Introduction

Crimean-Congo Hemorrhagic Fever (CCHF) is an infectious viral disease that is very serious and, at times, could be deadly. It most commonly spreads through ticks. It can also spread through personal contact with infected blood or bodily fluids from one person to another. CCHF was first identified in the Crimea in 1944 and then in Congo in 1956, hence the name of the disease.¹

What is crimean-congo hemorrhagic fever?

CCHF is caused by the virus, Nairovirus of the Bunyaviridae family.² The mode of infection is through tick bites or contact with the blood or tissues of infected animals like cattle, sheep, and goats. These animals carry the virus without showing symptoms and can remain doormat, but humans can become dangerously ill when they get infected. The disease is widespread in countries of Africa, the Balkans, the Middle East, and parts of Asia. People who travel to or live in these areas or any other rural territories where ticks are prevalent are at a higher risk of contracting the infection.

How does CCHF spread?

The common mode of infection is through the bite of an infected Hyalomma tick, which is one of the main carriers of the virus.³ When humans come in contact with infected animals through people working in farms, slaughterhouses, or handling livestock are at risk.  The virus can also enter the human body through cuts or breaks in the skin. CCHF can spread between people through direct contact with the blood, saliva, or other bodily fluids of an infected person. Healthcare workers are especially at risk when caring for patients with CCHF, so it is necessary to follow proper precautions. Medical equipment that is not sterilised properly can become contaminated and can spread the disease.

What are the symptoms of CCHF?

CCHF typically begins suddenly, with flu-like symptoms that progress rapidly. During the early stage (Days 1-4), patients can complain of high fever, headache, muscle aches, dizziness, back and joint pain, sensitivity to light, sore eyes, abdominal pain, vomiting and diarrhoea. At the late stage (Days 5-14), the symptoms become more severe, like bleeding (from the nose, gums, and under the skin), bruising, severe liver and kidney damage, confusion or mood swings, weakness and extreme tiredness

How does CCHF affect the body?

As soon as the CCHF virus enters the body, it first damages the cells lining the blood vessels. This damage causes the blood vessels to become leaky and weak, which leads to internal bleeding and damage to vital organs like the liver, kidneys, and lungs.⁴ This is why people with CCHF often bleed easily, both externally (e.g., from the nose or gums) and internally. The internal bleeding can lead to organ damage and, in severe conditions, even death if it is not treated properly. The liver and kidneys are the main organs that help filter toxins and waste products from the body. In CCHF, the virus causes severe damage to these organs, leading to liver failure and kidney dysfunction. This damage can result in jaundice (yellowing of the skin and eyes), dark urine, and swelling of the abdomen. As the disease progresses and the body loses blood through internal bleeding, it can go into shock. In this condition, the organs don’t get enough blood or oxygen to function properly. This is a life-threatening condition that can lead to death if not treated immediately. In severe cases, the virus can affect the brain and nervous system. This can lead to confusion, mood swings, and in rare cases, seizures or coma. The body’s ability to form blood clots to stop bleeding becomes impaired due to the damage to blood vessels. This means that even small cuts or bruises can result in excessive bleeding, making it hard for the body to stop the blood loss.

Who is at risk of CCHF?

Certain groups of people are more at risk of contracting CCHF, like farmers and livestock workers working with animals in rural areas, especially if they are in contact with animals or ticks that carry the virus. Doctors, nurses, and hospital staff who treat CCHF patients are at high risk, especially if they don’t use proper protective equipment. Hunters and butchers who handle infected animal carcasses can also pose a risk. People travelling to areas where CCHF is common should take precautions, particularly if they are visiting rural areas or participating in activities like hiking or camping.

How is CCHF diagnosed?

Diagnosing CCHF can be challenging because its early symptoms (fever, muscle pain, and fatigue) are similar to many other viral infections. To confirm a diagnosis, blood tests are usually carried out to detect the virus’s presence in the body and the body’s immune response to the virus. PCR (Polymerase Chain Reaction) detects the genetic material of the virus and is one of the most accurate ways to confirm CCHF. ELISA (Enzyme-Linked Immunosorbent Assay) looks for antibodies that the body produces in response to the virus.

How is CCHF treated?

There is no specific antiviral treatment for CCHF, which makes managing the disease challenging. Supportive care is the main approach to treatment, meaning doctors focus on relieving the symptoms and helping the body recover.⁵ Treatment may include hydrating the patient with fluids and electrolytes. This helps prevent dehydration and keeps the body’s organs functioning properly. Blood Transfusions are provided if a patient loses a lot of blood, and transfusions may be necessary to replace it. Medications like acetaminophen may help reduce pain and fever, though doctors avoid drugs that increase bleeding risks (like aspirin). Ribavirin is an antiviral drug that has shown some effectiveness in treating CCHF, but it is not always reliable and may not work for everyone. In severe cases, patients may need to be placed in intensive care, where they can receive close monitoring and more advanced treatments, such as mechanical ventilation, if they are having trouble breathing.

How to prevent CCHF?

Since there is no vaccine for CCHF, prevention focuses on avoiding exposure to the virus. Some key steps for prevention include avoiding tick bites when spending time outdoors in areas where ticks are common, wearing protective clothing (long sleeves, pants, boots) and using tick repellents. People who work with livestock should wear protective clothing, gloves, and masks to avoid contact with blood, tissues, and ticks. It’s also important to treat livestock for ticks to reduce the risk of infection. Healthcare workers should wear protective gear (gloves, gowns, masks) when treating CCHF patients to avoid contact with blood and bodily fluids. Hospitals should also follow strict infection control procedures, including proper disposal of medical equipment. In areas where CCHF is common, governments and health authorities can help control the disease by educating the public, controlling ticks in livestock, and providing proper medical care for those infected.

Conclusion

Crimean-Congo Hemorrhagic Fever is a dangerous disease that can have severe, even fatal, effects on the body. It primarily spreads through ticks, but can also pass from person to person through contact with infected blood or fluids. The disease causes bleeding, organ damage, and in some cases, death.

While there is no specific cure or vaccine for CCHF, supportive treatment can help manage symptoms. Preventing the disease involves avoiding tick bites, handling animals carefully, and following strict infection control practices in healthcare settings.

Staying informed and taking precautions, especially in areas where CCHF is common, can help reduce the risk of infection and keep both individuals and communities safe.