1. Crimean-Congo hemorrhagic fever (CCHF) Ahmad Al-Majali, DVM, PhD Food and Agriculture Organization of the UN Riyadh, KSA Ahmad.Almajali@FAO.org

2. COMMON VIRAL HEMORRHAGIC FEVERS Crimean-Congo haemorrhagic fever (Bunyaviridae) Rift valley fever (Bunyaviridae) Lassa fever (Arenaviridae) Marburg fever (Filoviridae) Ebola (Filoviridae) Yellow fever (Flaviviridae)

3. CRIMEN CONGO HEMORRHAGIC FEVER- Features Tick-borne disease Affects variety of animals, such as cattle, sheep, and camels Role of livestock in disease transmission not well understood little or no disease in zoonotic hosts Cause severe disease in humans (Public health importance) Surveillance in animal and vector populations provides an opportunity to monitor disease of potentially severe impact in humans

4. CCHFV Caused by infection with a tick-borne virus (Nairovirus) in the family Bunyaviridae. – Seven virus sero-groups/24 tick-borne species – Extensive genetic diversity 1944-1945 Soviet Military during war in Crimea 1967 People infected in Congo

5. Global distribution and phylogenetic relationships of Crimean- Congo hemorrhagic fever virus (CCHFV) strains

6. Transmission Reservoir and vector: Ixodid (hard) ticks, especially those of the genus, Hyalomma Other ticks of the Ixodes can be transmitters Trans-ovarian and trans-stadial Numerous wild and domestic animals serve as amplifying hosts for the virus. Transmission to humans occurs through contact with infected ticks or animal blood. From Human to human by blood and infected fluids Iatrogenic infection (hospital acquired infection)

7. Hyalomma Life cycle and transmission pathways to humans Source: NICD 2014

8. Risk of exposure Highest group at risk: – livestock workers, and slaughterhouse workers in endemic areas are at risk of CCHF. – Healthcare workers – All ages – 3 times more in males – Life long immunity after infection

9. Geographical Distribution Source CDC 2014

10. Geographical distribution

11. World Sero-prevalence study Source: Spengler et al., PLOS 2016

12. World sero-prevalence Source: Spengler et al., PLOS 2016

13. Number of countries reported seropositive animals

14. Clinical signs only in humans Pre-hemorrhagic phase: – Onset is sudden – Initial signs (1-4 days of illness):

15. Clinical Signs Hemorrhagic phase: – 4 days to 2 weeks: large areas of severe bruising, severe nosebleeds, and uncontrolled bleeding at injection sites – Fatality rate: 9-45%

16. Clinical Signs Convalescence phase: – Patients who survive this phase, the convalescence period begins about 15–20 days after onset of illness.

17. Diagnostic Tests ELISA-for IgG and IgM  IgM – up to four months  IgG – up to five years CF, AGD Cross-reaction with other nairoviruses (need seroprevalence plus tick studies) Virus isolation PCR and RT PCR-for detecting the viral genome

18. Prevention and control No vaccine available Reduce the risk of animal-to-human transmission – Eliminating or at least controlling tick infestations on animals or in stables/barns. – Quarantine for animals before they enter slaughterhouses or routine treatment of ruminants with pesticides 2 weeks prior to slaughter. – Using protective gear masks, gloves and gowns when slaughtering and butchering animals

19. Prevention and control Reduce the risk of tick-to-human transmission – Avoid tick bites – Remove ticks safely from the skin. Reduce the risk of human to human transmission

20. THANK YOU