Friday, September 09, 2016

ECDC: Rapid Risk Assessment On Locally Acquired CCHF - Spain

Tick Range - Credit ECDC


Seven days ago, in Spain: Two Cases Of Locally Acquired CCHF, we looked at the first autochthonous human cases of Crimean-Congo Hemorrhagic Fever ever reported in Spain.

The CCHV virus, however, had been detected in local ticks since at least 2010, most likely carried in by migratory birds from Northern Africa (see Crimean-Congo Hemorrhagic Fever Virus in Ticks, Southwestern Europe, 2010).

Today the ECDC has published a Rapid Risk Assessment on these two recent cases, and while they find the risks low, they warn that additional sporadic cases may occur in the future.

The following excerpt comes from the 7-page PDF file. 

Crimean–Congo haemorrhagic fever in Spain – 8 September 2016

Main conclusions and options for response

On 31 August 2016 the autonomous Community of Madrid, Spain, reported two cases of infection with Crimean–Congo haemorrhagic fever (CCHF) virus. The primary case is a 62-year-old man with potential exposure to CCHF virus in the countryside in the province of Ávila (Spain). The secondary case is a 50-year-old healthcare worker who attended the primary case during his ICU admission. These are the first autochthonous clinical cases of CCHF in Spain and in south-western Europe.

Recent detection of CCHF virus in ticks from the autonomous Community of Extremadura in western Spain, indicates the circulation of CCHF virus among wildlife. Therefore, the occurrence of CCHF virus infection is not an unexpected event in Spain. Nosocomial transmission of CCHF can occur even in a non-endemic region when appropriate infection prevention and control (IPC) measures have not been observed.

The probability of CCHF virus infection in Spain is low. However, other sporadic cases are possible. The risk of further human-to-human transmission in hospital settings can be significantly reduced by applying timely appropriate IPC measures.

The options for risk reduction are suggested as follows:

  • Enhanced awareness of the importance of early diagnosis and laboratory confirmation among healthcare providers in areas with potential circulation of CCHF virus. Timely and appropriate case management is crucial for the reduction of case fatality.
  • Standard precautions, preferably combined with contact and droplet precautionary measures, should be taken when caring for patients presenting with haemorrhagic fever syndrome, including when there is suspicion of CCHF.
  • Laboratory tests on patient samples present a high risk of transmission and should only be conducted under appropriate biological containment conditions.
  • As a precautionary measure, risk groups should be informed about the mode of transmission and urged to comply with advice on the prevention of tick bites. Risk groups in potentially affected areas are primarily:
  1. people working in close proximity to animals, especially livestock (e.g. agricultural workers in animal husbandry or slaughterhouse workers, veterinarians);
  2. − people exposed to tick-to-human transmission through their outdoor activities (e.g. hunters, forest workers, hikers); and − healthcare providers at risk of human-to-human transmission.
  • In order to better target preventive measures and raise clinical awareness, areas with CCHF virus circulation and areas suitable for CCHF circulation in the Iberian Peninsula should be defined by multidisciplinary investigations; in particular performing CCHF risk mapping, ecological and environmental studies, sero-surveys in host species and entomological investigations.
  • Ribavirin for post-exposure prophylaxis should be considered after high-risk exposure, despite the low quality of evidence for its effectiveness.
  • Genome sequencing of the CCHF viruses detected in Spain will provide additional information on the genetic diversity of viruses circulating in the Iberian Peninsula.
  • Since sporadic cases of the disease in affected areas in Spain are possible, transfusion and transplant professionals should be aware of possible CCHF exposure in affected areas. However, no specific measures for the safety of substances of human origin (SoHO) are recommended at this stage.
  • Further studies on the ecology of CCHF in the Iberian Peninsula are needed to delineate the areas at risk for tick-borne transmission.

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