Crimean-Congo Haemorrhagic Fever in Turkey

[Snowy Owl]

Crimean-Congo Haemorrhagic Fever in Turkey
http://www.who.int/csr/don/2003_08_08/en/index.html

8 August 2006

Between 1 January and 4 August 2006, 242 laboratory-confirmed cases, including 20 deaths (case-fatality rate (CFR), 8.3%), were reported by the Ministry of Health (MoH) of Turkey.

These figures correspond to 92 and 9 newly reported cases and deaths, respectively, since the last update, current as of 30 June 2006.

One of the newly reported fatal cases was a health care worker who acquired the infection while treating CCHF cases in Corum province. For the full report, please see the web site of the WHO Regional Office for Europe.

For more information about Crimean-Congo Haemorrhagic Fever, please see the WHO Fact Sheet.
​

 

[Snowy Owl]

Re: Crimean-Congo Haemorrhagic Fever in Turkey

7 August 2006

Crimean-Congo Hemorrhagic Fever (CCHF) activity in Turkey - update 1

Between 1 January and 4 August 2006, 242 laboratory-confirmed cases, including 20 deaths (CFR 8.3%), were reported by the Ministry of Health (MoH) of Turkey. These figures correspond to 92 and 9 newly reported cases and deaths, respectively, since the last update, current as of 30 June 2006. One of the newly reported fatal cases was a health care worker who acquired the infection while treating CCHF cases in Corum province.

The majority of newly reported cases were notified in the six northeastern provinces of Kelkit Valley (Tokat, Sivas, Gümüshane, Amasya, Yozgat and Corum provinces).

The MoH of Turkey, in close collaborations with the Ministry of Environment and the Ministry of Agriculture and Rural Affairs, is continuing to implement control measures, including enhanced CCHF surveillance nationwide.

The WHO Country Office in Turkey and the WHO Regional Office for Europe are closely monitoring the evolution of CCHF disease activity in Turkey.

Additional information on travel-related risks is available below:

	Crimean-Congo hemorrhagic fever - information for travellers to north-eastern Turkey (1 August 2006)
	Link to the website of the European Centre for Disease Prevention and Control (ECDC)
http://www.euro.who.int/surveillance/outbreaks/20060807_1

 

[Snowy Owl]

Re: Crimean-Congo Haemorrhagic Fever in Turkey

Fact sheet

Tuesday 8 August 2006

Crimean-Congo hemorrhagic fever – information for travellers to north-eastern Turkey

Between 1 January and 4 August 2006, a total of 242 laboratory confirmed cases and 20 deaths of Congo-Crimean hemorrhagic fever (CCHF) were reported in Turkey. Six provinces in the Black Sea and Central Anatolia region are the most affected (Tokat, Gümüshane, Amasya, Çorum, Yozgat and Sivas provinces). No cases have been reported from popular tourist resorts at the Mediterranean coast. Compared with previous years, this number may suggest increased activity of the virus in the area, although detection, diagnosis and notification have improved. In Turkey, CCHF in humans was first documented in 2002.


Provinces most affected, Crimean-Congo hemorrhagic fever, Turkey, as of 4 August 2006

Read more information:

• On the current increase of CCHF activity in Turkey on the WHO web site for the European Region: CCHF activity in Turkey, World Health Organization EURO, 6 July 2006
• On the situation of CCHF in Turkey in 2004: situation of Crimean-Congo hemorrhagic fever in Turkey, Emerging Infectious Diseases 2004

Agent:
The CCHF virus is a Nairovirus, within the Bunyaviridae group. The virus was first identified in 1944 in the Crimea, and later recognized to be the same virus causing high mortality in the Congo in 1969.

Reservoir:
The reservoir for CCHF virus includes hares, birds, ticks, cattle, sheep and goats.

Vector:
The most common and efficient vectors for CCHF are the hard ticks of the Hyalomma genus. Infected ticks remain infected through their different development stages, and trans-ovarian (transmission of the virus from infected female ticks to offspring via eggs) as well as venereal transmission have been demonstrated among some vector species.

Transmission mode:
Humans can be infected with CCHF through the bite of infected ticks, or crushing them with bare hands and through direct contact with infected blood and tissue from livestock. Human-to-human transmission may rarely occur through exposure to blood (injury with contaminated sharps or blood on non-intact skin).

Epidemiology:
CCHF virus is widespread. Evidence for the virus has been found among ticks in Africa, Asia, the Middle East and Eastern Europe. Previous outbreaks have been reported in Turkey in 2001-03 (83 cases), in Kosovo and in Albania in 2001 (18 and 8 cases respectively). In 2002, 3 cases were reported in Pakistan and 38 cases in Mauritania in 2003. Between 5 and 25 cases are reported each year in Bulgaria and South Africa. Between 1999 and 2004, a total of 155 cases were reported in Iran.

The majority of cases occur in persons involved in livestock industry, e.g. agricultural workers, slaughterhouse workers and veterinarians. Healthcare workers are at risk through unprotected contact with infectious blood or body fluids.

Clinical presentation:
The incubation period depends on the way in which the infection was acquired. After a tick bite, incubation is usually 1-3 days (maximum 9), while incubation after contact with blood or tissue is longer, from 5 to 6 days (maximum 13). Disease onset is sudden, with symptoms including high fever, muscle pain, dizziness, abnormal sensitivity to light and abdominal pain and vomiting. Later on, sharp mood swings may occur, and the patient may become confused and aggressive. After 2-4 days, the agitation is replaced by somnolence, depression and lassitude. There is usually evidence of hepatitis. Petechiae may progress to ecchymoses, and other hemorrhagic symptoms, generally occurring between the 3rd and 5th day. The mortality rate of CCHF is estimated to go up to 30%, with death occurring in the second week of illness. There is a prolonged convalescence.

Diagnosis:
CCHF is diagnosed through the detection of IgG and IgM antibodies to the virus (by ELISA), through the detection of the viral genome (by PCR), or though virus isolation.

Treatment:
Patient isolation and supportive therapy (including hemodynamic support, treatment of secondary infections …) are the main treatment strategies. Some benefit has been reported from the use of the anti-viral drug ribavirin.

Prevention:
No safe and effective vaccine is widely available for human use. Persons at risk through professional activities should be protected from tick bites using insect repellent on exposed skin and clothes. To prevent skin contact with infected tissue or blood, gloves and protective clothing should be worn. Healthcare workers should respect universal precautions to avoid occupational exposure. Persons living in endemic areas should use personal protective measures (such as repellent, inspection of skin and clothes for ticks) and avoid areas where ticks are known to be abundant during the active period of the year (spring to fall).

Persons travelling to endemic areas should take the following preventive measures to minimise the exposure to tick bites:

1. Minimise exposure, wearing light-coloured clothing (easier to see the ticks) covering arms and legs; tuck the trousers into the socks and keep the sleeves rolled down.
2. Use insect repellent on the exposed skin (e.g. DEET 30%) and on the clothes (e.g. permethrin); before using repellents, pregnant women and children under the age of 12 years should consult a physician or pharmacist.
3. Inspect the body after possible exposure, and remove ticks immediately by steady, gentle traction, using fine-tipped forceps or tweezers, protecting hands with gloves or tissue. With the forceps or tweezers, grasp the tick as close to the skin as possible, where the mouth parts of the tick enter the skin. Pull back gently but firmly, and without crushing the body of the tick. Avoid leaving mouth parts in the skin. Wash the affected area with water and soap and disinfect with colourless disinfectant. Observe the area for 30-40 days, and consult a doctor if a pustule, rash or other signs develop at the site of the bite. Do not use heat or any substance like petrol, ammoniac, etc. to remove the tick. They may cause an irritation reaction of the tick and increase the risk for infection.

Persons having travelled to the endemic areas, and presenting with symptoms after a history of tick bite, should contact their physician.

Read more information on CCHF and its prevention:

• CCHF fact sheet, World Health Organization
• CCHF fact sheet, European Network for Diagnostics of “Imported” Viral Diseases (ENIVD)

http://www.ecdc.eu.int/outbreaks/Crimean-Congo_Turkey.php

 

[Jeremy]

Re: Crimean-Congo Haemorrhagic Fever in Turkey

Anyone know how many cases of CCHF Turkey gets per year?

It would be interesting to see if this is out of the norm for them.

 

[miks1975]

Re: Crimean-Congo Haemorrhagic Fever in Turkey

Actually, there have been cases of CCHF in Kosovo as well this year. I was there at the end of May and they had several cases and 3 deaths while I was there. I looked in the WHO website and it doesn't seem like they reported the cases to them.

 

[Snowy Owl]

Re: Crimean-Congo Haemorrhagic Fever in Turkey

Thank you and welcome Miks1975,

Do you have any Kosovar news on this ??

 

[Snowy Owl]

Turkey battles biggest ever outbreak of Crimean-Congo Hemorrhagic Fever

Turkey battles biggest ever outbreak of Crimean-Congo Hemorrhagic Fever

Turkey battles biggest ever outbreak of Crimean-Congo Hemorrhagic Fever

http://www.turkishdailynews.com.tr/article.php?enewsid=51078

ISTANBUL - TDN with AP

Turkey is battling the largest-ever recorded outbreak of Crimean-Congo Hemorrhagic Fever (CCHF), which has killed at least 20 people this year, with experts saying on Tuesday that more cases of the Ebola-like disease are inevitable in coming months.

"We will unfortunately keep seeing cases at least until September, when the virus starts to slow down because of the cold weather," said Dr ?nder Erg?n?l, an associate professor at Marmara University who has been involved with the government's response to the outbreak.


Most of the cases have occurred in six provinces in the Black Sea and Central Anatolia regions: Tokat, Sivas, Gumushane, Amasya, Yozgat and Corum.


Authorities at the World Health Organization (WHO) are awaiting further information from the Turkish government, including where the other cases have arisen. Turkish authorities say no cases have been reported in tourist areas along the Mediterranean coast.


By Aug. 4, the disease was responsible for 242 cases, including 20 deaths, making it the largest reported outbreak since it was first identified in 1944, authorities say.


Last week a nurse treating patients with Crimean-Congo Hemorrhagic Fever died after being accidentally infected by a needle. To date four healthcare workers have been infected, though there have been no reports of the virus spreading in hospitals.


"There have been large outbreaks of this virus before, but we are concerned about the size of this particular outbreak in Turkey," said WHO's Regional Advisor for Communicable Diseases in the European Region Dr. Bernardus Ganter.


One of the reasons for the increased numbers, Ganter said, could be a more sophisticated detection system. Turkey's first outbreak of the disease was in 2002, and surveillance has strengthened considerably since.


"We are reassured that the outbreak appears limited to only one part of Turkey, in Anatolia," said Erg?n?l. More than 90 percent of cases have been reported in people who have had direct contact with animals, according to Erg?n?l.


In an attempt to control the outbreak, Turkish authorities have instituted stronger surveillance for the disease across the entire country as well as attempting to educate the population about how they can minimize their risk of contracting the disease by avoiding contact with ticks.


Veterinarians and entomologists are also looking at ways to control the tick population.


With several previous outbreaks of the disease in recent years, Turkey has considerable expertise in treating patients.


WHO has been in frequent contact with the Turkish Ministry of Health and is ready to send teams to the region if requested to do so. Ganter said the transmission season was expected to last until October.

Beware of ticks:
CCHF emerges particularly in the summer months and is spread to humans via the bite of an infected tick. The disease, which can be fatal to humans, has caused deaths in Turkey in recent years. What are the facts about this disease? How is the disease spread? What measures should be taken?
CCHF was first described in the Crimea in 1944 and later found in Congo in 1956. Vehbi Ko? Foundation American Hospital Pediatric Unit doctors state that CCHF is caused by ticks infected with the RNA virus, which is a member of the Nairovirus genus of the Bunyaviridae family.


Dr. G?lsemin G?loğlu of the Vehbi Ko? American Foundation Hospital Pediatric Unit says that in some situations the disease is contagious as a result of contact with the blood or tissue of infected animals. Noting that nearly 30 kinds of tick can carry the virus, Dr. G?loğlu says Hyalomma ticks are the most prevalent carriers of the Nairovirus.


What are the symptoms of CCHF?:
According to information provided by G?loğlu, the symptoms of the disease take nine days to appear after a tick bite, and infection from contact with infected blood or tissue of an infected animal takes from five to six days to a maximum of 13 days to appear. Early symptoms of the disease are fever, chills, shaking, aching muscles, lack of appetite, dizziness, vomiting and diarrhea. Bleeding under the skin, sore eyes, blood in the urine, nose and intestines are other symptoms of the disease. Pulmonary failure may also develop. The mortality rate is approximately 30 percent, occurring in the second week of the disease. If a patient makes a recovery, it occurs on the ninth or 10th day after the onset of the disease.


G?loğlu says the disease is diagnosed when antibodies are detected in the blood on the sixth day. In other laboratory tests, abnormalities such as a rise in liver enzymes can be seen. �There is no specific treatment method for the disease. Blood component replacement is a supportive treatment method. It is very important and necessary to receive professional help to remove the tick from the body. The tick should be removed from the body as a whole. It should not be removed by using ether or other anesthetic substances. It is not necessary to take antibiotics right after tick bite, but the person's fever should be carefully followed 10 days after bite. In the case of symptoms like high fever, the person should be taken to a hospital as soon as possible.�


Prevention of CCHF:
G?loğlu states that since there is no specific cure for CCHF, protective measures are very important in preventing the disease. �Those working with livestock in rural areas should wear gloves or other clothing to prevent their skin from coming in contact with infected animals. Pesticides should be applied to the body or clothing. Gloves should be worn while trying to remove a tick from the body. The body should be carefully examined after leaving rural areas. In the case of a tick bite, the person should go to a hospital as soon as possible.�
​

 

[Laidback Al]

Re: Crimean-Congo Haemorrhagic Fever in Turkey

June 10, 2007
CRIMEAN-CONGO HEMORRHAGIC FEVER - TURKEY
***********************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>
Date: 10 Jun 2007
Source: Gulfnews.com [edited]
<http://www.gulfnews.com/world/Turkey/10131256.html>

An outbreak of hemorrhagic fever in Turkey has sickened 133 people
and killed 7 of them so far this year [2007], the Health Ministry
said yesterday [9 Jun 2007].
The number of cases of Crimean-Congo hemorrhagic fever (CCHF) from
January to May [2007] was 13 percent higher than for the same period
in 2006, the ministry said.
Last year [2006], 27 of the 438 people who contracted the disease
died, Mehmet Ali Torunoglu, acting chief of the ministry's Department
of Communicable Diseases, said yesterday [9 Jun 2007].
"Definitely, there's an outbreak," said Dr Onder Ergonul, an
associate professor at Marmara University and a CCHF expert. 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, Ergonul said.
Authorities at the World Health Organization said they did not
believe there was anything unusual about the outbreak at the moment,
since CCHF occurs regularly in Turkey.
Turkey's 1st known outbreak of the disease was in 2002, and the
country has since adopted stronger surveillance systems, which may
account for the increased number of reported cases.
The Health Ministry has used acaracide, a chemical used against
parasites, to reduce the tick population in the Black Sea and Central
Anatolia regions, where more than 90 percent of the cases have been
reported.
The ministry has also worked to minimize agricultural workers' direct
contact with livestock, thus decreasing their chances of exposure to
the disease.
--
Communicated by:
ProMED-mail Rapporteur Mary Marshall
[ProMED thanks Rapporteur Joseph Dudley for submission of a similar report.
It is not clear from this report whether CCHF virus exposure was from
infected farm animals or from viremic blood of infected people. It
would be interesting to know how effective the acaracide treatment
has been in reducing tick populations.
A map of Turkey can be accessed at:
<http://www.lib.utexas.edu/maps/middle_east_and_asia/turkey_pol83.jpg>.
- Mod.TY]
[see also:
2006
----
Crimean Congo hemorrhagic fever - Turkey (05) 20060822.2359
Crimean-Congo hemorrhagic fever - Turkey (04): WHO 20060809.2230
Crimean-Congo hemorrhagic fever - Turkey (03): comment on tick
removal 20060728.2082
Crimean-Congo hemorrhagic fever - Turkey (02) 20060722.2013
Crimean-Congo hemorrhagic fever - Turkey 20060705.1844
2005
----
Crimean-Congo hem. fever - Turkey 20050729.2210
2004
----
Crimean-Congo hem. fever - Turkey 2002-2003: 1st report 20041016.2814]
...................................ty/msp/lm
http://www.promedmail.org/pls/prome..._BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,37909

 

[Gert van der Hoek]

Re: Crimean-Congo Haemorrhagic Fever in Turkey

Crimean-Congo Hemorrhagic Fever kills three

Monday, July 2, 2007

ANKARA - The Associated Press

An outbreak of hemorrhagic fever in Turkey claimed the lives of three more people on Saturday, increasing the death toll to 17 this year, media reports said.

The fever has sickened more than 190 people so far this year, authorities said. Two patients died in the city of Tokat and another one died in the city of Sivas on Saturday in central Turkey, Doğan news agency reported.

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

Last year, 27 of the 438 people in Turkey who contracted the disease died, the Health Ministry said.

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.

Authorities at the World Health Organization said earlier this month that they did not believe there was anything unusual about the outbreak at the moment, since CCHF occurs regularly in Turkey.

Turkey's first known outbreak of the disease was in 2002 and the country since has adopted stronger surveillance systems, which may account for the increased number of reported cases. The Health Ministry has used acaracide, a chemical used against parasites, to reduce the tick population in the Black Sea and Central Anatolia regions, where more than 90 percent of the cases have been reported.

http://www.turkishdailynews.com.tr/article.php?enewsid=77225

 

[Oric]

Re: Crimean-Congo Haemorrhagic Fever in Turkey

This fever is claiming more lives every year. The virus that causes the disease is in the same family as the Ebola virus and the ticks that spread the disease are non-extinctable. I guess this problem is going to get worse and worse every year. I am scared of going into nature and also for my kids

 

[Gert van der Hoek]

Re: Crimean-Congo Haemorrhagic Fever in Turkey

This fever is claiming more lives every year. The virus that causes the disease is in the same family as the Ebola virus and the ticks that spread the disease are non-extinctable. I guess this problem is going to get worse and worse every year. I am scared of going into nature and also for my kids

Hi Oric,

reports say the problem is in certain regions in Turkey, Central Anatolia and from there to the Black Sea.

Would you have more information about the spreading of the tick?

You live in Istanbul, do you feel in that region it is not safe to go out in nature?

 

[Gert van der Hoek]

Re: Crimean-Congo Haemorrhagic Fever in Turkey

Tick-spread disease claims new victim

A resident of Yozgat province died of Crimean-Congo Hemorrhagic Fever (CCHF), which is spread through infected tick bites.

Abbas Erdoğan of Yozgat was hospitalized in the village clinic then transferred to Ankara Numune Hospital. Erdoğan was diagnosed with CCHF in Ankara, where he died from the infection. The number of tick-borne fever fatalities has increased to 14 since the beginning of the year.

Two researchers from Ankara and Fırat universities were sent to the region to research the reason for the increase in the number of infected ticks carrying the CCHF virus.

The researchers began their study in the Yozgat districts of ?ekerek, Kadışehri, Aydıncık as well as in the provinces of Tokat and ?orum, where an increase in the tick population has been observed.

The researchers took blood samples from wild animals in areas infested with ticks. Yozgat Governor Amir ?i?ek said they will work to prevent the tick population from increasing once the study is concluded.

"We will adopt measures if it is found that the increase in the infected ticks stems from the blood of infected animals, ?i?ek said, adding, "We will work to prevent the increase in the tick population."

Local authorities are trying to inform residents of villages in the region about the danger that ticks pose and warn them to go to a medical facility if they are bitten by a tick.

http://www.todayszaman.com/tz-web/detaylar.do?load=detay&link=115452

 

[Gert van der Hoek]

Re: Crimean-Congo Haemorrhagic Fever in Turkey

Crimean-Congo Hemorrhagic Fever claims another life

The New Anatolian / Ankara

11 July 2007

An outbreak of hemorrhagic fever in Turkey has sickened more than 200 people and killed 13 of them so far this year, as a man in Cankiri's Ilgaz district who was taken to hospital due to Crimean-Congo Hemorrhagic Fever died while being under treatment.

The death toll rise to 13 as the lab results show that Ismail Elvan in Aydin aged 60 died of Crimean-Congo Hemorrhagic Fever.

It is also reported that another man from Ilgaz is under treatment in Ankara.

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

Last year, 27 of the 438 people in Turkey who contracted the disease died, the Health Ministry has said. 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.

Authorities at the World Health Organization said earlier this month that they did not believe there was anything unusual about the outbreak at the moment, since CCHF occurs regularly in Turkey. Turkey's first known outbreak of the disease was in 2002 and the country since has adopted stronger surveillance systems, which may account for the increased number of reported cases. The Health Ministry has used acaracide, a chemical used against parasites, to reduce the tick population in the Black Sea and Central Anatolia regions, where more than 90 percent of the cases have been reported.

http://www.thenewanatolian.com/tna-27631.html