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Background & Objectives: Crimean-Congo hemorrhagic fever (CCHF) is a tick-borne viral zoonosis with up to 50% mortality rate in humans. In addition to the role of animals in the transmission of the virus and spread of infected ticks through livestock trade, they can be employed as sentinel hosts for monitoring the infection. Iran is one of the endemic counties for CCHF and the disease has been documented in all provinces. However, in some provinces such as Kohgiluyeh and Boyer-Ahmad, the rate of the disease has been dramatically low. Therefore, this serosurvey was designed to investigate CCHF virus (CCHFV) seroprevalence among livestock in different parts of Kohgiluyeh and Boyer-Ahmad Province., Methods: This study was conducted in 2017, in which, blood samples were collected from 501 sheep and goats from eight different cities of Kohgiluyeh and Boyer-Ahmad Province. CCHFV IgG antibodies were detected in livestock serum samples by specific ELISA assays for detection of ovine and caprine antibodies., Results: In total, four sheep serum of out of 501 (0.8%) livestock samples (3 from Gachsaran and 1 from Dena) had CCHFV IgG antibodies. No significant association was found between CCHFV seropositivity and sex or age of animals (P>0.05)., Interpretation & Conclusion: Our findings suggest a minor CCHFV circulation in Kohgiluyeh and Boyer-Ahmad Province, Iran. However, due to the notion that outbreaks of tick-borne infections is hard to predict; steady and comprehensive monitoring programs especially in ticks and animals would be critical for understanding the circulation on the pathogen in a region., Competing Interests: None

Crimean-Congo hemorrhagic fever (CCHF) is an emerging tick-borne disease that is endemic in Africa, Asia, the Middle East, and the Balkan region of Europe; the disease is spreading northwards following widespread distribution of the main vector, Hyalomma marginatum, which was first found in Hungary in 2011. The aim of this pilot sero-surveillance study was to assess CCHF seroprevalence in Hungary. A total of 2700 serum samples obtained from healthy volunteer blood donors were screened using an in-house immunofluorescence assay and a commercially available ELISA kit. We found ten (0.37 %) seropositive donors. The western and central regions proved to be the most affected areas, with a prevalence of 2.97 %. Higher positivity was found among male donors (0.55 %) and younger donors (18-34 years; 0.78 %). Based on these results, a more extended surveillance focusing on specific at-risk populations and animals is advised. The results should also raise the awareness of clinicians and other high-risk populations, such as foresters and hunters, about the emerging threat of CCHF in Hungary., (Copyright © 2020 Elsevier GmbH. All rights reserved.)

Crimean-Congo haemorrhagic fever is a viral tick-borne zoonotic disease caused by a Nairovirus, Crimean-Congo haemorrhagic fever virus (CCHFV). The present survey aimed to determine the exposure of one-humped camels (Camelus dromedarius) from southern Tunisia to CCHFV. A total of 273 sera from extensively reared camels were collected from Tataouine district, Tunisia, and tested by CCHFV-specific enzyme linked immunosorbent assays. By combining the results of three serological tests, the overall seroprevalence of CCHFV was estimated as 89.7% (245/273). No viral RNA was detected from camel sera using quantitative real-time PCR (RT-qPCR). A total of 165 ticks were collected from camels and tested with RT-qPCR, and only one Hyalomma impeltatum tick was positive for virus RNA., (Copyright © 2020 Elsevier GmbH. All rights reserved.)

Objectives: The protracted and violent conflict in Syria has resulted in large-scale displacement of people and destruction of health and sanitation infrastructure. The aim of this study was to examine epidemiological trends in vector-borne disease (VBD) outbreaks before and following the onset of the Syrian conflict (2011)., Methods: ProMED, a digital disease surveillance tool, was queried for VBD outbreak reports affecting humans and animals in Syria and select bordering countries between 2003 and 2018. Data were normalized by dividing the number of unique VBD events by the total number of unique outbreak events reported by ProMED for each year. Suspected and confirmed case counts and deaths were manually extracted., Results: Reports on VBDs increased from a mean of 2.9/year pre-2011 to 12.8/year post-2011, a 343.5% (p < 0.05) increase. After normalization, reports increased by 485.5% (p < 0.05) over the time periods. Post-2011, the most commonly reported VBDs were leishmaniasis, Crimean-Congo hemorrhagic fever, and lumpy skin disease. Reported numbers of suspected and confirmed cases and deaths increased during the conflict period., Conclusions: VBD outbreak events in ProMED increased in Syria and select bordering countries after the onset of the Syrian conflict in 2011. Enhanced disease surveillance is critical to detect and manage outbreaks in conflict settings., (Copyright © 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: The Crimean-Congo Hemorrhagic fever (CCHF) is endemic in Iran and has a high fatality rate. The aim of this study was to investigate the association between CCHF incidence and meteorological variables in Zahedan district, which has a high incidence of this disease., Methods: Data about meteorological variables and CCHF incidence was inquired from 2010 to 2017 for Zahedan district. The analysis was performed using univariate and multivariate Seasonal Autoregressive Integrated Moving Average (SARIMA) models and Generalized Additive Models (GAM) using R software. AIC, BIC and residual tests were used to test the goodness of fit of SARIMA models, and R 2 was used to select the best model in GAM/GAMM., Results: During the years under study, 190 confirmed cases of CCHF were identified in Zahedan district. The fatality rate of the disease was 8.42%. The disease trend followed a seasonal pattern. The results of multivariate SARIMA showed the (0,1,1) (0,1,1) 12 model with maximum monthly temperature lagged 5 months, forecasted the disease better than other models. In the GAM, monthly average temperature lagged 5 months, and the monthly minimum of relative humidity and total monthly rainfall without lag, had a nonlinear relation with the incidence of CCHF., Conclusions: Meteorological variables can affect CCHF occurrence.

The occurrence of Crimean-Congo haemorrhagic fever (CCHF) in humans is linked with animals living in close vicinity, and information on the incidence of CCHF at the human-animal interface is scarce. Therefore, the current study was designed to identify the high-risk groups of individuals linked with animals in the Chakwal district of Pakistan having a history of CCHF cases in humans. In subject matter, coupled with risk factor analysis, we performed a sero-based CCHF surveillance in three selected risk groups of humans including abattoir workers (n = 137), milkmen (n = 169) and animal handlers (n = 147). Sera samples and questionnaire-based data were collected from each of the participants and screened for anti-CCHFV IgG antibodies using enzyme-linked immunosorbent assay. The highest seroprevalence was observed in animal handlers (n = 14, 9.52%, 95% CI: 4.68-13.99) followed by abattoir workers (n = 9, 6.57%, 95% CI: 2.42-10.72) and milkmen (n = 3, 1.78%, 95% CI: 0.24-4.24). The risk of seropositivity was significantly associated with humans linked with tick-infested animals (OR: 11.0, 95% CI: 1.5-83.0, p = .002), old age >40 years (OR: 6.6, 95% CI: 2.7-16.0, p < .0001), illiteracy (OR: 4.3, 95% CI: 1.5-13.0, p = .004) and humans without knowledge about CCHF (OR: 7.6, 95% CI: 1.8-33.0, p = .0009). The findings of the current study highlighted the seroprevalence of CCHF in high-risk groups of humans living in a disease-endemic area of Pakistan and highlight the need for well-integrated disease surveillance in the future to better comprehend disease control interventions., (© 2020 Blackwell Verlag GmbH.)

In Ukraine, a retrospective review of clinical case reports by public health officials suggest that human cases of febrile illnesses associated with hemorrhage may be due to infections of Crimean-Congo hemorrhagic fever virus (CCHFV) and Old World hantaviruses. In a serosurvey of 966 healthy individuals in the Lviv Oblast, Ukraine, bordering Poland, we found that 1.6% showed cross-reactivity to hantaviral antigens by an immunofluorescence assay (IFA) and 1.7% of the study participants had antibodies cross-reactive to CCHFV by enzyme-linked immunosorbent assay (ELISA). Demographic variables and history of exposures obtained through questionnaires were assessed by logistic regression models for association with seroprevalence for both viruses with no significant risk factors found. Analysis of spatial distribution identified two clusters of samples positive for antibodies to both hantaviruses and CCHFV, which, however, were not statistically significant (p > 0.05). In general, the study results suggest that the population of the study area is exposed to hantaviruses and CCHFV. Further surveillance for respective pathogens in Ukraine is warranted and prospective surveillance of febrile patients with unidentified febrile illness., (Copyright © 2020 Lozynskyi, Shulgan, Zarichna, Ben, Kessler, Cao, Nesterova, Glass, Spruill-Harrell, Taylor, Williams and Jonsson.)

Crimean-Congo hemorrhagic fever (CCHF) is a tick-borne disease that can be contracted by direct contact with viremic animals or humans. In West Africa, recurrent CCHF outbreaks have been constantly observed in Mauritania and Senegal. Moreover, acquisition and epidemiology of the infection in humans are correlated with the occurrence and the seroprevalence of the virus in livestock. The main objective of this study is to provide updated information on the local spread of CCHF in animals in the northern region of Senegal. Out of a total of 283 animal sera collected, CCHF-specific antibodies were identified in 92 (32.5%; confidence interval [CI] 95% 27.1-38.3) sera by double antigen sandwich enzyme-linked immunosorbent assay (ELISA) test. The prevalence of CCHF virus (CCHFV) infection among horses, cattle, sheep, dogs, donkeys, and goats was 70.3% (45/64), 57.1% (8/14), 22.1% (30/136), 18.2% (2/11), 17.2% (5/29), and 6.9% (2/29), respectively. The antibody titers were found significantly affected by age ( p  < 0.0001) and gender ( p  < 0.05). High tick infestation by Rhipicephalus spp. and Hyalomma spp. was recorded on horses. The high seroprevalence to CCHFV among animals in the northern region of Senegal observed in this study indicates the permanent presence of the infection in the northern region of the country suggesting the need to strengthen surveillance plans for CCHF in Senegal.

Crimean-Congo haemorrhagic fever (CCHF) is a widely distributed tick-borne disease. In Spain, the disease has emerged as outbreak associated with high-risk exposures. Our goal was to evaluate the prevalence of antibodies against the CCHF virus (CCHFV) in high-risk contacts. A cross-sectional study was conducted. Three hundred eighty-six high-risk contacts were identified comprising family contacts and hospital workers who had attended the cases. Fifty-seven cases with closer exposure were selected. However, forty-nine cases participated in the study. IgG antibodies were detected by immunoenzymatic techniques. All determinations tested negative for anti-CCHFV IgG antibodies. Most of the responders were women (73.5%), and belong to the intensive care department (53.1%). In relation to other possible sources of exposures, 18.4% travelled to countries with CCHF transmission risk. No CCHF positivity was recorded among selected high-risk contacts. This highlights the importance of standard precautions which might have protected healthcare workers and care providers from CCHF infection., (Copyright © 2020 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: Crimean-Congo hemorrhagic fever (CCHF) is a tick-borne disease that has various symptoms. Since rapid diagnosis is crucial for survival, understanding the characteristics of patients is important for clinicians while waiting for results. This study aimed to evaluate findings that support the preliminary diagnosis of suspected CCHF in patients and take a look at the management of CCHF in Turkey., Methods: Demographics, presenting symptoms and laboratory findings of the patients admitted with a suspicion of CCHF, were recorded from the patient files and database of Ministry of Health. A diagnosis of CCHF was based on detection of immunoglobulin M (IgM) antibodies and/or viral RNA. The patients with and without CCHF were compared in terms of differences in epidemiological, clinical and laboratory findings., Results: Out of 87 patients, 61 (70.1%) were CCHF and 26 (29.9%) were non-CCHF cases. Working with agriculture/livestock, tick exposure, contact with body fluids of animals, travel to rural areas within 2 weeks, fever, headache, leucopenia, anemia, international normalized ratio (INR) elevation were significantly more common in CCHF cases. According to multivariate analysis, tick exposure (odds ratio, OR 9.03, 95% confidence interval, CI 1.96-41.47, p = 0.005), contact with body fluids of animals (OR 14.9, 95% CI 2.23-99.94, p = 0.005), leucopenia (OR 13.65, 95% CI 2.55-72.91, p = 0.02) and anemia (OR 8.41, 95% CI 1.06-66.42, p = 0.04) were independently indicative for CCHF., Conclusion: As it takes a considerable time for a definitive diagnosis, determining epidemiological features and risk factors is an important step for preliminary diagnosis of CCHF as well as early implementation of precautions against nosocomial transmission of the virus.

This article presents the results of a comprehensive survey of Guinea with the aim of assessing the burden of Crimean-Congo hemorrhagic fever virus (CCHFV) in rural areas of the country. Human serum samples (n = 2207) were studied using enzyme-linked immunosorbent assay (ELISA) for the presence of specific IgG against CCHFV. In addition, 4273 samples of partially- or fully-engorged ticks from several sources (cattle, domestic and roving dogs, and small mammals) were collected and studied using ELISA and RT-qPCR to detect CCHFV antigen and specific RNA. The data obtained show that 3.0 % of the population in rural Guinea was seropositive, without significant geographical or sexual differences. Seropositive individuals, however, were mainly in the 'active age' group (16-45 years old). Among ticks studied, the estimated prevalence of CCHFV was 1.3 ± 0.4 %. Five out of eight tick species studied were identified as CCHFV carriers in Guinea. Therefore, it can be assumed that the territory of Guinea is a single, continuous, natural focus of CCHFV. This identified medium intensity focus merits further study., Competing Interests: Declaration of Competing Interest The authors declare that they have no competing/conflicting interests., (Copyright © 2020 Elsevier GmbH. All rights reserved.)

Crimean Congo hemorrhagic fever (CCHF) is a zoonotic viral disease presenting with fever and hemorrhagic manifestations in humans. After several outbreaks of CCHF being reported from Gujarat since 2011 till 2019 and from Rajasthan in 2014 and 2015, the present study reports the CCHF outbreak which was recorded from five human cases in three districts Jodhpur, Jaisalmer, and Sirohi of Rajasthan state since August 2019 till November 2019. A high percent of positivity was recorded in livestock animal samples for the CCHFV IgG antibody. CCHF virus (CCHFV) positive human blood samples and Hyalomma tick pool samples were sequenced using next-generation sequencing method. Two different M segment genotypes, encoding glycoprotein precursor, were identified from tick pools in the study: first from Asian and second from African lineage. The L gene (polymerase) and the S gene (nucleocapsid) clustered in the Asian lineage. The present study illustrates the existence of two different CCHFV lineages being circulating within the Hyalomma tick pools in the Rajasthan state, India. We also observed 3.56% amino acid changes between the death and the survived case of CCHFV in the M gene. This report also sets an alarm to enhance human, tick and livestock surveillance in other districts of Rajasthan and nearby states of India. Biosafety measures, barrier nursing along with the availability of personal protective equipment and ribavirin drug will always be a mainstay in preventing nosocomial infection for proper case management., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Background: Crimean Congo haemorrhagic fever (CCHF) is an emerging zoonotic infection with high mortality. Nosocomial spread is described secondary to body fluid contact., Methods: Patients meeting the case definition for viral haemorrhagic fever (VHF) from August to November 2019 were tested for CCHF after ruling out dengue, malaria, scrub typhus and leptospirosis in a tertiary teaching hospital in western Rajasthan, India. Diagnosis was confirmed using both quantitative reverse transcription polymerase chain reaction and immunoglobulin M/immunoglobulin G enzyme-linked immunosorbent assay for all patients. All hospital contacts were line listed and tested and symptomatic high-risk contacts received ribavirin post-exposure prophylaxis. Cohorting, personal protective equipment use and hand washing were employed to prevent nosocomial spread., Results: Four patients tested positive for CCHF. We encountered uncommon initial presentations involving motor weakness and supraventricular tachycardia. Elevated serum lactate dehydrogenase and creatinine kinase were useful in clinical diagnosis. Only one patient survived despite ribavirin therapy. There was zero nosocomial transmission. A partial segment of nucleocapsid of amplified CCHF virus was 99.62% identical to the Afghanistan and Oman strains., Conclusions: The distribution of CCHF appears to be expanding, with CCHF emerging as endemic in Rajasthan, India. In this setting of high mortality, hand washing and PPE use prevented nosocomial transmission., (© The Author(s) 2020. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene.)

A total of 1,337 serum and plasma specimens (939, 393 and 15 from cattle, sheep and goats, respectively) were collected monthly for one a year from ruminant species slaughtered in three Turkish cities endemic for Crimean-Congo hemorrhagic fever virus (CCHFV), Samsun, Sivas and Tokat. The serum samples were tested by commercial indirect ELISA to detect CCHFV antibodies, and positive or equivocal samples were later confirmed by a virus neutralization test (VNT). The seroprevalence in cattle, sheep, and goats was 36.21% (340/939), 6.27% (24/383), and 6.67% (1/15), respectively. Quantitative real-time RT-PCR was employed to detect viraemic animals at slaughter time. The percentage of CCHFV-viraemic animals was 0.67% (9/1337). The virus load varied between 4.1 x 10 1 and 2.4 x 10 3 RNA equivalent copies/mL in viraemic animals. The plasma samples that were positive for CCHFV genomic RNA were collected between April and May, when Hyalomma ticks are active. This study presents quantitative CCHFV load data in ruminant species at slaughter and interprets the likelihood of transmission for employees working in slaughterhouses in CCHFV-endemic regions.

Background: Crimean-Congo haemorrhagic fever virus (CCHFV) is a tick-borne zoonotic pathogen. It causes a fatal haemorrhagic disease in humans. Hard ticks, in particular Hyalomma spp., are considered to function as reservoir as well as vector for CCHFV., Methods: A cross-sectional study was conducted in the province of Balochistan, Pakistan, from September to November 2017. Ticks were collected from cattle, sheep and goats in livestock farms. The ticks were morphologically identified, followed by confirmation with molecular methods (PCR and sequencing). Furthermore, ticks were examined for CCHFV genomes (S segment) by a one-step multiplex real-time RT-qPCR and positive samples were sequenced to determine the CCHFV genotype., Results: In total, 525 of 529 livestock infesting adult ticks belonged to the genus Hyalomma, and 4 ticks to the genus Rhipicephalus (R. microplus 3×, R. turanicus 1×). In the genus Hyalomma, H. marginatum (28%), H. excavatum (26%), H. dromedarii (22%), H. anatolicum (16%) and H. scupense (8%) ticks were identified. Tick infestations were as follows: sheep 58%, goats 28% and cattle 14%. Four per cent (20/525) of ticks were CCHFV genome-positive, and all genomes clustered in CCHFV genotype Asia 1. Among CCHFV-positive ticks, 75% (15/20) were female and 25% (5/20) male. CCHFV genomes were most frequently detected in H. marginatum (30%, 6/20), followed by H. dromedarii (25%, 5/20), H. excavatum (20%, 4/20), H. anatolicum (20%, 4/20) and H. scupense (5%, 1/20). All CCHFV-positive ticks were found on sheep. The largest number of CCHFV-positive ticks were detected in the district of Kalat (60%, 12/20), followed by the districts of Quetta (30%, 6/20) and Killa Abdullah (10%, 2/20)., Conclusions: This study confirms the circulation of CCHFV in ticks in Balochistan, south-western Pakistan. It is imperative to take effective tick control measures in this area, especially to control livestock tick infestations to prevent CCHF infections in humans., (© 2020 The Authors. Transboundary and Emerging Diseases published by Blackwell Verlag GmbH.)

Being an endemic country for Crimean Congo hemorrhagic fever (CCHF), this study aimed to explore the genetic diversity of CCHF virus (CCHFV) detected in Pakistan during 2019. Serum samples from patients with clinical signs of hemorrhagic fever attending tertiary care hospitals in Pakistan were tested for CCHFV RNA using real-time PCR at Department of Virology, National Institute of Health. The partial S-gene fragments were directly sequenced to determine the prevailing CCHFV genotypes and their molecular epidemiology in Pakistan. During January-December 2019, 280 samples from suspected CCHF patients were tested and 28 (10%) were found positive on real-time PCR. Positive cases were detected from 14 districts and across all four provinces of Pakistan with majority reported during August-September. The mean age of CCHFV positive patients was 37.25 years (range 5-65 years) with a high frequency in males (92.8%; n = 26) and a case fatality rate of 40.7% was observed. Phylogenetic analysis showed that S- segment of 2019 PAK CCHFV strains (n = 13) belonged to Asia-1 genotype and clustered with regional strains from Iran, Oman, and Afghanistan. We conclude that Asia-1 genotype of CCHF virus remains endemic in Pakistan. Our findings emphasize to establish a laboratory based surveillance program to monitor the disease burden and identify outbreak hotspots for effective control., Competing Interests: The authors have declared that no competing interests exist.

Data on pathogen prevalence is crucial for informing exposure and disease risk. We evaluated serological evidence of tick-borne encephalitis (TBE), West Nile (WN), Hepatitis E virus (HEV), Crimean-Congo Hemorrhagic Fever (CCHF), Yersiniosis, Lyme Disease (LD), and brucellosis in 1033 patients presenting with acute febrile illness at 9 health care facilities from diverse ecological zones of Kenya: arid and semiarid (Garissa District Hospital, Lodwar District Hospital, Marigat District Hospital, Gilgil District Hospital), Lake Victoria basin (Kisumu District Hospital, Alupe District Hospital, Kombewa Sub-County Hospital), Kisii highland (Kisii District Hospital), and coastal (Malindi District Hospital). Epidemiological information of the patients such as geography, age, gender, and keeping animals were analyzed as potential risk factors. Of the 1033 samples, 619 (59.9%) were seropositive to at least one pathogen by IgM (current exposure), IgG/IgM (recent exposure), and IgG (past exposure). Collective seroprevalence for current, recent, and past to the pathogens was 9.4%, 5.1%, and 21.1% for LD; 3.6%, 0.5%, and 12.4% for WN; 0.9%, 0.5%, and 16.9% for HEV; 5.8%, 1.3%, and 3.9% for brucellosis; 5.7%, 0.2%, and 2.3% for yersiniosis; 1.7%, 0%, and 6.2% for TBE; and 0.4%, 0%, and 1.9% for CCHF. Brucellosis risk was higher in patients recruited at Garissa District Hospital (odds ratio [OR] = 3.41), HEV (OR = 2.45) and CCHF (OR = 5.46) in Lodwar District Hospital, LD in Alupe District Hospital (OR = 5.73), Kombewa Sub-district hospital (OR = 8.17), and Malindi District hospital (OR = 3.3). Exposure to LD was highest in the younger age group, whereas yersiniosis did not vary with age. Age was a significant risk for WN, brucellosis, CCHF, TBE, and HEV and in those aged >14 years there was an increased risk to WN (OR = 2.30, p  < 0.0001), brucellosis (OR = 1.84, p  = 0.005), CCHF (OR = 4.35, p  = 0.001), TBE (OR = 2.78, p  < 0.0001), and HEV (OR = 1.94, p  = 0.0001). We conclude that LD is pervasive and constitutes a significant health burden to the study population, whereas yersiniosis and CCHF are not significant threats. Going forward, community-based studies will be needed to capture the true seroprevalence rates and the associated risk factors.

We conducted a cross-sectional survey of Crimean-Congo hemorrhagic fever virus (CCHFV) in dromedary camels and attached ticks at 3 locations in the United Arab Emirates. Results revealed a high prevalence of CCHFV-reactive antibodies in camels and viral RNA in ticks and camel serum, suggesting the virus is endemic in this country.

We conducted a serologic survey for Crimean-Congo hemorrhagic fever virus antibodies in livestock (cattle, sheep, and goats; N = 3,890) on Corsica (island of France) during 2014-2016. Overall, 9.1% of animals were seropositive, suggesting this virus circulates on Corsica. However, virus identification is needed to confirm these results.

Crimean-Congo hemorrhagic fever virus (CCHFV) is a highly transmissible human pathogen. Infection is often misdiagnosed, in part because of poor availability of data in disease-endemic areas. We sampled 150 apparently healthy ruminants throughout Nigeria for virus seropositivity and detected virus-specific IgG in cattle (24%) and goats (2%), highlighting the need for further investigations.

Crimean-Congo hemorrhagic fever (CCHF) is the most popular tick-borne disease causing by Crimean-Congo hemorrhagic fever virus (CCHFV). There are several valuable reviews considering some fields of the CCHF aspects. While there is no a systematic review about means and trends of CCHF cases and fatality rate, means and trends of CCHF cases and fatality rates of human occupations involved in CCHF. Therefore, this meta-analysis review performed to highlight and provide a global detailed of the above CCHF aspects. Among 398 collected papers, 173 papers were become this meta-analysis review. The study results confirm that an apparent increasing CCHF cases occurred through the past decades. The trends of annually and periodically CCHF cases and fatality rates were also increased. The means of annually and periodically CCHF cases and fatality rates were 57 and 432 cases, and 10 cases and 32.2 % and 49 cases and 28.8 %, respectively. The means of annually and periodically CCHF fatality rates are about one-tenth of CCHF human cases. The mean of CCHF fatality rates in Africa (22.0 %) is lower than Asia (33.5 %) and Europe (33.8 %). Among occupations involved in CCHF, agricultural (28.9 %), health-care (19.2 %) and slaughterhouse (16.7 %) workers, and farmers (13.9 %) had the maximum CCHF fatality rates in order. Based on literature review of CCHFV S-segment aspects, several clades and genotypes are reported to distribute in Africa, Asia and Europe regions. There are very wide fields to investigate the epidemiology characteristics of CCHFV clades, genotypes and their distribution in the future., Competing Interests: Declaration of Competing Interest The author declare that he has no conflict of interest., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

We evaluated the epidemiological features and main risk factors of Crimean-Congo haemorrhagic fever (CCHF) in Corum, where the disease is endemic, by retrospectively analysing the medical records of all patients diagnosed with CCHF over five years. Diagnosis was made by the detection of virus RNA via reverse transcription polymerase chain reaction or by demonstrating IgM antibody of CCHF virus with an ELISA blood test. Of 399 patients, 22 (5.5%) patients died but we could show that the rates of incidence and mortality have decreased over the years. Early referral to health facilities, increased awareness and experience of health personnel working in high-risk areas may well be the main factor.

The distribution of Crimean-Congo hemorrhagic fever (CCHF), a tickborne arboviral disease, is not well known in West Africa. We report 2 recent human cases of CCHF with infectious syndrome and severe bleeding in Mauritania. CCHF was diagnosed by ELISA and real time reverse transcription PCR. No secondary CCHF cases were found.

We detected Crimean-Congo hemorrhagic fever virus infections in 4 provinces of Pakistan during 2017-2018. Overall, seroprevalence was 2.7% in humans and 36.2% in domestic livestock. Antibody prevalence in humans was highest in rural areas, where increased contact with animals is likely.

Background: Crimean-Congo hemorrhagic fever (CCHF) is an emerging infectious disease caused by a Nairovirus. CCHF is a tick-borne disease that is predominantly associated with Hyalomma ticks and have a widespread distribution in Africa, Asia and Europe. CCHF usually presents as a subclinical disease, but in some cases, it may present as a hemorrhagic fever with a high mortality rate. This systematic review of the literature was performed to identify the available evidence on the prevalence of CCHF in the European Region of the World Health Organization, based on seroprevalence (IgG antibodies)., Methodology: A systematic review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement protocol. PubMed, Embase, and the Web of Science were used for the search (up to January 31, 2019), combining the following MeSH terms: ["Crimean-Congo haemorrhagic fever" OR "Crimean-Congo hemorrhagic fever virus" OR "Congo-Crimea" OR "Crimea-Congo"] AND ["Europe"] AND ["epidemiology" OR "seroprevalence"]. The abstracts were screened. Subsequently, full-text articles were selected and reviewed based on the PICOS (Population-Intervention-Comparison-Outcomes-Study type) criteria by two independent reviewers for inclusion in the final analysis. The data were qualitatively synthesized without quantitative pooling due to the heterogeneity in the study populations and methodologies., Principal Findings: Thirty articles (9 from western Europe, 18 from central Europe and 3 from eastern Europe) were included in the analysis. All articles were cross-sectional studies (descriptive studies)., Conclusions: The highest seroprevalence of CCHF is found in central and eastern European countries. Southern and western Europe countries, such as Greece and Spain, have low levels of endemicity, but the spread of the infection, which is associated with climate change, is a possibility that we should keep in mind. Further studies, especially larger seroprevalence studies in humans and animals, are needed to establish the current status of the CCHF epidemiology and to generate standardized guidelines for action in the region., Competing Interests: The authors have declared that no competing interests exist.

This study was conducted in Samsun Province of Turkey to investigate the serological status of domesticated water buffaloes for both Crimean-Congo Hemorrhagic Fever (CCHF) and Lumpy Skin Disease (LSD). Serum was collected from a total of 272 water buffaloes from different age groups and both genders; of the total, 48.1% had been vaccinated against LSD with heterologous sheep-goat pox vaccine. The serum samples were individually assessed by using a commercial ID screen enzyme-linked immune-sorbent assay (ELISA) to detect neutralizing antibodies against both CCHF virus and LSD virus. All 272 buffaloes were negative for antibodies against the CCHF virus. All the unvaccinated buffaloes (141) were seronegative for LSD virus but of the 131 vaccinated buffaloes, 10 (7.6%) were seropositive for the LSD virus. In addition, 8.6% of vaccinated animals age >1 year old were seropositive for LSD, whereas the seropositivity was 5.1% for the animals age <= 1 year old. There was no significant difference for seropositivity between male and female animals in the >1 year old or <= 1 year old age groups. When seroprevalances for LSD in the tested water buffaloes are evaluated by gender, there was a significant difference between females (8.6%) and males (0%) in the <1 year old water buffaloes (X 2 =20.24; P<0.001). Separately, the results of this study indicate that Bafra district water buffaloes are not infected by CCHFV and LSDV and some of the buffaloes that vaccinated with LSDV did not develop sufficient antibodies to protect them after they were vaccinated for the LSD virus. Furthermore, the authors of this study conclude that both the commercially produced vaccine that is currently administered and the vaccination strategy have to be urgently evaluated by the veterinary authorities in Turkey. This is essential in order to combat the spread of LSD virus infection with an effective vaccine and a comprehensive management strategy across Turkey.

IntroductionCrimean-Congo haemorrhagic fever (CCHF) is a tick-borne disease in Africa, Asia, the Balkan peninsula, the south-east of Europe and the Middle East, with mortality rates of 3-30%. Transmission can also occur through contact with infected animals or humans.AimThis observational, prospective case series aimed to investigate detectable viral genomic RNA in whole-body fluids and antibody dynamics in consecutive daily samples of patients diagnosed with CCHF until discharge from hospital.MethodsWe tested 18 patients and 824 swabs and sera with RT-PCR and 125 serum samples serologically.ResultsThe longest duration until clearance of viral RNA was 18 days from serum collection and 18, 15, 13, 19 and 17 days, respectively, from nasal, oral, genital (urethral or vaginal) and faecal swab, and urine. In seven patients, viral load decreased in serum at the same time as it increased in urine or persisted at the same logarithmic values. Despite clearance in serum, viral RNA was detected in faeces and genital swabs in two and three patients, respectively. Viral clearance from body fluids occurred earlier than from serum in eight patients on ribavirin treatment. The shortest seroconversion time was 3 days after symptom onset for IgM and IgG. Seroconversion of IgG occurred until Day 14 of symptoms.ConclusionWe report persistence of viral RNA in urine, faeces and genital swabs despite serum clearance. This may indicate a need for extending isolation precautions, re-evaluating discharge criteria and transmission risk after discharge, and considering oral swabs as a less invasive diagnostic alternative.

Crimean-Congo haemorrhagic fever (CCHF) is a tick-borne zoonotic disease caused by the arbovirus Crimean-Congo haemorrhagic fever virus (CCHFV). Livestock serve as a transient reservoir for CCHFV, but do not show clinical signs. In this cross-sectional study, sheep and goats in Balochistan, Pakistan, were examined to determine the CCHFV seroprevalence, spatial distribution of seropositive sheep and goats, and to identify potential risk factors for seropositivity to CCHFV in these animals. To this end, farms and animals were selected by systematic sampling, blood samples from 800 sheep and 800 goats were collected and information regarding farm management and the kept animals were retrieved using a standard questionnaire. Sera were tested for antibodies against CCHFV in two independent ELISA formats and an immunofluorescence assay (IFA) following a hierarchical diagnostic decision tree. By these assays 149 (19 %, 95 %-CI: 16-21 %) out of 800 sheep serum samples and 37 (5 %, 95 %-CI: 3-6 %) out of 800 goat serum samples were positive for CCHFV-specific IgG antibodies. Interestingly, at least 8 (5 %, 95 %-CI: 2-10 %) out of 160 sera pools were from CCHFV viraemic sheep, as sera (in pools of 5) tested positive for CCHFV genome by real-time PCR (RT-qPCR). Risk factor analysis revealed that the open type of housing (OR = 3.76, 95 %-CI:1.57-9.56, p-value = 0.003), grazing (OR = 4.18, 95 %-CI:1.79-10.37, p-value = 0.001), presence of vegetation in or around the farm (OR = 3.13, 95 %-CI: 1.07-10.15, p-value = 0.043), lack of treatment against ticks (OR = 3.31, 95 %-CI: 1.16-10.21, p-value = 0.029), absence of rural poultry (OR = 2.93, 95 %-CI: 1.41-6.29, p-value = 0.004), animals with age ≥ 2 years (OR = 4.15, 95 %-CI: 2.84-6.19, p-value<0.001), animals infested with ticks (OR = 2.35, 95 %-CI: 1.59-3.52, p-value<0.001), and sheep species (OR = 4.72, 95 %-CI:3.24-6.86, p-value<0.001) represented statistically significant risk factors associated with seropositivity to CCHFV. Taken together this study confirms the circulation of CCHFV in livestock in Balochistan, Pakistan. The identification of risk factors might help to reduce the risk of infection in sheep and goats, which may also mitigate the risk for human infection. An interesting option for reducing the risk of CCHFV infection in small ruminants is keeping also chickens, since they pick ticks that transmit CCHFV., (Copyright © 2019 Elsevier GmbH. All rights reserved.)

BackgroundCrimean-Congo haemorrhagic fever virus (CCHFV) is considered an emerging or even a probable re-emerging pathogen in southern Europe. Presence of this virus had been reported previously in Spain in 2010.AimWe aimed to evaluate the potential circulation of CCHFV in western Spain with a serosurvey in asymptomatic adults (blood donors).MethodsDuring 2017 and 2018, we conducted a CCHFV serosurvey in randomly selected asymptomatic blood donors from western Spain. Three assays using specific IgG antibodies against CCHFV were performed: the VectoCrimea ELISA test, an in-house ELISA and indirect immunofluorescence (EuroImmun) test with glycoprotein and nucleoprotein.ResultsA total of 516 blood donors participated in this cross-sectional study. The majority of the study participants were male (68.4%), and the mean age was 46.3 years. Most of the participants came from rural areas (86.8%) and 68.6% had contact with animals and 20.9% had animal husbandry practices. One in five participants (109/516, 21.1%) were engaged in at-risk professional activities such as agriculture and shepherding, slaughtering, hunting, veterinary and healthcare work (mainly nursing staff and laboratory technicians). A total of 15.3% of the participants were bitten by ticks in the days or months before the date of sampling. We detected anti-CCHFV IgG antibodies with two diagnostic assays in three of the 516 individuals and with one diagnostic assay in six of the 516 individuals.ConclusionSeroprevalence of CCHFV was between 0.58% and 1.16% in Castile-León, Spain. This is the first study in western Spain that showed circulation of CCHFV in healthy people.

Objectives: We aimed to develop a prospective prediction tool on Crimean-Congo haemorrhagic fever (CCHF) to identify geographic regions at risk. The tool could support public health decision-makers in implementation of an effective control strategy in a timely manner., Methods: We used monthly surveillance data between 2004 and 2015 to predict case counts between 2016 and 2017 prospectively. The Turkish nationwide surveillance data set collected by the Ministry of Health contained 10 411 confirmed CCHF cases. We collected potential explanatory covariates about climate, land use, and animal and human populations at risk to capture spatiotemporal transmission dynamics. We developed a structured Gaussian process algorithm and prospectively tested this tool predicting the future year's cases given past years' cases., Results: We predicted the annual cases in 2016 and 2017 as 438 and 341, whereas the observed cases were 432 and 343, respectively. Pearson's correlation coefficient and normalized root mean squared error values for 2016 and 2017 predictions were (0.83; 0.58) and (0.87; 0.52), respectively. The most important covariates were found to be the number of settlements with fewer than 25 000 inhabitants, latitude, longitude and potential evapotranspiration (evaporation and transpiration)., Conclusions: Main driving factors of CCHF dynamics were human population at risk in rural areas, geographical dependency and climate effect on ticks. Our model was able to prospectively predict the numbers of CCHF cases. Our proof-of-concept study also provided insight for understanding possible mechanisms of infectious diseases and found important directions for practice and policy to combat against emerging infectious diseases., (Copyright © 2019 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.)

Crimean-Congo hemorrhagic fever (CCHF), Q fever, and Lyme disease are endemic to southern Kazakhstan, but population-based serosurveys are lacking. We assessed risk factors and seroprevalence of these zoonoses and conducted surveys for CCHF-related knowledge, attitudes, and practices in the Zhambyl region of Kazakhstan. Weighted seroprevalence for CCHF among all participants was 1.2%, increasing to 3.4% in villages with a known history of CCHF circulation. Weighted seroprevalence was 2.4% for Lyme disease and 1.3% for Q fever. We found evidence of CCHF virus circulation in areas not known to harbor the virus. We noted that activities that put persons at high risk for zoonotic or tickborne disease also were risk factors for seropositivity. However, recognition of the role of livestock in disease transmission and use of personal protective equipment when performing high-risk activities were low among participants.

Crimean-Congo Haemorrhagic Fever (CCHF) is a deadly viral zoonotic disease, which is endemic in Pakistan. We report a case study analysis of three cases of CCHF which occurred in Chakwal, Pakistan in 2016. The disease was suspected in three patients exhibiting clinical symptoms suggestive of CCHF; two of the three patients died. The presence of CCHF was detected by seroconversion (IgG) from the surviving patient, while the antigen was detected in Hyalomma ticks originating from animals in the vicinity. This report indicates increase threat emergence of CCHF in Pakistan and highlights its zoonotic implications requiring immediate interventions under the "One-Health" concept., (© 2019 Blackwell Verlag GmbH.)

Zoonotic diseases are endemic in the country of Georgia. Using the non-linear canonical correlation (NCC) method, the aim of this study was to examine the relationship between thirteen epidemiological risk factors and seropositivity to five zoonotic infections (anthrax, Q fever, tularemia, leptospirosis, and Crimean-Congo hemorrhagic fever [CCHF]) among Georgian military recruits during 2014-2016. According to this multivariate statistical technique, which is suitable for the analysis of two or more sets of qualitative variables simultaneously, two canonical variables were identified. These variables accounted for 68% of the variation between the two sets of categorical variables ("risk factors" and "zoonotic infections"). For the first canonical variable, there was a relationship among CCHF (canonical loading, which is interpreted in the same way as the Pearson's correlation coefficient, [cl] = 0.715), tick bites (cl = 0.418) and slaughter of animals (cl = 0.351). As for the second canonical variable, Q fever (cl = -0.604) and leptospirosis (cl = -0.486) were related to rodents inside and outside home (cl = -0.346) and sweeping in or around home (cl = -0.317). The NCC method allows researchers to obtain additional insights into the complex relationship between epidemiological risk factors and multiple zoonotic infections., (Published 2019. This article is a U.S. Government work and is in the public domain in the USA.)

Objective: This study aims to provide descriptive epidemiology of human CCHF cases in Afghanistan by demographic, geographical, and seasonal characteristics., Methodology: This paper's findings are based on the retrospective analysis of the National Surveillance System's collected data from 2016 to 2018. Weekly cases exceeding the 90th percentile of the expected number of cases were considered to be exceptional and above normal., Results: The National Surveillance System detected 1,284 CCHF cases from 2007 to 2018, of which 163 cases were in 2016, 245 cases in 2017 and 483 cases in 2018. A total of 891 suspected and confirmed cases were reported between 2016 and 2018, 293 (33%) of these cases were confirmed by detecting IgM antibody using ELISA and RT-PCR. Among confirmed cases, the three-year case fatality ratio (CFR) was 43.3%. Among the reported cases, 68.5% were males and 31.5% females. The frequent reported occupational groups were housewives (15%), health staff (13%), shepherds (11%), butchers (6%), students (6%), animal dealers and farmers (both 2%) respectively, 19% were unemployed, and occupation was not recorded for 26% of cases., Conclusion: Recently, CCHF has significantly increased in Afghanistan. Despite the increased frequency of cases, the laboratory capacity to test specimens and overall knowledge of CCHF management remains limited., (Copyright © 2019. Published by Elsevier Ltd.)

Crimean-Congo haemorrhagic fever virus (CCHFV) is a tick-borne pathogen, which causes an increasing number of severe infections in many parts of Africa, Asia and in Europe. The virus is primarily transmitted by ticks, however, the spectrum of natural hosts regarding CCHFV includes a wide variety of domestic and wild animals. Although the presence of CCHFV was hypothesized in Hungary, data in support of CCHFV prevalence has thus far, proven insufficient. In the present study, rodents belonging to four species, the yellow-necked mouse (Apodemus flavicollis), the striped field mouse (A. agrarius), the wood mouse (A. sylvaticus) and the bank vole (Myodes glareolus), were all systematically trapped in the Mecsek Mountain region (Southwest Hungary), from 2011 through 2013. Rodent sera were collected and screened for CCHFV antibodies with dot-blot pre-screening and immunofluorescence assay. Among the 2085 tested rodents, 20 (0.96%) were positive for IgG antibody against CCHFV. Seroprevalence was the highest (1.25%) in A. flavicollis serum samples. Distinctly, we now provide the first data regarding CCHFV occurrence and seroprevalence among wild rodents in Hungary. This observation represents a need for large-scale surveillance to effectively assess the enzootic background and the potential public health risk of CCHFV in Hungary., (Copyright © 2019 Elsevier GmbH. All rights reserved.)

Background/aim: Crimean-Congo hemorrhagic fever (CCHF) is a serious illness characterized by fever and hemorrhage. Endothelin-1 (ET-1), angiopoietin-2 (Ang-2), and endothelial cell-specific receptor tyrosine kinase (Tie-2) are believed to be important markers of the pathogenesis, clinical course, and prognosis of the disease. The aim of this study was to determine ET-1, Ang-2, and Tie-2 levels in adults with CCHF and investigate the associations between these markers and pathogenesis and disease course., Materials and Methods: Sixty CCHF patients were included in the study. The patients were classified according to disease severity criteria and Ang-2, Tie-2, and ET-1 levels were compared., Results: Mean serum ET-1 level was 36.62 ± 27.99 pg/mL in the patient group and 3.70 ± 4.71 pg/mL in the control group (P = 0.001). Mean serum Ang-2 levels were 2511.18 ± 1018.64 pg/mL in the patient group and 3570.76 ± 209.52 pg/mL in the control group (P = 0.001). Mean serum Tie-2 levels were 7.35 ± 7.75 ng/mL in the patient group and 0.67 ± 1.26 ng/mL in the control group (P = 0.001)., Conclusion: Elevated ET-1 and Tie-2 levels were associated with more severe disease course, while Ang-2 level was negatively correlated with severity in adult CCHF patients. ET-1, Tie-2, and Ang-2 levels are important prognostic parameters in CCHF and may contribute significantly to treatment and follow-up., (This work is licensed under a Creative Commons Attribution 4.0 International License)

Crimean-Congo haemorrhagic fever (CCHF) is the most widespread, tick-borne viral disease affecting humans and therefore this paper performed a meta-analysis to highlight seroprevalence features of CCHF in a global context. After a preliminary review of the 396 papers representing areas throughout the world, 206 were selected for detailed meta-analysis. In general the total means of CCHF seroprevalence were, respectively 4.7 and 24.6% for humans and animals; and 17.1, 18.9, 24.3, 29.3 and 27.1% for camels, cattle, goats, sheep and livestock. Statistical analysis revealed a significant difference in seroprevalence between humans and camels (P = 0.043), cattle (P = 0.010), goats (P = 0.015), sheep (P = 0.005) and livestock (P = 0.017). Regionally, there also was a difference between humans, and goats (P = 0.0001), sheep (P = 0.007) and livestock (P = 0.002). Globally, CCHF seroprevalence in at-risk professionals was 7.5 fold greater than in normal humans, while CCHF seroprevalence was 5 fold greater in animals, camels, cattle, goats, sheep and livestock than normal humans. Animal contact, animal husbandry, farming, tick bite history and secretion exposure were the most frequently reported CCHF seropositivity risk factors. This study serves as an important resource for epidemiological discussions related to CCHF and CCHF seroprevalence features, providing specific information in understanding human and animal mean and trend CCHF seroprevalence for different regions of the world and on an aggregate global scale; seroprevalence in at-risk professionals; and total mean and trend CCHF seropositivity involving risk factors., (Copyright © 2019 Elsevier B.V. All rights reserved.)

We studied the clinical and epidemiologic features of an outbreak of Crimean-Congo hemorrhagic fever in Herat Province, Afghanistan. The study comprised 63 patients hospitalized in 2017. The overall case-fatality rate was 22.2%; fatal outcome was significantly associated with a negative IgM test result, longer prothrombin time, and nausea.

Background: Undifferentiated febrile illness (UFI) is one of the most common reasons for people seeking healthcare in low-income countries. While illness and death due to specific infections such as malaria are often well-quantified, others are frequently uncounted and their impact underappreciated. A number of high consequence infectious diseases, including Ebola virus, are endemic or epidemic in the Federal Republic of Sudan which has experienced at least 12 UFI outbreaks, frequently associated with haemorrhage and high case fatality rates (CFR), since 2012. One of these occurred in Darfur in 2015/2016 with 594 cases and 108 deaths (CFR 18.2%). The aetiology of these outbreaks remains unknown., Methodology/principal Findings: We report a retrospective cohort study of the 2015/2016 Darfur outbreak, using a subset of 65 of 263 outbreak samples received by the National Public Health Laboratory which met selection criteria of sufficient sample volume and epidemiological data. Clinical features included fever (95.8%), bleeding (95.7%), headache (51.6%) and arthralgia (42.2%). No epidemiological patterns indicative of person-to-person transmission or health-worker cases were reported. Samples were tested at the Public Health England Rare and Imported Pathogens Laboratory using a bespoke panel of likely pathogens including haemorrhagic fever viruses, arboviruses and Rickettsia, Leptospira and Borrelia spp. Seven (11%) were positive for Crimean-Congo haemorrhagic fever virus (CCHFV) by real-time reverse transcription PCR. The remaining samples tested negative on all assays., Conclusions/significance: CCHFV is an important cause of fever and haemorrhage in Darfur, but not the sole major source of UFI outbreaks in Sudan. Prospective studies are needed to explore other aetiologies, including novel pathogens. The presence of CCHFV has critical infection, prevention and control as well as clinical implications for future response. Our study reinforces the need to boost surveillance, lab and investigative capacity to underpin effective response, and for local and international health security., Competing Interests: I have read the journal's policy and the authors of this manuscript have the following competing interests: HB, BG, JW & DB are members of the UK Public Health Rapid Support Team. AS, NJB, RH, SD and TB are affiliated to the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Emerging and Zoonotic Infections at University of Liverpool in partnership with PHE, in collaboration with the Liverpool School of Tropical Medicine. The views expressed are those of the authors and not necessarily those of the National Health Service, the National Institute for Health Research, the Department of Health and Social Care, or Public Health England.

In 2011, ticks were collected from livestock following an outbreak of Crimean Congo hemorrhagic fever (CCHF) in Gujarat state, India. CCHF-negative Hyalomma anatolicum tick pools were passaged for virus isolation, and two virus isolates were obtained, designated Karyana virus (KARYV) and Kundal virus (KUNDV), respectively. Traditional reverse transcription-PCR (RT-PCR) identification of known viruses was unsuccessful, but a next-generation sequencing (NGS) approach identified KARYV and KUNDV as viruses in the Reoviridae family, Orbivirus and Coltivirus genera, respectively. Viral genomes were de novo assembled, yielding 10 complete segments of KARYV and 12 nearly complete segments of KUNDV. The VP1 gene of KARYV shared a most recent common ancestor with Wad Medani virus (WMV), strain Ar495, and based on nucleotide identity we demonstrate that it is a novel WMV strain. The VP1 segment of KUNDV shares a common ancestor with Colorado tick fever virus, Eyach virus, Tai Forest reovirus, and Tarumizu tick virus from the Coltivirus genus. Based on VP1, VP6, VP7, and VP12 nucleotide and amino acid identities, KUNDV is proposed to be a new species of Coltivirus Electron microscopy supported the classification of KARYV and KUNDV as reoviruses and identified replication morphology consistent with other orbi- and coltiviruses. The identification of novel tick-borne viruses carried by the CCHF vector is an important step in the characterization of their potential role in human and animal pathogenesis. IMPORTANCE Ticks and mosquitoes, as well Culicoides , can transmit viruses in the Reoviridae family. With the help of next-generation sequencing (NGS), previously unreported reoviruses such as equine encephalosis virus, Wad Medani virus (WMV), Kammavanpettai virus (KVPTV), and, with this report, KARYV and KUNDV have been discovered and characterized in India. The isolation of KUNDV and KARYV from Hyalomma anatolicum , which is a known vector for zoonotic pathogens, such as Crimean Congo hemorrhagic fever virus, Babesia , Theileria , and Anaplasma species, identifies arboviruses with the potential to transmit to humans. Characterization of KUNDV and KARYV isolated from Hyalomma ticks is critical for the development of specific serological and molecular assays that can be used to determine the association of these viruses with disease in humans and livestock., (Copyright © 2019 American Society for Microbiology.)

The epidemiology of viral infections transmitted by arthropods is changing due to a variety of parameters related to the virus, the host and the environment. The Mediterranean region is highly affected by changes in the intensity and extension of global-scale climate patterns, and, due to its location, it provides a vulnerable environment for emergence of arboviral diseases. The main arboviruses that pose currently a public health threat in the Mediterranean region are West Nile virus and Crimean-Congo hemorrhagic fever virus and, in less extend, tick-borne encephalitis virus. Usutu virus that affects mainly birds, can infect also humans, while Dengue and Chikungunya viruses showed that they are capable to cause sporadic autochthonous cases, and even outbreaks in the Mediterranean region. Sandly-transmitted viruses continue to have a public health impact, and novel ones have been identified. The presence of competent vectors (mainly mosquitoes), combined by arbovirus introduction through viremic travelers returning from endemic regions, prompt for increased surveillance to mitigate the risk for local transmission. In order to tackle efficiently and effectively the emerging arboviral diseases, an integrated "One Health initiative" is required to be maintained, involving public health, animal health and environmental authorities. Awareness of medical and veterinary staff and laboratory capacity are crucial for the early detection of pathogens, while reporting the unusual and enhance surveillance are important., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Crimean-Congo hemorrhagic fever (CCHF) is a tick-borne disease that can evolve into deadly hemorrhagic fever and that is endemic in many parts of Europe, Middle East, Central Asia, and Africa. Because of several reports about CCHF outbreaks in the south of Sudan during the last years, we examined in this study if unrecognized CCHF-V infections also occurred in the eastern and central parts of the country. The study examined the seroprevalence of CCHF virus infection in 464 sera from three regions of Sudan without previous reports of CCHF infection. The total CCHF virus seroprevalence was 2.6% (12 sera). The percentage was significantly elevated (7.5%) in sera from Khashm el Girba in eastern Sudan. The population in this area should be educated about the risk of disease transmission and how to avoid the infection. Health-care providers should be informed about the disease to identify possible cases and to prevent nosocomial transmission.

We report detection of Lassa virus and Crimean-Congo hemorrhagic fever virus infections in the area of Bamako, the capital of Mali. Our investigation found 2 cases of infection with each of these viruses. These results show the potential for both of these viruses to be endemic to Mali.

Viral haemorrhagic fevers (VHFs) are a group of infectious, devastating and severe diseases caused by enveloped single-stranded RNA viruses. The endemicity, emergence or re-emergence of different VHF viruses and lack of vaccines and antiviral therapy for most VHFs result in a significant global threat. Most VHF viruses are restricted to specific parts of the world, and the dramatic expansion of their geographical distribution beyond their original habitats would greatly affect global public health. In the past few decades alone, several outbreaks have affected the Middle East, a part of the world containing arid to semi-arid, hot and water-scarce countries. Political instability, natural and humanitarian crises, direct contact with domesticated animals and climate change are the main factors in the dissemination of different zoonotic diseases, including vector-borne diseases. Some VHF viruses have been introduced into the Middle East (e.g. Alkhurma haemorrhagic fever) and others have been re-introduced and have become endemic in the region. Dengue fever, Crimean Congo haemorrhagic fever, Rift Valley fever and hantavirus haemorrhagic fever with renal syndrome are examples of re-emerging or endemic viruses in the region. The temporal and spatial extension of VHF distribution mandates a particular engagement from all the actors in the fields of animal, human and environmental health. The One Health concept is a multidisciplinary and multisectoral approach for promoting collaboration, coordination and communication among different nations, sectors and disciplines, which is highly relevant to the fight against endemic, emerging and re-emerging infectious agents at the human-animal-environment interface. The adoption of the One Health approach is a promising solution to addressing public health threats in the Middle East.

Background: Crimean-Congo hemorrhagic fever (CCHF) is a serious disease with a high fatality rate reported in many countries. The first case of CCHF in Oman was detected in 1995 and serosurveys have suggested widespread infection of humans and livestock throughout the country., Methodology: Cases of CCHF reported to the Ministry of Health (MoH) of Oman between 1995 and 2017 were retrospectively reviewed. Diagnosis was confirmed by serology and/or molecular tests in Oman. Stored RNA from recent cases was studied by sequencing the complete open reading frame (ORF) of the viral S segment at Public Health England, enabling phylogenetic comparisons to be made with other S segments of strains obtained from the region., Findings: Of 88 cases of CCHF, 4 were sporadic in 1995 and 1996, then none were detected until 2011. From 2011-2017, incidence has steadily increased and 19 (23.8%) of 80 cases clustered around Eid Al Adha. The median (range) age was 33 (15-68) years and 79 (90%) were male. The major risk for infection was contact with animals and/or butchering in 73/88 (83%) and only one case was related to tick bites alone. Severe cases were over-represented: 64 (72.7%) had a platelet count < 50 x 109/L and 32 (36.4%) died. There was no intrafamilial spread or healthcare-associated infection. The viral S segments from 11 patients presenting in 2013 and 2014 were all grouped in Asia 1 (IV) lineage., Conclusions: CCHF is well-established throughout Oman, with a single strain of virus present for at least 20 years. Most patients are men involved in animal husbandry and butchery. The high mortality suggests that there is substantial under-diagnosis of milder cases. Preventive measures have been introduced to reduce risks of transmission to animal handlers and butchers and to maintain safety in healthcare settings., Competing Interests: The authors have declared that no competing interests exist.

Crimean-Congo haemorrhagic fever (CCHF) is a zoonotic viral haemorrhagic disease. This disease is more common in people who work with animals infected with CCHF virus. The aim of this study was to evaluate the CCHF exposure in high-risk occupational groups in Kurdistan Province in the west of Iran. This cross-sectional study was conducted in 2014 in three counties of Kurdistan Province, viz. Sanandaj, Marivan and Sarvabad. About 50 butchers and slaughterhouse workers, 50 hunters, 50 health care workers and 100 subjects referred to clinical laboratories were sampled and examined for the diagnosis of IgG antibodies against the CCHF using ELISA method. The serum sample of one of the butchers and slaughterhouse workers was positive for CCHF virus. No positive case was found in any other studied groups. The study findings indicate that although CCHF is an endemic disease in different parts of Iran, there is a low rate of seropositivity among high-risk occupations in the west of Iran. Therefore, it is not probably a serious public health problem in this area., Competing Interests: None