Seroprevalence of Crimean-Congo haemorrhagic fever among three selected risk human groups in disease-endemic region of Pakistan

Interventions for the control of Crimean-Congo hemorrhagic fever and tick vectors

Crimean-Congo hemorrhagic fever (CCHF) is a zoonotic disease associated with its principal tick vector, Hyalomma spp. with increasing fatal incidence worldwide. Accordingly, CCHF is a World Health Organization-prioritized disease with the absence of effective preventive interventions and approved vaccines or effective treatments. This perspective raised from a multidisciplinary gap analysis considering a One Health approach beneficial for human and animal health and the environment exploring international collaborations, gaps and recommendations.

Crimean-Congo Hemorrhagic Fever Virus Diversity and Reassortment, Pakistan, 2017-2020

Sporadic cases and outbreaks of Crimean-Congo hemorrhagic fever (CCHF) have been documented across Pakistan since 1976; however, data regarding the diversity of CCHF virus (CCHFV) in Pakistan is sparse. We whole-genome sequenced 36 CCHFV samples collected from persons infected in Pakistan during 2017-2020. Most CCHF cases were from Rawalpindi (n = 10), followed by Peshawar (n = 7) and Islamabad (n = 4). Phylogenetic analysis revealed the Asia-1 genotype was dominant, but 4 reassorted strains were identified. Strains with reassorted medium gene segments clustered with Asia-2 (n = 2) and Africa-2 (n = 1) genotypes; small segment reassortments clustered with the Asia-2 genotype (n = 2). Reassorted viruses showed close identity with isolates from India, Iran, and Tajikistan, suggesting potential crossborder movement of CCHFV. Improved and continuous human, tick, and animal surveillance is needed to define the diversity of circulating CCHFV strains in Pakistan and prevent transmission.

Seroprevalence of Crimean Congo Hemorrhagic Fever Virus in Occupational Settings: Systematic Review and Meta-Analysis

Crimean Congo Hemorrhagic Fever (CCHF) Virus can cause a serious human disease, with the case fatality ratio previously estimated to be 30-40%. Our study summarized seroprevalence data from occupational settings, focusing on the following occupational groups: animal handlers, abattoir workers, farmers, healthcare workers, veterinarians, rangers, and hunters. Systematic research was performed on three databases (PubMed, EMBASE, MedRxiv), and all studies reporting seroprevalence rates (IgG-positive status) for CCHF virus were retrieved and their results were reported, summarized, and compared. We identified a total of 33 articles, including a total of 20,195 samples, i.e., 13,197 workers from index occupational groups and 6998 individuals from the general population. Pooled seroprevalence rates ranged from 4.751% (95% confidence intervals (95% CI) 1.834 to 11.702) among animal handlers, to 3.403% (95% CI 2.44 to 3.932) for farmers, 2.737% (95% CI 0.896 to 8.054) among rangers and hunters, 1.900% (95% CI 0.738 to 4.808) for abattoir workers, and 0.644% (95% CI 0.223-1.849) for healthcare workers, with the lowest estimate found in veterinarians (0.283%, 95% CI 0.040-1.977). Seroprevalence rates for abattoir workers (odds ratio (OR) 4.198, 95% CI 1.060-16.464), animal handlers (OR 2.399, 95% CI 1.318-4.369), and farmers (OR 2.280, 95% CI 1.419 to 3.662) largely exceeded the official notification rates for CCHF in the general population. CCHF is reasonably underreported, and pooled estimates stress the importance of improving the adherence to personal protective equipment use and appropriate preventive habits.

The spatial pattern of human exposure to Crimean-Congo haemorrhagic fever virus is not consistent with red deer-based risk predictions

The objective of this study was to evaluate the spatial risk of exposure to Crimean-Congo haemorrhagic fever virus (CCHFV) infection of healthy blood donors in an enzootic region with a predicted risk gradient based on a virus-animal interaction risk model. We designed a cross-sectional study to test if the exposure pattern of the human population to CCHFV spatially matches the predicted risk. We randomly selected 1384 donors from different risk gradients and analyzed their sera searching for CCHFV antibodies. None of the selected blood donors showed exposure to CCHFV. This study shows that exposure risk spatial patterns, as predicted from animal-tick-virus models, does not necessarily match the pattern of human-infected tick interactions leading to CCHFV infection and CCHF cases, at least in a region of predicted moderate infection risk. The findings suggest that future studies should bear the potential drivers of tick-human encounter rates into account to more accurately predict risks.

Prevalence and phylogenetic analysis of Crimean-Congo hemorrhagic fever virus in ticks collected from Punjab province of Pakistan

Crimean-Congo hemorrhagic fever (CCHF) is a tick-borne zoonotic disease of human that caused by CCHF virus. To study the epidemiological distribution of CCHFV, 2183 tick samples were collected from sheep, goats, cattle and buffalo of different livestock farms of ten districts of Punjab province of Pakistan. Detection of CCHFV was done using enzyme link immunosorbent assay (ELISA) after proper identification of tick samples. The partial S-segment of CCHFV from ELISA positive tick samples was amplified by PCR and sequenced to determine the genotype of CCHFV. Out of2183 collected tick samples, 1913 ticks belonged to 5 species of genus Hyalomma as H. antolicum (48%), H. marginatum (30.2%), H. rufipes (10.82%), H. impressum (5.43%) and H. dromedarii (5.27%). While 270 ticks belonged to 3 species of genus Rhipicephalus as R. microplus (44.8%), R. sanguineus (32.22%) and R. turanicus (24.8%). The overall antigenic prevalence of CCHFV was found to be 12.13% in collected tick samples and 21 tick pools were sequenced for partial S-segment of CCHFV. All of the 21 tick pools were clustered in genotype IV (Asia-1). The highest prevalence of CCHFV was found in district Chakwal (24.13%) followed by Mianwali (23.68%), Rawalpindi (23.07%), Attock (20.0%), Rajanpur (10.52%) and Lahore (8.33%). In positive tick pools, the highest prevalence of CCHFV antigen was found in H. antolicum (39.6%) followed by H. marginatum (30.18%), H. rufipes (13.2%), H. impressum (3.77%), H. dromedarii (1.88%), R. microplus (5.66%) and R. sanguineus (5.66%). The current study confirms the presence of CCHFV in the ticks population of Punjab. The CCHF virus present in Punjab belongs to Asia-1 genotype. It is important to control the tick infestation of the animals present in these areas. So that the transmission cycle of CCHF can be inhibited.