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1/6. Crimean-congo hemorrhagic fever, mauritania.

    From February to August 2003, 38 persons were infected with Crimean-congo hemorrhagic fever (CCHF) virus in mauritania; 35 of these persons were residents of Nouakchott. The first patient was a young woman who became ill shortly after butchering a goat. She transmitted the infection to 15 persons in the hospital where she was admitted and four members of her family. In Nouakchott, two disease clusters and 11 isolated cases were identified. The case-fatality ratio was 28.6%. Of the patients not infected by the first case-patient, almost half were butchers, which suggests that the primary mode of animal-to-human transmission was direct contact with blood of infected animals. The hospital outbreak alerted health authorities to sporadic cases that occurred in the following weeks, which would have probably gone otherwise unnoticed. Studies must be conducted to determine the potential risk for continued sporadic outbreaks of CCHF in humans and to propose prevention measures.
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2/6. Imported Crimean-congo hemorrhagic fever.

    Crimean-congo hemorrhagic fever (CCHF) is a tick-borne disease that may also be transmitted through person-to-person transmission by exposure to infected body fluids. Despite its wide geographic distribution in animals, CCHF virus is rarely associated with recognized human diseases. We report the first case of imported CCHF in france.
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3/6. Crimean-congo hemorrhagic fever: case series from a medical center in Golestan province, Northeast of iran (2004).

    Crimean-congo hemorrhagic fever (CCHF) is a widely distributed lethal disease, worldwide. humans are usually infected with CCHF virus through a tick bite or close contact with viral contaminated tissues or with blood of domestic animals or of infected patients. The present study reports six cases of CCHF, who were in contact with both infected tissues and blood from sheep. In some regions like Golestan province (North of iran), clinician suspicion may have an important role in early diagnosis and treatment of the disease. Conservative therapy (intensive monitoring) and prescription of antiviral medication (ribavirin) accompanied with corticosteroids, was useful at the early stage of CCHF.
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4/6. A common-source outbreak of Crimean-congo haemorrhagic fever on a dairy farm.

    An outbreak of Crimean-congo haemorrhagic fever (CCHF) on a dairy farm in the Orange Free State in 1984 is described. Forty-six cows were purchased from the western Cape Province in January 1984; 2 died from the tick-borne disease anaplasmosis in March and a labourer who helped butcher the carcasses became ill a few days later. Another cow died at the end of April and within 9 days 4 people who had come into contact with its blood became ill. antibodies to CCHF virus were found in the sera of the 5 patients but not in other residents of the farm. Three patients recovered from a severe influenza-like illness without seeking medical attention; 1 patient, who was admitted to hospital, recovered from illness marked by haematemesis, epistaxis and amnesia and the 5th patient died of complications of surgery for brain haemorrhage. Antibody studies indicated that many of the cows became infected with CCHF after their arrival on the farm. It can be deduced that animals reared in tick-free, or relatively tick-free, circumstances, which are then moved to where they are subject to heavy parasitization by ticks, can acquire common tick-borne diseases of livestock plus CCHF infection simultaneously. In such circumstances there is a definite risk of human exposure to CCHF-infected blood or other tissues.
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5/6. Investigations following initial recognition of Crimean-congo haemorrhagic fever in south africa and the diagnosis of 2 further cases.

    Sera from 124 cattle herds were tested, and antibodies to Crimean-congo haemorrhagic fever (CCHF) were found in 93 herds. The prevalence of antibodies was high in the interior of the country, in excess of 90% in some herds, but was less than 4% in cattle along the coast from Cape Town to East london. Only 17 out of 1109 (1,5%) human residents of 55 farms had antibodies to CCHF, while none of 164 veterinary research workers or 98 veterinarians engaged in farm animal practice had them. Specimens from 130 suspected cases of viral haemorrhagic fever were examined and CCHF was diagnosed only in the patient previously reported as the first case of the disease to be recognized in this country. A further 2 cases of CCHF were diagnosed by examining 318 specimens from patients with nonfatal febrile illness. Both patients had contact with livestock. Increasing awareness of the disease will probably lead to an increase in the number of cases diagnosed, but there are no grounds for concluding that the disease is on the increase.
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6/6. Crimean-congo haemorrhagic fever virus infection in the western province of saudi arabia.

    In 1990, an outbreak of suspected viral haemorrhagic fever involving 7 individuals occurred in Mecca in the Western Province of saudi arabia. congo-Crimean haemorrhagic fever (CCHF), not previously known to be present in saudi arabia, was incriminated. A study of the epidemiology of this virus was therefore carried out in Mecca, and in nearby Jeddah and Taif in 1991-1993; 13 species of ixodid ticks (5 Hyalomma spp., 5 rhipicephalus spp., 2 Amblyomma spp., 1 Boophilus sp.) were collected from livestock (camels, cattle, sheep, goats), and of these 10 were capable of transmitting CCHF. camels had the highest rate of tick infestation (97%), and H. dromedarii was the commonest tick (70%). Attempts to isolate virus from pools of H. dromedarii and H. anatolicum anatolicum were unsuccessful. The source of infection in 3 confirmed cases of CCHF was contact with fresh mutton and, in a suspected case, slaughtering sheep. An investigation in Mecca, which included a serological survey of abattoir workers, identified 40 human cases of confirmed or suspected CCHF between 1989 and 1990, with 12 fatalities. Significant risk factors included exposure to animal blood or tissue in abattoirs, but not tick bites. It is suspected that the CCHF virus may have been introduced to saudi arabia by infected ticks on imported sheep arriving at Jeddah seaport, and that it is now endemic in the Western Province.
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