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An Emerging Biothreat: Crimean-Congo Hemorrhagic Fever Virus in Southern and Western Asia
Paul W. Blair
Paul W. Blair
Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland;
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Jens H. Kuhn
Jens H. Kuhn
Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick, Maryland;
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David B. Pecor
David B. Pecor
Department of Entomology, Smithsonian Institution Museum Support Center, Suitland, Maryland;
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Dmitry A. Apanaskevich
Dmitry A. Apanaskevich
Department of Biology, Georgia Southern University, Statesboro, Georgia;
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Mark G. Kortepeter
Mark G. Kortepeter
College of Public Health, University of Nebraska, Omaha, Nebraska;
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Anthony P. Cardile
Anthony P. Cardile
United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, Maryland;
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Aileen Polanco Ramos
Aileen Polanco Ramos
WellStar Family Medicine, Marietta, Georgia
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Maryam Keshtkar-Jahromi
Maryam Keshtkar-Jahromi
Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland;
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Tick-borne Crimean-Congo hemorrhagic fever virus (CCHFV) is endemic in numerous countries, but the epidemiology and epizoology of Crimean-Congo hemorrhagic fever (CCHF) remain to be defined for most regions of the world. Using a broad database search approach, we reviewed the literature on CCHF and CCHFV in Southern and Western Asia to better define the disease burden in these areas. We used a One Health approach, moving beyond a focus solely on human disease burden to more comprehensively define this burden by reviewing CCHF case reports, human and animal CCHFV seroprevalence studies, and human and animal CCHFV isolations. In addition, we used published literature to estimate the distribution of Hyalomma ticks and infection of these ticks by CCHFV. Using these data, we propose a new classification scheme for organizing the evaluated countries into five categories by level of evidence for CCHF endemicity. Twelve countries have reported CCHF cases, five from Southern Asia and seven from Western Asia. These were assigned to level 1 or 2. Eleven countries that have evidence of vector circulation but did not report confirmed CCHF cases were assigned to level 3 or 4. This classification scheme was developed to inform policy toward strengthening CCHF disease surveillance in the Southern and Western Asia regions. In particular, the goal of this review was to inform international organizations, local governments, and health-care professionals about current shortcomings in CCHFV surveillance in these two high-prevalence regions.
Author Notes
Financial support: This work was funded in part through Battelle Memorial Institute’s prime contract with the US National Institute of Allergy and Infectious Diseases (NIAID) under Contract No. HHSN272200700016 (JHK). The content of this publication does not necessarily reflect the views or policies of the US Department of Health and Human Services or of the institutions and companies affiliated with the authors.
Disclaimer: Opinions, interpretations, conclusions, and recommendations are those of the authors and are not necessarily endorsed by the U.S. Army.
Authors’ addresses: Paul W. Blair and Maryam Keshtkar-Jahromi, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, E-mails: pblair6@jhmi.edu and maryam.keshtkar@jhmi.edu. Jens H. Kuhn, Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick, MD, E-mail: kuhnjens@mail.nih.gov. David B. Pecor, Department of Entomology, Smithsonian Institution Museum Support Center, Suitland, MD, E-mail: pecord@si.edu. Dmitry A. Apanaskevich, Department of Biology, Georgia Southern University, Statesboro, GA, E-mail: dapanaskevich@georgiasouthern.edu. Mark G. Kortepeter, College of Public Health, University of Nebraska, Omaha, NE, E-mail: mark.kortepeter@gmail.com. Anthony P. Cardile, Medical Division, United States Army Medical Research Institute of Infectious Diseases, MD, E-mail: anthony.p.cardile.mil@mail.mil. Aileen Polanco Ramos, WellStar Kennstone Regional Hospital, Marietta, GA, E-mail: aileen.polancoramos@gmail.com.
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