Crimean-Congo Hemorrhagic Fever

What is Crimean-Congo hemorrhagic fever?

The Crimean-Congo hemorrhagic fever (CCHF) is a tick-borne virus that can lead to severe illness in humans. CCHF commonly spreads in (is endemic to) Africa, Asia, the Middle East and parts of Europe. But given the high rates of global travel, it’s possible for transmission to occur in other places, too.

Crimean-Congo hemorrhagic fever can be fatal. If you think you may have been exposed to CCHF and have symptoms, seek immediate medical attention at your local emergency room. Tell them right away that you may have been exposed to CCHF.

What are the symptoms of Crimean-Congo hemorrhagic fever?

Symptoms of Crimean-Congo hemorrhagic fever include:

• High fever
• Muscle, back or belly pain
• Headache, often severe
• Nausea and vomiting
• Diarrhea
• Pink eye (conjunctivitis)
• Low blood pressure (hypotension)
• Flushing
• Yellow skin or eyes (jaundice)
• Nosebleeds or bleeding gums
• Mood changes
• Confusion
• Sensitivity to light (photophobia)

Symptoms start one to 13 days after infection. Three to five days after the initial symptoms start, you might also have heavier or more widespread bleeding and large bruises. Some people are infected but don’t have any symptoms.

What causes Crimean-Congo hemorrhagic fever?

Crimean-Congo hemorrhagic fever is caused by the CCHF virus. It’s usually caused by a bite from an infected tick, though you can also get it by coming into contact with infected animals or humans. CCHF is a member of the Bunyavirdae family, which is known to cause fevers and, sometimes, rashes.

How does Crimean-Congo hemorrhagic fever spread?

CCHF spreads through the bite of infected ticks, contact with blood and other body fluids from infected animals, and human-to-human contact. Infected body fluid or tissues can include:

• Blood
• Spit (saliva)
• Pee (urine)
• Poop (feces)
• Semen
• Vaginal fluids
• Respiratory droplets

Is Crimean-Congo hemorrhagic fever contagious?

Yes, CCHF transmits from person to person. You can get it through contact with someone infected with the virus, like shaking hands or hugging. You can also get it from touching things like towels or other personal items used by someone infected with the virus.

What are the risk factors for Crimean-Congo hemorrhagic fever?

You’re at a higher risk for CCHF if you:

• Live in an area where it spreads and have close contact with livestock — for instance, if you’re a veterinarian or work in a slaughterhouse
• Are caring for someone with CCHF
• Live with someone who has CCHF
• Work in a basic science lab that studies or tests for CCHF, but your lab should have exposure plans in place

What animals carry Crimean-Congo hemorrhagic fever?

Livestock and farm animals like cattle, sheep and goats can carry CCHF. Infected animals may not appear sick. This is why wearing protective clothing and equipment is important when handling animals, especially in areas where ticks spread CCHF.

What are the complications of Crimean-Congo hemorrhagic fever?

Complications of CCHF include:

• Severe bleeding
• Shock
• Organ failure
• Bleeding in your brain (cerebral hemorrhage)
• Death

CCHF has a high mortality rate. People who study infectious diseases (epidemiologists) suggest that about 30% to 50% of people who get CCHF end up dying from the illness. But it might be higher if you get the infection while you’re in a hospital (nosocomial) rather than from a tick or animal.

How is Crimean-Congo hemorrhagic fever diagnosed?

Healthcare providers diagnose CCHF with a blood test. Let your provider know if you’ve traveled to an area where CCHF spreads or have had contact with a person or animal who could have the infection.

Is there a cure for Crimean-Congo hemorrhagic fever?

There’s no specific cure for Crimean-Congo hemorrhagic fever. Providers often treat it with the antiviral medication ribavirin. You might also need:

• A blood transfusion
• Supplemental oxygen or mechanical ventilation
• Intravenous (IV) fluids
• Medications to manage symptoms, like pain or nausea

When should I go to the ER?

Go to the nearest emergency room right away — and let them know you might have CCHF — if you have severe symptoms, including:

• Chest, neck or stomach pain
• Difficulty breathing
• Severe vomiting or diarrhea
• Seizures
• Confusion

What questions should I ask my doctor?

It might be helpful to ask a healthcare provider:

• How do I prevent spreading the virus?
• What are my treatment options?
• How do I take care of myself?
• How long will it take to feel better?
• What new or worsening symptoms should I look out for?
• When should I follow up with you?

Can Crimean-Congo hemorrhagic fever be prevented?

If you live in an area where CCHF spreads, you can reduce your risk of getting and spreading it by:

• Avoiding tick bites. Wear protective clothing, use mosquito nets and wear bug spray that’s approved to repel ticks. If you work or play in areas where ticks are present, check yourself, your loved ones and your pets often for ticks. If you find one burrowed into your skin, see a healthcare provider.
• Avoiding direct contact with human blood and body fluids. Wear proper personal protective equipment (PPE) if you care for someone who may have Crimean-Congo hemorrhagic fever virus. Proper PPE includes gloves, goggles, aprons and masks. Avoid touching any of their body fluids, and wash your hands after contact, even if you wear gloves.
• Avoiding contact with body fluids and tissues of animals. Wear protective equipment if you have to handle animals (dead or alive) that could be infected, even if they don’t appear sick.
• Isolate yourself from others if you could have CCHF. When you seek medical attention, let your healthcare provider know right away that you could’ve been exposed.

Is there a Crimean-Congo hemorrhagic fever vaccine?

No, there isn’t a vaccine available for CCHF at this time. But scientists have been developing vaccines for CCHF for over a decade. They’re currently studying their safety and effectiveness in clinical trials. 

What can I expect if I have Crimean-Congo hemorrhagic fever?

If you’re severely ill with CCHF, your provider will treat you in the hospital to manage your symptoms and any complications. You’ll be isolated from others to prevent spreading the virus.

It may take several weeks for you to start to feel better. During your recovery, you may feel weak and continue to have flu-like symptoms. You may also have poor vision, hearing and memory loss. You should get these things back, but it can take time. Talk with your doctor if you have concerns about lasting symptoms.

What causes death in Crimea-Congo hemorrhagic fever?

There’s not a lot of research into the causes of death from CCHF. That said, some studies suggest that potential causes of death could include:

• Multiple organ failure
• Issues with blood clotting
• Your immune system doesn’t respond properly to the virus

Can you recover from it?

Yes, some people recover from mild CCHF infections. In some cases, people only develop mild symptoms. But for reasons that experts don’t yet fully understand, some people develop more severe illnesses that can be deadly.