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The clinical and epidemiological characteristics of CCHF and the impact of ribavirin therapy

Abstract number: 1133_147

Ergonul O.

Crimean-Congo haemorrhagic fever (CCHF) is a fatal viral infection described in parts of Africa, Asia, Eastern Europe, and Middle East. CCHF was first recognized during a large outbreak among agricultural workers in the mid 1940s in the Crimean peninsula, and a recent outbreak was reported from Turkey. The virus belongs to the genus Nairovirus in the Bunyaviridae family and causes severe diseases in humans, with the reported mortality rate of 3–30%. The mortality rate of CCHF virus (CCHFV) infection was lower in Turkey than the previously reported epidemics. Genetic analysis of the virus isolates from Turkey revealed a close relation with the isolates from former Yugoslavia and southwestern Russia. Humans become infected through the bites of ticks, by contact with a patient with CCHF during the acute phase of infection, or by contact with blood or tissues from viremic livestock. The occurrence of CCHF closely approximates the known world distribution of Hyalomma spp. ticks. After a short-incubation period, CCHF is characterized by a sudden onset of high fever, severe headache, dizziness, and myalgia. Additional symptoms can include nausea, vomiting, diarrhoea, and somnolence. In severe cases, haemorrhagic manifestations, ranging from petechiae to large areas of ecchymosis, develop. The levels of liver enzymes, creatinine phosphokinase, and lactate dehydrogenase are elevated, bleeding markers are elongated. In diagnosis, enzyme linked immunoassay and real-time reverse transcription-polymerase chain reaction (RT-PCR) are used. Treatment options for CCHF are limited. Ribavirin was suggested as an effective drug in recent studies, and it was found to be beneficial. No adverse event related to ribavirin therapy was noted. Based on our experiences in Turkey, ribavirin should be given to the patients suspected of CCHF infection who have severe thrombocytopenia, elevated ALT, AST, AST/ALT levels. The hospital health care workers (HCW) are under serious risk of transmission of the infection, particularly during the follow-up of the patient, with hemorrhages from the nose, mouth, gums, vagina, and injection sites. Simple barrier precautions were reported to be effective, but rigorously applied. Based on the results of our studies, we do not encourage prophylactic ribavirin use among HCWs, instead, in such cases, we suggest rigorous daily follow-up of the individual, by checking complete blood count, and biochemical tests if necessary.

Session Details

Date: 01/08/2007
Time: 00:00-00:00
Session name: XXIst ISTH Congress
Subject:
Location: Oxford, UK
Presentation type:
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