Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Medicine
Published in: BMC Medicine 1/2011

Open Access 01-12-2011 | Commentary

Crimean-Congo hemorrhagic fever: epidemiological trends and controversies in treatment

Authors: Helena C Maltezou, Anna Papa

Published in: BMC Medicine | Issue 1/2011

Login to get access

Abstract

Crimean-Congo hemorrhagic fever (CCHF) virus has the widest geographic range of all tick-borne viruses and is endemic in more than 30 countries in Eurasia and Africa. Over the past decade, new foci have emerged or re-emerged in the Balkans and neighboring areas. Here we discuss the factors influencing CCHF incidence and focus on the main issue of the use of ribavirin for treating this infection. Given the dynamics of CCHF emergence in the past decade, development of new anti-viral drugs and a vaccine is urgently needed to treat and prevent this acute, life-threatening disease.
Appendix
Available only for authorised users
Literature
1.
Vorou R, Pierroutsakos IN, Maltezou HC: Crimean-Congo hemorrhagic fever. Curr Opin Infect Dis. 2007, 20: 495-500. 10.1097/QCO.0b013e3282a56a0a.CrossRefPubMed
2.
Hoogstraal H: The epidemiology of tick-borne Crimean-Congo hemorrhagic fever in Asia, Europe, and Africa. J Med Entomol. 1979, 15: 307-417.CrossRefPubMed
3.
Heyman P, Cochez C, Hofhuis A, van der Giessen J, Sprong H, Porter SR, Losson B, Saegerman C, Donoso-Mantke O, Niedrig M, Papa A: A clear and present danger: tick-borne diseases in Europe. Expert Rev Anti Infect Ther. 2010, 8: 33-50. 10.1586/eri.09.118.CrossRefPubMed
4.
Casals J: Antigenic similarity between the virus causing Crimean hemorrhagic fever and Congo virus. Proc Soc Exp Biol Med. 1969, 131: 233-236.CrossRefPubMed
5.
Leblebicioglu H: Crimean-Congo haemorrhagic fever in Eurasia. Int J Antimicrob Agents. 2010, 36 (Suppl): S43-46.CrossRefPubMed
6.
Wölfel R, Paweska JT, Petersen N, Grobbelaar AA, Leman PA, Hewson R, Georges-Courbot MC, Papa A, Heiser V, Panning M, Günther S, Drosten C: Low-density macroarray for rapid detection and identification of Crimean-Congo hemorrhagic fever virus. J Clin Microbiol. 2009, 47: 1025-1030. 10.1128/JCM.01920-08.CrossRefPubMedPubMedCentral
7.
Maltezou HC, Maltezos E, Papa A: Contact tracing and serosurvey among healthcare workers exposed to Crimean-Congo hemorrhagic fever in Greece. Scand J Infect Dis. 2009, 41: 877-880. 10.3109/00365540903173619.CrossRefPubMed
8.
Aradaib IE, Erickson BR, Mustafa ME, Khristova ML, Saeed NS, Elageb RM, Nichol ST: Nosocomial outbreak of Crimean-Congo hemorrhagic fever, Sudan. Emerg Infect Dis. 2010, 16: 837-839.CrossRefPubMedPubMedCentral
9.
Nabeth P, Cheikh DO, Lo B, Faye O, Vall IO, Niang M, Wague B, Diop D, Diallo M, Diallo B, Diop OM, Simon F: Crimean-Congo hemorrhagic fever, Mauritania. Emerg Infect Dis. 2004, 10: 2143-2149.CrossRefPubMedPubMedCentral
10.
Athar MN, Baqai HZ, Ahmad M, Khalid MA, Bashir N, Ahmad AM, Balouch AH, Bashir K: Short report: Crimean-Congo haemorrhagic fever outbreak in Rawalpindi, Pakistan, February 2002. Am J Trop Med Hyg. 2003, 69: 284-287.PubMed
11.
Sidwell RW, Smee DF: Viruses of the Bunya- and Togaviridae families: potential as bioterrorism agents and means of control. Antiviral Res. 2003, 57: 101-111. 10.1016/S0166-3542(02)00203-6.CrossRefPubMed
12.
Maltezou HC, Papa A: Crimean-Congo hemorrhagic fever: risk for emergence of new endemic foci in Europe?. Travel Me Infect Dis. 2010, 8: 139-143. 10.1016/j.tmaid.2010.04.008.CrossRef
13.
Chinikar S, Ghiasi SM, Hewson R, Moradi M, Haeri A: Crimean-Congo hemorrhagic fever in Iran and neighboring countries. J Clin Virol. 2010, 47: 110-114. 10.1016/j.jcv.2009.10.014.CrossRefPubMed
14.
15.
Zakhashivilli , Tsertsvadze N, Chikviladze T, Jghenti E, Bekaia M, Kuchuloria T, Hepburn MJ, Imnadze P, Nanuashvili A: Crimean-Congo hemorrhagic ever in man, Republic of Georgia, 2009. Emerg Infect Dis. 2010, 16: 1326-1328.CrossRef
16.
17.
Maltezon HC, Andonova L, Andraghetti R, Bouloy M, Ergonul O, Jongejan F, Kalvatchev N, Nichol S, Niedrig M, Platonov A, Thomson G, Leitmeyer K, Zeller H: Crimean-Congo hemorrhagic fever in Europe: current situation calls for preparedness. Eur Surveill. 2010, 15: 19504.
18.
Smirnova SE: Circulation of Crimean-Congo hemorrhagic fever virus in the Stavropol territory in the seasons of 1999-2000. Zh Mikrobiol Epidemiol Immunobiol. 2005, 3: 49-53. in RussianPubMed
19.
Yilmaz GR, Buzgan T, Irmak H, Safran A, Uzun R, Cevik MA, Torunoglu MA: The epidemiology of Crimean-Congo hemorrhagic fever in Turkey, 2002-2007. Int J Infect Dis. 2009, 13: 380-386. 10.1016/j.ijid.2008.07.021.CrossRefPubMed
20.
Gunes T, Engin A, Poyraz O, Elaldi N, Kaya S, Dokmetas I, Bakir M, Cinar Z: Crimean-Congo hemorrhagic fever virus in high-risk population, Turkey. Emerg Infect Dis. 2009, 15: 461-464. 10.3201/eid1503.080687.CrossRefPubMedPubMedCentral
21.
Ertugrul B, Uyar Y, Yavas K, Turan C, Oncu S, Saylak O, Carhan A, Ozturk B, Erol N, Sakarya S: An outbreak of Crimean-Congo hemorrhagic fever in western Anatolia, Turkey. Int J Infect Dis. 2009, 13: e431-436. 10.1016/j.ijid.2009.02.011.CrossRefPubMed
22.
Randolph SE, Rogers DJ: Ecology of tick-borne disease and the role of climate. Crimean-Congo Hemorrhagic Fever. A Global Perspective. Edited by: Ergonul O, Whitehouse CA. 2007, Dordrecht: Springer, 167-186.CrossRef
23.
Randolph SE, Rogers DJ: The arrival, establishment and spread of exotic diseases: patterns and predictions. Nat Rev Microbiol. 2010, 8: 361-371. 10.1038/nrmicro2336.CrossRefPubMed
24.
Ergonul O: Crimean-Congo haemorrhagic fever. Lancet Infect Dis. 2006, 6: 203-214. 10.1016/S1473-3099(06)70435-2.CrossRefPubMed
25.
Filipe AR, Calisher CH, Lazuick J: Antibodies to Congo-Crimean haemorrhagic fever, Dhori, Thogoto and Bhanja viruses in southern Portugal. Acta Virol. 1985, 29: 324-328.PubMed
26.
Charrel RN, Attoui H, Butenko AM, Clegg JC, Deubel V, Frolova TV, Gould EA, Gritsun TS, Heinz FX, Labuda M, Lashkevich VA, Loktev V, Lundkvist A, Lvov DV, Mandl CW, Niedrig M, Papa A, Petrov VS, Plyusnin A, Randolph S, Süss J, Zlobin VI, de Lamballerie X: Tick-borne virus diseases of human interest in Europe. Clin Microbiol Infect. 2004, 10: 1040-1055. 10.1111/j.1469-0691.2004.01022.x.CrossRefPubMed
27.
Papa A, Dalla V, Papadimitriou E, Kartalis GN, Antoniadis A: Emergence of Crimean-Congo haemorrhagic fever in Greece. Clin Microbiol Infect. 2010, 16: 843-847.CrossRefPubMed
28.
Aradaib IE, Erickson BR, Karsany MS, Khristova ML, Elageb RM, Mohamed ME, Nichol ST: Multiple Crimean-Congo hemorrhagic fever virus strains are associated with disease outbreaks in Sudan, 2008-2009. PLoS Negl Trop Dis. 2011, 5: e1159-10.1371/journal.pntd.0001159.CrossRefPubMedPubMedCentral
29.
Estrada-Pena A, Venzal JM: Climate niches of tick species in the Mediterranean region: modeling of occurrence data, distributional constraints, and impact of climate change. J Med Entomol. 2007, 33: 1130-1138.CrossRef
30.
Keshtkar-Jahromi M, Kuhn JH, Christova I, Bradfute SB, Jahrling PB, Bavari S: Crimean-Congo hemorrhagic fever: current and future prospects of vaccines and therapies. Antiviral Res. 2011, 90: 85-92. 10.1016/j.antiviral.2011.02.010.CrossRefPubMed
31.
Maltezou HC, Papa A, Tsiodras S, Dalla V, Maltezos E, Antoniadis A: Crimean-Congo hemorrhagic fever in Greece: a public health perspective. Int J Infect Dis. 2010, 13: 713-716.CrossRef
32.
Papa A, Papadimitriou E, Christova I: The Bulgarian vaccine Crimean-Congo haemorrhagic fever virus strain. Scand J Infect Dis. 2011, 43: 225-229. 10.3109/00365548.2010.540036.CrossRefPubMed
33.
Watts DM, Ussery MA, Nash D, Peters CJ: Inhibition of Crimean-Congo hemorrhagic fever viral infectivity yields in vitro by ribavirin. Am J Trop Med Hyg. 1989, 41: 581-585.PubMed
34.
Paragas J, Whitehouse CA, Endy TP, Bray M: A simple assay for determining antiviral activity against Crimean-Congo hemorrhagic fever virus. Antiviral Res. 2004, 62: 21-25. 10.1016/j.antiviral.2003.11.006.CrossRefPubMed
35.
Tignor GH, Hanham CA: Ribavirin efficacy in an in vitro model of Crimean-Congo hemorrhagic fever virus (CCHF) infection. Antiviral Res. 1993, 22: 309-325. 10.1016/0166-3542(93)90040-P.CrossRefPubMed
36.
Bente DA, Alimonti JB, Shieh WJ, Camus G, Stroher U, Zaki S, Jones SM: Pathogenesis and immune response of Crimean-Congo hemorrhagic fever virus in a STAT-1 knockout mouse model. J Virol. 2010, 84: 11089-11100. 10.1128/JVI.01383-10.CrossRefPubMedPubMedCentral
37.
Mardani M, Jahromi MK, Naeni KH, Zeinali M: The efficacy of oral ribavirin in the treatment of Crimean-Congo hemorrhagic fever. Clin Infect Dis. 2003, 36: 1613-1618. 10.1086/375058.CrossRefPubMed
38.
Fisgin NT, Ergonul O, Doganci L, Tulek N: The role of ribavirin in the therapy of Crimean-Congo hemorrhagic fever: early use is promising. Eur J Clin Microbiol Infect Dis. 2009, 28: 929-933. 10.1007/s10096-009-0728-2.CrossRef
39.
Izadi S, Salehi M: Evaluation of the efficacy of ribavirin therapy on survival of Crimean-Congo hemorrhagic fever patients: a case-control study. Jpn J Infect Dis. 2009, 62: 11-15.PubMed
40.
Ergonul O, Celikbas A, Dokuzoguz B, Eren S, Baykam N, Esener H: Characteristics of patients with Crimean-Congo hemorrhagic fever in a recent outbreak in Turkey and impact of oral ribavirin therapy. Clin Infect Dis. 2004, 39: 284-287. 10.1086/422000.CrossRefPubMed
41.
Cevik MA, Elardi N, Akinci E, Onguru P, Erbay A, Buzgan T, Uzun R, Kubar A, Bodur H: A preliminary study to evaluate the effect of intravenous ribavirin treatment on survival rates in Crimean-Congo hemorrhagic fever. J Infect. 2008, 57: 350-359. 10.1016/j.jinf.2008.07.007.CrossRefPubMed
42.
Koksal I, Yilmaz G, Aksoy F, Aydin H, Yavuz I, Iskender S, Akcay K, Erensoy S, Caylan R, Aydin K: The efficacy of ribavirin in the treatment of Crimean-Congo hemorrhagic fever in Eastern Black Sea region in Turkey. J Clin Virol. 2010, 47: 65-68. 10.1016/j.jcv.2009.11.007.CrossRefPubMed
43.
Bodur H, Erbay A, Akinci E, Onguru P, Bayazit N, Eren SS, Kubar A: Effect of oral ribavirin treatment on the viral load and disease progression in Crimean-Congo hemorrhagic fever. Int J Infect Dis. 2011, 15: e44-e47. 10.1016/j.ijid.2010.09.009.CrossRefPubMed
44.
Soares-Weiser K, Thomas S, Thomson G, Garner P: Ribavirin for Crimean-Congo hemorrhagic fever: systemic review and meta-analysis. BMC Infect Dis. 2010, 10: 207-10.1186/1471-2334-10-207.CrossRefPubMedPubMedCentral
45.
Karlberg H, Lindegren G, Mirazimi A: Comparison of antiviral activity of recombinant and natural interferons against Crimean-Congo hemorrhagic fever virus. Open Virol J. 2010, 4: 38-41.PubMedPubMedCentral
46.
Andersson I, Bladh L, Mousavi-Jazi M, Magnusson KE, Lundkvist A, Haller O, Mirazimi A: Human MxA protein inhibits the replication of Crimean-Congo hemorrhagic fever virus. J Virol. 2004, 78: 4323-4329. 10.1128/JVI.78.8.4323-4329.2004.CrossRefPubMedPubMedCentral
47.
Andersson I, Karlberg H, Mousavi-Jazi M, Martinez-Sobrido L, Weber F, Mirazimi A: Crimean-Congo hemorrhagic fever virus delays activation of the innate immune response. J Med Virol. 2008, 80: 1397-1404. 10.1002/jmv.21222.CrossRefPubMed
48.
Saksida A, Duh D, Wraber B, Dedushaj I, Ahmeti S, Avsic-Zupanc T: Interacting roles of immune mechanisms and viral load in the pathogenesis of Crimean-Congo hemorrhagic fever. Clin Vaccine Immunol. 2010, 17: 1086-1093. 10.1128/CVI.00530-09.CrossRefPubMedPubMedCentral
49.
Papa A, Drosten C, Bino S, Papadimitriou E, Panning M, Velo E, Kota M, Harxhi A, Antoniadis A: Viral load and Crimean-Congo hemorrhagic fever. Emerg Infect Dis. 2007, 13: 805-806.CrossRefPubMedPubMedCentral
50.
Cevik MA, Erbay A, Bodur H, Eren SS, Akinci E, Sener K, Ongürü P, Kubar A: Viral load as a predictor of outcome in Crimean-Congo hemorrhagic fever. Clin Infect Dis. 2007, 45: e96-100. 10.1086/521244.CrossRefPubMed
51.
Papa A, Bino S, Velo E, Harxhi A, Kota M, Antoniadis A: Cytokine levels in Crimean-Congo hemorrhagic fever. J Clin Virol. 2006, 36: 272-276. 10.1016/j.jcv.2006.04.007.CrossRefPubMed
Metadata
Title
Crimean-Congo hemorrhagic fever: epidemiological trends and controversies in treatment
Authors
Helena C Maltezou
Anna Papa
Publication date
01-12-2011
Publisher
BioMed Central
Published in
BMC Medicine / Issue 1/2011
Electronic ISSN: 1741-7015
DOI
https://doi.org/10.1186/1741-7015-9-131

Other articles of this Issue 1/2011

BMC Medicine 1/2011 Go to the issue

Research article

Septin 9 methylated DNA is a sensitive and specific blood test for colorectal cancer

Research article

Variability of the chronic obstructive pulmonary disease key epidemiological data in Europe: systematic review

Research article

Nuclear envelope structural defects cause chromosomal numerical instability and aneuploidy in ovarian cancer

Debate

Should Global Burden of Disease Estimates Include Depression as a Risk Factor for Coronary Heart Disease?

Question and Answer

Q&A: Primary generalized glucocorticoid resistance

Research article

Combinations of motor measures more strongly predict adverse health outcomes in old age: the rush memory and aging project, a community-based cohort study