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Address correspondence to Hakan Leblebicioglu, MD, Coordinator of ESCMID Study Group for Infections in Travelers and Migrants (ESGITM), Department of Infectious Diseases & Clinical Microbiology, Ondokuz Mayis University Medical School, Samsun, 55139, Turkey. (H. Leblebicioglu).
We read with great interest the comprehensive review that highlights the recent major outbreaks and advice for prevention of these infections in the health care setting.
Emerging infectious diseases: focus on infection control issues for novel coronaviruses (Severe Acute Respiratory Syndrome-CoV and Middle East Respiratory Syndrome-CoV), hemorrhagic fever viruses (Lassa and Ebola), and highly pathogenic avian influenza viruses, A(H5N1) and A(H7N9).
However, a tick-borne disease, Crimean-Congo hemorrhagic fever (CCHF), which has caused outbreaks in the last 14 years, was missing. Outbreaks have occurred over a wide geographic area in African and Eurasian countries, such as Turkey, Russia, Pakistan, Afghanistan, Iran, and Kazakhstan, with annually >1,000 reported cases since 2002.
It is a tick-borne infection, and animal movements are shown to carry the disease. Recent figures have indicated that it could be a future threat for other continents.
CCHF has a seasonal pattern and mostly occurred in spring and summer months between May and September so at the next years there will be an overlap between CCHF season and Islamic festival of the sacrifice (Eid-al-Adha) drifting 10 days earlier in each year in the Northern hemisphere.
CCHF has the potential of human-to-human spread, such as Lassa fever and Ebola virus disease, and presents significant nosocomial infection risk and associated mortality. CCHF can be transmitted through exposure to blood or body fluids of patients, needlestick injury, splash, and aerosol-generating procedures
Because the initial period of the disease is characterized by flu-like symptoms, and the hemorrhages are late findings, many patients are diagnosed with influenza or upper respiratory infection. CCHF can be transmitted during that period with aerosol-producing interventions, especially when isolation and standard protective measures are not provided.
Nevertheless, CCHF should be remembered when a patient presents with thrombocytopenia or hemorrhages with a travel history to endemic regions or with exposure to ticks or animals. Absence of tick exposure should not exclude the disease because 69% of CCHF patients describe tick exposure.
All suspected cases should be isolated and tested for CCHF, and authorities and health care workers, including those who work in laboratories, should be informed. Health care workers should follow standard, contact, and droplet precautions and use N95 masks during aerosol-generated procedures. As outlined by Weber et al,
Emerging infectious diseases: focus on infection control issues for novel coronaviruses (Severe Acute Respiratory Syndrome-CoV and Middle East Respiratory Syndrome-CoV), hemorrhagic fever viruses (Lassa and Ebola), and highly pathogenic avian influenza viruses, A(H5N1) and A(H7N9).
preparedness, screening, triage, and inpatient care of cases with training of health care workers are key elements for managing CCHF. CCHF is an ongoing problem in certain countries, with possible spread to others, and should be included in the list of emerging and reemerging outbreaks to prevent further transmission in the health care setting.
References
Weber D.J.
Rutala W.A.
Fischer W.A.
Kanamori H.
Sickbert-Bennett E.E.
Emerging infectious diseases: focus on infection control issues for novel coronaviruses (Severe Acute Respiratory Syndrome-CoV and Middle East Respiratory Syndrome-CoV), hemorrhagic fever viruses (Lassa and Ebola), and highly pathogenic avian influenza viruses, A(H5N1) and A(H7N9).
Over the past several decades, we have witnessed the emergence of many new infectious agents, some of which are major public threats. New and emerging infectious diseases which are both transmissible from patient-to-patient and virulent with a high mortality include novel coronaviruses (SARS-CoV, MERS-CV), hemorrhagic fever viruses (Lassa, Ebola), and highly pathogenic avian influenza A viruses, A(H5N1) and A(H7N9). All healthcare facilities need to have policies and plans in place for early identification of patients with a highly communicable diseases which are highly virulent, ability to immediately isolate such patients, and provide proper management (e.g., training and availability of personal protective equipment) to prevent transmission to healthcare personnel, other patients and visitors to the healthcare facility.
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