Epidemiology of Crimean-Congo Hemorrhagic Fever in the Balkans

Crimean-Congo hemorrhagic fever (CCHF) is viral hemorrhagic fever with high significance in the Balkan Peninsula (Fig. 7-1), with a case fatality rate (CFR) of up to 40% and a high propensity for nosocomial spread. Epidemic outbreaks as well as sporadic cases have continuously been recorded in this area since 1952. There is strong evidence that Hyalomma marginatum marginatum ticks are implicated in the ecology of CCHF and serve as a principal vector of the virus in this region. Although the majority of documented cases have a history of tick bite, farmers having contact with the livestock have been found as a risk population for contracting the disease. Person-to-person transmissions, resulting in family outbreaks, as well as nosocomial transmissions in hospital settings, were frequently reported in the Balkans. Hospitalized patients, usually presented with a severe clinical course, were treated with supportive and replacement therapy. With regard to the availability of drugs and the country, antiviral drug ribavirin was effectively administered. Depending on the country, various preventive measures against the infection and spread of the disease are used. In general, after every outbreak or epidemic of CCHF, a better knowledge and awareness of the disease were obtained in general population, in high-risk groups and particularly among health-care workers.