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. 2016 Mar-Apr;14(2):73-80.
doi: 10.1016/j.tmaid.2016.03.002. Epub 2016 Mar 10.

Crimean-Congo haemorrhagic fever in travellers: A systematic review

Hakan Leblebicioglu  1 , Resat Ozaras  2 , Tom E Fletcher  3 , Nick J Beeching  4 ; ESCMID Study Group for Infections in Travellers and Migrants (ESGITM)
Affiliations

Crimean-Congo haemorrhagic fever in travellers: A systematic review

Hakan Leblebicioglu et al. Travel Med Infect Dis. 2016 Mar-Apr.

Abstract

Background: The recent Ebola epidemic has increased public awareness of the risk of travel associated viral haemorrhagic fever (VHF). International preparedness to manage imported cases Ebola virus infection was inadequate, highlighted by cases of nosocomial transmission. Crimean-Congo haemorrhagic fever (CCHF) is a re-emerging tick-borne VHF centred in the Eurasian region, affecting a large geographical area and with human-to-human transmission reported, especially in the healthcare setting.

Objectives: To systematically review the characteristics of travel associated Crimean-Congo haemorrhagic fever.

Methods: A systematic review of travel-associated cases of CCHF was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement protocol. PubMed, SCOPUS, Science Citation Index (SCI) and ProMED databases were searched for reports published between January 1960 and January 2016. Three independent reviewers selected and reviewed studies and extracted data.

Results: 21 cases of travel associated CCHF were identified, of which 12 died (3 outcome unknown) and 4 secondary (nosocomial) infections were reported. Risk occupations or activities for CCHF infection were reported in 8/12 cases when data were available. Travel from Asia to Asia occurred in 9 cases, Africa to Africa occurred in 5 cases, Africa to Europe in 3 cases, Asia to Europe in 2 cases and Europe to Europe in 2 cases.

Conclusion: CCHF related to travel is rare, is generally associated with at risk activities/occupation and is frequently fatal. Key to early diagnosis and prevention of nosocomial transmission is an understanding of CCHF risk factors and the geographical distribution of CCHF. International travel to CCHF endemic areas is increasing and clinicians and laboratory personnel managing returning travellers should maintain a high index of suspicion.

Keywords: Crimean-Congo haemorrhagic fever; Imported; Migration; Travel; Viral haemorrhagic fevers.

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Figures

Figure 1
Figure 1
Flowchart of literature search.
Figure 2
Figure 2
Map of imported CCHF cases (Updated from the Centers for Disease Control and Prevention. Each black arrow represents one infected traveller and the white arrow represents 9 infected cases travelling from Afghanistan to Pakistan. Coloured countries are endemic for CCHF.).
See this image and copyright information in PMC

Comment in

  • Crimean-Congo hemorrhagic fever - A ticking bomb?
    Al-Abri SS, Petersen E. Al-Abri SS, et al. Travel Med Infect Dis. 2016 Mar-Apr;14(2):71-2. doi: 10.1016/j.tmaid.2016.03.011. Epub 2016 Mar 29. Travel Med Infect Dis. 2016. PMID: 27044612 No abstract available.

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