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North Macedonia - Information on a confirmed case of Crimean-Congo Haemorrhagic Fever (Institute of Public Health, July 31, 2023)

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  • North Macedonia - Information on a confirmed case of Crimean-Congo Haemorrhagic Fever (Institute of Public Health, July 31, 2023)

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    INFORMATION ON A CONFIRMED CASE OF CRIMEAN-CONGO HEMORRHAGIC FEVER

    July 31, 2023

    Information


    Crimean-Congo hemorrhagic fever (CHF) is a naturally endemic disease that is transmitted by ticks and is caused by a virus (Nairovirus) from the Bunyaviridae family. The KKHT virus can cause severe outbreaks of viral hemorrhagic fever. The disease has a high mortality that reaches up to 40%. The virus is transmitted to humans, primarily through ticks on domestic animals. Human-to-human transmission is possible as a result of close contact with the blood, secretions, organs or other body fluids of infected persons. CKHT is endemic in Africa, the Balkans, the Middle East and Asia. There is no vaccine for humans and animals, and treatment is symptomatic.

    The first described epidemic of this disease in the Republic of North Macedonia was a family epidemic in 1971, in a family in the village of Chiflik - Tetovo, in which 13 people - members of the family - fell ill, and the disease ended with death in two of them (mortality was 15.3%). After this epidemic, one case was laboratory confirmed in 2010. Considering that in Macedonia there are other natural hotspots where the disease circulates in nature among ticks, wild and domestic animals and birds, this disease represents a potential danger because there is a possibility that a person can be infected by the bite of an infected tick.

    Of the neighboring countries, the disease is endemic in Kosovo, and sporadic cases have been registered in several other European countries.


    On 27.07.2023 in the late afternoon, the Department of Epidemiology of Infectious Diseases at PHI IJZ of RSM was notified by phone by the Department of Virology at IJZ, about material received for testing from a patient from Shtip, hospitalized at the Clinic for Infectious Diseases and Febrile conditions (KIBFS) in Skopje, in which the causative agent of Congo-Crimean hemorrhagic fever was proven.

    The competent epidemiologist from CJZ Shtip was immediately contacted.


    The confirmed case of KKHT is a 27-year-old woman from the village of Kuchica, municipality of Karbinci, Stip.

    The initial symptoms of the disease (high temperature up to 38.6°C, severe headache, malaise and vomiting) began on 21.07.2023. Data was obtained for a tick bite that occurred 2 days earlier, and which was extracted in domestic conditions. The patient sought medical help at the Shtip hospital, where she was hospitalized in the infectious department from 07.23-07.25.2023. Due to the deterioration of the condition, the patient was referred and hospitalized at the KIBFS in Skopje. The disease progressed quickly and on 27/07/2023 in the evening the patient died, a few hours after the result of Congo-Crimean hemorrhagic fever was confirmed. About the resulting death, PHI IJZ of RSM was notified on July 28, 2023.


    Expert teams from the Department of Epidemiology of Infectious Diseases at the IJZ, in cooperation with a competent epidemiologist from the CJZ Shtip, immediately went to the field on 28.07.2023, during which a field epidemiological survey was conducted in KB Shtip, the Emergency Medical Service in Shtip and in the village. Kuchica, where the patient lived. At the same time, another expert team did an epidemiological inspection of the KIBFS in Skopje, where the patient was treated and where she died.

    The 2 teams, in Shtip and in Skopje, searched the contacts between the family members and the health workers in all the health institutions where the patient stayed and who were in contact with the confirmed case. All contacts have been surveyed and their appropriate classification of disease risk has been made.

    Out of a total of 67 identified contacts, five people were assessed as high risk, 24 medium and 38 low risk.

    According to the WHO guide, material (blood) was taken for testing from four of the contacts identified as high risk, the material was transported and immediately tested at the Department of Virology at the PHI, where a negative result for KKHT was obtained for all 4 materials.

    Contacts classified as high and medium risk are recommended to be placed under health surveillance, and those at low risk are advised to monitor their health for the next 14 days.

    All competent institutions in the country have been notified by the Epidemiological Department at PHI IJZ of RSM, and the European Center for Disease Control has also been notified.

    The Agency for Food and Veterinary Medicine has been notified in order to communicate about the condition of the animals for this disease.

    DSZI has also been notified, which ex officio issues decisions to place the contacts under health surveillance (contacts with medium and high risk are instructed to measure their body temperature twice a day and monitor their health for a period of 14 days from the last risky contact).


    Direction was given and disinfection and disinfection was carried out by CJZ Shtip in the family house, in KB Shtip, IMP Shtip and the three ambulances of IMP Shtip, as well as in the premises of KIBFS.

    Informative and educational material posted on the website of the IJZ for KKHT, for the public and for health professionals.

    The Department of Epidemiology of Infectious Diseases at the IJZ monitors the situation, and if there is a change, it will inform accordingly.

    Department of Infectious Disease Epidemiology

    RSM Institute of Public Health


    "Safety and security don't just happen, they are the result of collective consensus and public investment. We owe our children, the most vulnerable citizens in our society, a life free of violence and fear."
    -Nelson Mandela

  • #2
    North Macedonia - Crimean Congo haemorrhagic fever (2006-) - Immediate notification [FINAL]

    GENERAL INFORMATION
    COUNTRY/TERRITORY OR ZONE
    ZONE

    ANIMAL TYPE
    TERRESTRIAL

    DISEASE CATEGORY
    Listed disease

    EVENT ID
    5634

    DISEASE
    Crimean Congo haemorrhagic fever (2006-)

    CAUSAL AGENT
    Crimean Congo haemorrhagic fever virus

    GENOTYPE / SEROTYPE / SUBTYPE
    -

    START DATE
    2023/08/10

    REASON FOR NOTIFICATION
    First occurrence in a zone or a compartment

    DATE OF LAST OCCURRENCE
    -

    CONFIRMATION DATE
    2023/09/05

    EVENT STATUS
    Resolved

    END DATE
    2024/04/08

    SELF-DECLARATION
    NO

    REPORT INFORMATION

    REPORT NUMBER
    Immediate notification

    REPORT ID
    IN_166826

    REPORT REFERENCE
    -

    REPORT DATE
    2024/04/09

    REPORT STATUS
    Validated

    NO EVOLUTION REPORT
    -

    EPIDEMIOLOGY
    SOURCE OF EVENT OR ORIGIN OF INFECTION
    Vectors

    EPIDEMIOLOGICAL COMMENTS
    No epidemiological comment

    QUANTITATIVE DATA SUMMARY
    MEASURING UNIT
    Animal

    SpeciesSusceptibleCasesDeathsKilled and Disposed ofSlaughtered/ Killed for commercial useVaccinated
    Sheep/goats (mixed herd) (DOMESTIC)
    NEW 17
    10 0 0 0 0
    TOTAL 17 10 0 0 0 0
    ...

    NEW OUTBREAKS

    OB_133867 - CC_STIP - KUCHICA

    OUTBREAK REFERENCE
    cc_stip

    START DATE
    2023/08/10

    END DATE
    2024/04/08

    DETAILED CHARACTERISATION
    -

    FIRST ADMINISTRATIVE DIVISION
    Karbinci

    SECOND ADMINISTRATIVE DIVISION
    -

    THIRD ADMINISTRATIVE DIVISION
    -

    EPIDEMIOLOGICAL UNIT
    Village

    LOCATION
    Kuchica

    Latitude, Longitude
    41.7409 , 22.382

    (Approximate location)
    OUTBREAKS IN CLUSTER
    -

    MEASURING UNIT
    Animal

    AFFECTED POPULATION DESCRIPTION
    -

    SpeciesSusceptibleCasesDeathsKilled and Disposed ofSlaughtered/ Killed for commercial useVaccinated
    Sheep/goats (mixed herd) (DOMESTIC)
    NEW 17
    10 0 0 0 0
    TOTAL 17 10 0 0 0 0
    ...

    "Safety and security don't just happen, they are the result of collective consensus and public investment. We owe our children, the most vulnerable citizens in our society, a life free of violence and fear."
    -Nelson Mandela

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