Investigation Around Cases of Crimean-Congo Hemorrhagic Fever—Mauritania, 2022

Abstract

Background Crimean-Congo hemorrhagic fever (CCHF) is a zoonotic arbovirosis. Humans are infected by tick bites or contact with blood of infected animals. CCHF can be responsible for severe outbreaks due to human-to-human transmission. Objectives The aims of the study were to increase awareness and promote the search for risk factors and disease monitoring to prevent CCHF epidemic, capacity building of laboratory diagnosis, appropriate measures to treat CCHF virus-infected patients, and information for the local population. Methods During the outbreak of hemorrhagic fever in Mauritania from February to May 2022, blood samples were collected from 88 patients suspected to be infected with the virus. Viral diagnosis was established by reverse transcriptase polymerase chain reaction (RT-PCR) and/or enzyme-linked immunosorbent assay (ELISA) at the laboratory of the National Institute of Public Health Research in Nouakchott, Mauritania. Results CCHF was confirmed by RT-PCR in 7 of 88 (8%) patients. Ticks were found in cattle, sheep, or goats in the areas where the subjects resided, with the exception of one CCHFV-positive patient in close contact with fresh animal meat. Exposure to potential risk factors for CCHF virus infection was found in all patients. The interval between the onset of symptoms and hospital admission was 2–3 days. All seven patients were admitted to our hospital and treated promptly by blood transfusion. Two patients died. Conclusion Mortality is very high in patients with the hemorrhagic form of CCHF. Disease prevention is necessary by strengthening vector control, avoiding contact and consumption of organic products from diseased animals, and vaccinating animals in areas where the disease is endemic. Furthermore, it is essential to establish management procedures for patients infected with CCHF virus.

Risk factors associated with Crimean-Congo hemorrhagic fever virus circulation among human, livestock and ticks in Mauritania through a one health retrospective study

“…From a public health point of view, CCHF outbreaks continue to cause fatality particularly among animal breeders [ 14 ]. The geographic distribution of the disease resulted from the present study suggest the presence of the virus among humans, livestock and ticks from almost all prospected provinces in Mauritania.…”

“…In Europe, CCHF is considered an emerging disease [ 11 ]. In West Africa, CCHF is endemic in Southern and Southeastern Mauritania and Northern Senegal where sporadic and more recently recurrent outbreaks have been constantly observed since the 1980’s [ 5 , 12 – 14 ]. Furthermore, the four most important Mauritanian domestic livestock species (small ruminants, cattle and camels) have been shown to play an important role in the epidemiology of the disease in the country where high level of CCHFV IgG antibody prevalence were recently reported [ 15 ].…”

Arthropod-Borne Viruses in Mauritania: A Literature Review

“…In fact, most of the documented RVF and CCHF epidemics in Mauritania were caused by close contact with blood or fresh organs of infected animals during slaughtering or when assisting female animals during delivery. This is supported by the fact that at least half of the index patients during the CCHF and RVF outbreaks in Mauritania were butchers, and many other index patients were housewives, suggesting that handling freshly cut meat is a risk for infection [10,13,54,56].…”

“…Between 4 February and 14 March 2022, seven CCHF cases, including two (28.5%) deaths, were reported in Mauritania, including one animal breeder from the department of Kobeni in the south-eastern region of Hodh El Gharbi [56,57]. During this outbreak, Hyalomma ticks were found on cattle, sheep, and goats in the areas where the patients resided, and one of the infected patients was in close contact with fresh animal meat [56]. Viral RNA sequence analysis of the S segment of all positive samples revealed the presence of two different CCHFV lineages, Africa I (Senegal) and Africa III (Mauritania/Mali) [59].…”

“…Unlike RVF, where outbreaks commonly occur during or shortly after the rainy season, CCHF outbreaks reported in humans in Mauritania mostly occurred during the long dry season (i.e., December-July) [56]. Globally, CCHF outbreaks have been reported in areas characterized by year-long warm temperatures, low precipitation, and moderate annual humidity as those prevailing in the Sahelian region in Africa [44,82] where Hyalomma marginatum ticks abound [83].…”