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In June 2018, Crimean-Congo haemorrhagic fever (CCHF) was diagnosed in a Greek construction worker who returned home after becoming ill with fever and haemorrhagic symptoms in south-western Bulgaria. Here, we describe the case along with the epidemiological investigation and phylogenetic analysis.
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CCHF was first recognised in Bulgaria in 1952; since then, several cases have been reported. Genetic characterisation of the Bulgarian strains showed that they cluster into the clade Europe 1 [5]. Our patient was infected in an area that was considered at low risk for CCHF outbreaks up to 2008, when a cluster of cases was observed in the region [6]. Although the seroprevalence in the human population in Blagoevgrad province is low (1%) [5], a seroprevalence of 41.9% in livestock was reported recently [7]. Since CCHFV is transmitted mainly by bite of infected Ixodid ticks, persons living in rural areas are at increased risk for acquiring the infection. This was the reason that information about preventive measures was sent to our patient?s Greek co-workers in Bulgaria, and all related public health authorities were informed about the case.
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The patient fully recovered and no secondary cases of CCHF have been reported. Since the northern part of Greece is close to CCHF-endemic countries, HCWs in this region should be made aware of CCHF; including the provision of training to better help them address questions from patients about travel history (identify potential risk of exposure). Physicians should include CCHF in the differential diagnosis for patients with haemorrhagic syndromes, especially if patients report a tick bite, outdoor activities or occupation in rural areas and recent travel to an endemic area.
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CCHF was first recognised in Bulgaria in 1952; since then, several cases have been reported. Genetic characterisation of the Bulgarian strains showed that they cluster into the clade Europe 1 [5]. Our patient was infected in an area that was considered at low risk for CCHF outbreaks up to 2008, when a cluster of cases was observed in the region [6]. Although the seroprevalence in the human population in Blagoevgrad province is low (1%) [5], a seroprevalence of 41.9% in livestock was reported recently [7]. Since CCHFV is transmitted mainly by bite of infected Ixodid ticks, persons living in rural areas are at increased risk for acquiring the infection. This was the reason that information about preventive measures was sent to our patient?s Greek co-workers in Bulgaria, and all related public health authorities were informed about the case.
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The patient fully recovered and no secondary cases of CCHF have been reported. Since the northern part of Greece is close to CCHF-endemic countries, HCWs in this region should be made aware of CCHF; including the provision of training to better help them address questions from patients about travel history (identify potential risk of exposure). Physicians should include CCHF in the differential diagnosis for patients with haemorrhagic syndromes, especially if patients report a tick bite, outdoor activities or occupation in rural areas and recent travel to an endemic area.