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SECRETARY OF STATE FOR
HEALTH
GENERAL DIRECTORATE OF HEALTH
PUBLIC
Alert Coordination Center and
Health Emergencies
Detection of cases of hemorrhagic fever of
Crimea-Congo in El Bierzo (León)
August 5, 2022
Summary of the situation and conclusions
In July 2022, two cases of Crimean-Congo hemorrhagic fever (CCHF) have been confirmed in two men with
residence in the Bierzo region. The first case of a 49-year-old hunter with a history of bites from
tick, began symptoms on July 12 and is in stable condition. The second case, aged 51, was
retrospectively diagnosed on July 20, having died on June 19 of an unknown cause with
suspected poisoning by sulfur compounds.
The CCHF virus (CCHFV) is transmitted primarily by ticks of the genus Hyalomma and can also be
produce person-to-person transmission through contact with the blood or secretions of a sick person. The
FHCC manifests clinically with fever, headache, muscle pain and in a few cases it evolves into forms
Severe with hemorrhagic manifestations. There is no specific treatment.
Between 2013 and 2022, a total of 12 cases with 4 deaths have been confirmed in Spain: 1 in 2013 in Ávila, 2 in
2016, one of them in Ávila and a secondary case to this in a health worker, 2 in 2018 in Badajoz and
Salamanca, 3 in 2020 in Salamanca, 2 in 2021 in Salamanca and León (el Bierzo) and 2 in 2022 in León (el Bierzo).
The circulation of the virus in our country has been known since 2010. Studies have been carried out on ticks and animals
wild and domestic to know the extension of the circulation, having been detected in extensive areas of
Castilla y León, Castilla-La Mancha, Extremadura, and Andalusia. They have also recently been detected in
animal serology studies carried out in Galicia and Catalonia. The province of León and in particular the
Bierzo region was considered low risk, given the low presence of Hyalomma and the low prevalence of
antibodies against the virus in wild and domestic animals in the serological studies carried out, in which
was around 1-2%.
The risk of more sporadic cases of CCHF occurring in areas where ticks are present
genus Hyalomma, especially in the population that resides or frequents said areas and that carries out activities
with increased exposure to their bites, it is considered moderate. The impact of the disease is considered
low given that, although a low percentage of infections may be a serious illness, the number of
people affected would not be high and adequate means of isolation and control of cases are available.
It is recommended to intensify public health measures in areas with the presence of the virus, especially in the
area where the cases have been recently detected, emphasizing the recommendations to the population for the
prevention and management of tick bites, active and passive surveillance of cases, and entomological study and
virus circulation in animals and humans.
Rationale for risk assessment
In the month of July 2022, two confirmed cases of Crimean-Congo hemorrhagic fever have been reported
(FHCC) in two men living in the Comarca del Bierzo, province of León. The FHCC is considered a
emerging disease in Eastern European countries. In Spain until 2021 only 10 cases had been detected.
The detection of these two new cases grouped in time and in a specific geographical area considered to be
low risk, where another case had also been detected in 2021 justifies this rapid risk assessment.
In 2019, an analysis of the situation and a broader assessment of the risk of this virus in Spain was carried out, which
can be found at the following link:
https://www.mscbs.gob.es/profesionales/saludPublica/ccayes/analisisituacion/infoSitua.htm
...
Event information
On July 18, the Autonomous Community of Castilla y León notified the Center for the Coordination of Alerts and
Health Emergencies and the National Epidemiology Center a suspicion of Crimean-Congo hemorrhagic fever (FHCC).
It was a 49-year-old male, hunter, resident in Ponferrada (Comarca del Bierzo, León)
with a history of tick bite that on July 12 began with gastrointestinal symptoms (pain
abdominal pain, diarrhea and vomiting) along with headache and fever. On July 16 he was hospitalized being observed
elevated transaminases and thrombocytopenia. On July 19, the National Center for Microbiology (CNM)
confirmed positivity against the CCHF virus (CCHFV) by real-time PCR. The case was transferred
July 20 to the high-level isolation unit in Donostia where he is progressing favorably.
On July 20, the National Institute of Toxicology and Forensic Sciences sends the CNM blood samples from a
51-year-old male, environmental agent, who had died on June 19, 2022 at the Hospital del Bierzo,
León, with a probable diagnosis of 20% cuprocalcium sulfate intoxication, hemorrhagic shock and coagulopathy.
Real-time PCR was positive against CCHFV in blood. The case did not refer to a history of bite of
tick, but he had been sulfating his orchard and symptoms began 24 hours later (06.15.2022). It was initially
diagnosed with respiratory infection with headache; subsequently he developed abdominal discomfort, diarrhea and the
On June 16, he was admitted with a severe coagulopathy, experiencing progressive deterioration until his
death 3 days later. As a consequence of this case, four close contacts were identified
performed the autopsy and four others who handled the samples in the laboratory. Currently, it has finished
follow-up with no secondary cases detected.
Likewise, in the Bierzo hospital, 50 professionals have been identified who were in contact with the
patients (Emergency Services, Internal Medicine and ICU). Health professionals used
standard individual protection (PPE) and no secondary cases have been detected.
It is not the first time that a case of FHCC has been detected in El Bierzo. On June 10, 2021, another case was confirmed
from FHCC, a woman resident in El Bierzo who had also been to some places in Ourense, around
of the Ribera Sacra, Galicia. This was the first case in this zone, considered up to that moment a zone of low
risk (see entomological and serological studies carried out).
In Castilla y León, the prevention public health activities of the FHCC have focused in recent years
in educating citizens about tick bites and also health professionals about
how to remove them and avoid antibiotic chemoprophylaxis. Since the identification of the cases in the Comarca del
Bierzo, these communication and health education tasks have intensified. In a complementary way,
new entomological and serological studies are being designed in risk groups (health professionals,
risk groups due to their work activity (environmental agents, agriculture and livestock veterinarians,
hunters) as well as the possibility of population study in the region and seroprevalence in animals to
determine the extent of CCHFV circulation in the affected area.
...
https://www.sanidad.gob.es/en/profe...ongo/docs/20220805_Crimea_Congo_El_Bierzo.pdf
https://www.sanidad.gob.es/en/profesionales/saludPublica/ccayes/alertasActual/alertActu.htm
