I am indebted to the National Institute for Communicable Diseases (NICD) in Johannesburg for their very informative newsletter, from which I culled this.
I would also like to very sincerely congratulate Professor Barry Schoub, a long-time former Director of the NICD, on his African Society for Laboratory Medicine (ASLM) Lifetime Achievement Award! Very well deserved.
Crimean-Congo haemorrhagic fever
Two cases of Crimean-Congo haemorrhagic fever (CCHF) acquired in South Africa have been laboratory confirmed in January 2013.
On 1 January 2013, a 31-year-old male working as a game warden on private game ranch near Jagersfontein (Free State Province) presented with clinical features suggestive of CCHF. The patient did not report any tick bites or direct exposure to unprocessed meat or slaughtering of animals. The Centre for Emerging and Zoonotic Diseases of the NICD/NHLS confirmed infection with CCHF virus by PCR and serology testing.
A second case of CCHF was laboratory confirmed on 12 January 2013 in a 44-year-old male hospitalised in Bloemfontein, Free State Province. He had been on a farm in Pomfret, North West Province (situated ±5 km from the border with Botswana), where he was bitten by a tick. Three days later he developed symptoms, and presented with fever, rash, conjunctivitis and pharyngitis. No laboratory-confirmed cases were identified in 2011- 2012.
Human CCHF cases have been reported annually from South Africa since 1981, when it was first recognised in the country; between 0 and 20 cases of CCHF are diagnosed each year. Through nearly thirty years of passive surveillance, a total of 187 cases has been laboratory confirmed. Although cases have been reported from all of the nine provinces, more than half of the cases originate from the semi-arid areas of Northern Cape Province (31.5% of cases) and Free State Province (23% of cases).
CCHF infection is generally asymptomatic in many species of wildlife (including antelope) and livestock animals (including cattle, sheep, goats, hares and ostriches). Humans become infected sporadically by ticks, particularly Hyalomma ticks, which are both reservoirs and vectors for CCHF virus. Other modes of transmission include direct contact with blood/tissues of infected animals, and in the case of healthcare workers, through direct contact with the blood/tissue of infected patients; nosocomial outbreaks are well described and have been associated with high mortality rates. Disease may be severe in people, with case-fatality rates reported as 3 – 30% across various studies.