Crimean-Congo haemorrhagic fever in travellers: A systematic review

Summary Background The recent Ebola epidemic has increased public awareness of the risk of travel associated viral haemorrhagic fever (VHF). International preparedness to manage imported cases Ebola virus infection was inadequate, highlighted by cases of nosocomial transmission. Crimean-Congo haemor...

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Bibliographic Details
Published in:	Travel medicine and infectious disease 2016-03, Vol.14 (2), p.73-80
Main Authors:	Leblebicioglu, Hakan, Ozaras, Resat, Fletcher, Tom E, Beeching, Nick J
Format:	Article
Language:	eng
Subjects:	Africa - epidemiology Animals Arachnids Asia - epidemiology Crimean-Congo haemorrhagic fever Cross Infection - epidemiology Cross Infection - mortality Cross Infection - transmission Ebola virus Epidemics Europe - epidemiology Fatalities Fever Health care Hemorrhagic Fever Virus, Crimean-Congo - physiology Hemorrhagic Fever, Crimean - epidemiology Hemorrhagic Fever, Crimean - mortality Hemorrhagic Fever, Crimean - transmission Humans Imported Infections Infectious Disease Laboratories Leisure Lyme disease Migration Public health Risk Factors Studies Tick-Borne Diseases - epidemiology Tick-Borne Diseases - mortality Tick-Borne Diseases - transmission Travel Travel medicine Viral haemorrhagic fevers Viruses
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Summary:	Summary Background The recent Ebola epidemic has increased public awareness of the risk of travel associated viral haemorrhagic fever (VHF). International preparedness to manage imported cases Ebola virus infection was inadequate, highlighted by cases of nosocomial transmission. Crimean-Congo haemorrhagic fever (CCHF) is a re-emerging tick-borne VHF centred in the Eurasian region, affecting a large geographical area and with human-to-human transmission reported, especially in the healthcare setting. Objectives To systematically review the characteristics of travel associated Crimean-Congo haemorrhagic fever. Methods A systematic review of travel-associated cases of CCHF was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement protocol. PubMed, SCOPUS, Science Citation Index (SCI) and ProMED databases were searched for reports published between January 1960 and January 2016. Three independent reviewers selected and reviewed studies and extracted data. Results 21 cases of travel associated CCHF were identified, of which 12 died (3 outcome unknown) and 4 secondary (nosocomial) infections were reported. Risk occupations or activities for CCHF infection were reported in 8/12 cases when data were available. Travel from Asia to Asia occurred in 9 cases, Africa to Africa occurred in 5 cases, Africa to Europe in 3 cases, Asia to Europe in 2 cases and Europe to Europe in 2 cases. Conclusion CCHF related to travel is rare, is generally associated with at risk activities/occupation and is frequently fatal. Key to early diagnosis and prevention of nosocomial transmission is an understanding of CCHF risk factors and the geographical distribution of CCHF. International travel to CCHF endemic areas is increasing and clinicians and laboratory personnel managing returning travellers should maintain a high index of suspicion.
ISSN:	1477-8939 1873-0442