Spain - 2 confirmed cases of Crimean-Congo hemorrhagic fever + 2 lab workers under observation

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Confirmed two cases of Crimean-Congo hemorrhagic fever in Spain

September 1, 2016. The National Center for Microbiology Carlos III Institute of Health has confirmed two cases of Crimean-Congo hemorrhagic fever, first diagnosed in Spain. The first case is that of a patient, now deceased, who was treated at a hospital in Madrid. The second case is a woman ICU nurse who treated this same patient.

The Ministry of Health, Social Services and Equality is working with the Community of Madrid in everything related to the case. The Ministry has activated the protocol established by the National Network of Epidemiological Surveillance and coordination mechanisms with all regions.

The Crimean-Congo virus belongs to the Bunyaviridae family and is causing Crimean-Congo hemorrhagic fever. This virus has a natural cycle in ticks that act as vectors whose main reservoir is wild and domestic ruminants. The disease is endemic in Africa, the Balkans, Middle East and Asia.

http://www.msssi.gob.es/gabinete/notasPrensa.do?id=4006

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Confirmed the first two cases of "Crimean-Congo hemorrhagic fever" in Spain

The Ministry of Health of the Community of Madrid has verified the disease. Call tranquility and monitored 190 people who had contact with those affected, the man died and the nurse who treated

09/01/2016 11: 41h - Updated: 01/09/2016 16: 54h.

The Ministry of Health of the Community of Madrid has confirmed this Thursday September 1 the first two cases of Crimean-Congo hemorrhagic fever detected in Spain and Western Europe , and has caused the death of the first affected male and entry into the ICU nurse who treated him.

The first is that of a male, a hiker who died on August 25 at the Gregorio Maranon Hospital , after being initially treated at the Infanta Leonor, where he said that he had detected a tick after a walk through the countryside in the Gredos Community of Castilla and Leon in the province of Avila. The man died of liver failure, has confirmed the Ministry Madrid.

And the second is the nurse who treated him in the hospital ICU Infanta Leonor, drive that is currently entered. Has said the head of the branch in Madrid, Jes?s S?nchez Martos , last night moved to the nurse at Hospital Carlos III of La Paz in a specialist to prevent new infections ambulance, a protocol already activated with the crisis of Ebola 2015. The nurse He was caught last August 29. He also called for calm because there is no "cause for alarm at all." "It has nothing to do with the ebola" has settled. The state of the patient, having spent a "better night" is stable within the gravity.

Madrid Ministry is monitoring 190 people who had contact with those affected. Among them, nearly a hundred health personnel is, according to the counselor Sanchez Martos. So far, these people have no symptoms. In surveillance could be extended and that all they have been informed and are being monitored, including two shots a day temperature. The temperature from which shall be greater vigilance will be, as in the case of the Ebola crisis last year, 37 degrees and a half (37.5). In cases of people at increased risk of having been exposed to fluids of patients determined their home insulation.

The Minister also announced in the call to the press that will create a cabinet of experts to monitor the evolution of affected and disease.

The hemorrhagic fever is a process that causes high fever, bleeding disorders, which can be transmitted by tick bite, and can spread between people through fluids.

Health officials of the Ministry of Madrid infomaron that introducing nurse - like symptoms of the patient, activated protocols Prevenci? n and the woman was isolated.

Health has sent samples of both patients to the National Center for Microbiology, and is waiting for the results to determine the pathology.

As a precautionary measure, the Ministry of Health is preparing a list of people who have been in contact with said patients to track.

http://www.abc.es/sociedad/abci-sanidad-y-madrid-coordinan-ante-posibles-casos-fiebre-hemorragica-201609011141_noticia.html

[Gert van der Hoek]

Geographic distribution of major vectors in Europe: ticks: Hyalomma marginatum, vector of Crimean Congo hemorrhagic fever (top left), Ixodes ricinus, vector of Lyme borreliosis and tick-borne encephalitis (top right), and Ae. albopictus (bottom left) and Ae. aegypti (bottom right), vectors of dengue (source: ECDC).






LINK TO TICK MAPS ECDC

[Gert van der Hoek]

A healthworker and a woman hospitalized in Avila with possible hemorrhagic fever

And are monitoring 281 cases, of which around 70% are health workers



Two new people have been hospitalized dawn on Saturday in Madrid with symptoms consistent with hemorrhagic fever Crimean-Congo (EFHC), reports the Ministry of Health, which emphasizes that it is a preventive measure.

One of those affected is a health of the Central Clinical Laboratory of the Community of Madrid, located at the Infanta Sof?a Hospital in San Sebasti?n de los Reyes, having "symptoms consistent with the disease" that "had contact with samples of the deceased and nurse infected "says Angel Gil, spokesman for the technical Committee set up by the Ministry to support research, professor of Preventive Medicine at the University Rey Juan Carlos. The woman is admitted to the isolation unit of the Hospital La Paz-Carlos III.

The other new affected possible is a woman who transited the area Solosancho in Avila, a people distinct but close to Villarejo, where the 62 year old man who died last August 25 was infected. "Her husband suffered a tick bite but had no fever or other symptoms. Yesterday the woman had fever and how they are listening to the news, decided to go to Ramon y Cajal, which he led to the Central Hospital of Defense G?mez Ulla" Gil reports. Both women remain stable.

[FrenchieGirl]

Health Ministry refuses to say if they are related to the two confirmed cases in Madrid earlier in the week.

Pressed by The Spain Report for more details on whether the two new suspected cases were related to the death of a 62-year old Madrid man and the infection of one of his intensive care nurses, the Health Ministry refused to provide any further information.

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Barcelona

Two technicians in a laboratory in the metropolitan area of Barcelona are "low risk potential contacts" of Crimean-Congo hemorrhagic fever because they manipulated samples of the patient who died in Madrid

http://www.lavanguardia.com/vida/20160902/4168797390/dos-tecnicos-bajo-vigilancia-tras-manipular-muestras-de-fiebre-hemorragica.html

[Gert van der Hoek]

Location of Extremadura

2 September 2016



The hemorrhagic fever virus was detected in ticks in Caceres six years ago




In 2010, on the edge of the Tagus River in Caceres with the Portuguese border, a group of experts Center Rickettsiosis and Arthropod - Borne Vectors Department of Infectious Diseases at St. Peter-Center Hospital Biomedical Research of La Rioja Diseases ( CIBIR) detected the virus Crimea Congo hemorrhagic fever ticks removed from a deer, according to ABC .

Specifically, these animals were infected by a kind of ticks, the Hyalomma, Hyalomma lusitanicum type. . The main transmitter of the disease vector, the tick of the species Hyalomma marginatum, was also present in migratory birds flying from Morocco to the Iberian Peninsula..

So the conclusion of this group, piloted by the head of department in the Rioja hospital, Jose Antonio Oteo, is that although Spain, according to WHO (World Health Organization), was 'free' of the disease, the truth is the findings were "necessary" to consider and circulate the virus in the country. "Consideration should be given to Crimean Congo hemorrhagic fever -cotejaron the specialists- as infection with great emerging potential in Spain."

Six years later, Dr. Oteo, along with members of his team as Ana Maria Palomar, have failed if not confirm that this tick has bitten humans, although the bug Hyalomma type does not feed on people, but on animals. The human being, in contact with these infected animals can contract the disease, but

the fact is that the rate of infection is very low and many people have developed antibodies to the virus in constant contact with this type of species,

it has confirmed to ABC Dr. Oteo. . A study in Russia showed that options for developing the disease in people, once infected with the virus, is 21.5% of cases.


In the opinion of Oteo, member of the Spanish Society of Clinical Microbiology and Infectious Diseases (SEIMC), why until now it had never produced any infection in humans is also that the Hyalomma tick does not usually bite people, lifting a degree in average temperature that is registered in the summer, returning to these more active and aggressive arthropods.

Incontestable as is that Spain is the arthropod vector, bites in humans are given by the same (confirmed case in the man of 62 who died on August 25 after being bitten by one of those ticks in the Avila mountain range Gredos) and there is a susceptible population of developing this disease. So

"in the coming years we will see sporadic cases of the disease in humans in our country,"

he corroborates Oteo. . However, the specialist calls for calm: only are detected by the Virsu in an area of Extremadura, between 1,143 copies of ticks tested in other regions of Spain, means that

the virus is "not widespread"

and it is conceivable that the percentage of infected ticks that spread the disease "is very low."

[Gert van der Hoek]

New rapid risk assessment on Crimean-Congo haemorrhagic fever in Spain




12 Sep 2016

On 31 August 2016 Spain reported two cases of infection with Crimean?Congo haemorrhagic fever (CCHF) virus. The primary case is a 62-year-old man with potential exposure to CCHF virus in the province of ?vila (Spain). The secondary case is a 50-year-old healthcare worker who attended the primary case during his admission to the intensive care unit. These are the first autochthonous clinical cases of CCHF in Spain and in south-western Europe, and accordingly ECDC has published a rapid risk assessment on the event.
Recent detection of CCHF virus in ticks from Extremadura in western Spain, indicates the circulation of CCHF virus among wildlife. Therefore, the occurrence of CCHF virus infection is not an unexpected event in Spain. Nosocomial transmission of CCHF can occur even in a non-endemic region when appropriate infection prevention and control measures have not been observed.
The probability of CCHF virus infection in Spain is low. However, other sporadic cases are possible. The risk of further human-to-human transmission in hospital settings can be significantly reduced by applying timely appropriate infection prevention and control measures.

• The rapid risk assessment outlines a range of options for risk reduction, including, among others:
  Enhanced awareness of the importance of early diagnosis and laboratory confirmation among healthcare providers in areas with potential circulation of CCHF virus.
• Standard precautions, preferably combined with contact and droplet precautionary measures, should be taken when caring for patients presenting with haemorrhagic fever syndrome.
• Laboratory tests on patient samples present a high risk of transmission and should only be conducted under appropriate biological containment conditions.
• As a precautionary measure, risk groups should be informed about the mode of transmission and urged to comply with advice on the prevention of tick bites.
• In order to better target preventive measures and raise clinical awareness, areas with CCHF virus circulation and areas suitable for CCHF circulation in the Iberian Peninsula should be defined by multidisciplinary investigations.

No specific measures for the safety of substances of human origin (SoHO) are recommended at this stage.

Read more
Rapid risk assessment: Crimean?Congo haemorrhagic fever in Spain
Crimean?Congo haemorrhagic fever (CCHF) virus
Viral haemorrhagic fevers, Ministry of Health, Spain

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Congo fever nurse discharged from Spanish hospital

A Spanish nurse who contracted Congo fever while caring for a man who died from the virus, in the first non-imported case reported in Western Europe, was discharged from hospital on Wednesday, officials said.


The unidentified nurse was admitted to the intensive care unit of a Madrid hospital on August 31 where she was treated for the illness, also known as Crimean-Congo haemorrhagic fever, in isolation
The regional government of Madrid said in a statement that she had been discharged and "would not need to be monitored and can lead a normal life".
It said health officials would monitor hospital staff who looked after the patient for 14 days after their last contact with her?a period that corresponds with the typical incubation period of the virus.

http://medicalxpress.com/news/2016-09-congo-fever-nurse-discharged-spanish.html

[Gert van der Hoek]

N Engl J Med. 2017 Jul 13;377(2):154-161. doi: 10.1056/NEJMoa1615162.

Autochthonous Crimean-Congo Hemorrhagic Fever in Spain.


Abstract

Crimean-Congo hemorrhagic fever (CCHF) is a widely distributed, viral, tickborne disease. In Europe, cases have been reported only in the southeastern part of the continent. We report two autochthonous cases in Spain.

The index patient acquired the disease through a tick bite in the province of ?vila - 300 km away from the province of C?ceres, where viral RNA from ticks was amplified in 2010.

The second patient was a nurse who became infected while caring for the index patient. Both were infected with the African 3 lineage of this virus.

(Funded by Red de Investigaci?n Cooperativa en Enfermedades Tropicales [RICET] and Efficient Response to Highly Dangerous and Emerging Pathogens at EU [European Union] Level [EMERGE].).