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Viral Hemorrhagic Fever Cases in the Country of Georgia: Acute Febrile Illness Surveillance Study Results

Tinatin KuchuloriaI. Javakhishvili Tbilisi State University, Tbilisi, Georgia; National Center for Disease Control and Public Health, Tbilisi, Georgia; Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia; Walter Reed Army Institute of Research, Silver Spring, Maryland; Global Disease Detection and Response Program, US Naval Medical Research Unit No. 3, Cairo, Egypt; US Army Medical Command; Bundeswehr Institute of Microbiology, Munich, Germany; US Army Medical Research Institute of Infectious Diseases, Fort Detrick, Maryland

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Paata ImnadzeI. Javakhishvili Tbilisi State University, Tbilisi, Georgia; National Center for Disease Control and Public Health, Tbilisi, Georgia; Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia; Walter Reed Army Institute of Research, Silver Spring, Maryland; Global Disease Detection and Response Program, US Naval Medical Research Unit No. 3, Cairo, Egypt; US Army Medical Command; Bundeswehr Institute of Microbiology, Munich, Germany; US Army Medical Research Institute of Infectious Diseases, Fort Detrick, Maryland

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Maiko ChokheliI. Javakhishvili Tbilisi State University, Tbilisi, Georgia; National Center for Disease Control and Public Health, Tbilisi, Georgia; Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia; Walter Reed Army Institute of Research, Silver Spring, Maryland; Global Disease Detection and Response Program, US Naval Medical Research Unit No. 3, Cairo, Egypt; US Army Medical Command; Bundeswehr Institute of Microbiology, Munich, Germany; US Army Medical Research Institute of Infectious Diseases, Fort Detrick, Maryland

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Tengiz TsertsvadzeI. Javakhishvili Tbilisi State University, Tbilisi, Georgia; National Center for Disease Control and Public Health, Tbilisi, Georgia; Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia; Walter Reed Army Institute of Research, Silver Spring, Maryland; Global Disease Detection and Response Program, US Naval Medical Research Unit No. 3, Cairo, Egypt; US Army Medical Command; Bundeswehr Institute of Microbiology, Munich, Germany; US Army Medical Research Institute of Infectious Diseases, Fort Detrick, Maryland

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Marina EndeladzeI. Javakhishvili Tbilisi State University, Tbilisi, Georgia; National Center for Disease Control and Public Health, Tbilisi, Georgia; Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia; Walter Reed Army Institute of Research, Silver Spring, Maryland; Global Disease Detection and Response Program, US Naval Medical Research Unit No. 3, Cairo, Egypt; US Army Medical Command; Bundeswehr Institute of Microbiology, Munich, Germany; US Army Medical Research Institute of Infectious Diseases, Fort Detrick, Maryland

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Ketevan MshvidobadzeI. Javakhishvili Tbilisi State University, Tbilisi, Georgia; National Center for Disease Control and Public Health, Tbilisi, Georgia; Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia; Walter Reed Army Institute of Research, Silver Spring, Maryland; Global Disease Detection and Response Program, US Naval Medical Research Unit No. 3, Cairo, Egypt; US Army Medical Command; Bundeswehr Institute of Microbiology, Munich, Germany; US Army Medical Research Institute of Infectious Diseases, Fort Detrick, Maryland

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Danielle V. ClarkI. Javakhishvili Tbilisi State University, Tbilisi, Georgia; National Center for Disease Control and Public Health, Tbilisi, Georgia; Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia; Walter Reed Army Institute of Research, Silver Spring, Maryland; Global Disease Detection and Response Program, US Naval Medical Research Unit No. 3, Cairo, Egypt; US Army Medical Command; Bundeswehr Institute of Microbiology, Munich, Germany; US Army Medical Research Institute of Infectious Diseases, Fort Detrick, Maryland

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Christian T. BautistaI. Javakhishvili Tbilisi State University, Tbilisi, Georgia; National Center for Disease Control and Public Health, Tbilisi, Georgia; Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia; Walter Reed Army Institute of Research, Silver Spring, Maryland; Global Disease Detection and Response Program, US Naval Medical Research Unit No. 3, Cairo, Egypt; US Army Medical Command; Bundeswehr Institute of Microbiology, Munich, Germany; US Army Medical Research Institute of Infectious Diseases, Fort Detrick, Maryland

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Moustafa Abdel FadeelI. Javakhishvili Tbilisi State University, Tbilisi, Georgia; National Center for Disease Control and Public Health, Tbilisi, Georgia; Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia; Walter Reed Army Institute of Research, Silver Spring, Maryland; Global Disease Detection and Response Program, US Naval Medical Research Unit No. 3, Cairo, Egypt; US Army Medical Command; Bundeswehr Institute of Microbiology, Munich, Germany; US Army Medical Research Institute of Infectious Diseases, Fort Detrick, Maryland

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Guillermo PimentelI. Javakhishvili Tbilisi State University, Tbilisi, Georgia; National Center for Disease Control and Public Health, Tbilisi, Georgia; Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia; Walter Reed Army Institute of Research, Silver Spring, Maryland; Global Disease Detection and Response Program, US Naval Medical Research Unit No. 3, Cairo, Egypt; US Army Medical Command; Bundeswehr Institute of Microbiology, Munich, Germany; US Army Medical Research Institute of Infectious Diseases, Fort Detrick, Maryland

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Brent HouseI. Javakhishvili Tbilisi State University, Tbilisi, Georgia; National Center for Disease Control and Public Health, Tbilisi, Georgia; Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia; Walter Reed Army Institute of Research, Silver Spring, Maryland; Global Disease Detection and Response Program, US Naval Medical Research Unit No. 3, Cairo, Egypt; US Army Medical Command; Bundeswehr Institute of Microbiology, Munich, Germany; US Army Medical Research Institute of Infectious Diseases, Fort Detrick, Maryland

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Matthew J. HepburnI. Javakhishvili Tbilisi State University, Tbilisi, Georgia; National Center for Disease Control and Public Health, Tbilisi, Georgia; Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia; Walter Reed Army Institute of Research, Silver Spring, Maryland; Global Disease Detection and Response Program, US Naval Medical Research Unit No. 3, Cairo, Egypt; US Army Medical Command; Bundeswehr Institute of Microbiology, Munich, Germany; US Army Medical Research Institute of Infectious Diseases, Fort Detrick, Maryland

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Silke WölfelI. Javakhishvili Tbilisi State University, Tbilisi, Georgia; National Center for Disease Control and Public Health, Tbilisi, Georgia; Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia; Walter Reed Army Institute of Research, Silver Spring, Maryland; Global Disease Detection and Response Program, US Naval Medical Research Unit No. 3, Cairo, Egypt; US Army Medical Command; Bundeswehr Institute of Microbiology, Munich, Germany; US Army Medical Research Institute of Infectious Diseases, Fort Detrick, Maryland

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Roman WölfelI. Javakhishvili Tbilisi State University, Tbilisi, Georgia; National Center for Disease Control and Public Health, Tbilisi, Georgia; Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia; Walter Reed Army Institute of Research, Silver Spring, Maryland; Global Disease Detection and Response Program, US Naval Medical Research Unit No. 3, Cairo, Egypt; US Army Medical Command; Bundeswehr Institute of Microbiology, Munich, Germany; US Army Medical Research Institute of Infectious Diseases, Fort Detrick, Maryland

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Robert G. RivardI. Javakhishvili Tbilisi State University, Tbilisi, Georgia; National Center for Disease Control and Public Health, Tbilisi, Georgia; Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia; Walter Reed Army Institute of Research, Silver Spring, Maryland; Global Disease Detection and Response Program, US Naval Medical Research Unit No. 3, Cairo, Egypt; US Army Medical Command; Bundeswehr Institute of Microbiology, Munich, Germany; US Army Medical Research Institute of Infectious Diseases, Fort Detrick, Maryland

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Minimal information is available on the incidence of Crimean–Congo hemorrhagic fever (CCHF) virus and hantavirus infections in Georgia. From 2008 to 2011, 537 patients with fever ≥ 38°C for ≥ 48 hours without a diagnosis were enrolled into a sentinel surveillance study to investigate the incidence of nine pathogens, including CCHF virus and hantavirus. Of 14 patients with a hemorrhagic fever syndrome, 3 patients tested positive for CCHF virus immunoglobulin M (IgM) antibodies. Two of the patients enrolled in the study had acute renal failure. These 2 of 537 enrolled patients were the only patients in the study positive for hantavirus IgM antibodies. These results suggest that CCHF virus and hantavirus are contributing causes of acute febrile syndromes of infectious origin in Georgia. These findings support introduction of critical diagnostic approaches and confirm the need for additional surveillance in Georgia.

Author Notes

* Address correspondence to Tinatin Kuchuloria, I. Javakhishvili Tbilisi State University, 1 Chavchavadze Avenue, Tbilisi 0179, Georgia. E-mail: drkuchuloria@yahoo.com

Financial support: This work was funded by the US Department of Defense Global Emerging Infections Surveillance (GEIS) Program and the Medical Biodefense Research Program of the Bundeswehr Joint Medical Service, and it was supported by the US Department of Defense Threat Reduction Agency.

Authors' addresses: Tinatin Kuchuloria, I. Javakhishvili Tbilisi State University, Tbilisi, Georgia, E-mail: drkuchuloria@yahoo.com. Paata Imnadze, I. Javakhishvili Tbilisi State University, Tbilisi, Georgia and National Center for Disease Control and Public Health, Tbilisi, Georgia, E-mail: pimnadze@ncdc.ge. Maiko Chokheli, National Center for Disease Control and Public Health, Tbilisi, Georgia, E-mail: chokhelimaiko@yahoo.com. Tengiz Tsertsvadze, I. Javakhishvili Tbilisi State University, Tbilisi, Georgia and Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia, E-mail: aids@gol.ge. Marina Endeladze and Ketevan Mshvidobadze, Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia, E-mails: marinaendeladze@ymail.com and katemshvidobadze@yahoo.com. Danielle V. Clark and Christian T. Bautista, Walter Reed Army Institute of Research, Silver Spring, MD, E-mails: dvclark@gmail.com and Christian.Bautista@us.army.mil. Moustafa Abdel Fadeel, Guillermo Pimentel, and Brent House, Global Disease Detection and Response Program, US Naval Medical Research Unit No. 3, Cairo, Egypt, E-mails: Moustafa.AbdelFadeel.eg@med.navy.mil, gpiment@gmail.com, and Brent.House@med.navy.mil. Matthew J. Hepburn and Robert G. Rivard, US Army Medical Research Institute of Infectious Diseases, Fort Detrick, MD, E-mails: matthew.hepburn@yahoo.com and robert.g.rivard.mil@mail.mil. Silke Wölfel and Roman Wölfel, Bundeswehr Institute of Microbiology, Munich, Germany, E-mails: silkewoelfel@bundeswehr.org and romanwoelfel@bundeswehr.org.

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