is an infection caused by a tick-borne virus (genus: Nairovirus, family: Bunyaviridae). The most important vector for CCHF is the ixodid tick. Along with tick bite, direct contact with the virus-affected animal is responsible for its spread. Pakistan witnessed its first case of CCHF in 1976 and has been a major victim of CCHF for years, but spikes in cases are seen after Eid-ul-Adha, an Islamic festival involving the sacrifice of cattle. The disease, in particular, is common among butchers, veterinarians, and livestock workers. From the start of this year till June 22, 2022, a total of four cases have been reported across the country. Pakistan faces major challenges in combating CCHF every year due to its specific geographical position and a majority of the population being involved with animal husbandry. There is no approved vaccine for its prevention. All these factors contribute to the burden on the already weakened healthcare system of Pakistan. Strict actions should be taken to contain the spread of the disease. The need of the hour is to engage the general population, raise awareness, and develop policies to ensure disease surveillance. This should be accompanied by fostering collaboration among animal and human health departments for efficient communication and early intervention. The focus should be on medical research to find an efficacious treatment and prophylaxis for the CCHF virus, which will be the cornerstone of future CCHF prevention and control strategies.
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Affiliation(s)
| | - Aroma Naeem
- School of MedicineKing Edward Medical UniversityLahorePakistan
| | | | - Nimra Mumtaz
- School of MedicineKing Edward Medical UniversityLahorePakistan
| | - Saima Gill
- School of MedicineKing Edward Medical UniversityLahorePakistan
| | - Laya Ohadi
- School of MedicineShahid Beheshti University of Medical SciencesTehranIran
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Sahito AM, Mir SL, Waseem M, Awan MAE, Shaikh S, Essar MY. The possibility of the emergence of Crimean-Congo virus cases during Eid ul Adha: A troubling situation during a blessed festival. Ann Med Surg (Lond) 2022; 81:104379. [PMID: 36051816 PMCID: PMC9424933 DOI: 10.1016/j.amsu.2022.104379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 08/11/2022] [Indexed: 11/29/2022] Open
Affiliation(s)
| | | | - Maria Waseem
- Dow University of Health Sciences, Karachi, Pakistan
| | | | - Somina Shaikh
- Dow University of Health Sciences, Karachi, Pakistan
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Ticks on the Run: A Mathematical Model of Crimean-Congo Haemorrhagic Fever (CCHF)-Key Factors for Transmission. EPIDEMIOLGIA (BASEL, SWITZERLAND) 2022; 3:116-134. [PMID: 36417271 PMCID: PMC9620928 DOI: 10.3390/epidemiologia3010010] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 02/28/2022] [Accepted: 03/02/2022] [Indexed: 12/14/2022]
Abstract
Crimean-Congo haemorrhagic fever (CCHF) is a zoonotic disease caused by the Crimean-Congo hemorrhagic fever virus (CCHFV). Ticks of the genus Hyalomma are the main vectors and represent a reservoir for the virus. CCHF is maintained in nature in an endemic vertebrate-tick-vertebrate cycle. The disease is prevalent in wide geographical areas including Asia, Africa, South-Eastern Europe and the Middle East. It is of great importance for the public health given its occasionally high case/fatality ratio of CCHFV in humans. Climate change and the detection of possible CCHFV vectors in Central Europe suggest that the establishment of the transmission in Central Europe may be possible in future. We have developed a compartment-based nonlinear Ordinary Differential Equation (ODE) system to model the disease transmission cycle including blood sucking ticks, livestock and human. Sensitivity analysis of the basic reproduction number R0 shows that decreasing the tick survival time is an efficient method to control the disease. The model supports us in understanding the influence of different model parameters on the spread of CCHFV. Tick-to-tick transmission through co-feeding and the CCHFV circulation through transstadial and transovarial transmission are important factors to sustain the disease cycle. The proposed model dynamics are calibrated through an empirical multi-country analysis and multidimensional plot reveals that the disease-parameter sets of different countries burdened with CCHF are different. This information may help decision makers to select efficient control strategies.
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Kuehnert PA, Stefan CP, Badger CV, Ricks KM. Crimean-Congo Hemorrhagic Fever Virus (CCHFV): A Silent but Widespread Threat. CURRENT TROPICAL MEDICINE REPORTS 2021; 8:141-147. [PMID: 33747715 PMCID: PMC7959879 DOI: 10.1007/s40475-021-00235-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2021] [Indexed: 12/22/2022]
Abstract
Purpose of Review This review is aimed at highlighting recent research and articles on the complicated relationship between virus, vector, and host and how biosurveillance at each level informs disease spread and risk. Recent Findings While human cases of CCHFV and tick identification in non-endemic areas in 2019–2020 were reported to sites such as ProMed, there is a gap in recent published literature on these and broader CCHFV surveillance efforts from the late 2010s. Summary A review of the complex aspects of CCHFV maintenance in the environment coupled with high fatality rate and lack of vaccines and therapeutics warrants the need for a One-Health approach toward detection and increased biosurveillance programs for CCHFV.
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Affiliation(s)
- Paul A Kuehnert
- Diagnostic Systems Division, US Army Medical Research Institute of Infectious Diseases, 1425 Porter St, Frederick, MD 21702 USA
| | - Christopher P Stefan
- Diagnostic Systems Division, US Army Medical Research Institute of Infectious Diseases, 1425 Porter St, Frederick, MD 21702 USA
| | - Catherine V Badger
- Virology Division, US Army Medical Research Institute of Infectious Diseases, 1425 Porter St, Frederick, MD 21702 USA
| | - Keersten M Ricks
- Diagnostic Systems Division, US Army Medical Research Institute of Infectious Diseases, 1425 Porter St, Frederick, MD 21702 USA
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11
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Ahmed A, Saqlain M, Tanveer M, Tahir AH, Ud-Din F, Shinwari MI, Khan GM, Anwer N. Knowledge, attitude and perceptions about Crimean Congo Haemorrhagic Fever (CCHF) among occupationally high-risk healthcare professionals of Pakistan. BMC Infect Dis 2021; 21:35. [PMID: 33413164 PMCID: PMC7792042 DOI: 10.1186/s12879-020-05714-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 12/16/2020] [Indexed: 12/04/2022] Open
Abstract
Background Crimean Congo Haemorrhagic Fever (CCHF), a tropically neglected infectious disease caused by Nairovirus, is endemic in low middle-income countries like Pakistan. Emergency health care professionals (HCPs) are at risk of contracting nosocomial transmission of CCHF. We, therefore, aim to analyze the knowledge, attitudes, and perceptions (KAP) of at-risk physicians, nurses, and pharmacists in Pakistan and the factors associated with good KAP. Method A validated questionnaire (Cronbach’s alpha 0.71) was used to collect data from HCPs in two CCHF endemic metropolitan cities of Pakistan by employing a cross-sectional study design. For data analysis percentages, chi-square test and Spearman correlation were applied by using SPSS version 22. Results Of the 478 participants, 56% (n = 268) were physicians, 37.4% (n = 179) were nurses, and 6.5% (n = 31) were pharmacists. The proportion of HCPs with good knowledge, attitude, and perception scores was 54.3%, 81, and 69%, respectively. Being a physician, having more work experience, having a higher age, working in tertiary care settings, were key factors for higher knowledge (p < 0.001). The correlation coefficient showed significant positive correlation between attitude- perception (r = 0.560, p < 0.001). Conclusion We have observed average knowledge of HCPs. Therefore, we recommend time to time education campaigns and workshops in highly endemic CCHF regions to be launched by health ministries and HCPs, in particular nurses, encouraged to follow authentic academic sources of information to prevent nosocomial transmission. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-020-05714-z.
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Affiliation(s)
- Ali Ahmed
- School of Pharmacy, Monash University, Jalan Lagoon Selatan, Bandar Sunway, 47500, Subang Jaya, Selangor, Malaysia. .,Department of Pharmacy, Quaid-i-Azam University, Islamabad, 45320, Pakistan.
| | - Muhammad Saqlain
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, 45320, Pakistan
| | - Maria Tanveer
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, 45320, Pakistan
| | | | - Fakhar Ud-Din
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, 45320, Pakistan
| | | | - Gul Majid Khan
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, 45320, Pakistan
| | - Naveed Anwer
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, 45320, Pakistan
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Parhizgari N, Piazak N, Mostafavi E. Vector-borne diseases in Iran: epidemiology and key challenges. Future Microbiol 2021; 16:51-69. [PMID: 33438476 DOI: 10.2217/fmb-2019-0306] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Vector-borne diseases have become a global health concern in recent decades as a result of global warming, globalization, growth in international trade and travel, use of insecticide and drug resistance. This review study addressed the key vector-borne diseases and their current status in Iran to emphasize the requirements for further research on vector-borne diseases. The dispersion patterns of these diseases differ in various regions. Some of them such as Crimean-Congo hemorrhagic fever, and Q fever are distributed all across Iran, whereas some others such as plague, leishmaniasis, tularemia, and malaria are restricted to specific areas. The high prevalence of vectors throughout the country necessitates enhancing the monitoring and surveillance of emerging and reemerging vector-borne diseases and their potential vectors.
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Affiliation(s)
- Najmeh Parhizgari
- Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.,Department of Epidemiology and Biostatistics, Research Centre for Emerging & Reemerging infectious diseases, Pasteur Institute of Iran, Tehran, Iran
| | - Norair Piazak
- Department of Parasitology, Pasteur Institute of Iran, Tehran, Iran
| | - Ehsan Mostafavi
- Department of Epidemiology and Biostatistics, Research Centre for Emerging & Reemerging infectious diseases, Pasteur Institute of Iran, Tehran, Iran.,National Reference Laboratory for Plague, Tularemia & Q fever, Research Centre for Emerging & Reemerging Infectious Diseases, Pasteur Institute of Iran, Akanlu, Kabudar Ahang, Hamadan, Iran
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Noreen N, Saima D, Irum N, Asghar RJ, Faiz AU, Mohiuddin N, Ali Khan M, Ullah Khan N, Khudaidad F, Khalid Khan F. ‘Characterisation of suspected Crimean-Congo Haemorrhagic Fever (CCHF) cases in a public sector hospital Islamabad’. GLOBAL SECURITY: HEALTH, SCIENCE AND POLICY 2020. [DOI: 10.1080/23779497.2020.1823869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- Nadia Noreen
- Directorate of Central Health Establishments, IIAP (Airport Health Establishment), Islamabad, Pakistan
| | - Dil Saima
- Livestock & Diary Department, FELTP Pakistan, Rawalpindi, Punjab, Pakistan
| | - Naveed Irum
- Administration, Pakistan Institute of Medical Sciences, Islamabad, Pakistan
| | - Rana Jawad Asghar
- Public Health Department, CEO Global Health Strategists & Implementers (GHSI), Islamabad, Pakistan
| | - Asad Ullah Faiz
- Regulations, Services & Coordinations, Ministry of National Health, Islamabad, Pakistan
| | - Naseer Mohiuddin
- Regulations, Services & Coordinations, Ministry of National Health, Islamabad, Pakistan
| | - Mumtaz Ali Khan
- Federal Disease Surveillance Division, NIH, Islamabad, Pakistan
| | - Naveed Ullah Khan
- Department of Surgery, Federal Government Polyclinic Hospital, Islamabad, Pakistan
| | - Farida Khudaidad
- Department Bolan University of Medical & Health Sciences, FELTP alumnus, Quetta, Pakistan
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Risks of Zoonotic Transmission of COVID-19 During Eid-Ul-Adha in Pakistan. Disaster Med Public Health Prep 2020; 14:e40-e41. [PMID: 32713407 PMCID: PMC7450243 DOI: 10.1017/dmp.2020.278] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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15
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Celebrating Eid-ul-Adha in the era of the COVID-19 pandemic in Pakistan: potential threats and precautionary measures. Clin Microbiol Infect 2020; 26:1714-1715. [PMID: 32712243 PMCID: PMC7376357 DOI: 10.1016/j.cmi.2020.07.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 07/09/2020] [Accepted: 07/14/2020] [Indexed: 11/30/2022]
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16
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Ahmed A, Tahir MJ, Siddiqi AR, Dujaili J. Potential of Crimean-Congo Hemorrhagic Fever outbreak during Eid-Ul-Adha Islamic festival and COVID-19 pandemic in Pakistan. J Med Virol 2020; 93:182-183. [PMID: 32644233 PMCID: PMC7362032 DOI: 10.1002/jmv.26285] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 07/07/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Ali Ahmed
- School of Pharmacy, Monash University, Bandar Sunway, Selangor, Malaysia
| | - Muhammad Junaid Tahir
- Ameer-ud-Din Medical College, University of Health Sciences, Lahore, Punjab, Pakistan
| | | | - Juman Dujaili
- School of Pharmacy, Monash University, Bandar Sunway, Selangor, Malaysia
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Sorvillo TE, Rodriguez SE, Hudson P, Carey M, Rodriguez LL, Spiropoulou CF, Bird BH, Spengler JR, Bente DA. Towards a Sustainable One Health Approach to Crimean-Congo Hemorrhagic Fever Prevention: Focus Areas and Gaps in Knowledge. Trop Med Infect Dis 2020; 5:tropicalmed5030113. [PMID: 32645889 PMCID: PMC7558268 DOI: 10.3390/tropicalmed5030113] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 06/30/2020] [Accepted: 07/01/2020] [Indexed: 12/13/2022] Open
Abstract
Crimean–Congo hemorrhagic fever virus (CCHFV) infection is identified in the 2018 World Health Organization Research and Development Blueprint and the National Institute of Allergy and Infectious Diseases (NIH/NIAID) priority A list due to its high risk to public health and national security. Tick-borne CCHFV is widespread, found in Europe, Asia, Africa, the Middle East, and the Indian subcontinent. It circulates between ticks and several vertebrate hosts without causing overt disease, and thus can be present in areas without being noticed by the public. As a result, the potential for zoonotic spillover from ticks and animals to humans is high. In contrast to other emerging viruses, human-to-human transmission of CCHFV is typically limited; therefore, prevention of spillover events should be prioritized when considering countermeasures. Several factors in the transmission dynamics of CCHFV, including a complex transmission cycle that involves both ticks and vertebrate hosts, lend themselves to a One Health approach for the prevention and control of the disease that are often overlooked by current strategies. Here, we examine critical focus areas to help mitigate CCHFV spillover, including surveillance, risk assessment, and risk reduction strategies concentrated on humans, animals, and ticks; highlight gaps in knowledge; and discuss considerations for a more sustainable One Health approach to disease control.
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Affiliation(s)
- Teresa E. Sorvillo
- One Health Institute, School of Veterinary Medicine, University of California Davis, 1089 Veterinary Medicine Drive, Davis, CA 95616, USA;
- Viral Special Pathogens Branch, Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA; (S.E.R.); (C.F.S.); (J.R.S.)
- Correspondence: ; Tel.: +1-530-752-7526
| | - Sergio E. Rodriguez
- Viral Special Pathogens Branch, Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA; (S.E.R.); (C.F.S.); (J.R.S.)
- Department of Microbiology & Immunology, University of Texas Medical Branch, Galveston, TX 77555, USA; (M.C.); (D.A.B.)
- Galveston National Laboratory, University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Peter Hudson
- Huck Institutes of the Life Sciences, The Pennsylvania State University, University Park, PA 16802, USA;
| | - Megan Carey
- Department of Microbiology & Immunology, University of Texas Medical Branch, Galveston, TX 77555, USA; (M.C.); (D.A.B.)
- Galveston National Laboratory, University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Luis L. Rodriguez
- Foreign Animal Disease Research Unit, Plum Island Animal Disease Center, Agricultural Research Service, United States Department of Agriculture, Orient Point, NY 11957, USA;
| | - Christina F. Spiropoulou
- Viral Special Pathogens Branch, Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA; (S.E.R.); (C.F.S.); (J.R.S.)
| | - Brian H. Bird
- One Health Institute, School of Veterinary Medicine, University of California Davis, 1089 Veterinary Medicine Drive, Davis, CA 95616, USA;
- Viral Special Pathogens Branch, Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA; (S.E.R.); (C.F.S.); (J.R.S.)
| | - Jessica R. Spengler
- Viral Special Pathogens Branch, Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA; (S.E.R.); (C.F.S.); (J.R.S.)
| | - Dennis A. Bente
- Department of Microbiology & Immunology, University of Texas Medical Branch, Galveston, TX 77555, USA; (M.C.); (D.A.B.)
- Galveston National Laboratory, University of Texas Medical Branch, Galveston, TX 77555, USA
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Differential Growth Characteristics of Crimean-Congo Hemorrhagic Fever Virus in Kidney Cells of Human and Bovine Origin. Viruses 2020; 12:v12060685. [PMID: 32630501 PMCID: PMC7354505 DOI: 10.3390/v12060685] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 06/15/2020] [Accepted: 06/16/2020] [Indexed: 12/29/2022] Open
Abstract
Crimean-Congo hemorrhagic fever virus (CCHFV) causes a lethal tick-borne zoonotic disease with severe clinical manifestation in humans but does not produce symptomatic disease in wild or domestic animals. The factors contributing to differential outcomes of infection between species are not yet understood. Since CCHFV is known to have tropism to kidney tissue and cattle play an important role as an amplifying host for CCHFV, in this study, we assessed in vitro cell susceptibility to CCHFV infection in immortalized and primary kidney and adrenal gland cell lines of human and bovine origin. Based on our indirect fluorescent focus assay (IFFA), we suggest a cell-to-cell CCHF viral spread process in bovine kidney cells but not in human cells. Over the course of seven days post-infection (dpi), infected bovine kidney cells are found in restricted islet-like areas. In contrast, three dpi infected human kidney or adrenal cells were noted in areas distant from one another yet progressed to up to 100% infection of the monolayer. Pronounced CCHFV replication, measured by quantitative real-time RT-PCR (qRT-PCR) of both intra- and extracellular viral RNA, was documented only in human kidney cells, supporting restrictive infection in cells of bovine origin. To further investigate the differences, lactate dehydrogenase activity and cytopathic effects were measured at different time points in all mentioned cells. In vitro assays indicated that CCHFV infection affects human and bovine kidney cells differently, where human cell lines seem to be markedly permissive. This is the initial reporting of CCHFV susceptibility and replication patterns in bovine cells and the first report to compare human and animal cell permissiveness in vitro. Further investigations will help to understand the impact of different cell types of various origins on the virus–host interaction.
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Investigation of Crimean-Congo hemorrhagic fever virus in ruminant species slaughtered in several endemic provinces in Turkey. Arch Virol 2020; 165:1759-1767. [PMID: 32435856 DOI: 10.1007/s00705-020-04665-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 04/15/2020] [Indexed: 10/24/2022]
Abstract
A total of 1,337 serum and plasma specimens (939, 393 and 15 from cattle, sheep and goats, respectively) were collected monthly for one a year from ruminant species slaughtered in three Turkish cities endemic for Crimean-Congo hemorrhagic fever virus (CCHFV), Samsun, Sivas and Tokat. The serum samples were tested by commercial indirect ELISA to detect CCHFV antibodies, and positive or equivocal samples were later confirmed by a virus neutralization test (VNT). The seroprevalence in cattle, sheep, and goats was 36.21% (340/939), 6.27% (24/383), and 6.67% (1/15), respectively. Quantitative real-time RT-PCR was employed to detect viraemic animals at slaughter time. The percentage of CCHFV-viraemic animals was 0.67% (9/1337). The virus load varied between 4.1 x 101 and 2.4 x 103 RNA equivalent copies/mL in viraemic animals. The plasma samples that were positive for CCHFV genomic RNA were collected between April and May, when Hyalomma ticks are active. This study presents quantitative CCHFV load data in ruminant species at slaughter and interprets the likelihood of transmission for employees working in slaughterhouses in CCHFV-endemic regions.
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Tipih T, Burt FJ. Crimean-Congo Hemorrhagic Fever Virus: Advances in Vaccine Development. Biores Open Access 2020; 9:137-150. [PMID: 32461819 PMCID: PMC7247048 DOI: 10.1089/biores.2019.0057] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2020] [Indexed: 01/12/2023] Open
Abstract
Crimean-Congo hemorrhagic fever (CCHF) is a severe human disease with mortality rates of up to 30%. The disease is widespread in Africa, Asia, the Middle East and Eastern Europe. The last few years have seen disease emergence in Spain for the first time and disease re-emergence in other regions of the world after periods of inactivity. Factors, such as climate change, movement of infected ticks, animals, and changes in human activity, are likely to broaden endemic foci. There are therefore concerns that CCHF might emerge in currently nonendemic regions. The absence of approved vaccines or therapies heightens these concerns; thus Crimean-Congo hemorrhagic fever virus (CCHFV) is listed by the World Health Organization as a priority organism. However, the current sporadic nature of CCHF cases may call for targeted vaccination of risk groups as opposed to mass vaccinations. CCHF vaccine development has accelerated in recent years, partly because of the discovery of CCHF animal models. In this review, we discuss CCHF risk groups who are most likely to benefit from vaccine development, the merits and demerits of available CCHF animal models, and the various approaches which have been explored for CCHF vaccine development. Lastly, we present concluding remarks and research areas which can be further explored to enhance the available CCHFV vaccine data.
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Affiliation(s)
- Thomas Tipih
- Division of Virology, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - Felicity Jane Burt
- Division of Virology, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
- National Health Laboratory Service, Bloemfontein, South Africa
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Ibrahim A, Budisatria IGS, Widayanti R, Artama WT. The impact of religious festival on roadside livestock traders in urban and peri-urban areas of Yogyakarta, Indonesia. Vet World 2019; 12:1408-1415. [PMID: 31749574 PMCID: PMC6813619 DOI: 10.14202/vetworld.2019.1408-1415] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background and Aim: Eid al-Adha is one of the most important festivals celebrated by Muslims in Indonesia. Roadside livestock traders open their stalls during the Eid al-Adha period. This study aimed to investigate the characteristics and behaviors of roadside livestock traders in urban and peri-urban areas in Yogyakarta, Indonesia. Materials and Methods: In-depth interviews with 36 roadside livestock traders were conducted on August 7-23, 2018 in urban (n=20) and peri-urban (n=16) areas of Yogyakarta. The collected data were analyzed by descriptive and statistical analysis using one-way analysis of variance. Results: The results indicate that the trading activities of roadside livestock traders in urban areas last longer (p<0.05) than in peri-urban areas. No difference was found in the opening day of stalls, the number of buyers, and trends in animal prices set by roadside livestock traders in urban and peri-urban areas. Most traders sell sheep and goats, buy livestock at the animal market, and only open their stalls during Eid al-Adha. Prices are high in this period, and buyers directly visit the stalls. A significant difference exists in the selling price of livestock between Eid al-Adha and ordinary days (non-festival), and most roadside traders benefit from the Eid al-Adha momentum. Conclusion: Significant similarities exist among roadside livestock traders during the Eid al-Adha period in urban and peri-urban areas of Yogyakarta, Indonesia. Sheep are more desirable than goats and cattle in this period, and Eid al-Adha generates a high profit for roadside livestock traders.
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Affiliation(s)
- Alek Ibrahim
- Study Program of Veterinary Science, Faculty of Veterinary Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - I Gede Suparta Budisatria
- Department of Animal Production, Faculty of Animal Science, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Rini Widayanti
- Department of Biochemistry and Molecular Biology, Faculty of Veterinary Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Wayan Tunas Artama
- Department of Biochemistry and Molecular Biology, Faculty of Veterinary Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
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Sahak MN, Arifi F, Saeedzai SA. Descriptive epidemiology of Crimean-Congo Hemorrhagic Fever (CCHF) in Afghanistan: Reported cases to National Surveillance System, 2016-2018. Int J Infect Dis 2019; 88:135-140. [PMID: 31442628 PMCID: PMC6853159 DOI: 10.1016/j.ijid.2019.08.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 08/10/2019] [Accepted: 08/15/2019] [Indexed: 11/17/2022] Open
Abstract
Crimean-Congo Hemorrhagic Fever (CCHF) has significantly increased in Afghanistan during recent years. Those who are exposed to the vector (Hyalomma ticks), infected animals, the blood and tissues of freshly slaughtered livestock are most at risk. The cases reach to its peak during Eid-al-Adha when people are sacrificing animals. Information on CCHF pathogen genotypes and lineage, strain movement and sequence diversity of the CCHF in Afghanistan is not known yet.
Objective This study aims to provide descriptive epidemiology of human CCHF cases in Afghanistan by demographic, geographical, and seasonal characteristics. Methodology This paper’s findings are based on the retrospective analysis of the National Surveillance System’s collected data from 2016 to 2018. Weekly cases exceeding the 90th percentile of the expected number of cases were considered to be exceptional and above normal. Results The National Surveillance System detected 1,284 CCHF cases from 2007 to 2018, of which 163 cases were in 2016, 245 cases in 2017 and 483 cases in 2018. A total of 891 suspected and confirmed cases were reported between 2016 and 2018, 293 (33%) of these cases were confirmed by detecting IgM antibody using ELISA and RT-PCR. Among confirmed cases, the three-year case fatality ratio (CFR) was 43.3%. Among the reported cases, 68.5% were males and 31.5% females. The frequent reported occupational groups were housewives (15%), health staff (13%), shepherds (11%), butchers (6%), students (6%), animal dealers and farmers (both 2%) respectively, 19% were unemployed, and occupation was not recorded for 26% of cases. Conclusion Recently, CCHF has significantly increased in Afghanistan. Despite the increased frequency of cases, the laboratory capacity to test specimens and overall knowledge of CCHF management remains limited.
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Al-Abri SS, Hewson R, Al-Kindi H, Al-Abaidani I, Al-Jardani A, Al-Maani A, Almahrouqi S, Atkinson B, Al-Wahaibi A, Al-Rawahi B, Bawikar S, Beeching NJ. Clinical and molecular epidemiology of Crimean-Congo hemorrhagic fever in Oman. PLoS Negl Trop Dis 2019; 13:e0007100. [PMID: 31022170 PMCID: PMC6504112 DOI: 10.1371/journal.pntd.0007100] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Revised: 05/07/2019] [Accepted: 03/04/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Crimean-Congo hemorrhagic fever (CCHF) is a serious disease with a high fatality rate reported in many countries. The first case of CCHF in Oman was detected in 1995 and serosurveys have suggested widespread infection of humans and livestock throughout the country. METHODOLOGY Cases of CCHF reported to the Ministry of Health (MoH) of Oman between 1995 and 2017 were retrospectively reviewed. Diagnosis was confirmed by serology and/or molecular tests in Oman. Stored RNA from recent cases was studied by sequencing the complete open reading frame (ORF) of the viral S segment at Public Health England, enabling phylogenetic comparisons to be made with other S segments of strains obtained from the region. FINDINGS Of 88 cases of CCHF, 4 were sporadic in 1995 and 1996, then none were detected until 2011. From 2011-2017, incidence has steadily increased and 19 (23.8%) of 80 cases clustered around Eid Al Adha. The median (range) age was 33 (15-68) years and 79 (90%) were male. The major risk for infection was contact with animals and/or butchering in 73/88 (83%) and only one case was related to tick bites alone. Severe cases were over-represented: 64 (72.7%) had a platelet count < 50 x 109/L and 32 (36.4%) died. There was no intrafamilial spread or healthcare-associated infection. The viral S segments from 11 patients presenting in 2013 and 2014 were all grouped in Asia 1 (IV) lineage. CONCLUSIONS CCHF is well-established throughout Oman, with a single strain of virus present for at least 20 years. Most patients are men involved in animal husbandry and butchery. The high mortality suggests that there is substantial under-diagnosis of milder cases. Preventive measures have been introduced to reduce risks of transmission to animal handlers and butchers and to maintain safety in healthcare settings.
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Affiliation(s)
- Seif S. Al-Abri
- Seif Al-Abri, Directorate General for Disease Surveillance and Control, MoH, Muscat, Oman
- Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, United Kingdom
- * E-mail:
| | - Roger Hewson
- Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, United Kingdom
- WHO Collaborating Centre for Virus Reference and Research (Special Pathogens), Public Health England – National Infection Service, Porton Down, Salisbury, United Kingdom
- Faculty of Infectious and Tropical Diseases, Dept Pathogen Molecular Biology, London School of Hygiene & Tropical Medicine Institute of Tropical Medicine, Dept Emerging Disease, Nagasaki University, Nagasaki, Japan
| | - Hanan Al-Kindi
- Central Public Health Laboratory, Directorate General for Disease Surveillance and Control, MoH, Muscat, Oman
| | - Idris Al-Abaidani
- Department of Communicable Diseases, Directorate General for Disease Surveillance and Control, MoH, Muscat, Oman
| | - Amina Al-Jardani
- Central Public Health Laboratory, Directorate General for Disease Surveillance and Control, MoH, Muscat, Oman
| | - Amal Al-Maani
- Department of Infection Prevention and Control, Directorate General for Disease Surveillance and Control, MoH, Muscat, Oman
| | - Samira Almahrouqi
- Central Public Health Laboratory, Directorate General for Disease Surveillance and Control, MoH, Muscat, Oman
| | - Barry Atkinson
- WHO Collaborating Centre for Virus Reference and Research (Special Pathogens), Public Health England – National Infection Service, Porton Down, Salisbury, United Kingdom
| | - Adil Al-Wahaibi
- Department of Surveillance, Directorate General for Disease Surveillance and Control, MoH, Muscat, Oman
| | - Bader Al-Rawahi
- Department of Communicable Diseases, Directorate General for Disease Surveillance and Control, MoH, Muscat, Oman
| | - Shyam Bawikar
- Department of Surveillance, Directorate General for Disease Surveillance and Control, MoH, Muscat, Oman
| | - Nicholas J. Beeching
- Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, United Kingdom
- Tropical and Infectious Disease Unit, Royal Liverpool University Hospital, Liverpool, United Kingdom
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Educational Intervention Based on Health Belief Model on the Adoption of Preventive Behaviors of Crimean-Congo Hemorrhagic Fever in Ranchers. HEALTH SCOPE 2019. [DOI: 10.5812/jhealthscope.14112] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Al-Tawfiq JA, Memish ZA. Dengue Hemorrhagic Fever Virus in Saudi Arabia: A Review. Vector Borne Zoonotic Dis 2018; 18:75-81. [PMID: 29319426 DOI: 10.1089/vbz.2017.2209] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Dengue fever is a global disease with a spectrum of clinical manifestation ranging from mild febrile disease to a severe disease in the form of dengue hemorrhagic fever and dengue shock syndrome. Dengue virus is one viral hemorrhagic fever that exists in the Kingdom of Saudi Arabia in addition to Alkhurma (Alkhurma) Hemorrhagic Fever, Chikungunya virus, Crimean-Congo Hemorrhagic Fever, and Rift Valley Fever. The disease is limited to the Western and South-western regions of Saudi Arabia, where Aedes aegypti exists. The majority of the cases in Saudi Arabia had mild disease and is related to serotypes 1-3 but not 4. The prospect for Dengue virus control relies on vector control, health education, and possibly vaccine use. Despite extensive collaborative efforts between multiple governmental sectors, including Ministry of Health, Ministry of Municipalities and Rural Affairs, and Ministry of Water, dengue remains a major public health concern in the regions affected.
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Affiliation(s)
- Jaffar A Al-Tawfiq
- 1 Johns Hopkins Aramco Healthcare , Dhahran, Kingdom of Saudi Arabia.,2 Indiana University School of Medicine , Indianapolis, Indiana
| | - Ziad A Memish
- 3 Ministry of Health , Riyadh, Kingdom of Saudi Arabia.,4 Hubert Department of Global Health, Rollins School of Public Health, Emory University , Atlanta, Georgia
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Dereli AS, Kayser V. Crimean–Congo Hemorrhagic Fever: A bibliometric assessment of the literature. J Infect Public Health 2018; 11:147-148. [DOI: 10.1016/j.jiph.2017.06.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 06/09/2017] [Indexed: 10/19/2022] Open
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Abbas T, Xu Z, Younus M, Qayyum A, Riaz MT. Seasonality in hospital admissions of Crimean-Congo hemorrhagic fever and its dependence on ambient temperature-empirical evidence from Pakistan. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2017; 61:1893-1897. [PMID: 28455635 DOI: 10.1007/s00484-017-1359-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 08/31/2016] [Accepted: 04/17/2017] [Indexed: 06/07/2023]
Abstract
Crimean-Congo hemorrhagic fever (CCHF) has been reported from all provinces of Pakistan. Little is known about the seasonal variations in the disease and its association with weather conditions. In this study, we explored time-series data about monthly number of CCHF admissions (2007-2010) in three public sector hospitals of Quetta-the capital city of Baluchistan province of Pakistan. Cosinor analysis was carried out to investigate seasonality in the data. To assess the effect of average monthly ambient temperature (°C) on disease, a distributed lag nonlinear model (DLNM) was applied. Cosinor model revealed statistically significant seasonality in monthly number of CCHF patients admitted to the study hospitals. The estimated amplitude was 3.24 cases per month with phase in mid-June and low point in mid-December. DLNM confirmed nonlinear and delayed effect of temperature on hospital admissions. At a lag of 2 months, the cumulative relative risk was more than 1 at temperature at 18.37 °C and above. In addition, relative risk was significantly high at 60th (21.98 °C), 70th (24.50 °C), 80th (27.33 °C), and 90th (29.25 °C) percentiles of temperature (relative to median value, 18.37 °C). Inclusion of Eid-al-Adha as a predictor did not improve the fitness of DLNM. Based on our analysis, we concluded significant seasonality in CCHF hospital admissions. Our findings also suggested average monthly ambient temperature (°C) as a significant predictor of CCHF hospitalizations. DLNM presented in this study may be improved with inclusion of other possible time-varying predictors particularly meteorological conditions of this region.
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Affiliation(s)
- Tariq Abbas
- University College of Veterinary & Animal Sciences, Islamia University of Bahawalpur, Baghdad-ul-Jadeed Campus, Bahawalpur, Pakistan.
| | - Zhiwei Xu
- School of Public Health, Institute of Health and Biomedical Innovation, Queensland University of Technology, Victoria Park Road, Kelvin Grove, QLD, 4059, Australia
| | - Muhammad Younus
- University of Veterinary & Animal Sciences, Lahore, Pakistan
| | - Abdul Qayyum
- University College of Veterinary & Animal Sciences, Islamia University of Bahawalpur, Baghdad-ul-Jadeed Campus, Bahawalpur, Pakistan
| | - Muhammad T Riaz
- Livestock & Dairy Development Department, Government of Punjab, Lahore, Pakistan
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Dowall SD, Carroll MW, Hewson R. Development of vaccines against Crimean-Congo haemorrhagic fever virus. Vaccine 2017; 35:6015-6023. [PMID: 28687403 PMCID: PMC5637709 DOI: 10.1016/j.vaccine.2017.05.031] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 04/24/2017] [Accepted: 05/10/2017] [Indexed: 11/19/2022]
Abstract
Crimean-Congo haemorrhagic fever virus (CCHFV) is a deadly human pathogen of the utmost seriousness being highly lethal causing devastating disease symptoms that result in intense and prolonged suffering to those infected. During the past 40years, this virus has repeatedly caused sporadic outbreaks responsible for relatively low numbers of human casualties, but with an alarming fatality rate of up to 80% in clinically infected patients. CCHFV is transmitted to humans by Hyalomma ticks and contact with the blood of viremic livestock, additionally cases of human-to-human transmission are not uncommon in nosocomial settings. The incidence of CCHF closely matches the geographical range of permissive ticks, which are widespread throughout Africa, Asia, the Middle East and Europe. As such, CCHFV is the most widespread tick-borne virus on earth. It is a concern that recent data shows the geographic distribution of Hyalomma ticks is expanding. Migratory birds are also disseminating Hyalomma ticks into more northerly parts of Europe thus potentially exposing naïve human populations to CCHFV. The virus has been imported into the UK on two occasions in the last five years with the first fatal case being confirmed in 2012. A licensed vaccine to CCHF is not available. In this review, we discuss the background and complications surrounding this limitation and examine the current status and recent advances in the development of vaccines against CCHFV.
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Affiliation(s)
- Stuart D Dowall
- Public Health England, Porton Down, Salisbury, Wiltshire SP4 0JG, UK
| | - Miles W Carroll
- Public Health England, Porton Down, Salisbury, Wiltshire SP4 0JG, UK
| | - Roger Hewson
- Public Health England, Porton Down, Salisbury, Wiltshire SP4 0JG, UK.
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Leblebicioglu H, Ozaras R, Sunbul M. Crimean-Congo hemorrhagic fever: A neglected infectious disease with potential nosocomial infection threat. Am J Infect Control 2017; 45:815-816. [PMID: 28410826 DOI: 10.1016/j.ajic.2016.05.039] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 05/03/2016] [Indexed: 10/19/2022]
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Alkhurma hemorrhagic fever virus. Microbes Infect 2017; 19:305-310. [PMID: 28456648 DOI: 10.1016/j.micinf.2017.04.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 04/15/2017] [Accepted: 04/16/2017] [Indexed: 01/03/2023]
Abstract
Alkhurma hemorrhagic fever virus (AHFV) was first isolated in Jeddah, Saudi Arabia, in the 1990s from the blood of a butcher. Subsequently, the virus was recognized in many patients in Saudi Arabia and rarely from Egypt and Djibouti. In this review, we summarize the current literature on AHFV globally with special focus on Saudi Arabia.
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Tanyel E, Sunbul M, Fletcher TE, Leblebicioglu H. Aetiology of PCR negative suspected Crimean-Congo hemorrhagic fever cases in an endemic area. Pathog Glob Health 2017; 110:173-7. [PMID: 27677379 PMCID: PMC5072119 DOI: 10.1080/20477724.2016.1213958] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Crimean–Congo hemorrhagic fever (CCHF) is a potentially fatal tick-borne viral infection that is widely distributed worldwide. The diagnosis is frequently missed due to the non-specific initial symptoms and the differential diagnosis included many infectious and non-infectious causes. This retrospective study describes the clinical features and final diagnoses of 116 suspect CCHF cases that were admitted to a tertiary CCHF center in Turkey, and were CCHF IgM and PCR negative.
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Affiliation(s)
- Esra Tanyel
- a Department of Infectious Disease and Clinical Microbiology , Ondokuz Mayıs University, Medical School , Samsun , Turkey
| | - Mustafa Sunbul
- a Department of Infectious Disease and Clinical Microbiology , Ondokuz Mayıs University, Medical School , Samsun , Turkey
| | - Tom E Fletcher
- a Department of Infectious Disease and Clinical Microbiology , Ondokuz Mayıs University, Medical School , Samsun , Turkey.,b Liverpool School of Tropical Medicine , Liverpool , UK
| | - Hakan Leblebicioglu
- a Department of Infectious Disease and Clinical Microbiology , Ondokuz Mayıs University, Medical School , Samsun , Turkey
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Abstract
Viral hemorrhagic fever (VHF) refers to a group of diseases characterized by an acute febrile syndrome with hemorrhagic manifestations and high mortality rates caused by several families of viruses that affect humans and animals. These diseases are typically endemic in certain geographical regions and sometimes cause major outbreaks. The history of hemorrhagic fever in the Arabian Peninsula refers to the 19th century and most outbreaks were reported in the Tihamah region—the Red Sea coastal plain of the Arabian Peninsula in the west and southwest of Saudi Arabia and Yemen. Herein, we describe the agents that cause VHFs and their epidemiology in Tihamah, the history of the diseases, transmission, species affected, and clinical signs. Finally, we address challenges in the diagnosis and control of VHFs in this region.
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Atif M, Saqib A, Ikram R, Sarwar MR, Scahill S. The reasons why Pakistan might be at high risk of Crimean Congo haemorrhagic fever epidemic; a scoping review of the literature. Virol J 2017; 14:63. [PMID: 28335777 PMCID: PMC5364605 DOI: 10.1186/s12985-017-0726-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 03/08/2017] [Indexed: 11/10/2022] Open
Abstract
Pakistan has faced a number of significant healthcare challenges over the past decade. In 2000, one of these events - a deadly epidemic of Crimean Congo Haemorrhagic Fever (CCHF) - struck Pakistan. The people of Pakistan are at a very high risk of acquiring CCHF, due to a number of factors which emerge from a scoping review of the literature. First, the underdeveloped healthcare system of the country is currently not prepared to cope with challenges of this nature. Healthcare professionals and medical institutes are not sufficiently equipped to properly diagnose, manage and prevent CCHF. Second, a large percentage of the general public is unaware of the spread and control of the vector. The agricultural sector of Pakistan is vast and thus many people are involved in animal husbandry and the handling of livestock which can lead to the transmission of the CCHF virus. Even in urban areas the risk of transmission is significantly higher around the time of Eid-ul-Azha, when Muslims slaughter animals. Finally, the political upheavals faced by the country have also increased Pakistan's vulnerability because a large number of refugees from Afghanistan, a CCHF endemic country, have migrated to Pakistan as a result of the Afghan war. Most of the refugees and their animals settle in Baluchistan and Khyber Pakhtunkhwa provinces, which consequently have a higher prevalence of CCHF. This scoping review of the literature highlights the potential causes of high risk CCHF and draws conclusions and makes recommendations that policy-makers in Pakistan may wish to consider in-order to improve on the current situation.
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Affiliation(s)
- Muhammad Atif
- The Islamia University of Bahawalpur, Bahawalpur, Punjab, Pakistan
| | - Anum Saqib
- The Islamia University of Bahawalpur, Bahawalpur, Punjab, Pakistan.
| | - Raazeyah Ikram
- The Islamia University of Bahawalpur, Bahawalpur, Punjab, Pakistan
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Al-Abri SS, Abaidani IA, Fazlalipour M, Mostafavi E, Leblebicioglu H, Pshenichnaya N, Memish ZA, Hewson R, Petersen E, Mala P, Nhu Nguyen TM, Rahman Malik M, Formenty P, Jeffries R. Current status of Crimean-Congo haemorrhagic fever in the World Health Organization Eastern Mediterranean Region: issues, challenges, and future directions. Int J Infect Dis 2017; 58:82-89. [PMID: 28259724 PMCID: PMC7110796 DOI: 10.1016/j.ijid.2017.02.018] [Citation(s) in RCA: 101] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 02/17/2017] [Accepted: 02/20/2017] [Indexed: 01/19/2023] Open
Abstract
The paper provides a comprehensive overview of the status of Crimean-Congo hemorrhagic fever (CCHF) in countries across the World Health Organization Eastern Mediterranean Region (WHO EMR). The increasing incidence of CCHF disease in the region and its spread to new geographical areas is highlighted. Knowledge gaps concerning the burden and circulation of CCHF virus in the WHO EMR are identified. A strategic framework is described, which details the research and development work necessary to curb the ongoing and new threats posed by CCHF virus.
Crimean-Congo haemorrhagic fever (CCHF) is the most widespread, tick-borne viral disease affecting humans. The disease is endemic in many regions, such as Africa, Asia, Eastern and Southern Europe, and Central Asia. Recently, the incidence of CCHF has increased rapidly in the countries of the World Health Organization Eastern Mediterranean Region (WHO EMR), with sporadic human cases and outbreaks of CCHF being reported from a number of countries in the region. Despite the rapidly growing incidence of the disease, there are currently no accurate data on the burden of the disease in the region due to the different surveillance systems used for CCHF in these countries. In an effort to increase our understanding of the epidemiology and risk factors for the transmission of the CCHF virus (CCHFV; a Nairovirus of the family Bunyaviridae) in the WHO EMR, and to identify the current knowledge gaps that are hindering effective control interventions, a sub-regional meeting was organized in Muscat, Oman, from December 7 to 9, 2015. This article summarizes the current knowledge of the disease in the region, identifies the knowledge gaps that present challenges for the prevention and control of CCHFV, and details a strategic framework for research and development activities that would be necessary to curb the ongoing and new threats posed by CCHFV.
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Affiliation(s)
| | | | - Mehdi Fazlalipour
- Department of Arbovirus and Viral Hemorrhagic Fever, Pasteur Institute of Iran, Tehran, Iran
| | - Ehsan Mostafavi
- Research Centre for Emerging and Re-emerging Infectious Diseases, Pasteur Institute of Iran, Tehran, Iran
| | - Hakan Leblebicioglu
- Department of Infectious Diseases and Clinical Microbiology, Ondokuz Mayis University, Samsun, Turkey
| | - Natalia Pshenichnaya
- Head of Infectious Diseases Department, Infectious Disease Department, Rostov State Medical University, Moscow, Russia
| | - Ziad A Memish
- Hubert Department of Global Health, School of Public Health, Emory University, Atlanta, USA
| | - Roger Hewson
- Arboviruses and VHFs, WHO Collaborating Centre (Special Pathogens), National Infection Service Public Health England, Porton Down, Salisbury, UK
| | | | - Peter Mala
- Infectious Hazards Management, World Health Organization, Eastern Mediterranean Regional Office, Cairo, Egypt
| | - Tran Minh Nhu Nguyen
- Infectious Hazards Management, World Health Organization, Eastern Mediterranean Regional Office, Cairo, Egypt
| | - Mamunur Rahman Malik
- Infectious Hazards Management, World Health Organization, Eastern Mediterranean Regional Office, Cairo, Egypt.
| | - Pierre Formenty
- Infectious Hazards Management, World Health Organization, Geneva, Switzerland
| | - Rosanna Jeffries
- Infectious Hazards Management, World Health Organization, Geneva, Switzerland
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Sweileh WM. Global research trends of World Health Organization's top eight emerging pathogens. Global Health 2017; 13:9. [PMID: 28179007 PMCID: PMC5299748 DOI: 10.1186/s12992-017-0233-9] [Citation(s) in RCA: 122] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 02/03/2017] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND On December 8th, 2015, World Health Organization published a priority list of eight pathogens expected to cause severe outbreaks in the near future. To better understand global research trends and characteristics of publications on these emerging pathogens, we carried out this bibliometric study hoping to contribute to global awareness and preparedness toward this topic. METHOD Scopus database was searched for the following pathogens/infectious diseases: Ebola, Marburg, Lassa, Rift valley, Crimean-Congo, Nipah, Middle Eastern Respiratory Syndrome (MERS), and Severe Respiratory Acute Syndrome (SARS). Retrieved articles were analyzed to obtain standard bibliometric indicators. RESULTS A total of 8619 journal articles were retrieved. Authors from 154 different countries contributed to publishing these articles. Two peaks of publications, an early one for SARS and a late one for Ebola, were observed. Retrieved articles received a total of 221,606 citations with a mean ± standard deviation of 25.7 ± 65.4 citations per article and an h-index of 173. International collaboration was as high as 86.9%. The Centers for Disease Control and Prevention had the highest share (344; 5.0%) followed by the University of Hong Kong with 305 (4.5%). The top leading journal was Journal of Virology with 572 (6.6%) articles while Feldmann, Heinz R. was the most productive researcher with 197 (2.3%) articles. China ranked first on SARS, Turkey ranked first on Crimean-Congo fever, while the United States of America ranked first on the remaining six diseases. Of retrieved articles, 472 (5.5%) were on vaccine - related research with Ebola vaccine being most studied. CONCLUSION Number of publications on studied pathogens showed sudden dramatic rise in the past two decades representing severe global outbreaks. Contribution of a large number of different countries and the relatively high h-index are indicative of how international collaboration can create common health agenda among distant different countries.
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MESH Headings
- Animals
- Bibliometrics/history
- Communicable Diseases/epidemiology
- Communicable Diseases, Emerging/epidemiology
- Communicable Diseases, Emerging/prevention & control
- Coronavirus Infections/complications
- Coronavirus Infections/epidemiology
- Coronavirus Infections/prevention & control
- Disease Outbreaks/prevention & control
- Hemorrhagic Fever, Crimean/complications
- Hemorrhagic Fever, Crimean/epidemiology
- Hemorrhagic Fever, Crimean/prevention & control
- Hemorrhagic Fever, Ebola/complications
- Hemorrhagic Fever, Ebola/epidemiology
- Hemorrhagic Fever, Ebola/prevention & control
- History, 20th Century
- History, 21st Century
- Humans
- Lassa Fever/complications
- Lassa Fever/epidemiology
- Lassa Fever/prevention & control
- Marburg Virus Disease/complications
- Marburg Virus Disease/epidemiology
- Marburg Virus Disease/prevention & control
- Nipah Virus/pathogenicity
- Research/statistics & numerical data
- Research/trends
- Rift Valley Fever/complications
- Rift Valley Fever/epidemiology
- Rift Valley Fever/prevention & control
- Severe Acute Respiratory Syndrome/complications
- Severe Acute Respiratory Syndrome/epidemiology
- Severe Acute Respiratory Syndrome/prevention & control
- World Health Organization/organization & administration
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Affiliation(s)
- Waleed M Sweileh
- Department of Physiology and Pharmacology/Toxicology, College of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine.
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36
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McKenzie JS, Dahal R, Kakkar M, Debnath N, Rahman M, Dorjee S, Naeem K, Wijayathilaka T, Sharma BK, Maidanwal N, Halimi A, Kim E, Chatterjee P, Devleesschauwer B. One Health research and training and government support for One Health in South Asia. Infect Ecol Epidemiol 2016; 6:33842. [PMID: 27906123 PMCID: PMC5131453 DOI: 10.3402/iee.v6.33842] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Revised: 10/26/2016] [Accepted: 10/27/2016] [Indexed: 12/14/2022] Open
Abstract
Introduction Considerable advocacy, funding, training, and technical support have been provided to South Asian countries to strengthen One Health (OH) collaborative approaches for controlling diseases with global human pandemic potential since the early 2000s. It is essential that the OH approach continues to be strengthened given South Asia is a hot spot for emerging and endemic zoonotic diseases. The objectives of this article are to describe OH research and training and capacity building activities and the important developments in government support for OH in these countries to identify current achievements and gaps. Materials and methods A landscape analysis of OH research, training, and government support in South Asia was generated by searching peer-reviewed and grey literature for OH research publications and reports, a questionnaire survey of people potentially engaged in OH research in South Asia and the authors’ professional networks. Results Only a small proportion of zoonotic disease research conducted in South Asia can be described as truly OH, with a significant lack of OH policy-relevant research. A small number of multisectoral OH research and OH capacity building programmes were conducted in the region. The governments of Bangladesh and Bhutan have established operational OH strategies, with variable progress institutionalising OH in other countries. Identified gaps were a lack of useful scientific information and of a collaborative culture for formulating and implementing integrated zoonotic disease control policies and the need for ongoing support for transdisciplinary OH research and policy-relevant capacity building programmes. Discussion Overall we found a very small number of truly OH research and capacity building programmes in South Asia. Even though significant progress has been made in institutionalising OH in some South Asian countries, further behavioural, attitudinal, and institutional changes are required to strengthen OH research and training and implementation of sustainably effective integrated zoonotic disease control policies.
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Affiliation(s)
- Joanna S McKenzie
- International Development Group, Institute of Veterinary Animal and Biomedical Sciences, Massey University, Palmerston North, New Zealand;
| | | | | | - Nitish Debnath
- United Nations Food and Agriculture Organisation, Dhaka, Bangladesh
| | - Mahmudur Rahman
- Institute of Epidemiology Disease Control and Research, Directorate General of Health Services, Ministry of Health and Family Welfare, Government of the People's Republic of Bangladesh, Dhaka, Bangladesh
| | - Sithar Dorjee
- Bhutan Agriculture and Food Regulation Authority, Thimpu, Bhutan
| | - Khalid Naeem
- Animal Sciences Institute, Pakistan Agriculture Research Centre, Islamabad, Pakistan
| | | | | | | | | | - Eunmi Kim
- International Development Group, Institute of Veterinary Animal and Biomedical Sciences, Massey University, Palmerston North, New Zealand
| | | | - Brecht Devleesschauwer
- Department of Public Health and Surveillance, Scientific Institute of Public Health (WIV-ISP), Brussels, Belgium
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Spengler JR, Estrada-Peña A, Garrison AR, Schmaljohn C, Spiropoulou CF, Bergeron É, Bente DA. A chronological review of experimental infection studies of the role of wild animals and livestock in the maintenance and transmission of Crimean-Congo hemorrhagic fever virus. Antiviral Res 2016; 135:31-47. [PMID: 27713073 DOI: 10.1016/j.antiviral.2016.09.013] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 09/01/2016] [Accepted: 09/29/2016] [Indexed: 12/11/2022]
Abstract
This article provides a definitive review of experimental studies of the role of wild animals and livestock in the maintenance and transmission of Crimean-Congo hemorrhagic fever virus (CCHFV), the etiologic agent of Crimean-Congo hemorrhagic fever (CCHF), beginning with the first recognized outbreak of the human disease in Crimea in 1944. Published reports by researchers in the former Soviet Union, Bulgaria, South Africa, and other countries where CCHF has been observed show that CCHFV is maintained in nature in a tick-vertebrate-tick enzootic cycle. Human disease most commonly results from the bite of an infected tick, but may also follow crushing of infected ticks or exposure to the blood and tissues of infected animals during slaughter. Wild and domestic animals are susceptible to infection with CCHFV, but do not develop clinical illness. Vertebrates are important in CCHF epidemiology, as they provide blood meals to support tick populations, transport ticks across wide geographic areas, and transmit CCHFV to ticks and humans during the period of viremia. Many aspects of vertebrate involvement in the maintenance and spread of CCHFV are still poorly understood. Experimental investigations in wild animals and livestock provide important data to aid our understanding of CCHFV ecology. This article is the second in a series of reviews of more than 70 years of research on CCHF, summarizing important findings, identifying gaps in knowledge, and suggesting directions for future research.
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Affiliation(s)
- Jessica R Spengler
- Viral Special Pathogens Branch, Division of High Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | | | - Aura R Garrison
- United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, MD, USA
| | - Connie Schmaljohn
- United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, MD, USA
| | - Christina F Spiropoulou
- Viral Special Pathogens Branch, Division of High Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Éric Bergeron
- Viral Special Pathogens Branch, Division of High Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Dennis A Bente
- Department of Microbiology & Immunology, Galveston, TX, USA; Galveston National Laboratory, University of Texas Medical Branch, Galveston, TX, USA
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Akuffo R, Brandful JAM, Zayed A, Adjei A, Watany N, Fahmy NT, Hughes R, Doman B, Voegborlo SV, Aziati D, Pratt D, Awuni JA, Adams N, Dueger E. Crimean-Congo hemorrhagic fever virus in livestock ticks and animal handler seroprevalence at an abattoir in Ghana. BMC Infect Dis 2016; 16:324. [PMID: 27392037 PMCID: PMC4939019 DOI: 10.1186/s12879-016-1660-6] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 06/22/2016] [Indexed: 12/01/2022] Open
Abstract
Background Crimean-Congo Haemorrhagic Fever Virus (CCHFV) is a zoonotic virus transmitted by Ixodid ticks and causes Crimean-Congo hemorrhagic fever (CCHF) disease in humans with up to 50 % mortality rate. Methods Freshly slaughtered livestock at the Kumasi abattoir in the Ashanti Region of Ghana were examined for the presence of ticks once a month over a 6-month period from May to November 2011. The ticks were grouped into pools by species, sex, and animal source. CCHFV was detected in the ticks using reverse transcription PCR. Blood samples were collected from enrolled abattoir workers at initiation, and from those who reported fever in a preceding 30-day period during monthly visits 2–5 months after initiation. Six months after initiation, all participants who provided baseline samples were invited to provide blood samples. Serology was performed using enzyme linked immunosorbent assay (ELISA). Demographic and epidemiological data was also obtained from enrolled participants using a structured questionnaire. Results Of 428 freshly slaughtered animals comprising 130 sheep, 149 cattle, and 149 goats examined, 144 ticks belonging to the genera Ambylomma, Hyalomma and Boophilus were identified from 57 (13.3 %): 52 (34.9 %), 4 (3.1 %) and 1 (0.7 %) cattle, sheep and goat respectively. Of 97 tick pools tested, 5 pools comprising 1 pool of Hyalomma excavatum and 4 pools of Ambylomma variegatum, collected from cattle, were positive for CCHFV. Of 188 human serum samples collected from 108 abattoir workers, 7 (3.7 %) samples from 6 persons were anti-CCHF IgG positive with one of them also being CCHF IgM positive. The seroprevalence of CCHFV identified in this study was 5.7 %. Conclusions This study detected human exposure to CCHF virus in slaughterhouse workers and also identified the CCHF virus in proven vectors (ticks) of Crimean Congo hemorrhagic fever in Ghana. The CCHFV was detected only in ticks collected from cattle, one of the livestock known to play a role in the amplification of the CCHF virus.
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Affiliation(s)
- R Akuffo
- U.S Naval Medical Research Unit No. 3, Cairo, Egypt. .,Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana. .,Present Address: NAMRU-3, PSC 452, P.O Box 5000, FPO, AE 09835-9998, 3A Imtidad Ramses Street. Adjacent to Abbassia Fever Hospital, Abbassia, Cairo, Egypt.
| | - J A M Brandful
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - A Zayed
- U.S Naval Medical Research Unit No. 3, Cairo, Egypt
| | - A Adjei
- University of Ghana, Accra, Ghana
| | - N Watany
- U.S Naval Medical Research Unit No. 3, Cairo, Egypt
| | - N T Fahmy
- U.S Naval Medical Research Unit No. 3, Cairo, Egypt
| | - R Hughes
- U.S Naval Medical Research Unit No. 3, Cairo, Egypt
| | - B Doman
- U.S Naval Medical Research Unit No. 3, Cairo, Egypt
| | | | - D Aziati
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - D Pratt
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - J A Awuni
- Veterinary Services of Ghana, Accra, Ghana
| | - N Adams
- U.S Naval Medical Research Unit No. 3, Cairo, Egypt
| | - E Dueger
- U.S Naval Medical Research Unit No. 3, Cairo, Egypt.,Centers for Disease Control and Prevention, Atlanta, GA, USA
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39
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Leblebicioglu H, Ozaras R, Fletcher TE, Beeching NJ. Crimean-Congo haemorrhagic fever in travellers: A systematic review. Travel Med Infect Dis 2016; 14:73-80. [PMID: 26970396 PMCID: PMC7110636 DOI: 10.1016/j.tmaid.2016.03.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 02/17/2016] [Accepted: 03/01/2016] [Indexed: 01/03/2023]
Abstract
Background The recent Ebola epidemic has increased public awareness of the risk of travel associated viral haemorrhagic fever (VHF). International preparedness to manage imported cases Ebola virus infection was inadequate, highlighted by cases of nosocomial transmission. Crimean-Congo haemorrhagic fever (CCHF) is a re-emerging tick-borne VHF centred in the Eurasian region, affecting a large geographical area and with human-to-human transmission reported, especially in the healthcare setting. Objectives To systematically review the characteristics of travel associated Crimean-Congo haemorrhagic fever. Methods A systematic review of travel-associated cases of CCHF was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement protocol. PubMed, SCOPUS, Science Citation Index (SCI) and ProMED databases were searched for reports published between January 1960 and January 2016. Three independent reviewers selected and reviewed studies and extracted data. Results 21 cases of travel associated CCHF were identified, of which 12 died (3 outcome unknown) and 4 secondary (nosocomial) infections were reported. Risk occupations or activities for CCHF infection were reported in 8/12 cases when data were available. Travel from Asia to Asia occurred in 9 cases, Africa to Africa occurred in 5 cases, Africa to Europe in 3 cases, Asia to Europe in 2 cases and Europe to Europe in 2 cases. Conclusion CCHF related to travel is rare, is generally associated with at risk activities/occupation and is frequently fatal. Key to early diagnosis and prevention of nosocomial transmission is an understanding of CCHF risk factors and the geographical distribution of CCHF. International travel to CCHF endemic areas is increasing and clinicians and laboratory personnel managing returning travellers should maintain a high index of suspicion.
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Affiliation(s)
- Hakan Leblebicioglu
- Department of Infectious Diseases and Clinical Microbiology, Ondokuz Mayis University Medical School, Samsun, Turkey.
| | - Resat Ozaras
- Department of Infectious Diseases and Clinical Microbiology, Istanbul University Cerrahpasa Medical School, Istanbul, Turkey
| | - Tom E Fletcher
- Department of Infectious Diseases and Clinical Microbiology, Ondokuz Mayis University Medical School, Samsun, Turkey; Liverpool School of Tropical Medicine, Liverpool L3 5QA, United Kingdom
| | - Nick J Beeching
- Liverpool School of Tropical Medicine, Liverpool L3 5QA, United Kingdom; NIHR HPRU in Emerging and Zoonotic Infections, University of Liverpool, Liverpool L69 7BE, United Kingdom
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40
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Wasfi F, Dowall S, Ghabbari T, Bosworth A, Chakroun M, Varghese A, Tiouiri H, Ben Jemaa M, Znazen A, Hewson R, Zhioua E, Letaief A. Sero-epidemiological survey of Crimean-Congo hemorrhagic fever virus in Tunisia. ACTA ACUST UNITED AC 2016; 23:10. [PMID: 26956221 PMCID: PMC4783585 DOI: 10.1051/parasite/2016010] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 02/23/2016] [Indexed: 11/18/2022]
Abstract
Crimean-Congo hemorrhagic fever (CCHF) is a tick-borne disease associated with a high case fatality rate and transmitted mainly by Hyalomma marginatum. The geographical distribution of H. marginatum covers most of the Western Mediterranean basin. We aimed to investigate whether CCHF virus (CCHFv) is circulating in Tunisia. Samples from unexplained acute febrile patients (n = 181) and a high risk group of humans, mainly slaughter workers (n = 38), were collected in the summer of 2014 and analyzed for exposure to CCHFv using serological tests and real-time RT-PCR. Ticks were collected from Northern and Southern Tunisia during May–June 2014 and examined for the presence of CCHFv by real-time RT-PCR. Of the 181 febrile patients, 5 showed only high titers of IgM suggesting a recent exposure to CCHFv. Among 38 slaughter workers, 2 had IgG anti-CCHFv responses yielding a seroprevalence of 5.2%. No CCHFv was detected in ticks and sera. Our results provide evidence of human exposure to CCHFv in Tunisia.
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Affiliation(s)
- Fares Wasfi
- Institut Pasteur de Tunis, Laboratory of Vector Ecology, 13 Place Pasteur, 1002 Tunis, Tunisia
| | - Stuart Dowall
- Public Health England, Porton Down, Salisbury, Wiltshire SP4 0JG, UK
| | - Tayssir Ghabbari
- Infectious Diseases Department, Farhat Hached University Hospital, 4004 Sousse, Tunisia
| | - Andrew Bosworth
- Public Health England, Porton Down, Salisbury, Wiltshire SP4 0JG, UK
| | - Mohamed Chakroun
- Infectious Diseases Department, Fatouma Bourguiba University Hospital, 5000 Monastir, Tunisia
| | - Anitha Varghese
- Public Health England, Porton Down, Salisbury, Wiltshire SP4 0JG, UK
| | | | | | - Abir Znazen
- Laboratory of Microbiology, 3000 Sfax, Tunisia
| | - Roger Hewson
- Public Health England, Porton Down, Salisbury, Wiltshire SP4 0JG, UK - National Institute of Health Research, Health Protection Research Unit in Emerging and Zoonotic Infections, L3 5RF Liverpool, UK
| | - Elyes Zhioua
- Institut Pasteur de Tunis, Laboratory of Vector Ecology, 13 Place Pasteur, 1002 Tunis, Tunisia
| | - Amel Letaief
- Infectious Diseases Department, Farhat Hached University Hospital, 4004 Sousse, Tunisia
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Leblebicioglu H, Ozaras R, Irmak H, Sencan I. Crimean-Congo hemorrhagic fever in Turkey: Current status and future challenges. Antiviral Res 2015; 126:21-34. [PMID: 26695860 DOI: 10.1016/j.antiviral.2015.12.003] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 12/09/2015] [Accepted: 12/10/2015] [Indexed: 01/12/2023]
Abstract
Crimean-Congo hemorrhagic fever (CCHF) is a tick-borne viral disease of humans that affects a wide geographic area of Africa and Eurasia, including Turkey, Iran, Pakistan, Afghanistan and Russia. Since the first detection of CCHF cases in Turkey in 2002, more than 9700 patients have been reported, with an overall mortality rate just under 5%. This article assesses the present epidemiological situation of CCHF in Turkey, with an updated literature review, describes national practices and summarizes lessons learned in preparation for future outbreaks.
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Affiliation(s)
- Hakan Leblebicioglu
- Department of Infectious Diseases and Clinical Microbiology, Ondokuz Mayis University Medical School, Samsun, Turkey.
| | - Resat Ozaras
- Department of Infectious Diseases and Clinical Microbiology, Istanbul University Cerrahpasa Medical School, Istanbul, Turkey.
| | - Hasan Irmak
- Republic of Turkey Ministry of Health, Ankara, Turkey.
| | - Irfan Sencan
- Department of Infectious Diseases and Clinical Microbiology, Diskapi Yildirim Beyazit Education and Research Hospital, Ankara, Turkey.
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42
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Ahmad A, Khan MU. Crimean-Congo hemorrhagic fever in Pakistan: Are we going in the right direction? J Res Pharm Pract 2015; 4:173-4. [PMID: 26645021 PMCID: PMC4645127 DOI: 10.4103/2279-042x.167052] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Akram Ahmad
- Department of Clinical Pharmacy, UCSI University, Cheras, Kuala Lumpur, Malaysia E-mail:
| | - Muhammad Umair Khan
- Department of Clinical Pharmacy, UCSI University, Cheras, Kuala Lumpur, Malaysia E-mail:
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