Question 1

What is Crimean-Congo haemorrhagic fever?

Accepted Answer

CCHF is a severe tick-borne viral haemorrhagic fever caused by CCHF virus (CCHFV) — a Nairovirus. Transmitted primarily through the bite of Hyalomma ticks or through direct contact with blood or tissues of infected animals or humans. It causes severe disease in approximately 10-40% of infected individuals — with high case fatality and haemorrhagic manifestations. It is endemic across Africa, the Balkans, the Middle East and Central Asia, and is expanding into Europe.

Question 2

How is CCHF transmitted?

Accepted Answer

Tick bites: Hyalomma ticks transmit CCHF virus from tick larvae/nymph to adult ticks (transstadial transmission) and to animals. Infected ticks bite humans — primarily farmers, shepherds, veterinarians and slaughterhouse workers. Contact with animal blood: slaughtering or handling livestock in the days after tick infestation — when animals are viraemic — is a common exposure. Human-to-human: direct contact with blood or body fluids of infected patients — the most serious nosocomial risk.

Question 3

What are the symptoms?

Accepted Answer

CCHF has four phases: (1) Incubation (1-13 days after tick bite; 5-6 days after infected tissue contact). (2) Pre-haemorrhagic/febrile phase (3-5 days): sudden fever, headache, severe myalgia, backache, joint pain, photophobia, nausea, vomiting, abdominal pain. (3) Haemorrhagic phase (days 3-6 in severe cases): petechiae, ecchymoses, epistaxis, gum bleeding, haematemesis, melaena; DIC; thrombocytopenia, elevated liver enzymes, renal failure. (4) Convalescent phase (days 10-20): slow recovery in survivors.

Question 4

Why is CCHF a WHO priority pathogen?

Accepted Answer

CCHF has characteristics meeting all WHO R&D Blueprint criteria: case fatality rate 10-40% (inadequate countermeasures); large susceptible population across 30+ countries; potential for nosocomial spread causing healthcare worker deaths; geographic range actively expanding with climate change (Hyalomma ticks moving north); massively underreported burden; no approved vaccine; and inadequate evidence for antiviral treatment efficacy. The potential for CCHF to cause healthcare facility outbreaks in new areas where clinical awareness is low is a major concern.

Question 5

How is CCHF treated?

Accepted Answer

Supportive care is the mainstay — fluid replacement, electrolyte management, treatment of haemorrhagic complications (platelet transfusion, fresh frozen plasma, cryoprecipitate for DIC), dialysis for renal failure, and mechanical ventilation for respiratory failure. Ribavirin: recommended by WHO based on observational data and in vitro activity; early initiation (within 4 days) is most important; IV preferred. No other specific antiviral is approved. Monoclonal antibodies and hyperimmune immunoglobulin are being investigated.

Question 6

Why is CCHF expanding into Europe?

Accepted Answer

CCHF has been detected in Spain (2010 — first autochthonous European cases outside the Balkans), and subsequently in France (2023) and England (imported). Hyalomma tick range expansion — driven by warming temperatures and migratory bird movements carrying infected ticks northward — is the primary mechanism. Climate models project further northward expansion of Hyalomma ticks — potentially into new European countries. The Georgia and South Caucasus region is in the established CCHF endemic zone.

Question 7

Is CCHF present in Georgia?

Accepted Answer

The South Caucasus — including Georgia, Azerbaijan and Armenia — is within the CCHF endemic range. Hyalomma ticks are found in the region; CCHF cases have been documented in adjacent countries. Healthcare providers should include CCHF in the differential diagnosis of unexplained febrile haemorrhagic illness in individuals with livestock exposure or tick bites. PHIG coordinates zoonotic disease surveillance including CCHF.

Question 8

How does GMJ News cover CCHF?

Accepted Answer

GMJ News covers WHO CCHF fact sheets, European emergence, Turkey and Balkan outbreak data, ribavirin evidence, vaccine development (CEPI INO-4500), nosocomial prevention, and the South Caucasus endemic risk. CCHF is directly relevant to Georgian health security surveillance and PHIG's One Health mandate.

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