One health investigation following a cluster of Crimean-Congo haemorrhagic fever, North Macedonia, July to November 2023

Dejan Jakimovski^{1

2

3}, Pavle Banović^{4

5

6}, Katerina Spasovska^{2

3}, Goran Rangelov², Marija Cvetanovska^{2

3}, Fadil Cana², Verica Simin^{7

5}, Ivana Bogdan^{7

5}, Dragana Mijatović^{8

5}, Aleksandar Cvetkovikj^{9

5}, Igor Djadjovski¹⁰, Iva Christova^{11

5}, Eleftherios Meletis^{12

13}, Polychronis Kostoulas^{12

13}, Brigitta Zana¹⁴, Zsófia Lanszki^{15

14}, Tamás Görföl¹⁴, Zsófia Tauber^{16

14}, Gabor Kemenesi^{15

14

5}

Affiliations

¹ Clinical medicine Task Force, Balkan Association for Vector-Borne Diseases, Novi Sad, Serbia.
² University Clinic for Infectious Diseases and Febrile Conditions, Skopje, North Macedonia.
³ Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, Skopje, North Macedonia.
⁴ Clinic for Lyme Borreliosis and Other Tick-Borne Diseases, Pasteur Institute Novi Sad, Novi Sad, Serbia.
⁵ Diagnostics and Laboratory research Task Force, Balkan Association for Vector-Borne Diseases, Novi Sad, Serbia.
⁶ Department of Microbiology with Parasitology and Immunology, Faculty of Medicine in Novi Sad, University of Novi Sad, Novi Sad, Serbia.
⁷ Department for Microbiological and Other Diagnostics, Pasteur Institute Novi Sad, Novi Sad, Serbia.
⁸ Department for Research & Monitoring of Rabies & Other Zoonoses, Pasteur Institute Novi Sad, Novi Sad, Serbia.
⁹ Department of Parasitology and Parasitic Diseases, Faculty of Veterinary Medicine-Skopje, Ss. Cyril and Methodius University in Skopje, Skopje, North Macedonia.
¹⁰ Farm Animal Health Department, Faculty of Veterinary Medicine-Skopje, Ss. Cyril and Methodius University in Skopje, Skopje, North Macedonia.
¹¹ National Reference Laboratory on Vector-Borne Pathogens, Leptospira and Listeria, Microbiology Department, National Center of Infectious and Parasitic Diseases, Sofia, Bulgaria.
¹² Epidemiology and Biostatistics Task Force, Balkan Association for Vector-Borne Diseases, Novi Sad, Serbia.
¹³ Faculty of Public and One Health, University of Thessaly, Karditsa, Greece.
¹⁴ National Laboratory of Virology, Szentágothai Research Centre, University of Pécs, Pécs, Hungary.
¹⁵ Institute of Biology, Faculty of Sciences, University of Pécs, Pécs, Hungary.
¹⁶ School of Biomedical Sciences, University of Plymouth, Plymouth, United Kingdom.

PMID: 39885822
PMCID: PMC11920785
DOI: 10.2807/1560-7917.ES.2025.30.4.2400286

One health investigation following a cluster of Crimean-Congo haemorrhagic fever, North Macedonia, July to November 2023

Dejan Jakimovski et al. Euro Surveill. 2025 Jan.

. 2025 Jan;30(4):2400286.

doi: 10.2807/1560-7917.ES.2025.30.4.2400286.

Authors

Affiliations

¹ Clinical medicine Task Force, Balkan Association for Vector-Borne Diseases, Novi Sad, Serbia.
² University Clinic for Infectious Diseases and Febrile Conditions, Skopje, North Macedonia.
³ Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, Skopje, North Macedonia.
⁴ Clinic for Lyme Borreliosis and Other Tick-Borne Diseases, Pasteur Institute Novi Sad, Novi Sad, Serbia.
⁵ Diagnostics and Laboratory research Task Force, Balkan Association for Vector-Borne Diseases, Novi Sad, Serbia.
⁶ Department of Microbiology with Parasitology and Immunology, Faculty of Medicine in Novi Sad, University of Novi Sad, Novi Sad, Serbia.
⁷ Department for Microbiological and Other Diagnostics, Pasteur Institute Novi Sad, Novi Sad, Serbia.
⁸ Department for Research & Monitoring of Rabies & Other Zoonoses, Pasteur Institute Novi Sad, Novi Sad, Serbia.
⁹ Department of Parasitology and Parasitic Diseases, Faculty of Veterinary Medicine-Skopje, Ss. Cyril and Methodius University in Skopje, Skopje, North Macedonia.
¹⁰ Farm Animal Health Department, Faculty of Veterinary Medicine-Skopje, Ss. Cyril and Methodius University in Skopje, Skopje, North Macedonia.
¹¹ National Reference Laboratory on Vector-Borne Pathogens, Leptospira and Listeria, Microbiology Department, National Center of Infectious and Parasitic Diseases, Sofia, Bulgaria.
¹² Epidemiology and Biostatistics Task Force, Balkan Association for Vector-Borne Diseases, Novi Sad, Serbia.
¹³ Faculty of Public and One Health, University of Thessaly, Karditsa, Greece.
¹⁴ National Laboratory of Virology, Szentágothai Research Centre, University of Pécs, Pécs, Hungary.
¹⁵ Institute of Biology, Faculty of Sciences, University of Pécs, Pécs, Hungary.
¹⁶ School of Biomedical Sciences, University of Plymouth, Plymouth, United Kingdom.

PMID: 39885822
PMCID: PMC11920785
DOI: 10.2807/1560-7917.ES.2025.30.4.2400286

Abstract

BackgroundCrimean-Congo haemorrhagic fever (CCHF) is a severe illness characterised by fever, bleeding and high case-fatality rates. The disease is caused by CCHF virus (CCHFV), transmitted by ticks and infectious body fluids and tissues.AimAfter CCHF was diagnosed in three persons in 2023, we aimed to investigate the presence of antibodies against CCHFV in healthcare workers (HCW), sheep and goats, and of CCHFV in ticks, in an area in North Macedonia and characterise virus strains.MethodsIn 2023, we collected blood samples from HCWs involved in treating CCHF patients and sera and ticks from sheep and goats in the village in North Macedonia where the index case resided. The blood samples were analysed by ELISA. Ticks were tested for presence of CCHFV, and the virus from a CCHF case was sequenced.ResultsSamples from four of 52 HCWs and 10 of 17 small ruminants had antibodies against CCHFV. The virus was not detected from any of the 24 Rhipicephalus bursa ticks. The virus strain from the index case clustered with regional strains within the Europe-1 lineage (genotype V) group and was closest to strains from Kosovo‡.ConclusionThis report shows CCHFV is endemic in North Macedonia. Raising awareness of the risk factors and educating people about the measures they can take to reduce exposure to the virus is important. Healthcare workers need to be aware of the disease. Early detection, robust diagnostic methods, surveillance and collaborative efforts are necessary to prevent and control CCHF in the affected regions.

Keywords: Crimean-Congo haemorrhagic fever; One Health approach; Outbreak; Public health surveillance; Tick-borne diseases.

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Conflict of interest statement

Conflict of interest: None declared.

Figures

**Figure 1**
Description of the main activities during and after a cluster of Crimean–Congo haemorrhagic fever, North Macedonia, 2023

**Figure 2**
Location of small ruminant farms tested for Crimean–Congo haemorrhagic fever virus, 2023 (n = 3) and human cases of Crimean–Congo haemorrhagic fever 2001–2023 (n = 239), North Macedonia and neighbouring countries^a

**Figure 3**
Neighbour-joining phylogenetic trees of three viral genomic segments of Crimean–Congo haemorrhagic fever virus from one patient, North Macedonia, 2023 and sequences from Genbank (n = 3)

See this image and copyright information in PMC

References

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One health investigation following a cluster of Crimean-Congo haemorrhagic fever, North Macedonia, July to November 2023

Affiliations

One health investigation following a cluster of Crimean-Congo haemorrhagic fever, North Macedonia, July to November 2023

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

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LinkOut - more resources

Full Text Sources