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      Healthcare-associated Crimean-Congo haemorrhagic fever in Turkey, 2002–2014: a multicentre retrospective cross-sectional study

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          Abstract

          Healthcare-related transmission of Crimean-Congo haemorrhagic fever (CCHF) is a well-recognized hazard. We report a multicentre retrospective cross-sectional study undertaken in Turkey in 2014 in nine hospitals, regional reference centres for CCHF, covering the years 2002 to 2014 inclusive. Data were systematically extracted from charts of all personnel with a reported health care injury/accident related to CCHF. Blood samples were tested for CCHF IgM/IgG by enzyme-linked immunosorbent assay and/or viral nucleic acid detection by PCR after the injury. Fifty-one healthcare-related exposures were identified. Twenty-five (49%) of 51 resulted in laboratory-confirmed infection, with a 16% (4/25) overall mortality. The main route of exposure was needlestick injury in 32/51 (62.7%). A potential benefit of post-exposure prophylaxis with ribavirin was identified.

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          Review of the Literature and Proposed Guidelines for the Use of Oral Ribavirin as Postexposure Prophylaxis for Lassa Fever

          Daniel Bausch, Christiane Hadi, Sheik Khan … (2010)
          Abstract Lassa fever is an acute viral hemorrhagic illness; the virus is endemic in West Africa and also of concern with regard to bioterrorism. Transmission of Lassa virus between humans may occur through direct contact with infected blood or bodily secretions. Oral administration of the antiviral drug ribavirin is often considered for postexposure prophylaxis, but no systematically collected data or uniform guidelines exist for this indication. Furthermore, the relatively low secondary attack rates for Lassa fever, the restriction of the area of endemicity to West Africa, and the infrequency of high-risk exposures make it unlikely that controlled prospective efficacy trials will ever be possible. Recommendations for postexposure use of ribavirin can therefore be made only on the basis of a thorough understanding and logical extrapolation of existing data. Here, we review the pertinent issues and propose guidelines based on extensive review of the literature, as well as our experience in this field. We recommend oral ribavirin postexposure prophylaxis for Lassa fever exclusively for definitive high-risk exposures. These guidelines may also serve for exposure to other hemorrhagic fever viruses susceptible to ribavirin.
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            Nosocomial outbreak of viral hemorrhagic fever caused by Crimean Hemorrhagic fever-Congo virus in Pakistan, January 1976.

            Mohammed A Ghafoor, M Saleen, Craig Webb … (1980)
            This paper describes the clinical, epidemiological, and laboratory investigations undertaken to isolate and identify the etiological agent of a nosocomial cluster of hemorrhagic fever cases due to Crimean hemorrhagic fever (CHR)-Congo virus. Since this virus is usually transmitted by ticks it was surprising that the index case, in a nomadic shepherd, occurred during the winter season when ticks are relatively inactive. These are the first cases of CHF-Congo virus found in humans in Pakistan. Investigations on other biological properties, particularly strain differences and virulence, are being continued at the Islamabad laboratory.
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              Crimean-Congo hemorrhagic fever in Europe: current situation calls for preparedness.

              M. Bouloy, Stuart T. Nichol, R Andraghetti … (2010)
              During the last decade Crimean-Congo hemorrhagic fever (CCHF) emerged and/or re-emerged in several Balkan countries, Turkey, southwestern regions of the Russian Federation, and the Ukraine, with considerable high fatality rates. Reasons for re-emergence of CCHF include climate and anthropogenic factors such as changes in land use, agricultural practices or hunting activities, movement of livestock that may influence host-tick-virus dynamics. In order to be able to design prevention and control measures targeted at the disease, mapping of endemic areas and risk assessment for CCHF in Europe should be completed. Furthermore, areas at risk for further CCHF expansion should be identified and human, vector and animal surveillance be strengthened.
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                Author and article information

                Contributors
                H. Leblebicioglu
                Journal
                Journal ID (nlm-ta): Clin Microbiol Infect
                Journal ID (iso-abbrev): Clin. Microbiol. Infect
                Title: Clinical Microbiology and Infection
                Publisher: Elsevier
                ISSN (Print): 1198-743X
                ISSN (Electronic): 1469-0691
                Publication date PMC-release: 1 April 2016
                Publication date (Print): April 2016
                Volume: 22
                Issue: 4
                Pages: 387.e1-387.e4
                Affiliations
                [1) ]Department of Infectious Diseases and Clinical Microbiology, Ondokuz Mayis University Medical School, Samsun, Turkey
                [2) ]Department of Infectious Diseases and Clinical Microbiology, Yildirim Beyazit University Medical School, Ankara, Turkey
                [3) ]Department of Infectious Diseases and Clinical Microbiology, Ankara Numune Research and Training Hospital, Ankara, Turkey
                [4) ]Department of Infectious Diseases and Clinical Microbiology, Ankara Research and Training Hospital, Ankara, Turkey
                [5) ]Department of Infectious Diseases and Clinical Microbiology, Gaziosmanpasa University Medical School, Tokat, Turkey
                [6) ]Department of Infectious Diseases and Clinical Microbiology, Cumhuriyet University Medical School, Sivas, Turkey
                [7) ]Department of Infectious Diseases and Clinical Microbiology, SB Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
                [8) ]Department of Infectious Diseases and Clinical Microbiology, Ataturk University Medical School, Erzurum, Turkey
                [9) ]Department of Infectious Diseases and Clinical Microbiology, Karadeniz Technical University Medical School, Erzurum, Turkey
                [10) ]Liverpool School of Tropical Medicine, Liverpool, United Kingdom
                [11) ]NIHR HPRU in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, United Kingdom
                Author notes
                [∗ ] Corresponding author: H. Leblebicioglu, Department of Infectious Diseases and Clinical Microbiology, Ondokuz Mayis University Medical School, Samsun, Turkey hakanomu@ 123456yahoo.com
                Article
                Publisher ID: S1198-743X(16)00005-7
                DOI: 10.1016/j.cmi.2015.11.024
                PMC ID: 5023843
                PubMed ID: 26806137
                SO-VID: 561b28c8-e970-4e39-8342-e7e31a87dc9a
                Copyright © © 2016 The Authors. European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd.
                License:

                This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

                History
                Date received : 3 July 2015
                Date revision received : 19 November 2015
                Date accepted : 22 November 2015
                Categories
                Subject: Research Note

                ScienceOpen disciplines: Microbiology & Virology
                Keywords: crimean-congo haemorrhagic fever,healthcare associated,infection prevention and control,ribavirin,viral haemorrhagic fever
                Data availability:
                ScienceOpen disciplines: Microbiology & Virology
                Keywords: crimean-congo haemorrhagic fever, healthcare associated, infection prevention and control, ribavirin, viral haemorrhagic fever

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