Health Care Response to CCHF in US Soldier and Nosocomial Transmission to Health Care Providers,Germany, 2009

In 2009, a lethal case of Crimean–Congo hemorrhagic fever (CCHF), acquired by a US soldier in Afghanistan, was treated at a medical center in Germany and resulted in nosocomial transmission to 2 health care providers (HCPs). After his arrival at the medical center (day 6 of illness) by aeromedical evacuation, the patient required repetitive bronchoscopies to control severe pulmonary hemorrhage and renal and hepatic dialysis for hepatorenal failure. After showing clinical improvement, the patient died suddenly on day 11 of illness from cerebellar tonsil herniation caused by cerebral/cerebellar edema. The 2 infected HCPs were among 16 HCPs who received ribavirin postexposure prophylaxis. The infected HCPs had mild or no CCHF symptoms. Transmission may have occurred during bag-valve-mask ventilation, breaches in personal protective equipment during resuscitations, or bronchoscopies generating infectious aerosols. This case highlights the critical care and infection control challenges presented by severe CCHF cases, including the need for experience with ribavirin treatment and postexposure prophylaxis.     

Crimean-Congo hemorrhagic fever in Turkey

In 2002 and 2003, a total of 19 persons in Turkey had suspected cases of Crimean-Congo hemorrhagic fever (CCHF) or a similar viral infection. Six serum samples were tested; all six were found positive for immunoglobulin M antibodies against CCHF virus. Two of the samples yielded CCHF virus isolates. Genetic analysis of the virus isolates showed them to be closely related to isolates from former Yugoslavia and southwestern Russia. These cases are the first of CCHF reported from Turkey. Eighteen patients handled livestock, and one was a nurse with probable nosocomial infection. The case-fatality rate was 20% among confirmed CCHF case-patients (1 of 5 patients), and the overall case-fatality rate was 11% (2 of 19 patients). In addition to previously reported symptoms and signs, we report hemophagocytosis in 50% of our patients, which is the first report of this clinical phenomenon associated with CCHF.     

Crimean-Congo hemorrhagic fever, Kazakhstan, 2009-2010

We evaluated Crimean-Congo hemorrhagic fever (CCHF) surveillance data from southern Kazakhstan during 2009-2010 and found both spatial and temporal association between reported tick bites and CCHF cases. Public health measures should center on preventing tick bites, increasing awareness of CCHF signs and symptoms, and adopting hospital infection control practices.     

一起流行性出血热疫苗接种人员发病事件的应急调查

目的 分析江西省某县流行性出血热疫苗接种人员发病的原因,为今后类似事件的调查提供经验与借鉴。方法 回顾性收集4例疑似病例的流行病学调查资料和疫苗接种资料,应用胶体金法和ELISA法对病例血清标本进行汉坦病毒IgM/IgG抗体检测。结果 4例疑似病例均有流行性出血热疫苗接种史。病例1和病例4有发热、“三红”、“三痛”、水肿和尿蛋白阳性等出血热相关的症状,病例1汉坦病毒IgG抗体检测阳性,病例4的IgM和IgG阳性,病例2和病例3无出血热相关的典型症状,汉坦病毒IgM/IgG抗体检测阴性。依据流行性出血热诊断标准综合研判,病例1和病例4被确诊为流行性出血热病例,病例2和病例3排除流行性出血热。结论 该起事件共发现2例流行性出血热确诊病例,2例误诊病例。建议加强医疗机构对出血热诊治知识的培训,提高医疗机构出血热的实验室诊断率,提升医疗机构流行性出血热病例的早发现和早诊断能力。     

一起肾综合症出血热暴发疫情的调查

目的了解某起肾综合症出血热暴发疫情的原因,采取有效措施控制疫情。方法现场流行病学调查及实验室检测。使用"厦门市波生生物技术有限公司"生产的流行性出血热诊断试剂,采用胶体金法,检测病例出血热抗体IgM、IgG;采用RT-PCR方法对鼠肺进行核酸检测。结果该次事件为一起由野鼠引起的经消化道感染的肾综合症出血热暴发疫情。结论普及肾综合症出血热防治知识、接种疫苗、加强卫生消毒、防鼠灭鼠,可有效预防肾综合症出血热的发生。     

塔里木盆地新疆出血热蜱类及宿主动物感染调查

目的检测塔里木盆地蜱类、啮齿动物和家畜新疆出血热（克里米亚-刚果出血热，CCHF）的感染状况和自然界分布现状。方法将病原材料蜱或啮齿动物脏器或羊血液标本接种1～2日龄乳鼠，取具有典型临床症状的检查材料采用反向血凝（RPHA）和免疫荧光（IFA）方法做免疫学鉴定，并采用RT-PCR技术检测目标材料中CCHFV特异性S基因片段。结果实验室接种采集自环塔里木盆地21个县（市）的蜱类、啮齿动物脏器和羊血液标本422组，获得典型临床症状发病材料49份，其中以巴楚、尉犁、于田和若羌地区的新疆出血热临床典型发病检出率较高。用RPHA鉴定43份，阳性6份，阳性率为1．4％；RPHA阳性材料分布于尉犁、轮台和于田3个地区。用IFA鉴定42份，阳性13份，阳性率为3．1％；IFA阳性材料分布于巴楚、尉犁、民丰、轮台和于田5个地区。用RT-PCR方法检测32份，检测到CCHFV特异性S基因片段（329～548n1）31份，阳性材料分布于阿克苏、阿瓦提、巴楚、洛浦、尉犁、民丰、且末、若羌、轮台和于田10个地区。以亚东璃眼蜱的感染率最高，其次是羊，从子午沙鼠脏器材料中检测到CCHFVS基因片段。结论新疆出血热在新疆南部地区是以河流为依托，分布在环塔里木盆地区的沙漠绿洲胡杨灌木区域内，主要宿主媒介是亚东璃眼蜱，羊、骆驼等家畜和塔里木兔、子午沙鼠和大耳跳鼠可作为新疆出血热的储存宿主。     

深圳市福田区1997-2006年流行性出血热流行病学分析及对策

目的分析福田区流行性出血热的发病规律为制定流行性出血热的预防和控制措施提供科学依据。方法病例对象来源于疫情报告资料、EHF个案调查表和实验室结果。EHF鼠密度调查采用笼日法,带毒率用ELISA法检测鼠血清EHF特异性抗体。将上述疫情报告资料和实验室数据进行流行病学和统计学分析。结果福田区的EHF病例在1997～2006年间共发生40例,呈低度活跃,发病人群多见于男性和青壮年,男性占总数的90%,青壮年则占总数的80%,职业分布中以工人和民工多发,占42.5%;EHF在区内呈现明显春夏峰型;鼠媒监测方面褐家鼠占总捕获鼠的94.59%,平均捕获率9.72%,发现鼠EHF感染率高达32.41%。区内EHF病毒分型主要为汉坦病毒(HV)Ⅱ型即汉城病毒(SEOV)。结论福田区EHF符合家鼠型传播特点,褐家鼠是区内的主要宿主动物和传染源。加强对于EHF防治的健康教育、重视环境和食品卫生、加强对EHF的疾病监测、科学灭鼠防鼠、开展重点人群的预防接种是预防控制EHF疫情、防止疫情传播的有效措施。     

Subclinical infections with Crimean-Congo hemorrhagic fever virus, Turkey

To investigate Crimean-Congo hemorrhagic fever virus in Turkey, we conducted a seroepidemiologic survey during January-April 2009. Seroprevalence of infection was 10% in a sample from an outbreak region and increased with patient age, indicating that the virus had been previously present in Turkey. We also estimated that 88% of infections were subclinical.     

Third-generation smallpox vaccine strain-based recombinant vaccines for viral hemorrhagic fevers

Vaccinia virus has been used as a smallpox vaccine. Now that smallpox has been eradicated, the vaccinia virus is expected to be used as a bioterrorism countermeasure and a recombinant vaccine vector for other infectious diseases, such as viral hemorrhagic fevers. Many vaccinia virus strains were used as smallpox vaccines in the smallpox eradication campaign coordinated by the World Health Organization. These strains can be classified into generations, according to the history of improving production methods and efforts to reduce the adverse reactions. Significantly, the third-generation of smallpox vaccine strains, which include modified vaccinia Ankara (MVA) and LC16m8, are currently popular as recombinant vaccine vectors due to their well-balanced safety and immunogenicity profiles. The present review firstly focuses on the characteristics of the smallpox vaccine generations. The historical background of the development of the third-generation smallpox vaccine strains is detailed, along with the history of the transition of the vaccinia virus generation used as vectors for hemorrhagic fever vaccines to the third generation. Among the vaccinia viruses, MVA is currently the most commonly used vector for developing hemorrhagic fever vaccines, including dengue fever, yellow fever, Ebola viral disease, Lassa fever, Rift Valley fever, and Crimean-Congo hemorrhagic fever. LC16m8 is a vaccine candidate for severe fever with thrombocytopenia syndrome. The current status and recent advances in the development of these hemorrhagic fever vaccines using third-generation vaccinia strains are discussed.     

首次从青海省绵羊血清中检出新疆出血热病毒IgG抗体

1988年7～8月,采集青海省海西自治州乌兰县郭里木乡231只改良绵羊血清,用间接免疫荧光方法检出新疆出血热病毒IgG抗体5份;自该县蓄集乡825只改良绵羊血清中检出新疆出血热抗体6份。鉴于这些绵羊均为本地所产,证实海西州乌兰县是新疆出血热自然疫源地。     

Genetic characterization and molecular clock analyses of the Crimean-Congo hemorrhagic fever virus from human and ticks in India, 2010–2011

A nosocomial outbreak of Crimean Congo hemorrhagic fever (CCHF) was reported among humans in Ahmadabad district, Gujarat, India during January, 2011. In the present study we provide the complete genomic sequences of four CCHFV isolates derived from two human patients and two pools of Hyalomma anatolicum ticks during the period of this outbreak and the complete S segment sequence of two retrospective human serum samples, positive for CCHFV in 2010. Sequence-based molecular characterization of the Indian CCHFV showed that they possessed the functional motifs known to occur in the S, M and L gene segment products as in other CCHF viruses. The S segment of the six Indian CCHF viruses showed 99.8% nucleotide identity. Notably both tick isolates shared 100% nucleotide identity with one of the Indian human isolates of 2011. Phylogenetic analysis based on the S segment demonstrated that the Indian CCHFV isolates formed a distinct cluster in the Asian-Middle East group IV of CCHF viruses. The S segment was closest to a Tajikistan strain TADJ/HU8966 of 1990 (98.5% nucleotide identity) and was of South-Asia 2 type while the M segment was of type M2. Both M and L segments were closest to an Afghanistan strain Afg09-2990 of 2009 (93% and 98% nucleotide identity, respectively). The Indian isolates were thus identified as a South-Asia 2/M2 far-east virus combination and the differing parental origin in the S and L/M segments is suggestive that it may be an intra-genotypic reassortant. Molecular clock studies further revealed that the ancestry of the viruses was not very recent and dated back to about 33 years on the basis of the S segment while it was about 15 years based on the M segment. Thus though the 2011 outbreak may not have resulted from a very recent introduction, considering that so far there is no evidence of multiple circulating strains in the country, the possibility of a recent re-introduction of the virus from any of the neighboring countries cannot be ruled out. The study thus warrants the need for continued surveillance and increased sampling of CCHFV in different parts of the country.     

2001—2011年北京市西城区肾综合征出血热疫情流行病学分析

目的总结分析2001—2011年北京市西城区肾综合征出血热疫情分布情况。方法总结西城区肾综合征出血热的疫情资料,对其流行病学特征及流行趋势进行分析。结果历年发病率在0.11/10万～0.64/10万之间,具有一定的波动性,2001、2005年出现两个发病高峰,春季多发,30～50岁年龄段为主,在各街道间表现为散在发生又相对集中的特点;鼠带毒率为0.80%,抗体阳性率为2.14%。结论西城区总体疫情趋于平稳,主要与开展重点人群的健康宣教、大力开展爱国卫生运动改善环境有关。     

Morbidity and mortality of Crimean-Congo hemorrhagic fever in Iraq: cases reported to the National Surveillance System, 1990-2010

Although Crimean-Congo hemorrhagic fever (CCHF) is endemic in the Middle East, its incidence in Iraq has not been well described since the early 1980s. To document trends and patterns of CCHF occurrence, we analyzed CCHF case reports from Iraq's National Surveillance System in 2010 and aggregate reports from previous years. A suspected case was defined as fever, hemorrhagic symptoms and a history of animal contact. Serologic testing was conducted for confirmation. Between 1998 and 2009, the annual number of confirmed cases ranged from zero to six. In 2010, 11 confirmed and 28 suspected cases were reported. The case fatality rate was 36% among confirmed cases, 4% among suspected cases. Most confirmed cases occurred during a three-week period in a single province. While CCHF is uncommon in Iraq, sporadic cases and outbreaks do occur. Surveillance could be strengthened by updating the case definition and case investigation forms.     

Alkhurma hemorrhagic fever in humans, Najran, Saudi Arabia

Alkhurma virus is a flavivirus, discovered in 1994 in a person who died of hemorrhagic fever after slaughtering a sheep from the city of Alkhurma, Saudi Arabia. Since then, several cases of Alkhurma hemorrhagic fever (ALKHF), with fatality rates up to 25%, have been documented. From January 1, 2006, through April 1, 2009, active disease surveillance and serologic testing of household contacts identified ALKHF in 28 persons in Najran, Saudi Arabia. For epidemiologic comparison, serologic testing of household and neighborhood controls identified 65 serologically negative persons. Among ALKHF patients, 11 were hospitalized and 17 had subclinical infection. Univariate analysis indicated that the following were associated with Alkhurma virus infection: contact with domestic animals, feeding and slaughtering animals, handling raw meat products, drinking unpasteurized milk, and being bitten by a tick. After multivariate modeling, the following associations remained significant: animal contact, neighboring farms, and tick bites.     

旅客列车鼠类携带肾综合征出血热病毒情况调查

目的调查旅客列车上的鼠类携带肾综合征出血热病毒情况。方法在经过流行性出血热疫区的列车上捕捉鼠,进行出血热病毒的特异抗体和抗原检测。结果在4组列车上捕获26只褐家鼠,12只小家鼠,有1只小家鼠携带出血热病毒抗原,携带率为8.33%,褐家鼠中没检测出病毒抗原或抗体。结论该4组列车经过安徽、江苏、上海等省市的主要大城市,由于列车上的鼠类携带出血热病毒,可远距离地将出血热病传播到沿铁路线的城市,因此,列车上灭鼠对控制出血热疫区扩散有重要的流行病学意义。     

Development of vaccines against Crimean-Congo haemorrhagic fever virus

Crimean-Congo haemorrhagic fever virus (CCHFV) is a deadly human pathogen of the utmost seriousness being highly lethal causing devastating disease symptoms that result in intense and prolonged suffering to those infected. During the past 40 years, this virus has repeatedly caused sporadic outbreaks responsible for relatively low numbers of human casualties, but with an alarming fatality rate of up to 80% in clinically infected patients. CCHFV is transmitted to humans by Hyalomma ticks and contact with the blood of viremic livestock, additionally cases of human-to-human transmission are not uncommon in nosocomial settings. The incidence of CCHF closely matches the geographical range of permissive ticks, which are widespread throughout Africa, Asia, the Middle East and Europe. As such, CCHFV is the most widespread tick-borne virus on earth. It is a concern that recent data shows the geographic distribution of Hyalomma ticks is expanding. Migratory birds are also disseminating Hyalomma ticks into more northerly parts of Europe thus potentially exposing naïve human populations to CCHFV. The virus has been imported into the UK on two occasions in the last five years with the first fatal case being confirmed in 2012. A licensed vaccine to CCHF is not available. In this review, we discuss the background and complications surrounding this limitation and examine the current status and recent advances in the development of vaccines against CCHFV.     

浙江省埃博拉出血热输入及本地传播风险评估

埃博拉出血热是由埃博拉病毒引起的一种发生于人类和非人灵长目动物（猴子、大猩猩和黑猩猩等）的急性传染病。2014年2月份以来,埃博拉出血热在西非国家大肆蔓延,并造成上千人死亡,8月8日世界卫生组织将其列为“国际关注的突发公共卫生事件”。本文通过专家会商法对浙江省埃博拉出血热输入传播风险开展快速评估,为各部门采取有效防控措施提供依据。     

凤城市鼠密度及带毒率调查研究

目的分析凤城市鼠种构成、密度、带毒率,为肾综合征出血热防治提供科学依据。方法采用鼠夹夹夜法,诱饵为花生米。结果共捕获鼠种7种,鼠种构成中,村内以褐家鼠为优势鼠种,占59.65%;村外以黑线姬鼠为优势鼠种,占82.05%。村内鼠密度6.19%,村外5.60%,总鼠密度5.88%。结论凤城地区的出血热疫情流行高峰和春秋季节鼠密度及带毒情况密切相关。