The global distribution of Crimean-Congo hemorrhagic fever

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Abstract

Background

Crimean-Congo hemorrhagic fever (CCHF) is a tick-borne infection caused by a virus (CCHFV) from the Bunyaviridae family. Domestic and wild vertebrates are asymptomatic reservoirs for the virus, putting animal handlers, slaughter-house workers and agricultural labourers at highest risk in endemic areas, with secondary transmission possible through contact with infected blood and other bodily fluids. Human infection is characterized by severe symptoms that often result in death. While it is known that CCHFV transmission is limited to Africa, Asia and Europe, definitive global extents and risk patterns within these limits have not been well described.

Methods

We used an exhaustive database of human CCHF occurrence records and a niche modeling framework to map the global distribution of risk for human CCHF occurrence.

Results

A greater proportion of shrub or grass land cover was the most important contributor to our model, which predicts highest levels of risk around the Black Sea, Turkey, and some parts of central Asia. Sub-Saharan Africa shows more focalized areas of risk throughout the Sahel and the Cape region.

Conclusions

These new risk maps provide a valuable starting point for understanding the zoonotic niche of CCHF, its extent and the risk it poses to humans.

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Most cited references 84

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Selecting pseudo-absences for species distribution models: how, where and how many?

Morgane Barbet-Massin, Frédéric Jiguet, Cécile Albert … (2012)

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A new world malaria map: Plasmodium falciparum endemicity in 2010

Peter W. Gething, Anand P Patil, David Smith … (2012)

Background Transmission intensity affects almost all aspects of malaria epidemiology and the impact of malaria on human populations. Maps of transmission intensity are necessary to identify populations at different levels of risk and to evaluate objectively options for disease control. To remain relevant operationally, such maps must be updated frequently. Following the first global effort to map Plasmodium falciparum malaria endemicity in 2007, this paper describes the generation of a new world map for the year 2010. This analysis is extended to provide the first global estimates of two other metrics of transmission intensity for P. falciparum that underpin contemporary questions in malaria control: the entomological inoculation rate (PfEIR) and the basic reproductive number (PfR). Methods Annual parasite incidence data for 13,449 administrative units in 43 endemic countries were sourced to define the spatial limits of P. falciparum transmission in 2010 and 22,212 P. falciparum parasite rate (PfPR) surveys were used in a model-based geostatistical (MBG) prediction to create a continuous contemporary surface of malaria endemicity within these limits. A suite of transmission models were developed that link PfPR to PfEIR and PfR and these were fitted to field data. These models were combined with the PfPR map to create new global predictions of PfEIR and PfR. All output maps included measured uncertainty. Results An estimated 1.13 and 1.44 billion people worldwide were at risk of unstable and stable P. falciparum malaria, respectively. The majority of the endemic world was predicted with a median PfEIR of less than one and a median PfR c of less than two. Values of either metric exceeding 10 were almost exclusive to Africa. The uncertainty described in both PfEIR and PfR was substantial in regions of intense transmission. Conclusions The year 2010 has a particular significance as an evaluation milestone for malaria global health policy. The maps presented here contribute to a rational basis for control and elimination decisions and can serve as a baseline assessment as the global health community looks ahead to the next series of milestones targeted at 2015.

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Crimean-Congo haemorrhagic fever

Önder Ergönül (2006)

Summary Crimean-Congo haemorrhagic fever (CCHF) is an often fatal viral infection described in about 30 countries, and it has the most extensive geographic distribution of the medically important tickborne viral diseases, closely approximating the known global distribution of Hyalomma spp ticks. Human beings become infected through tick bites, by crushing infected ticks, after contact with a patient with CCHF during the acute phase of infection, or by contact with blood or tissues from viraemic livestock. Clinical features commonly show a dramatic progression characterised by haemorrhage, myalgia, and fever. The levels of liver enzymes, creatinine phosphokinase, and lactate dehydrogenase are raised, and bleeding markers are prolonged. Infection of the endothelium has a major pathogenic role. Besides direct infection of the endothelium, indirect damage by viral factors or virus-mediated host-derived soluble factors that cause endothelial activations and dysfunction are thought to occur. In diagnosis, enzyme-linked immunoassay and real-time reverse transcriptase PCR are used. Early diagnosis is critical for patient therapy and prevention of potential nosocomial infections. Supportive therapy is the most essential part of case management. Recent studies suggest that ribavirin is effective against CCHF, although definitive studies are not available. Health-care workers have a serious risk of infection, particularly during care of patients with haemorrhages from the nose, mouth, gums, vagina, and injection sites. Simple barrier precautions have been reported to be effective.

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Author and article information

Journal

Journal ID (nlm-ta): Trans R Soc Trop Med Hyg

Journal ID (iso-abbrev): Trans. R. Soc. Trop. Med. Hyg

Journal ID (publisher-id): trstmh

Journal ID (hwp): trstmh

Title: Transactions of the Royal Society of Tropical Medicine and Hygiene

Publisher: Oxford University Press

ISSN (Print): 0035-9203

ISSN (Electronic): 1878-3503

Publication date (Print): August 2015

Publication date (Electronic): 04 July 2015

Publication date PMC-release: 04 July 2015

Volume: 109

Issue: 8

Pages: 503-513

Affiliations

[a ]Department of Zoology, University of Oxford, Oxford, UK

[b ]Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK

[c ]Department of Pediatrics, Harvard Medical School and Children's Hospital Informatics Program, Boston Children's Hospital, Boston, MA, USA

[d ]Livestock Systems and Environment (LSE), International Livestock Research Institute (ILRI),Nairobi, Kenya

[e ]Biological Control and Spatial Ecology, Université Libre de Bruxelles, Brussels, Belgium

[f ]Fonds National de la Recherche Scientifique, Brussels, Belgium

[g ]Fogarty International Center, National Institutes of Health, Bethesda, MD, USA

[h ]Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA

Author notes

[* ]Corresponding author: Tel: +44 (0) 1865 271 137; E-mail: jane.messina@ 123456zoo.ox.ac.uk

Article

Publisher ID: trv050

DOI: 10.1093/trstmh/trv050

PMC ID: 4501401

PubMed ID: 26142451

SO-VID: 450f2019-c097-4e9d-8a1a-69aca5bf7da3

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.