'The Deadly Hunter': Unmasking Crimean-Congo Hemorrhagic Fever (CCHF)

Pashu Sandesh, 03 August 2023

Sapna Sharma¹, Baleshwari Dixit² and Apurv Kaushik³

¹Teaching Associate, DUVASU, Mathura

²Assistant Professor, Co.V.Sc. & A.H., NDVSU, Rewa

³Teaching Associate, DUVASU, Mathura

Abstract

Crimean-Congo Hemorrhagic Fever (CCHF) is an emerging zoonotic disease caused by the Crimean-Congo Hemorrhagic Fever virus (CCHFV). Primarily transmitted through ticks and contact with infected animals, CCHF poses a significant public health threat in various regions worldwide. This abstract provides an overview of CCHF, including its epidemiology, transmission, clinical manifestations, diagnosis, and preventive measures. Rapid diagnosis, early detection, and comprehensive public health strategies are essential to mitigate the impact of CCHF and prevent its further spread. Understanding the complexities of this disease is crucial for healthcare professionals, policymakers, and communities to effectively combat and control CCHF outbreaks.

Keywords: CCHF, Khunymuny, Karakhalak, Stealthy Spread, Hyalomma, RT-PCR

Introduction:

In the shadows of rural areas across different continents, an elusive and deadly hunter lurks Crimean-Congo Hemorrhagic Fever (CCHF). Congo fever, Central Asian hemorrhagic fever, Congo virus illness, Hungribta (blood taking), Crimean hemorrhagic fever, Khunymuny (nose bleeding), Karakhalak (black death), and viral tick-borne hemorrhagic fever sickness are other names for CCHF. This viral disease is not your average flu or common cold. Instead, it poses a severe threat to human health and has earned its reputation as one of the most feared zoonotic diseases. Crimean-Congo Hemorrhagic Fever is a tick-borne viral disease caused by the CCHF virus (CCHFV), which belongs to the Nairovirus genus in the Bunyaviridae family which is enveloped, negative-sense, single-stranded RNA virus. The virus circulates between ticks and animals, particularly livestock such as cattle, sheep, and goats. Humans can contract CCHF through tick bites or by direct contact with infected animal blood or tissues. In rare cases, person-to-person transmission can occur through contact with infected bodily fluids. The disease has gained global attention due to its rapid transmission, high fatality rate, and ability to cause outbreaks in different geographical regions.

Epidemiology:

In the Crimean Peninsula, CCHF was initially identified in 1944, while at Congo; it was first isolated in 1956. The virus and the sickness it produced were given their current names at that time. In various nations in Africa, Asia, the Middle East, and portions of Europe, CCHF is endemic. Before 2011, there has never been a CCHF case in India. Jan 2011 is the first time CCHF outbreaks have been reported in India; a total of 5 cases of CCHF from Gujarat have been found. The primary hosts of the CCHFV are ticks of the Hyalomma genus, which can carry and transmit the virus to both animals and humans. The virus circulates in nature through a complex cycle involving ticks, animals, and humans, with the potential for sporadic outbreaks and seasonal variations in different regions. Outbreaks often occur in areas with a high population of livestock and a significant presence of tick vectors. Several factors, including climate change, ecological changes, and increased human-animal interaction, contribute to the disease's emergence and spread.

The Stealthy Spread:

CCHF's stealthy nature lies in its ability to spread undetected until symptoms manifest, making it challenging to control and contain outbreaks. Its geographical range spans from Africa to Asia, including regions in Europe and the Middle East. Farmers, agricultural workers, veterinarians, and healthcare professionals are at higher risk due to their proximity to animals and ticks. Tick-borne transmission is the primary route for CCHFV to infect humans. Ticks acquire the virus by feeding on infected animals and subsequently transmit it to other hosts, including humans. In addition to tick bites, CCHF can also spread through contact with infected animal blood and tissues, and in rare cases, through human-to-human transmission via bodily fluids.

Clinical Manifestations:

The incubation period for CCHF is typically between 2 to 14 days, after which the disease progresses rapidly. Initial symptoms often resemble those of the flu, including fever, headache, muscle pain, and dizziness. Early symptoms include fever, headache, muscle pain, and dizziness, often leading to misdiagnosis as other common viral infections. However, the severity of CCHF sets it apart. As the disease advances, more severe symptoms may develop, such as bruising, petechiae (small red or purple spots on the skin), and bleeding from the nose or gums. In some cases, CCHF can lead to hemorrhagic fever with life-threatening complications, such as liver and kidney failure.

Diagnosis:

Early diagnosis of CCHF is crucial for prompt treatment and containment of outbreaks. Laboratory testing, including serological assays, reverse transcription-polymerase chain reaction (RT-PCR), and virus isolation, are essential for confirming CCHFV infection. However, due to the nonspecific initial symptoms and potential cross-reactivity with other viruses, differential diagnosis is critical. 

Treatment and Management:

There is currently no specific antiviral treatment for CCHF, and patient care focuses on managing symptoms and providing supportive treatment. Patients with severe cases may require hospitalization, supportive therapy (e.g., intravenous fluids), and blood products to manage bleeding disorders.

Prevention: Your Best Defense

As with many infectious diseases, prevention is the best defence against CCHF. Here are some vital prevention measures to keep the public safe:

• Tick Avoidance: When venturing into rural or tick-prone areas, wear long-sleeved clothing, tuck pants into socks, and use insect repellents containing DEET.
• Animal Contact: Avoid direct contact with infected animals, their blood, or bodily fluids. If you work with livestock or animals, use personal protective equipment (PPE) like gloves and masks.
• Proper Hygiene: Regularly wash your hands with soap and water, especially after handling animals, and avoid touching your face.
• Tick Checks: After outdoor activities, carefully inspect your body and clothing for ticks. Promptly remove any ticks using tweezers, grasping them close to the skin's surface.
• Swift Medical Attention: If you experience symptoms like high fever and unusual bleeding, seek immediate medical attention, and inform healthcare professionals of any recent animal exposure.

Conclusion:

Crimean-Congo Hemorrhagic Fever is a severe viral disease and may seem like a distant threat, but its capacity for rapid spread and severity demands our vigilance. It requires vigilant surveillance, effective tick control measures, and public awareness to prevent and control outbreaks. Understanding the disease, its mode of transmission, and practising preventive measures can significantly reduce the risk of infection. Whether you live in tick-prone regions or plan to travel to affected areas, adopting precautionary steps can safeguard your health and that of your community. Let's stay informed, spread awareness, and thwart the advances of this deadly hunter together. By adopting proactive measures and staying vigilant, we can work towards a world less threatened by this formidable disease.