Systematic Review and Meta-analysis of Postexposure Prophylaxis for Crimean-Congo Hemorrhagic Fever Virus among Healthcare Workers

Abstract

We performed a systematic review and meta-analysis on the effectiveness of ribavirin use for the prevention of infection and death of healthcare workers exposed to patients with Crimean-Congo hemorrhagic fever virus (CCHFV) infection. Splashes with blood or bodily fluids (odds ratio [OR] 4.2), being a nurse or physician (OR 2.1), and treating patients who died from CCHFV infection (OR 3.8) were associated with healthcare workers acquiring CCHFV infection; 7% of the workers who received postexposure prophylaxis (PEP) with ribavirin and 89% of those who did not became infected. PEP with ribavirin reduced the odds of infection (OR 0.01, 95% CI 0-0.03), and ribavirin use <48 hours after symptom onset reduced the odds of death (OR 0.03, 95% CI 0-0.58). The odds of death increased 2.4-fold every day without ribavirin treatment. Ribavirin should be recommended as PEP and early treatment for workers at medium-to-high risk for CCHFV infection.

Keywords: Albania; Arabic Emirates; CCHF; CCHFV; Crimean-Congo hemorrhagic fever; Crimean-Congo hemorrhagic fever virus; Germany; India; Iran; Kazakhstan; Mauritania; PRISMA; Pakistan; Russia; South Africa; Sudan; Tajikistan; Turkey; and Spain; early treatment; healthcare workers; meta-analysis; postexposure prophylaxis; ribavirin; systematic review; vector-borne infections; viral hemorrhagic fever; viruses; zoonoses.

Figure 1

Identification and selection of studies included in a meta-analysis of the effectiveness of postexposure prophylaxis with ribavirin and early treatment with ribavirin among healthcare workers exposed to patients infected with Crimean-Congo hemorrhagic fever virus, 1976–2017. IPD, individual participant data.

Figure 2

Effectiveness of PEP and early treatment with ribavirin among healthcare workers exposed to patients infected with Crimean-Congo hemorrhagic fever virus, 1976–2017. A) Two-step meta-analysis of the effectiveness of PEP with ribavirin for preventing Crimean-Congo hemorrhagic fever virus infection. We could determine the effect estimates for only 4 individual studies, and we included 33 reports in the final pooled estimate. B) Two-step meta-analysis on the effectiveness of early ribavirin use for preventing death caused by Crimean-Congo hemorrhagic fever virus infection. We could determine the effect estimate for only 2 individual studies, and we included 33 reports in the final pooled estimate. OR, odds ratio; PEP, postexposure prophylaxis.

Figure 3

Flowchart of healthcare workers exposed to patients infected with Crimean-Congo hemorrhagic fever virus who did and did not receive PEP with ribavirin or early ribavirin treatment <48 hours after symptom onset, 1976–2017. *Healthcare workers for which PEP information was not included in the original report. PEP, postexposure prophylaxis.