Healthcare-associated Crimean-Congo haemorrhagic fever in Turkey, 2002–2014: a multicentre retrospective cross-sectional study

Abstract

Healthcare-related transmission of Crimean-Congo haemorrhagic fever (CCHF) is a well-recognized hazard. We report a multicentre retrospective cross-sectional study undertaken in Turkey in 2014 in nine hospitals, regional reference centres for CCHF, covering the years 2002 to 2014 inclusive. Data were systematically extracted from charts of all personnel with a reported health care injury/accident related to CCHF. Blood samples were tested for CCHF IgM/IgG by enzyme-linked immunosorbent assay and/or viral nucleic acid detection by PCR after the injury. Fifty-one healthcare-related exposures were identified. Twenty-five (49%) of 51 resulted in laboratory-confirmed infection, with a 16% (4/25) overall mortality. The main route of exposure was needlestick injury in 32/51 (62.7%). A potential benefit of post-exposure prophylaxis with ribavirin was identified.

Ribavirin for treating Crimean Congo haemorrhagic fever

“…Human-to-human transmission occurs within families and in healthcare settings, including nosocomial outbreaks. The greatest risk of nosocomial exposure is from splash exposures and needle stick injuries (Conger 2015; Leblebicioglu 2016a). Case series studies also suggest that in rare cases airborne transmission from ventilated patients may also occur (Pshenichnaya 2015).…”

“…Ribavirin is also used in healthcare settings as a form of post-exposure prophylaxis for those exposed to CCHF (Leblebicioglu 2016a). Non-randomized studies show that it could be effective in treating cases of CCHF (Fisher-Hoch 1995; Mardani 2003; Dokuzoguz 2013), although this has been debated (Kalin 2014; Leblebicioglu 2016a). One such idea is that administration of ribavirin early in the disease, when it appears to be at its most effective, may be a promising approach (Dokuzoguz 2013; Ozbey 2014).…”

Unexpected Risks for Campers and Hikers: Tick-Borne Infections

“…Cases generally come from rural and farming areas. [46][47][48]52,58 Although CCHF and Tularemia are notifiable diseases in Turkey, there are not any case records for campers or hikers. For future studies, prospective or retrospective studies for tick-borne infections that focus on campers, hikers, climbers, and others should be conducted.…”

“…A total of 9787 cases were recorded by the Turkish Ministry of Health between 2002 and 2015. 52 Although 2 cases of CCHF were reported in Germany in 2009, it was brought in from Afghanistan. 53 Most recently, two CCHF cases were reported on August 31, 2016 by the health authorities in Madrid, Spain; thus, CCHF has reached a Mediterranean country.…”

“…52 First, CCHF should be suspected in the case of presenting two situations: (i) clinical findings indicate fever and bleeding, (ii) epidemiologic risk factors include travel to an endemic region within the previous two weeks and exposure to tick bite or contact with animal tissue or body fluids. 42,52 In laboratory findings, leukopenia, thrombocytopenia, hemolisis, hyperbilirubinemia, and elevated transaminases are confirmed which clinically lead to bleeding diathesis. In severe cases, clinical and laboratory findings of disseminated intravascular coagulation and multiorgan failure may be observed.…”