Monitoring for the possible introduction of Crimean-Congo haemorrhagic fever virus in Italy based on tick sampling on migratory birds and serological survey of sheep flocks

Do birds play a role in the transmission of Toscana virus? Initial isolation results from birds in northernmost Türkiye

AIMS

Recent research has prioritized emerging and re-emerging diseases that affect human and animal health, particularly to describe how these diseases enter countries and determine their transmission cycles. Given that migratory birds play a significant role in spreading infections, the present study analysed their migration paths and specimens to investigate Orthoflavivirus, Orthonairovirus, Alphavirus and Phlebovirus in birds in Samsun province, Türkiye.

METHODS AND RESULTS

For these viruses, 312 samples from 56 birds were analysed using RT-PCR and qRT-PCR. Toscana virus (TOSV) was identified in 14 birds (four mallards, five partridges, four quails and one pigeon), representing 25% of the birds sampled. Genotype B was reported in all 14 birds. After inoculating the positive tissues in cell cultures, TOSV was isolated from the organs of pigeons, mallards and partridges.

CONCLUSIONS

This is the first time TOSV has been isolated in cell culture from birds and indicates that they may play a role in spreading TOSV in Türkiye. The results also suggest that TOSV might be carried between countries by migratory birds.

Serological evidence and factors associated with Crimean-Congo haemorrhagic fever in sheep in Burkina Faso

BACKGROUND

Crimean-Congo haemorrhagic fever (CCHF) is caused by an orthonairovirus transmitted by bites from infected ticks or by direct contact with blood or tissues of infected ticks, viraemic patients or viraemic livestock.

OBJECTIVE

It was implemented to access the seropositivity and associated factors with CCHF in sheep in two provinces in Burkina Faso.

METHODS

Three hundred and sixty-four sheep sera have been taken from 73 herds in four municipalities and two provinces. The double-antigen sandwich ELISA test was used to test for antibodies against CCHF virus (CCHFV). Data have also been collected using questionnaire to assess factors associated with CCHF seropositivity.

RESULTS

Fifty-four (54 out to 364 sheep were seropositive given an overall seropositivity of 14.8% (95% confidence interval [CI]: 10.9%-19.8%) with an adjusted seropositivity of 13.1%. The study showed that 15.6% (95% CI: 10.2-21.0) and 14.1% (95% CI: 9.2-19.1) of sheep in the provinces of Mouhoun and Kénédougou, respectively, had antibodies against CCHFV. The highest seropositivity was found in Dédougou municipality (24.4%). The study showed that sheep from the municipalities of Dédougou (AOR = 8.4; 95% CI: 2.2-31.8), N'dorola (AOR = 14.7; 95% CI: 3.8-56.8), Sindou (AOR = 4.9; 95% CI: 1.2-20.7), sheep aged between 27 and 36 months (AOR = 6.4; 95% CI: 2.3-17.3) and sheep with ticks (AOR = 24.8; 95% CI: 7.7-80.1) were more likely to be seropositive to CCHF.

CONCLUSIONS

The study revealed that sheep in Burkina Faso experienced contacts with CCHFV and suggests the importance of implementing control action in the country.

The climate niche of the invasive tick species Hyalomma marginatum and Hyalomma rufipes (Ixodidae) with recommendations for modeling exercises

The finding of immature stages of some Hyalomma spp. feeding on migratory birds in Europe is unexceptional. The reports of adults of Hyalomma in Europe (incl. the British Isles) after successful molting from immatures have increased in recent years. It has been claimed that the warming of the target territory could favor the populations of these invasive ticks. Although evaluations of the impact on health or measures of adaptation are on their way, the climate niches of these species remain undefined, preventing preventive policies. This study delineates such niches for both Hyalomma marginatum (2,729 collection points) and Hyalomma rufipes (2,573 collections) in their distribution area, together with 11,669 points in Europe where Hyalomma spp. are believed to be absent in field surveys. Niche is defined from daily data of temperature, evapotranspiration, soil humidity and air saturation deficit (years 1970-2006). A set of eight variables (annual/seasonal accumulated temperature and vapor deficit) has the maximum discriminatory power separating the niches of both Hyalomma and a negative dataset, with an accuracy near 100%. The sites supporting H. marginatum or H. rufipes seem to be controlled by the joint action of the amount of water in the air (accounting for mortality) and the accumulated temperature (regulating development). The use of accumulated annual temperature as the only variable for predictive purposes of colonization of Hyalomma spp. looks unreliable, as far as values of water in air are excluded.

Development of humanised antibodies for Crimean-Congo Haemorrhagic fever virus: Comparison of hybridoma-based versus phage library techniques

Humanised antibodies targeting Crimean-Congo Haemorrhagic virus (CCHFV) are needed for the development and standardisation of serological assays. These assays are needed to address a shortfall in available tests that meet regulatory diagnostic standards and to aid surveillance activities to extend knowledge on the distribution of CCHFV. To generate a humanised monoclonal antibody against CCHFV, we have compared two methods: the traditional mouse hybridoma approach with subsequent sequencing and humanisation of antibodies versus a non-animal alternative using a human combinatorial antibody library (HuCAL). Our results demonstrated that the mouse hybridoma followed by humanisation protocol gave higher affinity antibodies. Whilst not yet able to demonstrate the generation of equivalent humanised antibodies without the use of animals, sequencing data enables the subsequent production of recombinant antibodies, thus providing a reduction in future animal usage for this application. Ultimately, our report provides information on development of a humanised standardised control, which can form an important positive control component of serological assays against CCHFV.

Criteria for selecting sentinel unit locations in a surveillance system for vector-borne disease: A decision tool

Objectives

With vector-borne diseases emerging across the globe, precipitated by climate change and other anthropogenic changes, it is critical for public health authorities to have well-designed surveillance strategies in place. Sentinel surveillance has been proposed as a cost-effective approach to surveillance in this context. However, spatial design of sentinel surveillance system has important impacts on surveillance outcomes, and careful selection of sentinel unit locations is therefore an essential component of planning.

Methods

A review of the available literature, based on the realist approach, was used to identify key decision issues for sentinel surveillance planning. Outcomes of the review were used to develop a decision tool, which was subsequently validated by experts in the field.

Results

The resulting decision tool provides a list of criteria which can be used to select sentinel unit locations. We illustrate its application using the case example of designing a national sentinel surveillance system for Lyme disease in Canada.

Conclusions

The decision tool provides researchers and public health authorities with a systematic, evidence-based approach for planning the spatial design of sentinel surveillance systems, taking into account the aims of the surveillance system and disease and/or context-specific considerations.

First serological evidence of Crimean-Congo haemorrhagic fever virus in transhumant bovines in Italy

Crimean-Congo haemorrhagic fever (CCHF) is an emerging tick-borne disease caused by the arbovirus Crimean-Congo haemorrhagic fever virus (CCHFV; family Nairoviridae). Given the public health impact, CCHF is considered a priority disease for the European Union. This study describes the first detection of anti-CCHFV antibodies in transhumant bovines in Italy. Sera from 794 cattle collected across Basilicata region (Southern Italy) were screened using a commercial ELISA kit. The animal-level and herd-level seroprevalences detected were 1.89% [95%CI: 1.12-3.1] and 29.63% [95%CI: 15.68-48.65], respectively. Results of the χ² test for trend show that the exposure to CCHFV was significantly associated with increasing age, with the odds 5 times higher in 11-22-year old cattle than 1-4-year old cattle. The detection of antibodies against CCHFV in indigenous cattle indicates that the infection occurred in the study area and may warrant further consideration. Additionally, no significant spatial clustering of CCHF infection was detected, supporting the hypothesis that the disease is widespread in the region. Further studies at larger scale are needed to identify the areas at higher risk of zoonotic infection. A One Health approach should be implemented to better understand the disease risk and dynamics in the country, which effectively address the related public health threat.

Direct and Indirect Role of Migratory Birds in Spreading CCHFV and WNV: A Multidisciplinary Study on Three Stop-Over Islands in Italy

The annual movements of migratory birds can contribute to the spread of African ticks and tick-borne pathogens of potential public health concern across Europe. The aim of the study was to investigate their role in the possible introduction of African ticks and tick-borne pathogens into European countries during spring migration. A total of 2344 ticks were collected during three spring seasons from 1079 birds captured on three Italian stop-over islands during their northbound migration. Once identified, each tick was tested by RT-PCR for the presence of Crimean-Congo hemorrhagic fever (CCHFV), West Nile (WNV), and Usutu (USUV) viruses. Moreover, carcasses of birds found dead were collected and tested for the possible presence of WNV and USUV. Results confirmed a higher contribution of trans-Saharan migrants compared to intra-Palearctic ones and the prevalence of African tick species in the sample. CCHFV was detected for the second time in Italy in a Hyalomma rufipes, and WNV was found in two ticks of the same genus, all carried by trans-Saharan birds. WNV lineage 1 was also found in the organs of a Garden warbler. These results confirm the role of migratory birds in carrying African ticks, as well as viruses of zoonotic importance, from Africa into Europe.

A Systematic Review of the Distribution of Tick-Borne Pathogens in Wild Animals and Their Ticks in the Mediterranean Rim between 2000 and 2021

Tick-borne pathogens (TBPs) can be divided into three groups: bacteria, parasites, and viruses. They are transmitted by a wide range of tick species and cause a variety of human, animal, and zoonotic diseases. A total of 148 publications were found on tick-borne pathogens in wild animals, reporting on 85 species of pathogens from 35 tick species and 17 wild animal hosts between 2000 and February 2021. The main TBPs reported were of bacterial origin, including Anaplasma spp. and Rickettsia spp. A total of 72.2% of the TBPs came from infected ticks collected from wild animals. The main tick genus positive for TBPs was Ixodes. This genus was mainly reported in Western Europe, which was the focus of most of the publications (66.9%). It was followed by the Hyalomma genus, which was mainly reported in other areas of the Mediterranean Rim. These TBPs and TBP-positive tick genera were reported to have come from a total of 17 wild animal hosts. The main hosts reported were game mammals such as red deer and wild boars, but small vertebrates such as birds and rodents were also found to be infected. Of the 148 publications, 12.8% investigated publications on Mediterranean islands, and 36.8% of all the TBPs were reported in seven tick genera and 11 wild animal hosts there. The main TBP-positive wild animals and tick genera reported on these islands were birds and Hyalomma spp. Despite the small percentage of publications focusing on ticks, they reveal the importance of islands when monitoring TBPs in wild animals. This is especially true for wild birds, which may disseminate their ticks and TBPs along their migration path.

Systematic Review on Crimean–Congo Hemorrhagic Fever Enzootic Cycle and Factors Favoring Virus Transmission: Special Focus on France, an Apparently Free-Disease Area in Europe

Crimean–Congo hemorrhagic fever (CCHF) is a viral zoonotic disease resulting in hemorrhagic syndrome in humans. Its causative agent is naturally transmitted by ticks to non-human vertebrate hosts within an enzootic sylvatic cycle. Ticks are considered biological vectors, as well as reservoirs for CCHF virus (CCHFV), as they are able to maintain the virus for several months or even years and to transmit CCHFV to other ticks. Although animals are not symptomatic, some of them can sufficiently replicate the virus, becoming a source of infection for ticks as well as humans through direct contact with contaminated body fluids. The recent emergence of CCHF in Spain indicates that tick–human interaction rates promoting virus transmission are changing and lead to the emergence of CCHF. In other European countries such as France, the presence of one of its main tick vectors and the detection of antibodies targeting CCHFV in animals, at least in Corsica and in the absence of human cases, suggest that CCHFV could be spreading silently. In this review, we study the CCHFV epidemiological cycle as hypothesized in the French local context and select the most likely parameters that may influence virus transmission among tick vectors and non-human vertebrate hosts. For this, a total of 1,035 articles dating from 1957 to 2021 were selected for data extraction. This study made it possible to identify the tick species that seem to be the best candidate vectors of CCHFV in France, but also to highlight the importance of the abundance and composition of local host communities on vectors' infection prevalence. Regarding the presumed transmission cycle involving Hyalomma marginatum, as it might exist in France, at least in Corsica, it is assumed that tick vectors are still weakly infected and the probability of disease emergence in humans remains low. The likelihood of factors that may modify this equilibrium is discussed.

Distribution of Tick-Borne Pathogens in Domestic Animals and Their Ticks in the Countries of the Mediterranean Basin between 2000 and 2021: A Systematic Review

Tick-borne pathogens (TBPs) include a wide range of bacteria, parasites and viruses that cause a large spectrum of animal, human and zoonotic tick-borne diseases (TBDs). The object of this review was to establish an inventory and an analysis of TBPs found in domestic animals in the countries of the Mediterranean Basin. This geographic area occupies a central position between several continents and is an area of movement for animals, humans and pathogens of interest and their vectors, which is important in terms of animal and human health. In this systematic review, we included a total of 271 publications produced between 2000–2021 concerning TBPs in domestic animals. Among this literature, we found a total of 90 pathogen species (known as TBPs) reported in the 20 countries of the area; these were detected in tick species from domestic animals and were also directly detected in domestic animals. In all, 31 tick species were recorded and 12 domestic animal species, the latter comprising nine livestock and three pet species. More than 50% of the publications were from Western Europe. Island data were extracted and assessed, as islands of the Mediterranean Basin were represented in 16% of the publications and 77.8% of the TBPs reported. Our results show the importance of islands in the monitoring of TBPs, despite the low percentage of publications.

Seroepidemiology of Crimean-Congo Haemorrhagic Fever among cattle in Cameroon: Implications from a One Health perspective

Background

Crimean-Congo Haemorrhagic Fever (CCHF) is a tick-borne viral zoonotic disease distributed across several continents and recognized as an ongoing health threat. In humans, the infection can progress to a severe disease with high fatality, raising public health concerns due to the limited prophylactic and therapeutic options available. Animal species, clinically unaffected by the virus, serve as viral reservoirs and amplifier hosts, and can be a valuable tool for surveillance. Little is known about the occurrence and prevalence of Crimean-Congo Haemorrhagic Fever Virus (CCHFV) in Cameroon. Knowledge on CCHFV exposure and the factors associated with its presence in sentinel species are a valuable resource to better understand transmission dynamics and assess local risks for zoonotic disease emergence.

Methods and findings

We conducted a CCHFV serological survey and risk factor analysis for animal level seropositivity in pastoral and dairy cattle in the North West Region (NWR) and the Vina Division (VD) of the Adamawa Region in Cameroon. Seroprevalence estimates were adjusted for sampling design-effects and test performance. In addition, explanatory multivariable logistic regression mixed-effects models were fit to estimate the effect of animal characteristics, husbandry practices, risk contacts and ecological features on the serological status of pastoral cattle. The overall seroprevalence was 56.0% (95% CI 53.5–58.6) and 6.7% (95% CI 2.6–16.1) among pastoral and dairy cattle, respectively. Animals going on transhumance had twice the odds of being seropositive (OR 2.0, 95% CI 1.1–3.8), indicating that animal movements could be implicated in disease expansion. From an ecological perspective, absolute humidity (OR 0.6, 95% CI 0.4–0.9) and shrub density (OR 2.1, 95% CI 1.4–3.2) were associated with seropositivity, which suggests an underlying viral dynamic connecting vertebrate host and ticks in a complex transmission network.

Conclusions

This study demonstrated high seroprevalence levels of CCHFV antibodies in cattle in Cameroon indicating a potential risk to human populations. However, current understanding of the underlying dynamics of CCHFV locally and the real risk for human populations is incomplete. Further studies designed using a One Health approach are required to improve local knowledge of the disease, host interactions and environmental risk factors. This information is crucial to better project the risks for human populations located in CCHFV-suitable ecological niches.

Crimean-Congo haemorrhagic fever poses an important threat for public health, particularly in endemic locations in Eurasia and parts of Africa. Despite its long-standing recognition, CCHF is considered a neglected disease, with sporadic official case reports and evidence of serological circulation in remote rural areas and less frequently, in peri-urban settings in sub-Saharan Africa. However, the drivers associated with its emergence and the spatial-temporal patterns linked to its circulation and spread are not well-understood. In this study, we identified a high proportion of cattle with CCHFV antibodies suggestive of high levels of viral circulation in the North West and the Adamawa Regions in Cameroon. In pastoral cattle, there was a positive relationship between going on transhumance, older age, higher shrub density and lower absolute humidity and CCHFV individual seropositivity. In contrast, non-indigenous breeds reported a lower risk of being seropositive. These results can be interpreted in connection to the underlying dynamics of CCHFV cycle and underline potential mechanisms linked to disease expansion. From a public health perspective, high levels of exposure to CCHFV in cattle highlight the possibility of unrecognized human infection and therefore, emphasize on the need to remain vigilant to possible disease risks for local groups involved in pastoralism and to dairy smallholders across the region.

Potential Role of Birds in the Epidemiology of Coxiella burnetii, Coxiella-like Agents and Hepatozoon spp

Birds may be involved in the epidemiology of infectious and/or parasitic diseases which affect mammals, including humans. Q fever, caused by Coxiella burnetii, is an important zoonosis causing economic losses mainly due to pathologies induced in ruminants. Even though birds are known to be potential reservoirs of C. burnetii, their role in the epidemiological cycle of the pathogen is not completely verified. In recent years, new bacteria identified as Coxiella-like agents, have been detected in birds affected by different pathologies; the potential role of these bacteria as pathogens for mammals is not currently known. Hepatozoon spp. are haemoprotozoa, causing arthropod borne affections within several vertebrate classes. The infection of vertebrate host develops after ingestion of the arthropod final hosts containing oocysts; different tissues and blood cells are then colonized by other parasite stages, such as merozoites and gamonts. In avian hosts, there are several recognized Hepatozoon species; however, their life cycle and pathogenicity have not been fully elucidated. Referring to a carrier role by avian species and their ticks in the epidemiology of canine hepatozoonosis, the only clinically relevant affection caused by this parasite genus, they would act as carriers of infected ticks and, when Hepatozoon americanum is involved, as paratenic hosts, as well.

Epidemiological Aspects of Crimean-Congo Hemorrhagic Fever in Western Europe: What about the Future?

Crimean-Congo hemorrhagic fever virus (CCHFV) is an arthropod-borne virus (arbovirus), mainly transmitted by ticks, belonging to the genus Orthonairovirus (family Nairoviridae, order Bunyavirales). CCHFV causes a potentially severe, or even fatal, human disease, and it is widely distributed in Africa, Asia, eastern Europe and, more recently, in South-western Europe. Until a few years ago, no cases of Crimean-Congo hemorrhagic fever (CCHF) had been reported in western Europe, with the exception of several travel-associated cases. In 2010, the CCHFV was reported for the first time in South-western Europe when viral RNA was obtained from Hyalomma lusitanicum ticks collected from deer in Cáceres (Spain). Migratory birds from Africa harboring CCHFV-infected ticks and flying to Spain appear to have contributed to the establishment of the virus (genotype III, Africa-3) in this country. In addition, the recent findings in a patient and in ticks from deer and wild boar of viral sequences similar to those from eastern Europe (genotype V, Europe-1), raise the possibility of the introduction of CCHFV into Spain through the animal trade, although the arrival by bird routes cannot be ruled out (Africa-4 has been also recently detected). The seropositive rates of animals detected in regions of South-western Spain suggest an established cycle of tick-host-tick in certain areas, and the segment reassortment detected in the sequenced virus from one patient evidences a high ability to adaptation of the virus. Different ixodid tick genera can be vectors and reservoirs of the virus, although Hyalomma spp. are particularly relevant for its maintenance. This tick genus is common in Mediterranean region but it is currently spreading to new areas, partly due to the climate change and movement of livestock or wild animals. Although to a lesser extent, travels with our pets (and their ticks) may be also a factor to be considered. As a consequence, the virus is expanding from the Balkan region to Central Europe and, more recently, to Western Europe where different genotypes are circulating. Thus, seven human cases confirmed by molecular methods have been reported in Spain from 2016 to August 2020, three of them with a fatal outcome. A One Health approach is essential for the surveillance of fauna and vector populations to assess the risk for humans and animals. We discuss the risk of CCHFV causing epidemic outbreaks in Western Europe.

The Integration of Human and Veterinary Studies for Better Understanding and Management of Crimean-Congo Haemorrhagic Fever

Outbreaks that occur as a result of zoonotic spillover from an animal reservoir continue to highlight the importance of studying the disease interface between species. One Health approaches recognise the interdependence of human and animal health and the environmental interplay. Improving the understanding and prevention of zoonotic diseases may be achieved through greater consideration of these relationships, potentially leading to better health outcomes across species. In this review, special emphasis is given on the emerging and outbreak pathogen Crimean-Congo Haemorrhagic Fever virus (CCHFV) that can cause severe disease in humans. We discuss the efforts undertaken to better understand CCHF and the importance of integrating veterinary and human research for this pathogen. Furthermore, we consider the use of closely related nairoviruses to model human disease caused by CCHFV. We discuss intervention approaches with potential application for managing CCHFV spread, and how this concept may benefit both animal and human health.

Crimean-Congo Hemorrhagic Fever Virus (CCHFV): A Silent but Widespread Threat

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.

Serological and molecular study of Crimean-Congo Hemorrhagic Fever Virus in cattle from selected districts in Uganda

BACKGROUND

Crimean-Congo Hemorrhagic Fever (CCHF) is a severe tick-borne viral hemorrhagic disease caused by Crimean-Congo Hemorrhagic Fever Virus (CCHFV) that poses serious public health challenges in many parts of Africa, Europe and Asia.

METHODS

We examined 500 cattle sera samples from five districts for CCHFV antibodies using in-house and commercially available (IDVet) ELISA, Immunofluorescent assay (IFA) and Real-time polymerase chain reaction (RT-PCR).

RESULTS

500 cattle (73.8 % females) were analyzed; CCHFV seropositivity was 12.6 % (n = 63) and 75.0 % (n = 375) with the in-house and IDVet ELISAs, respectively. Seropositivity was associated with geographical location, increasing age, being female, and having a higher tick burden. Twenty four out of the 37 (64.8 %) were seropositive for CCHFV using IFA and all were negative for virus on RT-PCR. The IFA results were more comparable to IDVet (κ_coefficient = 0.88, p = <0.01) than to in-house (κ_coefficient = 0.32, p = 0.02).

CONCLUSIONS

Our study confirmed the presence and high prevalence of anti-CCHF antibodies in cattle based on three methods from all the five study districts, confirming presence and exposure of CCHFV. Given the zoonotic potential for CCHFV, we recommend a multidisciplinary public health surveillance and epidemiology of CCHFV in both animals and humans throughout the country.

Tick species from Africa by migratory birds: a 3-year study in Italy

The role of resident or migratory birds in dispersal of tick species and tick-borne pathogens is still poorly known in Italy. We report here the results of a 3-year project based on sampling ticks from migratory birds, as well as from the vegetation at three stop-over sites for migrants, namely the islands of Ventotene (Latium), Asinara (Sardinia) and Ustica (Sicily). During the spring seasons from 2017-2019, in total 2681 ticks were collected, 2344 of which were sampled from migratory birds and 337 from the vegetation. Ticks were identified by morphology or by molecular tools when necessary. In total, 16 tick species were identified among which the following were exclusively found on birds: Hyalomma rufipes (43.3%), Hy. truncatum (0.1%), Ixodes frontalis (11.8%), Ix. inopinatus (0.2%), Ix. ricinus (3%), Haemaphysalis punctata (0.08%), Hae. erinacei (0.1%), Amblyomma variegatum (0.08%) and Argas vulgaris 0.1%), whereas five species were exclusively collected from the vegetation: Rhipicephalus bursa (10.5%), Rh. turanicus (5.9%), Rh. sanguineus sensu lato (2%), Rh. pusillus (2.4%), Hae. sulcata (0.08%). Hy. marginatum (10.3%) and Ix. ventalloi (9.3%) were found both on birds and on the vegetation on the island Ustica. It is worth noting that the search for ticks on the vegetation did not detect allochthonous tick species. Although we found several interesting local species and allochthonous ticks like Hy. rufipes, Am. variegatum and Ar. vulgaris on birds, further investigations are needed to better define the possible role of migratory birds in the introduction of ticks and tick-borne diseases in Italy, above all after the evidence of imported ticks positive to Crimean Congo hemorrhagic fever (CCHF) virus in several European countries.

The emerging tick-borne Crimean-Congo haemorrhagic fever virus: A narrative review

Crimean-Congo Haemorrhagic Fever (CCHF) is an increasingly relevant viral zoonosis caused by the negative-sense single-stranded (ss) RNA Crimean-Congo Haemorrhagic Fever Orthonairovirus (CCHFV) (Nairoviridae family, Bunyavirales order). The viral genome is divided into three segments (L-M-S) of distinct size and functions. The infection is generally mediated by a tick vector, in particular belonging to the Hyalomma genus, and the transmission follows a tick-vertebrate-tick ecologic cycle, with asymptomatic infected animals functioning as reservoirs and amplifiers for CCHFV. Human hosts could be infected primarily through infected ticks or by contact with infected hosts or their body fluids and tissues, also in a nosocomial way and in occupational contexts. Infected symptomatic patients generally manifest a nonspecific illness, which progresses across four stages, with possibly lethal outcomes. Disease outbreaks show a widespread geographic diffusion and a highly variable mortality rate, dramatically peaking in untreated patients. The lack of an adequate animal model and the elevated virus biological risk (only manageable under biosafety level 4 conditions) represent strongly limiting factors for a better characterization of the disease and for the development of specific therapies and vaccines. The present review discusses updated information on CCHFV-related disease, including details about the virus (taxonomy, structure, life cycle, transmission modalities) and considering CCHF pathogenesis, epidemiology and current strategies (diagnostic, therapeutic and preventive).

Towards a Sustainable One Health Approach to Crimean-Congo Hemorrhagic Fever Prevention: Focus Areas and Gaps in Knowledge

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.

First record of Hyalomma rufipes in the Czech Republic, with a review of relevant cases in other parts of Europe

We found a male Hyalomma rufipes Koch, 1844 tick feeding on a horse grazing near Valtice, south Moravia, Czech Republic on October 24, 2019. The horse was born in Czechland and did not leave the country at least during the last five years. Relevant findings of Hyalomma ticks in other parts of central Europe are reviewed, including also records of pre-imaginal Hyalomma marginatum complex ticks on migrating birds all over Europe.

Seroepidemiological Investigation of Crimean-Congo Hemorrhagic Fever Virus in Sheep and Camels of Inner Mongolia of China

Crimean-Congo hemorrhagic fever (CCHF) is a highly lethal infectious disease in humans caused by tick-borne Crimean-Congo hemorrhagic fever virus (CCHFV). To determine the potential risk of CCHF in the pastoral area of Northwestern China, the presence of antibody to CCHFV in the sera of two most common tick hosts, sheep and camels, in Inner Mongolia of China was evaluated. The purified recombinant nucleocapsid protein (NP) of CCHFV was prepared from a prokaryotic vector expressing the NP encoding gene, which was employed as the antigen to probe antibody against CCHFV in tick vectors using an immunoblotting assay. In total, 58.3% (35/60) and 54% (12/22) of camels were positive of antibody to CCHFV in sera at Alxa Youqi County and Ulan Hudu Gacha Village of Inner Mongolia Province, respectively. However, only 6.7% (2/30) of sera of sheep were determined positive in antibody to CCHFV in the Wulan Hudug check area in this study. Consequently, these results indicate that 54-58.3% camels were infected by CCHFV after exposure to tick bites in Inner Mongolia, which was significantly higher than 6.7% of infection in the sheep in this area, suggesting there is a certain relationship between the serological reactivity and exposure time to ticks, range of activity, living behaviors, and breeding time. Further intensive surveillance of livestock and exposed population is required to better understand the spread of CCHFV in this area.

Mapping the environmental suitability of etiological agent and tick vectors of Crimean-Congo hemorrhagic fever

Crimean-Congo hemorrhagic fever (CCHF) is one of the most important public health threats in many regions across Africa, Europe, and Asia. This study used ecological niche modeling analyses to map the environmental suitability of both CCHF virus (CCHFV), and its tick vectors (Amblyomma variegatum, Dermacentor marginatus, Hyalomma marginatum, Hyalomma rufipes, Hyalomma truncatum, Rhipicephalus appendiculatus, and Rhipicephalus evertsi evertsi) in the Old World countries. The CCHFV was anticipated to occur with high environmental suitability across southern and central Europe, northwestern Africa, central Asia, and western Mediterranean region. Ecological niche models of tick vectors anticipated diverse patterns based on the tick species in question; D. marginatus and H. marginatum showed high environmental suitability in southern and central Europe, and North Africa. The remaining vector species were anticipated to occur in Africa. All models were statistically robust and performed better than random (P < 0.001). Finally, we tested the niche similarities between CCHFV and diverse tick vectors and could not reject the null hypotheses of niche similarity in all vector-virus combinations (P > 0.05) except the combinations of CCHFV with A. variegatum, R. evertsi evertsi and R. appendiculatus (P < 0.05).

Serologic survey of the Crimean-Congo haemorrhagic fever virus infection among wild rodents in Hungary

Crimean-Congo haemorrhagic fever virus (CCHFV) is a tick-borne pathogen, which causes an increasing number of severe infections in many parts of Africa, Asia and in Europe. The virus is primarily transmitted by ticks, however, the spectrum of natural hosts regarding CCHFV includes a wide variety of domestic and wild animals. Although the presence of CCHFV was hypothesized in Hungary, data in support of CCHFV prevalence has thus far, proven insufficient. In the present study, rodents belonging to four species, the yellow-necked mouse (Apodemus flavicollis), the striped field mouse (A. agrarius), the wood mouse (A. sylvaticus) and the bank vole (Myodes glareolus), were all systematically trapped in the Mecsek Mountain region (Southwest Hungary), from 2011 through 2013. Rodent sera were collected and screened for CCHFV antibodies with dot-blot pre-screening and immunofluorescence assay. Among the 2085 tested rodents, 20 (0.96%) were positive for IgG antibody against CCHFV. Seroprevalence was the highest (1.25%) in A. flavicollis serum samples. Distinctly, we now provide the first data regarding CCHFV occurrence and seroprevalence among wild rodents in Hungary. This observation represents a need for large-scale surveillance to effectively assess the enzootic background and the potential public health risk of CCHFV in Hungary.

Hyalomma rufipes on an untraveled horse: Is this the first evidence of Hyalomma nymphs successfully moulting in the United Kingdom?

During September 2018, a tick was submitted to Public Health England's Tick Surveillance Scheme for identification. The tick was sent from a veterinarian who removed it from a horse in Dorset, England, with no history of overseas travel. The tick was identified as a male Hyalomma rufipes using morphological and molecular methods and then tested for a range of tick-borne pathogens including; Alkhurma virus, Anaplasma, Babesia, Bhanja virus, Crimean-Congo Haemorrhagic fever virus, Rickettsia and Theileria. The tick tested positive for Rickettsia aeschlimannii, a spotted fever group rickettsia linked to a number of human cases in Africa and Europe. This is the first time H. rufipes has been reported in the United Kingdom (UK), and the lack of travel by the horse (or any in-contact horses) suggests that this could also be the first evidence of successful moulting of a Hyalomma nymph in the UK. It is postulated that the tick was imported into the UK on a migratory bird as an engorged nymph which was able to complete its moult to the adult stage and find a host. This highlights that passive tick surveillance remains an important method for the detection of unusual species that may present a threat to public health in the UK. Horses are important hosts of Hyalomma sp. adults in their native range, therefore, further surveillance studies should be conducted to check horses for ticks in the months following spring bird migration; when imported nymphs may have had time to drop off their avian host and moult to adults. The potential human and animal health risks of such events occurring more regularly are discussed.

Diagnostic tests for Crimean-Congo haemorrhagic fever: a widespread tickborne disease

Crimean-Congo haemorrhagic fever (CCHF) is a widespread tickborne disease that circulates in wild and domestic animal hosts, and causes severe and often fatal haemorrhagic fever in infected humans. Due to the lack of treatment options or vaccines, and a high fatality rate, CCHF virus (CCHFV) is considered a high-priority pathogen according to the WHO R&D Blueprint. Several commercial reverse transcriptase PCR (RT-PCR) and serological diagnostic assays for CCHFV are already available, including febrile agent panels to distinguish CCHFV from other viral haemorrhagic fever agents; however, the majority of international laboratories use inhouse assays. As CCHFV has numerous amplifying animal hosts, a cross-sectoral 'One Health' approach to outbreak prevention is recommended to enhance notifications and enable early warning for genetic and epidemiological shifts in the human, animal and tick populations. However, a lack of guidance for surveillance in animals, harmonisation of case identification and validated serodiagnostic kits for animal testing hinders efforts to strengthen surveillance systems. Additionally, as RT-PCR tests tend to be lineage-specific for regional circulating strains, there is a need for pan-lineage sensitive diagnostics. Adaptation of existing tests to point-of-care molecular diagnostic platforms that can be implemented in clinic or field-based settings would be of value given the potential for CCHFV outbreaks in remote or low-resource areas. Finally, improved access to clinical specimens for validation of diagnostics would help to accelerate development of new tests. These gaps should be addressed by updated target product profiles for CCHFV diagnostics.