Epidemiology of Crimean-Congo Hemorrhagic Fever (CCHF) in Africa—Underestimated for Decades

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  • 1 Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland;
  • 2 Bezmialem Vakif University, Istanbul, Turkey;
  • 3 Integrated Research Facility, Division of Clinical Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Fort Detrick, Frederick, Maryland;
  • 4 Department of Entomology, Walter Reed Biosystematics Unit, Smithsonian Institution, Suitland, Maryland;
  • 5 Department of Entomology, Walter Reed Army Institute of Research, Silver Spring, Maryland;
  • 6 US National Tick Collection, The James H. Oliver Jr. Institute for Coastal Plain Science, Georgia Southern University, Statesboro, Georgia

Crimean-Congo hemorrhagic fever (CCHF) is endemic in Africa, but the epidemiology remains to be defined. Using a broad database search, we reviewed the literature to better define CCHF evidence in Africa. We used a One Health approach to define the impact of CCHF by reviewing case reports, human and animal serology, and records of CCHF virus (CCHFV) isolations (1956–mid-2020). In addition, published and unpublished collection data were used to estimate the geographic distribution of Hyalomma ticks and infection vectors. We implemented a previously proposed classification scheme for organizing countries into five categories by the level of evidence. From January 1, 1956 to July 25, 2020, 494 CCHF cases (115 lethal) were reported in Africa. Since 2000, nine countries (Kenya, Mali, Mozambique, Nigeria, Senegal, Sierra Leone, South Sudan, Sudan, and Tunisia) have reported their first CCHF cases. Nineteen countries reported CCHF cases and were assigned level 1 or level 2 based on maturity of their surveillance system. Thirty countries with evidence of CCHFV circulation in the absence of CCHF cases were assigned level 3 or level 4. Twelve countries for which no data were available were assigned level 5. The goal of this review is to inform international organizations, local governments, and healthcare professionals about shortcomings in CCHF surveillance in Africa to assist in a movement toward strengthening policy to improve CCHF surveillance.

Author Notes

Address correspondence to Maryam Keshtkar-Jahromi, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Mason F. Lord Bldg., Center Tower, Suite 381, 5200 Eastern Ave., Baltimore, MD 21224. E-mail: maryam.keshtkar@jhmi.edu

Disclaimer: The views and conclusions contained in this document are those of the authors and should not be interpreted as necessarily representing the official policies, either expressed or implied, of the U.S. Department of Health and Human Services or of the institutions and companies affiliated with the authors.

Financial support: This work was supported in part through Laulima Government Solutions, LLC prime contract with the U.S. National Institute of Allergy and Infectious Diseases (NIAID) under contract number HHSN272201800013C. J. H. K. performed this work as an employee of Tunnell Government Services (TGS), a subcontractor of Laulima Government Solutions, LLC under contract number HHSN272201800013C.

Authors’ addresses: Ahmet Irfan Temur, Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, and Department of Medicine, Bezmialem Vakif Universitesi, Istanbul, Istanbul, Turkey, E-mail: ahmet.temur01@gmail.com. Jens H. Kuhn, Integrated Research Facility at Fort Detrick, Division of Clinical Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick, MD, E-mail: kuhnjens@niaid.nih.gov. David B. Pecor, Walter Reed Biosystematics Unit, Department of Entomology, Smithsonian Institution, Suitland, MD, and Department of Entomology, Walter Reed Army Institute of Research, Silver Spring, MD, E-mail: pecord@si.edu. Dmitry A. Apanaskevich, US National Tick Collection, James H. Oliver Jr. Institute for Coastal Plain Science, Georgia Southern University, Statesboro, GA, E-mail: dapanaskevich@georgiasouthern.edu. Maryam Keshtkar-Jahromi, Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, E-mail: maryam.keshtkar@jhmi.edu.

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