Crimean Congo Haemorrhagic Fever (CCHF)

Common in Asia, the Middle East, Southern Russia, Eastern Europe, East and West Africa.

Nosocomial infection is common (blood and other body fluids).

Mortality is high (30 %).

Outbreak is common.

Transmission is by tick bite.

 

Reservoirs- goat, sheep and cattle.

There is only one serotype.

Virulent strains are found in Asia.

 

Incubation period is 2-7 days.

Clinical Presentations

Prodromal symptoms include an abrupt onset of sore throat, high grade fever, chills and rigors.

Vomiting and diarrhoea may accompany the above symptoms.

Myalgia and headache, back pain, sore eyes, photophobia are also other symptoms observed in patients infected with CCHF viruses.

 

Bleeding tendencies.

Petechial rash in the throat and purpura.

Epistaxis, haemoptysis, haematuria, haematemesis, and melaena.

Conjunctival injections.

Hepatomegaly  with tenderness.

 

Complications

1. Haemorrhagic signs

DIC leading to shock and oligouria (Renal failure).

 

2. Hepatorenal failure

Jaundice, stupor, coma and death

 

Investigations

CBC- neutropenia, leukopenia and thrombocytopenia

LFT- increase in transaminase level

 

Tests

Appropriate samples includes blood (clotted and in EDTA), Urine, respiratory secretions, and stool.

Serology IgM is produced after 7 days from the onset of fever.

Cell culture- the virus grow in vero cells.

Treatment

 

Mainly supportive care.

Some drugs that can be used include

  • Interferon

  • Ribavirin oral or intravenous

 

Adults

Ribavirin 2 gm iv loading dose followed by 1 gm qid for 4 days then 500mg tid for additional 6 days.

 

Children

Ribavirin 30 mg/kg iv loading dose followed by 16 mg/kg iv qid for 4 days then 8 mg/kg iv tid for 6 days.

 

  • Ribavirin may cause haemolytic anaemia

  • Immunoglobulin from convalescent may not be effective

  

 Prevention

There is no vaccine.

 

The most important measures are

  • Quarantine

  • Insect repellents

  • Clothing and footwear

 

Infection control

Disposable equipment should be used.

Protective clothing should be available for staff.

Disinfections- Soap can inactivate the virus.

0.5 % sodium hypochlorite solutions (10 % aqueous solutions of household bleach) or gluteraldehyde (2%) phenolic disinfectant (0.5-3 %) can be used to disinfect equipments or hard surface.

 

Post-exposure Prophylaxis 

Exposed staff and patients should receive Ribavirin soon after significant exposure.

Ribavirin 500 mg by mouth every 6 hours for 7 days.