Photo Credit- CDC
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A recurring theme in public health is just how quickly, and easily, that `exotic’ diseases can cross vast oceans or borders, given our modern air travel industry and our penchant for international travel (see The Global Reach Of Infectious Disease).
The introduction of Chikungunya to the Caribbean last fall, and the ensuing (and ongoing) epidemic, are almost certainly the result of an infected traveler coming from an endemic region of the world.
Similarly the reintroduction of Dengue to South Florida in 2009, and the arrival of West Nile Virus in New York in 1999, are both thought to have arrived via infected international travelers, and both (probably after multiple introductions) have managed to gain a foothold in the United States.
More dramatically, but with less public health impact, earlier this year we saw the first North American importation of H5N in a nurse returning from China (see H5N1 In Canada: A Matter Of Import), while a few months later we saw Minnesota: Rare Imported Case Of Lassa Fever.
The good news is - despite their fearsome reputations - neither of these two diseases are easily spread between humans, and no secondary infections were reported.
The continual importation of measles has seen us go from the near-elimination of the virus in this country in 2000 to this year’s CDC Telebriefing: Worst US Measles Outbreak In 20 Years. And the most recent Arbovirus surveillance report lists thus far for 2014 the detection of 24 imported cases of Dengue, 52 imported cases of Chikungunya, and 20 imported cases of Malaria . . . in Florida alone.
Given this track record, no one should be terribly surprised to learn that the Public Health England reported yesterday their second known case of imported CCHF (Crimean-Congo Hemorrhagic Fever). While CCHF can be transmitted from one human to another, it requires contact with infected blood or bodily fluids, and so it isn’t easily done.
Crimean-Congo haemorrhagic fever case identified in UK
From: Public Health England
History: Published 3 July 2014
Part of: Public health
PHE is aware of a laboratory-confirmed case of CCHF in a UK traveller who was bitten by a tick while on holiday in Bulgaria.
The patient is responding well to treatment and there is no risk to the general population.
As a precautionary measure, close contacts of the patient, including hospital staff involved in the patient’s care, will be given health advice and encouraged to contact their GP if they experience symptoms.
Although Crimean-Congo haemorrhagic fever (CCHF) can be acquired from an infected person, this would require direct contact with their blood or body fluids and the risk even for close contacts is considered very low.
This is the second laboratory-confirmed case of CCHF in the UK, following the diagnosis in 2012 of CCHF in a UK resident who had recently returned from Afghanistan.
CCHF is the commonest viral haemorrhagic fever worldwide. It is not found in the UK but is endemic in many countries in Africa, the Middle East, Asia and Eastern Europe, including Turkey and Bulgaria.
People most at risk are agricultural workers, healthcare workers and military personnel deployed to endemic areas. CCHF is most often transmitted by a tick bite but can also be spread through contact with infected patients or animals.
Dr Tim Brooks, Head of Public Health England’s (PHE’s) Rare and Imported Pathogens Laboratory (RIPL) said:
It’s extremely rare to see a case of Crimean-Congo haemorrhagic fever in the UK, and it’s important to note there is no risk to the general population. As a precaution, close contacts of the patient will be contacted and monitored, but the risk of transmission is very low and would require direct contact with bodily fluids.
The first imported case of CCHF in the UK, mentioned above, was a 38-year old man who flew into Glasgow, Scotland from the Middle East (see Update: CCHF Patient In Scotland Dies).
While uncommon in Western Europe, this tickborne virus is widely distributed across parts of Eastern Europe, the former Soviet Union, the Mediterranean, central Asia, southern Europe, Africa, the Middle East, and the Indian subcontinent.
Credit WHO
CCHF is a Nairovirus in the family Bunyaviridae, and was first described in the Crimea in 1944. Later it was also isolated in the Congo (1969) – hence the name.
CCHF is normally transmitted to humans via the bite of a tick, or via contact with the blood of infected animals, although there have been reports of nosocomial (in hospital) transmission as well (see 2010 WHO report on Pakistan).
Today’s story isn’t so much about one rare imported case of CCHF, but about how important it is that we anticipate, and prepare for, the inevitable arrival of many more imported diseases.
Which is why the CDC, along with other international public (and animal) health agencies are involved in a series of initiatives to improve global health surveillance & emergency response in this age of rising infectious diseases. The rationale for which is explained on the CDC’s Global Health Website at:
Why Global Health Security Matters
Disease Threats Can Spread Faster and More Unpredictably Than Ever Before
(Excerpt)
A disease threat anywhere can mean a threat everywhere. It is defined by
- the emergence and spread of new microbes;
- globalization of travel and trade;
- rise of drug resistance; and
- potential use of laboratories to make and release—intentionally or not—dangerous microbes.
