9 October, 2012
Crimean Congo haemorrhagic fever: UK ex Afghanistan
On 5 October 2012, a case of Crimean Congo haemorrhagic fever was confirmed in a 38 year old male who arrived in Glasgow on an international flight (from Afghanistan via Dubai) on 2 October 2012 . The patient was hospitalised within three hours of his arrival in Scotland. Initially he was cared for in isolation at Brownlee Specialist Unit, Gartnaval Hospital, Glasgow [1-2]. On 5 October, he was transferred to the high security infectious diseases unit at the Royal Free hospital in London, using specialist air transport [3- 4]. Appropriate public health measures have been undertaken. Contacts with the case have been traced as a precautionary measure, however, the risk is considered to be low [1-2].
This is the first laboratory confirmed case of CCHF known to be imported into the UK .
Crimean Congo haemorrhagic fever
CCHF has a wide geographical distribution including Eastern Europe, Asia and Africa. In 2012, outbreaks have occurred in Pakistan, India, Iran, Kosovo and Turkey . CCHF is caused by a virus of the Bunyaviridae family. It is primarily a zoonosis with natural hosts including hares, birds, cattle, sheep, pigs and goats. The disease is transmitted to humans either by the bite of an infected tick (usually ixodid ticks of the Hyalomma genus) or through direct contact with blood or other tissue from infected livestock. Person to person transmission, due to direct or indirect contact with skin, mucous membranes, or body fluids of infected patients can occur, particularly in endemic areas .
The incubation period of CCHF after a tick bite is between one and three days. It is longer (usually five to six days with a maximum of 13 days) after contact with blood or tissue from infected animals. Initial symptoms are fever, myalgia, headache and dizziness; some patients will have nausea and diarrhoea. As the disease progresses, haemorrhagic manifestations develop. In severe illness the mortality rate is approximately 30%, with a wide range [7-9].
Advice for travellers
The risk of CCHF to contacts of this case is very low. Further information and reassurance for individuals in Scotland who are concerned is available from
NHS24 on 08000 858531.
The risk of CCHF to tourist travellers visiting endemic areas is very low. The majority of cases of CCHF occur amongst those working in agriculture including animal husbandry, veterinarians or animal slaughter workers. Healthcare workers are at risk from direct (unprotected) contact with the blood, body fluids or tissues of an infected person .
Travellers to affected areas are advised to take measures to minimise their exposure to ticks. These include:
- Wear clothing with long sleeves and long trousers (tucked into socks), which can be treated with insecticide sprays such as permethrin.
- Apply insect repellent (DEET) to exposed skin.
- Check the body for ticks regularly. Larval ticks are tiny and difficult to see. Adult ticks, once they have fed and become engorged, may be the size of a coffee bean. Common areas for ticks to attach are at the hair-line, behind the ears, elbows, backs of knees, groin and armpits.
- Remove ticks as soon as possible by using a pair of tweezers or tick remover. The tweezers should be placed as close as possible to the skin and then the tick pulled slowly, ensuring the mouth parts are removed. Care needs to be taken not to squeeze the stomach contents into the site of the bite.
- Animal handlers should take precautions to avoid exposure to blood and tissues of livestock and healthcare workers should observe appropriate infection control measures.
There is no vaccine to prevent CCHF.
Outbreaks of CCHF are listed in the NaTHNaC Outbreak Surveillance Database.
1. NHS Greater Glasgow and Clyde. Media Centre. Public Health Investigate Case of Crimean Congo Viral Haemorrhagic Fever. [Accessed 9 October 2012]. Available at: http://www.nhsggc.org.uk/content/default.asp?page=s1192_3
2. Health Protection Agency. Confirmed case of Crimean Congo Haemorrhagic Fever in the UK. [Accessed 9 October, 2012]. Available at: http://www.hpa.org.uk/NewsCentre/NationalPressReleases/
3. Department of Health. Management of Hazard Group 4 viral haemorrhagic fevers and similar human infectious diseases of high consequence, Advisory Committee on Dangerous Pathogens [Accessed 9 October, 2012]. Available at: http://www.hpa.org.uk/webc/HPAwebFile/HPAweb_C/
4. NHS Greater Glasgow and Clyde. Media Centre. Crimean Congo Viral Haemorrhagic Fever Patient Transferred to London [Accessed 9 October, 2012]. Available at: http://www.nhsggc.org.uk/content/default.asp?page=s1192_
5. Health Protection Agency. Global epidemiology of CCHF. [Accessed 9 October, 2012] Available at: http://www.hpa.org.uk/webw/HPAweb&HPAwebStandard/
6. Health Protection Agency. CCHF Transmission. [Accessed 9 October, 2012]. Available at: http://www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsA
7. Health Protection Agency. CCHF Background Information. [Accessed 9 October 2012]. Available at: http://www.hpa.org.uk/Topics/InfectiousDiseases/Infections
8. Solomon T. Viral Haemorrhagic Fevers In. Cook GC and Zumla A. Manson’s Tropical Diseases, 21st Edn., Ch.43, 773-793
9. Field VF, Ford L, Hill DR, eds. Health Information for Overseas Travel. National Travel Health Network and Centre, London, UK, 2010