Turkey: ticks carrying Crimean-Congo hemorrhagic fever on the rise

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Source: http://www.turkishdailynews.com.tr/a...enewsid=104898

Tick panic in Istanbul
Tuesday, May 20, 2008

ISTANBUL ? TDN with wire dispatches

More than a hundred people were rushed to hospitals in Istanbul after finding ticks on their skin over the weekend.

In the last month, seven have died around the country from Crimean-Congo hemorrhagic fever, which passes through tick bites.

Over a hundred adults and around 60 children came to the Haseki Training and Research Hospital where the ticks were removed.

The patients were told to return if they suffered from bleeding, high fever, muscle pain and vomiting.

The Crimean-Congo hemorrhagic fever mainly strikes farm and slaughterhouse workers in the countryside in the central Anatolia and Black Sea regions.

Local media said ticks carrying the virus are multiplying faster than usual due to global warming and high temperatures.

The disease normally occurs through bites of infected ticks or from direct contact with infected blood and tissue from livestock. Human to human transmission, through exposure to contaminated blood, is more rare.

There is no vaccine against the disease. A body rash and bleeding from the bowels and gums, often accompanied by hepatitis and pulmonary failure, follow in severe cases.

The mortality rate can reach 30 percent from the disease, which was first identified in Crimea in 1944 and later appeared in Congo.

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Gov?t declares war against ticks

Three Turkish ministries have devised an action plan to combat the spread by ticks of Crimean-Congo hemorrhagic fever (CCHF) as the weather warms up and people head outdoors, increasing their vulnerability to sometimes deadly tick bites.

The first step of the action plan -- developed in coordination with the Ministry of Agriculture and Rural Affairs, the Ministry of Health and the Ministry of Environment and Forestry -- involves the spraying of animal feeding grounds and areas where they seek shelter with pesticides. The second step involves combating environmental conditions conducive to ticks.

Agriculture and Rural Affairs Minister Mehdi Eker said that tons of spraying equipment and pesticide had been sent to the regions at highest risk for tick overpopulation. He also said they had imported a liquid repellent, marketed under the name "Ken-Kov" in Turkey.

Eker said the repellent can be applied topically to the skin and is not harmful to humans, recommending that agricultural workers in particular make use of the product. He added that the repellent has been used in Europe and the United States, and also by soldiers in the field. The ministry has started a pesticide spraying campaign at all tick breeding grounds.

The Ministry of Agriculture and Rural Affairs said the most important factor increasing the tick population in Turkey was an overpopulation of wild pigs, which are the biggest carriers of ticks, and has asked the Ministry of Environment to bring the situation under control.

Environment and Forestry Ministry officials say wolves will be used to balance out the population of wild pigs -- which has reached 300,000 -- while birds will be used in efforts to control the tick population. To that end, the ministry has begun to release wolves into areas where an abundance of wild pigs have been seen.

Officials noted a decrease in the bird population following several cases of bird flu, and have been trying to breed birds that feed on ticks. To direct these birds to tick feeding grounds, officials have already installed 375 artificial forest lakes where animals graze.

The provinces posing the highest risk of CCHF infection are Tokat, ?orum, Yozgat, Samsun, Amasya and Sivas. Tick-bite cases are mostly seen in May and June but are still a serious risk until the end of October, officials said.

In Yozgat, health officials have been distributing a tick repellent spray to the public, targeting three high-risk areas in particular. Provincial Health Director Mustafa Uyanık said they had distributed spray to 841 homes and explained its use to families: The repellent should be sprayed on clothing and left to dry for two hours before wearing. The protection lasts up to three weeks.

Numerous wild and domesticated animals, such as cattle, goats, sheep and hares, can serve as hosts for the virus. Transmission to humans occurs through contact with infected animal blood or ticks.

Last week, a woman from the Central Anatolian province of Yozgat died at an Ankara hospital, where she was being treated for CCHF. The woman contracted the disease from a tick bite she received while grazing her cattle.

The woman's death is the sixth fatal case of CCCHF in the country this year.

Also last weekend, more than 500 İstanbulites who picnicked in rural areas over the holiday weekend filled hospitals on Monday with complaints of tick bites. According to the Anatolia news agency, many of those who had picnicked in İstanbul's Kemerburgaz, Arnavutk?y, Sarıyer and ?ekmek?y districts noticed upon returning home that ticks were attached to their bodies. Sixty of the individuals were children, Anatolia reported.

Following the increase in the number of tick bite incidents over the weekend, workers from the İstanbul Metropolitan Municipality expedited their task of spraying pesticides in popular picnic areas.

A statement released by the municipality on May 19 said 250 municipal workers were conducting pesticide spraying in green areas and parks across the city where people typically relax. The statement also noted that the spraying aimed to prevent the emergence of diseases carried by ticks and could also be carried out in other places as requested by the public.

In early May, another woman, from the Central Anatolian province of Sivas, died at an Ankara hospital where she was being treated for CCHF. A male victim of CCHF from ?orum, also in Central Anatolia, died in early May after being bitten by a tick while tending his livestock.

Crimean-Congo hemorrhagic fever cost 94 lives in Turkey

In the past five years 94 people have died of CCHF in Turkey.

In documented outbreaks, the fatality rates for patients hospitalized for CCHF have ranged from 9 percent to as high as 50 percent of those afflicted.

People who have come into contact with a tick should be monitored for 10 days following contact and seek professional medical care if symptoms of fever, headache, nausea, vomiting or diarrhea present themselves. Treatment for CCHF is primarily symptomatic and supportive, as there is no established course of treatment.

The onset of CCHF is sudden, with initial signs and symptoms including headache, high fever, back pain, joint pain, stomach pain and vomiting. Red eyes, a flushed face, a red throat and red spots on the palate are common. Symptoms may also include jaundice and in severe cases, changes in mood and sensory perception. As the illness progresses, large areas of severe bruising, severe nosebleeds and uncontrolled bleeding at injection sites can be seen, beginning on about the fourth day of illness and lasting for about two weeks.

CCHF can be transmitted from one infected human to another by contact with infected blood or body fluids. Documented spread of CCHF has also occurred in hospitals due to improper sterilization of medical equipment, reuse of injection needles and contamination of medical supplies.

An infection with a tick-borne virus (Nairovirus) in the family Bunyaviridae causes CCHF. The disease was first identified in the Crimea in 1944 and given the name Crimean hemorrhagic fever. It was then later recognized in 1969 as the cause of illness in the Congo, thus resulting in the current name of the disease.

The first Turkish case of CCHF was reported in 2002. Officials said the disease reached Turkey from Crimea through wild pigs that fled the conflict region at the time. It is found in Eastern Europe, particularly in the former Soviet Union. It is also distributed throughout the Mediterranean, in northwestern China, central Asia, southern Europe, Africa, the Middle East and the Indian subcontinent.


24 May 2008, Saturday
ERCAN YAVUZ ANKARA

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Re: Turkey: ticks carrying Crimean-Congo hemorrhagic fever on the rise

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TAEK tries tick sterilization to prevent further tick-borne disease

The Turkish Atomic Energy Agency (TAEK) has taken a step to prevent a rise in the tick population through a male sterilization and release program, a method scientists expect will help prevent further cases of tick-transmitted disease.

TAEK officials announced that they have started sterilizing ticks collected from regions where people have died from Crimean-Congo hemorrhagic fever (CCHF) -- a tick-borne viral disease that often proves fatal -- in order to control the number of ticks that spread CCHF and other infectious diseases. The technique utilizes a form of irradiation to destroy or seriously debilitate the testes of the male insects.

?We have collected many ticks from regions where there have been incidents of CCHF-related deaths. We have sterilized them and then released them back to the wild. These sterilized ticks will continue to copulate, but will not be able to reproduce or will produce unviable larvae. With this method, we expect to see a significant decrease in the number of ticks carrying CCHF,? said a TAEK official.

The same official noted that using insecticides against ticks is not an effective way of curbing their population in the long term. ?These insects often develop resistance to such insecticides over time,? he added.

Meanwhile, a man from northern Samsun province died on Tuesday at a hospital where he was being treated for CCHF. Seyit Yal?ınkaya, who was living in the Armutlu village of Asarcık district, was sent to Ondokuz Mayıs University Hospital last week after he was bitten by a tick while working in his garden.

Yal?ınkaya?s death is the 17th fatal case of CCHF in four Turkish provinces, namely Samsun, ?orum, Tokat and Amasya, this year. The number of tick bite cases increase as the weather gets warmer and people engage in more activities outdoors. In the past five years, 94 people have died in Turkey from CCHF. People who have come into contact with a tick should be monitored for 10 days following contact and seek professional medical care if symptoms of fever, headache, nausea, vomiting or diarrhea present themselves.

05 June 2008, Thursday
SELİM KUVEL ANKARA

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Re: Turkey: ticks carrying Crimean-Congo hemorrhagic fever on the rise

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Treating tick-borne disease proves costly for two doctors

Medical tests have confirmed that two physicians are infected with Crimean-Congo hemorrhagic fever (CCHF), a disease carried by certain tick species.

Chief physician of Ankara Numune Hospital, where the two doctors had treated a patient with complaints of a tick bite, verified yesterday that the doctors have the disease after results came in from blood samples. The disease is also known to be transmitted through direct contact with the blood or secretions of an infected person. The doctors were most likely infected by direct contact with the patient's blood when it splashed into the doctors' eyes as they tried to stop the bleeding of the patient's nose.

Blood samples have also been taken from a nurse and other health personnel at the hospital and sent to the Refik Saydam Health Center for analysis. The results will show whether or not the nurse and the other personnel have CCHF, which has recently sparked fears throughout the country.

Doctors O.U. and A.K. are already displaying symptoms of CCHF. Health staff said currently about 20 people suspected of having CCHF are under observation at Ankara Numune Hospital.

Meanwhile, another person in the central Anatolian province of Yozgat died of CCHF. After being bitten by a tick, A.Y., from the village of Karakaya, had first been seen at the city hospital and then was transferred to Erciyes University Medical Faculty Hospital.

The death toll from CCHF in Yozgat is now three following A.Y.'s death. This year 500 people in the province have gone to area hospitals with complaints of tick bites. More than 20 people from throughout central Anatolia have died this year from CCHF.

In addition, a woman from Bursa reportedly has CCHF. The 45-year-old woman was working in the field when she was bitten by a tick. She did not seek treatment for the bite because the tick was not stuck to her skin. After being hospitalized with vaginal bleeding twice following the bite, she was placed in intensive care and diagnosed with CCHF.

Another woman, a resident of Manisa, sought treatment for a tick bite at a hospital. The tick was removed by doctors from Kırkağa? State Hospital.

Experts say people who have come into contact with a tick should be monitored for 10 days following contact and seek professional medical care if symptoms of fever, headache, nausea, vomiting or diarrhea present themselves. Treatment for CCHF is primarily symptomatic and supportive, as there is no established course of treatment.

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Re: Turkey: ticks carrying Crimean-Congo hemorrhagic fever on the rise

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Doctor highlights early diagnosis in overcoming CCHF

A doctor who contracted Crimean-Congo hemorrhagic fever (CCHF), a disease carried by certain species of tick, while treating a patient, has stressed the importance of early diagnosis for overcoming the disease. CCHF has claimed the lives of 144 people in Turkey since it was first observed in the country in 2002.

Dr. Tarık Irmak, from the infectious diseases department at Ankara's Numune Education and Research Hospital, spoke yesterday at a conference on recent developments in viral hemorrhagic fevers in İstanbul.

Speaking to the Anatolia news agency, Irmak explained how he contracted the disease and what measures should be taken against it.

He said he and three of his fellow doctors had contracted the disease when they were splashed with blood from a CCHF patient as they were applying cardiac massage. "When the symptoms of the disease begin to appear, we started treatment and recovered. Now I do not have any complaints other than a slight tiredness. My other three friends also overcame the disease."

Regarding the measures people should take to avoid the disease, Irmak said those who work in rural areas, in particular, should be tested if symptoms of CCHF emerge. "Each person bitten by a tick should not run to the hospital. The important thing is to go to hospital as early as the symptoms, such as fever, headache, nausea, vomiting or diarrhea, present themselves," he said.

28 June 2008, Saturday
TODAY'S ZAMAN WITH WIRES İSTANBUL

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Tick summit held in Ankara
Saturday, June 28, 2008

ANKARA - Turkish Daily News

A tick summit was held Thursday at the Ministry of Health to discuss overcoming the tick crisis in the country, which has killed 30 people in the last six months. A center is to be established by the ministry to handle tick-related problems in a more coordinated way.

In a meeting organized by the Health Ministry, the measures to be taken against the Crimean-Congo hemorrhagic fever, or CCHF, which is transmitted by tick bites, were discussed.

There are numerous tick-related diseases and different types of ticks cause different kinds of diseases. The type of tick found in Turkey is most common in rural areas, particularly in the central Anatolian and Black Sea regions. Its smaller and younger forms transmit the disease to small wild animals, while the more mature types affect bigger wild and domestic animals.

Climate conditions and changes in the ecological balances affect the spread of the disease, and there is a direct connection between the spread of the disease and the climate, flora, and the quality and quantity of wild animals.

The ministry has been working in close cooperation with the World Health Organization in order to combat tick-related diseases, which were first detected in the country in 2003.

In a recent meeting the Health Ministry held with the agriculture and environment ministries and academics, a series of measures were decided on to combat the tick crisis.

A center will be established in the ministry with the participation of high senior officials from the Health Ministry and experts from other concerned ministries to ensure the crisis is handled in the most coordinated way. Studies will also be carried out in order to raise awareness about the issue among locals in the rural areas where the ticks are widespread.

The application of insecticide, which is provided by the Agriculture Ministry, to animals will continue in vulnerable regions in order to reduce the tick population.

There is no effective vaccine against CCHF. Experts thus recommend people learn ways to protect themselves against ticks. As of June 25, 2008, the number of infected people with tick-borne diseases in Turkey was 492, with 30 losing their lives. According to the ministry, there is not much risk for those living in urban areas.

[tropical]

Re: Turkey: ticks carrying Crimean-Congo hemorrhagic fever on the rise

"Climate conditions and changes in the ecological balances affect the spread of the disease, and there is a direct connection between the spread of the disease and the climate, flora, and the quality and quantity of wild animals."

Another "gift" to the Earth population from the poluters.

Prohibitive insulation between sum. daylight causing skin cancers because of many ozone layer holes take away from us a basic thing, but that rays seems not stoping the viruses.

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Re: Turkey: ticks carrying Crimean-Congo hemorrhagic fever on the rise

Source: http://www.turkishdailynews.com.tr/a...enewsid=109351

Three more die from tick bites
Wednesday, July 9, 2008
BURSA ? Doğan News Agency

Three people were pronounced dead at hospitals Monday in the provinces of Bursa, ?anakkale and Samsun, taking the death toll from tick bites to 37 in the past two months.

According to Doğan news agency, Mustafa Kayrı from the western province of Bursa went camping 10 days ago and was bitten by a tick. He was hospitalized and diagnosed with the deadly Crimean-Congo Hemorrhagic Fever, or CCHF, and moved to the intensive care unit.

In the western province of ?anakkale, İbrahim G?ven died in hospital after being treated for suspected CCHF infection. He had told relatives that he had seen a tick on his body. He was buried in a zinc casket with lime spread over the grave as a precaution. Another person had died from CCHF in the same province last month.

Another man, Cafer Sağlam, died from CCHF Monday in the northern province of Samsun after he was bitten by a tick and removed it with his hand.

The Health Ministry also issued a statement to warn people against tick bite cases. In case of a tick bite the skin should be covered with the proper medicine. The tick should be removed by doctors using tweezers with great care and iodine should be applied to the bite. Health Ministry officials said ticks should never be killed by hand.

Moreover, those people, touched by any tick, should be kept under medical observation for 10 days, and go to the nearest hospital if they have symptoms such as fever, headache, nausea, vomiting or diarrhea, officials from the Health Ministry said.

Crimean-Congo Hemorrhagic Fever mainly affects animals. Ticks, which live on sheep and cattle, can sometimes pass the virus to people.

It is an Ebola-like fever where patients can bleed to death if they are not treated quickly. Those infected can transmit the virus through their blood or saliva. The disease is endemic in parts of Africa, Asia and Europe. Health authorities said a warmer climate, which Turkey has experienced in recent years, could mean a larger tick population that could in turn infect more people with the disease.