Crimean-Congo Hemorrhagic Fever in Migrant Worker Returning from Oman to India, 2016

Yadav, Pragya D; Thacker, Sachin; Patil, Deepak Y.; Jain, Rajlaxmi; Mourya, Devendra T.

doi:10.3201/eid2306.161950

“…This is the first study to describe the complete sequence of the S segment ORFs of a series of CCHFV isolates from the region. The results largely confirm findings from partial sequencing of sporadic isolates from the UAE [19,28] and Oman [10,27] since the mid 1990's. The phylogenetic relationship of these sequences with other published sequences from the region is depicted in Figure 4.…”

Section: Resultssupporting

confidence: 79%

“…Limited data are available on the prevalent clade(s), or group(s) of organisms from a single ancestor, of CCHFV in the Arabian Peninsula. Sequencing of the S, M, and L segments of CCHFV isolated from the 1996 patient in Oman (recorded as Oman 1997 in GenBank) showed that it belonged to Asia lineage 1 (clade IV) [10,26], as was the virus isolated from a patient who returned to India with CCHF acquired in Oman in 2016 [27]. Virus isolates from 4 patients in the UAE in 1994 and 1995 also align with the Asia 1 (clade IV) lineage, as did contemporaneous isolates from Hyalomma ticks obtained from livestock imported into the UAE from Somalia [9,19,28].…”

Section: Introductionmentioning

confidence: 99%

Molecular epidemiology and high mortality of Crimean-Congo hemorrhagic fever in Oman: a re-emerging infection

Al-Abri

¹

,

Hewson

²

,

Al-Kindi³

et al. 2018

Preprint

2

1

0

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BackgroundCrimean-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. MethodologyCases 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. FindingsOf 88 cases of CCHF, 4 were sporadic in 1995 and 1996, then none occurred 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 10 9 /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 3CCHF 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. Author summaryCrimean-Congo hemorrhagic fever, an often fatal tick-borne viral disease, has made an impact in the Sultanate of Oman-affecting nationals and expatriates alike-for the past 20 years. In this retrospective review of the epidemiology and outcomes of cases in Oman from 1995 to 2017, we identified 4 sporadic cases in 1995 and 1996, then none until 2011, followed by a steady increase until 2017. The mortality rate of 32 of 88 cases (36.4%) is high in comparison to studies from other countries and this could be explained by under-diagnoses of milder cases in the Sultanate.Transmission is commonly associated with animal husbandry and butchering and 88% cases were infected by contact with animals, whereas transmission by tick bite is more commonly recorded in some countries. A proportion of cases (23.8%) were clustered around the Eid-Al-Ahda festival which has, from 2011-2017, occurred in the summer months, which have a higher risk of transmission. This additional risk has been noted and preventive measures have been introduced to reduce the risk of transmission to animal handlers and butchers.

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“…Limited data are available on the prevalent clade(s), or group(s) of organisms from a single ancestor, of CCHFV in the Arabian Peninsula. Sequencing of the S, M, and L segments of CCHFV isolated from the 1996 patient in Oman (recorded as Oman 1997 in GenBank) showed that it belonged to Asia lineage 1 (clade IV) [10,26], as was the virus isolated from a patient who returned to India with CCHF acquired in Oman in 2016 [27]. Virus isolates from 4 patients in the UAE in 1994 and 1995 also align with the Asia 1 (clade IV) lineage, as did contemporaneous isolates from Hyalomma ticks obtained from livestock imported into the UAE from Somalia [9,19,28].…”

Section: Introductionmentioning

confidence: 99%

Clinical and molecular epidemiology of Crimean-Congo hemorrhagic fever in Oman

Al-Abri

¹

,

Hewson

²

,

Al-Kindi³

et al. 2019

View full text Add to dashboard Cite

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 10 9 /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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“…Over the past 20 years, CCHF has emerged or re-emerged in several countries often with dramatically increased case numbers. Furthermore, there has been a marked increase of imported cases of CCHF in European and South Asian countries [13][14][15][16][17]. The root causes of the increased CCHF incidence rates are not fully understood, but factors such as shifts in climate patterns, animal and human migratory patterns, population increase in livestock and wildlife accompanied by changes in agricultural practices and increased land use may be responsible [18,19].…”

mentioning

confidence: 99%

Nucleocapsid protein-based vaccine provides protection in mice against lethal Crimean-Congo hemorrhagic fever virus challenge

Zivcec

¹

,

Safronetz

²

,

Scott

³

et al. 2018

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Crimean-Congo hemorrhagic fever (CCHF) is an acute, often fatal viral disease characterized by rapid onset of febrile symptoms followed by hemorrhagic manifestations. The etiologic agent, CCHF orthonairovirus (CCHFV), can infect several mammals in nature but only seems to cause clinical disease in humans. Over the past two decades there has been an increase in total number of CCHF case reports, including imported CCHF patients, and an expansion of CCHF endemic areas. Despite its increased public health burden there are currently no licensed vaccines or treatments to prevent CCHF. We here report the development and assessment of the protective efficacy of an adenovirus (Ad)-based vaccine expressing the nucleocapsid protein (N) of CCHFV (Ad-N) in a lethal immunocompromised mouse model of CCHF. The results show that Ad-N can protect mice from CCHF mortality and that this platform should be considered for future CCHFV vaccine strategies.

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Crimean-Congo Hemorrhagic Fever in Migrant Worker Returning from Oman to India, 2016

Cited by 23 publications

References 14 publications

Molecular epidemiology and high mortality of Crimean-Congo hemorrhagic fever in Oman: a re-emerging infection

Molecular epidemiology and high mortality of Crimean-Congo hemorrhagic fever in Oman: a re-emerging infection

Clinical and molecular epidemiology of Crimean-Congo hemorrhagic fever in Oman

Nucleocapsid protein-based vaccine provides protection in mice against lethal Crimean-Congo hemorrhagic fever virus challenge

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