Skip directly to page options Skip directly to A-Z link
Volume 29, Number 2—February 2023
CME ACTIVITY - Synopsis

Crimean-Congo Hemorrhagic Fever, Spain, 2013–2021

Helena Miriam Lorenzo Juanes1, Cristina Carbonell1, Begoña Febrer Sendra, Amparo López-Bernus, Alberto Bahamonde, Alberto Orfao, Carmen Vieira Lista, María Sánchez Ledesma, Ana Isabel Negredo, Beatriz Rodríguez-Alonso, Beatriz Rey Bua, María Paz Sánchez-Seco, Juan Luis Muñoz Bellido, Antonio Muro, and Moncef Belhassen-GarcíaComments to Author 
Author affiliations: Universidad de Salamanca, Salamanca, Spain (H. Lorenzo-Juanes, C. Carbonell, B. Febrer-Sendra, A. López-Bernus, A. Orfao, C. Viera Lista, M. Sánchez Ledesma, B. Rodriguez Alonso, B. Rey Bua, J.L. Muñoz Bellido, A. Muro, M. Belhassen-Garcia); Instituto de Investigación Biomédica de Salamanca, Salamanca (H.M. Lorenzo Juanes, C. Carbonell, B. Febrer Sendra, A. López-Bernus, C. Vieira Lista, B. Rodriguez-Alonso, B. Rey Bua, M.P. Sánchez-Seco, A. Muro, M. Belhassen-Garcia); Hospital Universitario de Salamanca, Salamanca (H.M. Lorenzo Juanes, C. Carbonell, M. Sánchez Ledesma, B. Rodríguez-Alonso, B. Rey Bua); Hospital El Bierzo, Ponferrada, Spain (A. Bahamonde); Centro de Investigación del Cáncer, Salamanca (A. Orfao); Centro de Investigación Biomédica en Red de Cáncer, Madrid, Spain (A. Orfao); Centro Nacional de Microbiologiia, Majadahonda, Spain (A.I. Negredo, M.P. Sánchez-Seco); Red de Investigación Colaborativa en Enfermedades Tropicales, Madrid (A.I. Negredo, M.P. Sánchez-Seco, J.L. Muñoz Bellido); Centro de Investigación Biomédica en Red en Enfermedades Infecciosas, Madrid (A.I. Negredo, M.P. Sánchez-Seco)

Main Article

Figure 1

Locations of CCHF cases (A) and phylogenetic tree of CCHFV (B) in Spain, 2013–2021. Dots on the map indicate patients with a CCHF diagnosis in Spain: black dots indicate cases from this study, and colored dots indicate cases previously described. Two cases (patients 8 and 10) were not sequenced. The phylogenetic tree was constructed by the neighbor-joining method based on sequences of the small segment of the virus. The numbers on the right indicate bootstrap values for the groups; values <75 are not shown. Other sequences are listed by GenBank accession number, strain, geographic origin, and sampling year. Genotypes are indicated by Roman numerals according to Carroll et al. (14) with the equivalent clade nomenclature according to Chamberlain et al. (15) in brackets; I, West Africa (Africa 1); III, South and West Africa (Africa 3); IV, Middle East/Asia, divided into 2 groups (Asia 1/Asia 2); V, Europe/Turkey (Europe 1); VI, Greece (Europe 2). New lineage, Africa 4 described by Negredo et al. (12). CCHF, Crimean-Congo hemorrhagic fever; CCHFV, CCHF virus.

Figure 1. Locations of CCHF cases (A) and phylogenetic tree of CCHFV (B) in Spain, 2013–2021. Dots on the map indicate patients with a CCHF diagnosis in Spain: black dots indicate cases from this study, and colored dots indicate cases previously described. Two cases (patients 8 and 10) were not sequenced. The phylogenetic tree was constructed by the neighbor-joining method based on sequences of the small segment of the virus. The numbers on the right indicate bootstrap values for the groups; values <75 are not shown. Other sequences are listed by GenBank accession number, strain, geographic origin, and sampling year. Genotypes are indicated by Roman numerals according to Carroll et al. (14) with the equivalent clade nomenclature according to Chamberlain et al. (15) in brackets; I, West Africa (Africa 1); III, South and West Africa (Africa 3); IV, Middle East/Asia, divided into 2 groups (Asia 1/Asia 2); V, Europe/Turkey (Europe 1); VI, Greece (Europe 2). New lineage, Africa 4 described by Negredo et al. (12). CCHF, Crimean-Congo hemorrhagic fever; CCHFV, CCHF virus.

Download

Main Article

References
  1. Ballinger  MJ, Medeiros  AS, Qin  J, Taylor  DJ. Unexpected differences in the population genetics of phasmavirids (Bunyavirales) from subarctic ponds. Virus Evol. 2017;3:vex015. DOIPubMedGoogle Scholar
  2. Dai  S, Deng  F, Wang  H, Ning  Y. Crimean-Congo hemorrhagic fever virus: current advances and future prospects of antiviral strategies. Viruses. 2021;13:1195. DOIPubMedGoogle Scholar
  3. Çevik  MA, Erbay  A, Bodur  H, Gülderen  E, Baştuğ  A, Kubar  A, et al. Clinical and laboratory features of Crimean-Congo hemorrhagic fever: predictors of fatality. Int J Infect Dis. 2008;12:374–9. DOIPubMedGoogle Scholar
  4. Bodur  H, Akinci  E, Ascioglu  S, Öngürü  P, Uyar  Y. Subclinical infections with Crimean-Congo hemorrhagic fever virus, Turkey. Emerg Infect Dis. 2012;18:640–2. DOIPubMedGoogle Scholar
  5. Mostafavi  E, Pourhossein  B, Chinikar  S. Clinical symptoms and laboratory findings supporting early diagnosis of Crimean-Congo hemorrhagic fever in Iran. J Med Virol. 2014;86:1188–92. DOIPubMedGoogle Scholar
  6. Bente  DA, Forrester  NL, Watts  DM, McAuley  AJ, Whitehouse  CA, Bray  M. Crimean-Congo hemorrhagic fever: history, epidemiology, pathogenesis, clinical syndrome and genetic diversity. Antiviral Res. 2013;100:159–89. DOIPubMedGoogle Scholar
  7. Spengler  JR, Bente  DA. Crimean-Congo hemorrhagic fever in Spain—new arrival or silent resident? N Engl J Med. 2017;377:106–8. DOIPubMedGoogle Scholar
  8. Estrada-Peña  A, de la Fuente  J. The ecology of ticks and epidemiology of tick-borne viral diseases. Antiviral Res. 2014;108:104–28. DOIPubMedGoogle Scholar
  9. Monsalve-Arteaga  L, Alonso-Sardón  M, Muñoz Bellido  JL, Vicente Santiago  MB, Vieira Lista  MC, López Abán  J, et al. Seroprevalence of Crimean-Congo hemorrhagic fever in humans in the World Health Organization European region: A systematic review. PLoS Negl Trop Dis. 2020;14:e0008094. DOIPubMedGoogle Scholar
  10. Negredo  A, de la Calle-Prieto  F, Palencia-Herrejón  E, Mora-Rillo  M, Astray-Mochales  J, Sánchez-Seco  MP, et al.; Crimean Congo Hemorrhagic Fever@Madrid Working Group. Autochthonous Crimean-Congo Hemorrhagic Fever in Spain. N Engl J Med. 2017;377:154–61. DOIPubMedGoogle Scholar
  11. Negredo  A, Sánchez-Ledesma  M, Llorente  F, Pérez-Olmeda  M, Belhassen-García  M, González-Calle  D, et al. Retrospective identification of early autochthonous case of Crimean-Congo hemorrhagic fever, Spain, 2013. Emerg Infect Dis. 2021;27:1754–6. DOIPubMedGoogle Scholar
  12. Negredo  A, Sánchez-Arroyo  R, Díez-Fuertes  F, de Ory  F, Budiño  MA, Vázquez  A, et al. Fatal case of Crimean-Congo hemorrhagic fever caused by reassortant virus, Spain, 2018. Emerg Infect Dis. 2021;27:1211–5. DOIPubMedGoogle Scholar
  13. Monsalve Arteaga  L, Muñoz Bellido  JL, Negredo  AI, García Criado  J, Vieira Lista  MC, Sánchez Serrano  JÁ, et al. New circulation of genotype V of Crimean-Congo haemorrhagic fever virus in humans from Spain. PLoS Negl Trop Dis. 2021;15:e0009197. DOIPubMedGoogle Scholar
  14. Carroll  SA, Bird  BH, Rollin  PE, Nichol  ST. Ancient common ancestry of Crimean-Congo hemorrhagic fever virus. Mol Phylogenet Evol. 2010;55:1103–10. DOIPubMedGoogle Scholar
  15. Chamberlain  J, Cook  N, Lloyd  G, Mioulet  V, Tolley  H, Hewson  R. Co-evolutionary patterns of variation in small and large RNA segments of Crimean-Congo hemorrhagic fever virus. J Gen Virol. 2005;86:3337–41. DOIPubMedGoogle Scholar
  16. Bakır  M, Gözel  MG, Köksal  I, Aşık  Z, Günal  Ö, Yılmaz  H, et al. Validation of a severity grading score (SGS) system for predicting the course of disease and mortality in patients with Crimean-Congo hemorrhagic fever (CCHF). Eur J Clin Microbiol Infect Dis. 2015;34:325–30. DOIPubMedGoogle Scholar
  17. Estrada-Peña  A, Palomar  AM, Santibáñez  P, Sánchez  N, Habela  MA, Portillo  A, et al. Crimean-Congo hemorrhagic fever virus in ticks, Southwestern Europe, 2010. Emerg Infect Dis. 2012;18:179–80. DOIPubMedGoogle Scholar
  18. Monsalve Arteaga  L, Muñoz Bellido  JL, Vieira Lista  MC, Vicente Santiago  MB, Fernández Soto  P, Bas  I, et al. Crimean-Congo haemorrhagic fever (CCHF) virus-specific antibody detection in blood donors, Castile-León, Spain, summer 2017 and 2018. Euro Surveill. 2020;25:1900507. DOIPubMedGoogle Scholar
  19. Moraga-Fernández  A, Ruiz-Fons  F, Habela  MA, Royo-Hernández  L, Calero-Bernal  R, Gortazar  C, et al. Detection of new Crimean-Congo haemorrhagic fever virus genotypes in ticks feeding on deer and wild boar, Spain. Transbound Emerg Dis. 2021;68:993–1000. DOIPubMedGoogle Scholar
  20. Espunyes  J, Cabezón  O, Pailler-García  L, Dias-Alves  A, Lobato-Bailón  L, Marco  I, et al. Hotspot of Crimean-Congo hemorrhagic fever virus seropositivity in wildlife, northeastern Spain. Emerg Infect Dis. 2021;27:2480–4. DOIPubMedGoogle Scholar
  21. Sánchez-Seco  MP, Sierra  MJ, Estrada-Peña  A, Valcárcel  F, Molina  R, de Arellano  ER, et al.; Group for CCHFv Research. Widespread detection of multiple strains of Crimean-Congo hemorrhagic fever virus in ticks, Spain. Emerg Infect Dis. 2021;28:394–402. DOIPubMedGoogle Scholar
  22. Negredo  A, Habela  MÁ, Ramírez de Arellano  E, Diez  F, Lasala  F, López  P, et al. Survey of Crimean-Congo hemorrhagic fever enzootic focus, Spain, 2011–2015. Emerg Infect Dis. 2019;25:1177–84. DOIPubMedGoogle Scholar
  23. Papa  A, Sidira  P, Larichev  V, Gavrilova  L, Kuzmina  K, Mousavi-Jazi  M, et al. Crimean-Congo hemorrhagic fever virus, Greece. Emerg Infect Dis. 2014;20:288–90. DOIPubMedGoogle Scholar
  24. Ahmeti  S, Berisha  L, Halili  B, Ahmeti  F, von Possel  R, Thomé-Bolduan  C, et al. Crimean-Congo hemorrhagic fever, Kosovo, 2013–2016. Emerg Infect Dis. 2019;25:321–4. DOIPubMedGoogle Scholar
  25. Yilmaz  GR, Buzgan  T, Irmak  H, Safran  A, Uzun  R, Cevik  MA, et al. The epidemiology of Crimean-Congo hemorrhagic fever in Turkey, 2002-2007. Int J Infect Dis. 2009;13:380–6. DOIPubMedGoogle Scholar
  26. Aker  S, Akıncı  H, Kılıçoğlu  C, Leblebicioglu  H. The geographic distribution of cases of Crimean-Congo hemorrhagic fever: Kastamonu, Turkey. Ticks Tick Borne Dis. 2015;6:730–6. DOIPubMedGoogle Scholar
  27. Henter  JI, Horne  A, Aricó  M, Egeler  RM, Filipovich  AH, Imashuku  S, et al. HLH-2004: Diagnostic and therapeutic guidelines for hemophagocytic lymphohistiocytosis. Pediatr Blood Cancer. 2007;48:124–31. DOIPubMedGoogle Scholar
  28. Tasdelen Fisgin  N, Fisgin  T, Tanyel  E, Doganci  L, Tulek  N, Guler  N, et al. Crimean-Congo hemorrhagic fever: five patients with hemophagocytic syndrome. Am J Hematol. 2008;83:73–6. DOIPubMedGoogle Scholar
  29. Johnson  S, Henschke  N, Maayan  N, Mills  I, Buckley  BS, Kakourou  A, et al. Ribavirin for treating Crimean Congo haemorrhagic fever. Cochrane Database Syst Rev. 2018;6:CD012713. DOIPubMedGoogle Scholar
  30. Palomar  AM, Portillo  A, Santibáñez  P, Mazuelas  D, Arizaga  J, Crespo  A, et al. Crimean-Congo hemorrhagic fever virus in ticks from migratory birds, Morocco. Emerg Infect Dis. 2013;19:260–3. DOIPubMedGoogle Scholar

Main Article

1These authors contributed equally to this article.

Page created: January 23, 2023
Page updated: January 23, 2023
Page reviewed: January 23, 2023
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
file_external