Krim-Kongo Hämorrhagisches Fieber

[Birgitt]

CRIMEAN-CONGO HEMORRHAGIC FEVER - TURKEY (06): TREATMENT
********************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Fri 4 Jul 2008
Source: Today's Zaman online [edited]
<http://www.todayszaman.com/tz-web/detay ... ink=146541>


Crimean-Congo hemorrhagic fever update
--------------------------------------
The Health Ministry Basic Health Services General Director Seracattin
Com has stated that: "This year we've had 551 Crimean-Congo
hemorrhagic fever (CCHF) patients, but there have only been 33 deaths."

Health Ministry Basic Health Services General Director Seracattin Com
explained that those people who contract CCHF but successfully recover
develop antibodies against the virus. "We collect blood samples from
these patients and process their blood to produce hyper-immune
globulin. We administer this to patients suffering from the disease,"
he said. Even in severe cases, 9 out of 10 patients recovered from
the disease.

Com indicated that they would exhaust hyper-immune globulin stocks in several
months and would collect new blood samples, particularly from people
in the Kelkit Valley, which is infested by ticks. "We have records of
the patients who have suffered from CCHF since 2002. We will conduct
medical examinations and collect blood samples from suitable donors. I
can't say how much blood we'll collect; we will try to amass a stock
that will last for one year," he said. Com asserted that the sera are
being successfully used in many cases.

--
Communicated by:
Claudio Po
<ClPo@regione.emilia-romagna.it>

[This report documents a considerable increase in CCHF cases and
fatalities in Turkey during the course of the past 4 weeks. The death
total is now reported to be 33 (among 551 cases) compared with 15
deaths among approximately 300 cases by the beginning of June 2008.
The recently developed immunotherapy procedure outlined above has yet
to fulfill its potential.

The HealthMap/ProMED-mail interactive map of Turkey is available at:
<http://healthmap.org/promed?v=39.1,35.2,5>, and a map delineating
the administrative provinces of Turkey can be accessed at:
<http://www.mapsofworld.com/turkey/turke ... l-map.html>. - Mod.CP]

[Birgitt]

Weitere Informationen zu Krim-Kongo Hämorrhagisches Fieber HIER

[Birgitt]

Vor Krim-Kongo-Fieber und Gelbfieber wird gewarnt
Erkrankungen in der Türkei und Südamerika
27.06.2008 - Ärzte Zeitung

Der Zeckenschutz hat in der aktuellen reisemedizinischen Beratung hohen Stellenwert: So werden etwa aus der Türkei Erkrankungen an Krim-Kongo hämorrhagischem Fieber (CCHF) gemeldet, teilt das Centrum für Reisemedizin (CRM) mit.

Krim-Kongo-Fieber: Das durch Zecken übertragene CCHF ist mit zunehmender Tendenz in weiten Teilen der Türkei endemisch geworden. Schwerpunkte liegen im zentralen und nördlichen Anatolien. In diesem Jahr hat es bereits 20 Tote durch CCHF gegeben. Die Erkrankung ist in der Türkei erst seit 2002 bekannt. Zur Prophylaxe ist auf den Schutz vor Zeckenstichen durch Kleidung und Repellentien zu achten. Der Kontakt zu Erkrankten ist zu meiden ... mehr

Gruß
Birgitt

[Birgitt]

Griechin starb an dem von Zecken übertragenen Krim-Kongo-Fieber
03.07.2008 - Ärzte Zeitung

ATHEN (dpa). In Griechenland ist eine 46 Jahre alte Frau an dem seltenen Krim-Kongo-Fieber gestorben. Einen Impfschutz gegen die nur von Zecken übertragene Krankheit gibt es bislang weltweit nicht. Wie der griechische Staatsrundfunk am Donnerstag berichtete, starb die Frau in der Präfektur Evros an der griechisch-türkischen Grenze ... mehr

Gruß
Birgitt

[Birgitt]

Südafrika - Krim-Kongo hämorrhagisches Fieber (CCHF)
21.07.2008

In der Eastern Cape Provinz ist ein Farmer nach Zeckenkontakt an CCHF erkrankt. Der Erreger, ein Virus, wird gewöhnlich durch Zecken übertragen, gelegentlich aber auch von Mensch zu Mensch. Schutz vor Zeckenstichen beachten, Kontakt mit Kranken meiden. / Quelle: crm

[Birgitt]

CRIMEAN CONGO HEMORRHAGIC FEVER - SOUTH AFRICA (02): (EASTERN CAPE)
*******************************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Thu 24 Jul 2008
Source: iol News online [edited]
<http://www.iol.co.za/index.php?from=rss ... 745C229929>


Farmer with Crimea-Congo fever dies
-----------------------------------
A farmer and professional hunter from Adelaide in the Eastern Cape
died on Thursday [4 Jul 2008] after having been diagnosed with
Crimea-Congo haemorrhagic fever, the health department said.

Spokesperson Sizwe Kupelo said the man, 39, died at the St Georges
hospital. "Following his diagnosis a health investigation team was
sent to Adelaide to see if anyone else was infected. "No one else was
diagnosed with the fever," he said. The man was admitted to hospital
on 12 Jul 2008.

The viral disease is transmitted to humans by ticks or contact with
blood or tissue from infected animals, and is potentially fatal.
Kupelo said the man was reportedly bitten by a tick on 3 Jul 2008,
and went to see a doctor 4 days later. Then, 3 days after that he
developed a range of typical fever symptoms including nausea,
vomiting, and joint pains.

The fever is the most common of a range of haemorrhagic fevers that
occurs in South Africa. According to the National Institute for
Communicable Diseases, anything between 5 and 25 cases are reported
each year, most of them in the Karoo, the Western Free State, the
Northern Cape and North West province. Most of the sufferers are
farmers, farm labourers, hunters or abattoir workers. Symptoms
include fever, aching muscles, dizziness, neck pain and stiffness,
headache, sore eyes, nausea and vomiting, diarrhoea, nose bleeding,
and other non-normal bleeding. According to the World Health
Organisation, one in 3 sufferers dies from the disease. There is no
safe and effective vaccine widely available for human use.

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[This reports the death of the patient described in greater detail in
the ProMEDmail post of 15 Jul 2008 archived as 'Crimean-Congo hem.
fever - South Africa: (Eastern Cape) 20080716.2162.'

Supplementary information on all aspects of Crimean-Congo hemorrhagic
fever can be found in the WHO Factfile at
<http://www.who.int/mediacentre/factsheets/fs208/en/>. A map of the
provinces of South Africa is available at
<http://www.places.co.za/html/visualfind.html>. The
HeathMap/ProMED-mail interactive map of South Africa at
<http://healthmap.org/promed?v=-29,25.1,5> can be used to locate
Adelaide in the centre of Eastern Cape province. - Mod.CP]

[Birgitt]

Anhängliche Zecken kurzerhand schockfrosten
Im Urlaub in Risikogebieten an die Vorbeugung denken - Von den Parasiten übertragenes Krim-Kongo-Fieber breitet sich aus
25.07.2008 - Eßlinger Zeitung

Die Nachrichten klingen dramatisch: Allein in der Türkei sind in den vergangenen anderthalb Jahren an die 60 Menschen an dem von Zecken übertragenen Krim-Kongo-Fieber (CCHF) gestorben. Zum ersten Mal wurde diese Viruserkrankung jetzt auch in der Gegend um die beliebte Urlauberstadt Antalya am Mittelmeer festgestellt. „Vorbeugung ist das A und O“, betont deshalb Christoph Mauz. Der Esslinger Fachapotheker für Toxikologie und Ökologie hat sich eingehend mit dem Thema beschäftigt ... mehr

Gruß
Birgitt

[Birgitt]

CRIMEAN-CONGO HEMORRHAGIC FEVER - TÜRKEI (14): BACKGROUND
*********************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Thu 14 Aug 2008
Source: Eurosurveillance, Volume 13, Issue 33, 2008 [edited]
<http://www.eurosurveillance.org/ViewArt ... leId=18953>


Crimean-Congo haemorrhagic fever (CCHF) is a
disease caused by a virus belonging to the
_Bunyaviridae_ family. CCHF virus isolation
and/or disease have been reported from more than
30 countries in Africa, Asia, southeastern
Europe, and the Middle East [1]. The main
transmission routes of the virus are tick-bite
and contact with tissues, body fluids and blood
of infected animals [1-4]. Nosocomial
transmission is another important route of
infection [1]. The incubation period is generally
described as 1-3 days after tick-bite and 5-6
days after exposure to infected animal or human
blood or body fluid, but it can be longer. Fever,
chills, headache, fatigue and myalgia are the
most common symptoms in the pre-haemorrhagic
period. The disease progresses to haemorrhagic
form in severe cases [1]. The fatality rate of
disease is reported between 7.5-50 percent in
hospitalised patients [4-7]. This wide range may
due to phylogenetic variation of the virus,
transmission route and different treatment
facilities [4-7].

Epidemiological situation in Turkey
-----------------------------------
Although confirmed CCHF patients or serological
evidence of the virus were being reported from
neighboring countries, there had been no evidence
of CCHF cases before 2002 in Turkey. The 1st
cases were detected in the town of Tokat in the
Kelkit Valley region in northern Turkey in 2002
[8].

Between 2002 and 2007, a total of 1820 confirmed
cases, including 92 deaths, were reported to the
Ministry of Health (MoH) of Turkey, showing an
increasing trend over the years. The majority of
cases (95 percent) were reported from middle and
eastern Anatolia, particularly from the cities of
Tokat, Sivas, Yozgat, Corum, and Erzurum [9].
Most of the cases were diagnosed between March
and October, with peak levels in June and July,
which correspond with the tick season. The
average case fatality rate between 2002 and 2007
was 5 percent, (range 4.5 percent-6.2) [9]. 70
percent of the cases had a history of tick
contact, while most of the remaining 30 percent
had a history of contact with livestock, and 3
cases were attributed to nosocomial transmission
[9] [see 1st ProMED ref. below].

Studies on ticks performed in areas where human
cases had been reported found CCHF in _Hyalomma
marginatum marginatum_ pools (10,11).

Since December 2003, CCHF is a notifiable disease
in Turkey. Cases with epidemiological risk
factors, clinical symptoms and laboratory
findings compatible with CCHF are reported to the
Ministry of Health (MoH) as probable cases. The
case definition for probable cases includes:

Epidemiological risk factors: Tick-bite or tick
contact; work in animal husbandry or farm;
contact with the body fluid of a CCHF patient;
work at a laboratory; close contact with a CCHF
case.

Clinical symptoms: Fever, haemorrhage,
headache of acute onset, myalgia/arthralgia,
lethargy, nausea/vomiting, or abdominal pain/
diarrhea.

Laboratory findings: Thrombocytopenia (platelets less than 150
000/mm3) and/or leucopenia (WBC less than 4000/mm3), elevated levels
of alanine aminotransferase (ALT), aspartate aminotransferase (AST),
lactate dehydrogenase (LDH) and creatine phosphokinase (CK).

Cases with confirmed CCHF virus RNA in the blood
or body fluid samples through RT-PCR evaluation
or IgM positivity through ELISA are considered
confirmed CCHF cases. The laboratory diagnostics
for CCHF are done on the national level in the
Virology Laboratory of Refik Saydam Hygiene
Center in Ankara.

Preliminary results in 2008
---------------------------
The 1st CCHF case in 2008 was detected and notified to the MoH on 24
Mar 2008. As of 30 Jun 2008, 688 confirmed cases have been reported: 4
in March, 57 in April, 282 in May and 345 in June 2008. Of these, 41
patients have died due to CCHF, corresponding to a case fatality rate
[CFR] of 5.96 percent. As in previous years, most of the cases were
from the Middle and Eastern Anatolia region (91 percent). Sporadic
cases (9 percent of the total) have been reported from the
southeastern and western parts of Turkey as well.

The male to female ratio was 1.07. The mean age of the patients was
44.3 plus or minus 19.5 years (range: 2-93 years). The proportion of
cases was highest among patients of working age, especially adults
from rural areas. The distribution of patients according to occupation
was 51.8 percent farmers, followed by 18.9 percent homemakers (who in
rural areas generally work in agriculture and animal husbandry), and
16.5 percent those working in the animal husbandry sector.

Regarding possible modes of transmission, 71 percent of the cases had
a history of tick bite; 21.9 percent reported unprotected contact with
blood or body fluids of domestic animals; 5healthcare workers exposed
to patients' blood and body fluids by mucosal contact have been
diagnosed as nosocomi al CCHF cases until the end of June 2008. None
of them died.

Control measures
-----------------
A scientific advisory commission was set up by
MoH in 2003. This commission meets regularly, and
its recommendations regarding treatment options,
isolation measures, suggestions for disinfection,
and approach in handling the deceased have been
put in action.

In 2004, MoH in collaboration with the Ministry
of Agriculture and Rural Affairs (MARA) initiated
a surveillance and control programme including
education regarding the disease and its
transmission routes, tick removal, handling
tick-bite cases, protected contact with animals,
prevention of nosocomial infections and early
detection of cases. This programme has been
conducted throughout the whole country, and
especially intensively in the epidemic region. It
has been updated in 2007.

In 2008, brochures, posters and TV spots
informing about the risk of CCHF infection were
updated and distributed to educate the public and
the healthcare workers. In the epidemic area,
education programmes have been conducted door to
door by provincial health directorates under the
MoH. These included information regarding
inspecting body for ticks, removing ticks as soon
as possible, limiting exposure to body fluids or
blood of livestock and using permethrine
repellent 0.5 percent for treating clothes. The
MoH collaborates closely with the MARA regarding
tick combat in livestock at the central and
provincial level.

Conclusion
----------
Cases of CCHF have been reported in Turkey since
2002, mostly in spring and summer and in middle
and eastern Anatolia. This has been associated
with factors such as climatic features
(temperature, humidity, etc.), changes of vector
population, geographical conditions, flora, wild
life and the animal husbandry sector [12]. The
number of cases has been increasing over the
years, which may also be due to better awareness
of health care personnel and the public about the
disease in addition to the above factors [9].

[By G R Yilmaz 1, T Buzgan1, M A Torunoglu1, A
Safran1, H Irmak1, S Com1, Y Uyar2, A Carhan2, E
Ozkaya2, M Ertek2 1 Ministry of Health, Primary
Health Care Directorate, Ankara,Turkey 2 Refik
Saydam Hygiene Center, Ankara, Turkey]

References:

1. Whitehouse CA. Crimean-Congo Hemorrhagic
Fever. Antivir Res. 2004;64(3):145-60.
2. Hoogstraal H. The epidemiology of tick-borne
Crimean-Congo haemorrhagic fever in Asia, Europe
and Africa. J Med Entomol. 1979;15:307-417
3. Schwarz TF, Nsanze A, Ameen AM. Clinical
features of Crimean-Congo Haemorrhagic Fever in
the United Arab Emirates. Infection.
1997;40:364-7.
4. Ozkurt Z, Kiki I, Erol S, Erdem F, Yilmaz N,
Parlak M, et al. Crimean-Congo hemorrhagic fever
in Eastern Turkey: clinical features, risk
factors and efficacy of ribavirin therapy. J
Infect. 2006;52(3): 207-15.
5. Ergonul O, Celikbas A, Baykam N, Eren S,
Dokuzoguz B. Analysis of risk-factors among
patients with Crimean-Congo haemorrhagic fever
virus infection: severity criteria revisited.
Clin Microbiol Infect. 2006 Jun;12(6):551-4
6. Cevik MA, Erbay A, Bodur H, Gulderen E, Bastug
A, Kubar A, et al. Clinical and laboratory
features of Crimean-Congo Hemorrhagic Fever:
predictors of fatality. Int J Infect Dis.
2008;12(4):374-9.
7. Centers for Disease Control and Prevention.
Crimean-Congo Haemorrhagic Fever. Factsheet.
Available from:
<http://www.cdc.gov/ncidod/dvrd/spb/mnpa ... s/cchf.htm>
8. Gozalan A, Esen B, Fitzner J, Tapar FS, Ozkan
AP, Georges-Courbot MC, et al. Crimean-Congo
haemorrhagic fever cases in Turkey. Scand J
Infect Dis. 2007;39(4):332-6.
9. Yilmaz GR, Buzgan T, Irmak H, Safran A, Uzun
R, Cevik MA, et al. The epidemiology of
Crimean-Congo Hemorrhagic Fever in Turkey:
2002-2007. Int J Infect Dis. In press 2008.
10. Tonbak S, Aktas M, Altay K, Azkur AK, Kalkan
A, Bolat Y, et al. Crimean-Congo Hemorrhagic
Fever Virus: Genetic Analysis and Tick Survey in
Turkey. J Clin Microbiol. 2006;44(11):4120-4.
11. Whitehouse CA, Hottel H, Deniz A, et al.
Molecular detection of Crimean-Congo Haemorrhagic
Fever virus in ticks from Turkey. In: American
Society of Tropical Medicine and Hygiene 55th
Annual Meeting, November 12-16, 2006, Atlanta,
Georgia, USA.
12. Estrada-Pena A, Vatansever Z, Gargili A,
Aktas M, Uzun R, Ergonul O, et al. Modeling the
spatial distribution of Crimean-Congo Hemorrhagic
Fever outbreaks in Turkey. Vector Borne Zoonotic
Dis. 2007;7(4):667-78.

--
Communicated by:
ProMED-mail <promed@promedmail.org>

[From zero cases before 2002 to 688 cases so far in 2008 certainly
qualifies CCHF to be considered as an emerging disease in Turkey. -
Mod.CP]

[Birgitt]

Griechenland - Krim-Kongo hämorrhagisches Fieber CCHF
25.08.2008

Zwei Todesfälle an dieser mit Fieber, schweren Allgemeinerscheinungen und gelegentlich Blutungen einhergehenden Erkrankung wurden bis Ende August aus der Evros-Praefektur gemeldt. Der Evros ist ein Grenzfluss im NO des Landes. In der benachbarten Türkei wurde in den letzten Jahren eine zunehmende Zahl dieser Erkrankung gemeldet, allerdings in den zentralen und östlichen Landesteilen (s.dort). Der Erreger, ein Virus, wird gewöhnlich durch Zecken übertragen, gelegentlich aber auch von Mensch zu Mensch. Schutz vor Zeckenstichen beachten, Kontakt mit Kranken meiden. / Quelle: crm

[Birgitt]

Türkei - Krim-Kongo hämorrhagisches Fieber (CCHF)
18.05.2009

Im Mai verstarben 2 Personen in Samsun am Schwarzen Meer an CCHF. Die Erkrankung geht mit Fieber, schweren Allgemeinerscheinungen und gelegentlich Blutungen einher und tritt besonders in der warmen Jahreszeit auf. Der Erreger, ein Virus, kommt vor allem im zentralen, nördlichen und östlichen Anatolien mit den Provinzen Samsun, Corum, Tokat, Amasya sowie Gumushane, Sivas, Bayburt, Cankin, Yozgat, Karabuk, Kastamonu, Erzurum und Erzincan vor; aus den Urlaubsgebiete im Süden der Türkei wurden bisher keine Fälle berichtet. Die Übertragung erfolgt gewöhnlich durch Zecken, gelegentlich aber auch von Mensch zu Mensch. Schutz vor Zeckenstichen beachten, Kontakt mit Kranken meiden. / Quelle: crm

[Alexander]

Gefährliche Viruserkrankung breitet sich in Türkei aus

Reisemediziner warnen vor einer durch Zecken übertragenen Krankheit, die sich in der Türkei ausbreitet. Betroffen von dem sogenannten Krim-Kongo hämorrhagischen Fieber (CCHF) sind inzwischen nach Angaben des Centrums für Reisemedizin weite Teile Anatoliens sowie die Küsten von Mittelmeer und Schwarzem Meer. mehr...

Grüsse
Alexander

[Birgitt]

CRIMEAN-CONGO HEMORRHAGIC FEVER - TURKEY (02): (TOKAT, YOZGAT)
***********************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Sun 24 May 2009
Source: Hurriyetet Daily News [edited]
<http://www.hurriyet.com.tr/english/dome ... sp?scr=3D1>


Two people died on Friday [22 May 2009] after being bitten by ticks
in central Anatolia, news agencies reported, while a scientific study
of ticks has identified 3 species in Tokat that carry Crimean-Congo
hemorrhagic fever virus [CCHFV]. A 38-year-old man died after he was
bitten by a tick in the Zile district of the central Anatolian
province of Tokat, reported the Dogan news agency. Last week, he had
been bitted by a tick and removed the tick himself, the Dogan news
agency reported. A couple of days later, he became sick and was
hospitalized and suspected to have contracted CCHFV infection

A 59-year-old woman living in a village of Yozgat [province] also
died on Friday [22 May 2009] after she was hospitalized as a
suspected case of CCHFV infection. Blood samples from both the man
and the woman were sent to Ankara for a conclusive diagnosis,
reported the private news channel NTV.

The investigation that aimed to examine the different types of ticks
in Turkey identified that 3 among 25 tick species carried the virus,
the Anatolia news agency reported. The study was initiated with the
support of the Scientific and Technical Research Council of Turkey
(TUBITAK) in 2006 in the Kelkit basin. The project in the long run
aims to examine all tick species throughout the whole of Turkey.

--
Communicated by:
ProMED-mail Rapporteur Susan Baekeland

[In 2008, 55 people died in Turkey from CCHFV infection, bringing the
total number of CCHFV infection deaths to 147 since the 1st case in 2002.

The 2 deaths reported above are assumed to be the 3rd and 4th fatal
cases of CCHFV infection reported in Turkey this year [2009]. The
number of cases can be expected to increase from now on, with the
onset of warmer weather and proliferation of the tick vector.

The HealthMap/ProMED-mail interactive map of Turkey is available at
<http://healthmap.org/r/00bZ>.
A map showing the location of the provinces of Tokat and Yozgat can
be accessed at
<http://www.mapsofworld.com/turkey/turke ... l-map.html>.
Tokat and Yozgat lie to the south of the coastal province of Samsun,
where the 1st 2 cases in 2009 were recorded. - Mod.CP]

[Birgitt]

Türkei - Krim-Kongo hämorrhagisches Fieber (CCHF)
25.05.2009

2 weitere Personen verstarben Ende Mai (ein 38-jähriger Mann und eine 59-jährige Frau) in Zentralanatolien an CCHF. Damit stieg die Zahl der Todesfälle in der Türkei in diesem Jahr auf 4 an. Die Erkrankung geht mit Fieber, schweren Allgemeinerscheinungen und gelegentlich Blutungen einher und tritt besonders in der warmen Jahreszeit auf. Der Erreger, ein Virus, kommt vor allem im zentralen, nördlichen und östlichen Anatolien mit den Provinzen Samsun, Corum, Tokat, Amasya sowie Gumushane, Sivas, Bayburt, Cankin, Yozgat, Karabuk, Kastamonu, Erzurum und Erzincan vor; aus den Urlaubsgebiete im Süden der Türkei wurden bisher keine Fälle berichtet. Die Übertragung erfolgt gewöhnlich durch Zecken, gelegentlich aber auch von Mensch zu Mensch. Schutz vor Zeckenstichen beachten, Kontakt mit Kranken meiden. / Quelle: crm

[Birgitt]

CRIMEAN-CONGO HEMORRHAGIC FEVER - TURKEY (03)
*********************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Wed 27 May 2009
Source: Today's Zaman, Press roundup [edited]
<http://www.todayszaman.com/tz-web/detay ... &bolum=130>


"Swine flu in the world, ticks in Turkey," read the headline of the daily's
top story yesterday [26 May 2009], reporting that while New York was shaken
by its 2nd death caused by swine flu, Turkey lost 5 people to Crimean-Congo
hemorrhagic fever (CCHF), caused by a virus transmitted by ticks, over the
past 4 days.

With the warming temperatures, CCHF cases have returned to Turkey. Two
people died from CCHF on Monday [25 May 2009], bringing the number of CCHF
victims in the past 4 days to 5. About 70 people lost their lives to CCHF
in Turkey last summer [2008]. The number of people who have died as a
result of swine flu around the world this year [2009] has increased to 91.
The 2nd death caused by swine flu in New York has led authorities to close
schools and caused cancellations of hotel reservations, the daily reported.

--
communicated by:
ProMED-mail rapporteur Susan Baekeland

[This brief report indicates that there have been 5 deaths in Turkey within
the past 4 days as a result of Crimean-Congo hemorrhagic fever virus
infection. These deaths are presumed to be additional to the 4 deaths
reported previously in Today's Zaman newspaper (see the preceding
ProMED-mail post), but this is not certain, as the provinces where the
deaths occurred are not identified. Undoubtedly, the number of cases will
increase as the tick vector becomes more abundant as the temperature rises.
- Mod.CP]

[Birgitt]

CRIMEAN-CONGO HEMORRHAGIC FEVER - TURKEY (04)
*********************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Fri 29 May 2009
Source: Today's Zaman [edited]
<http://www.todayszaman.com/tz-web/detay ... &bolum=100>


Experts advise vigilance against ticks
--------------------------------------
[Crimean-Congo hemorrhagic fever (CCHF) made its appearance in Turkey in
the country in 2002.] Since then, there have been 2315 cases of this
potentially fatal virus in 100 villages throughout Turkey, with 140 people
dying as a result. [The table in the footnote at the source URL shows a
somewhat higher figure. - Mod.CP]

The Ministry of Health has produced a map showing regions where people are
at risk of contracting CCHF, with the majority of the areas being in the
Central Anatolian and central Black Sea regions. The focus at this point in
terms of risk appears to be on the regions around Gumushane, Tokat, Sivas,
Amasya, Corum, Yozgat, Kastamonu, Karabuk and Cankiri.

Tick bites tend to be more prevalent when the weather starts to warm up,
but this year [2009] the 1st tick bites seen by health professionals came
earlier than expected. Experts say that with warmer weather staring earlier
than usual, ticks have laid eggs and these eggs have then hatched in
advance of their normal time, meaning that people are coming in close
contact with ticks earlier than in previous years.

Experts also note that ticks remain active essentially until the weather
outside becomes too cold for them and that people will thus have to remain
vigilant until November and all through the summer months. Experts also
warn people to check their bodies carefully after spending time outdoors,
especially in open fields or forest lands.

Dr Orhan Yildiz of Erciyes University's medical faculty noted that a fully
grown tick produces around 6000 baby ticks yearly and that there is no way
to prevent this from happening. Yildiz noted that as the number of ticks
rises, so does the number of cases of people being bitten and getting ill
from the tick bites. He points to the early rise in temperatures in some
parts of Turkey as having led to early tick egg hatchings.

Yildiz also pointed to general climate change in the world, the limitations
placed on rabbit hunting and the wholesale destruction of many chickens in
Turkey around the time of the bird flu scare as all being factors that have
led to a steep rise in the number of ticks in the nation. He says that more
difficult days in fighting these ticks face Turkey in the future.

Dr Zati Vatansever of Kars Kafkas University's veterinary faculty noted
that early detection of a tick on the body can play a large role in
preventing serious illness and even death. Dr Vatansever noted that many
people returning from working or relaxing outdoors are not even aware that
they have been bitten by a tick, and he warned: "When people who have been
outside in a field or on a picnic return home, they should check themselves
carefully. Ticks suck blood from cows. So, if we give certain anti-tick
medicine to the cows, we should be able to reduce the numbers of these
ticks somewhat. There is no other method that we know of. There is some
talk of other ways that could be used to fight ticks, but it's nothing but
sensationalism." Vatansever also noted that while there are 900 different
kinds of ticks that have been scientifically identified, there are around
30 different kinds in Turkey, and that one of these carries the virus.

Incorrect information about ticks
---------------------------------
Vatansever noted that there is a lot of incorrect information about ticks
circulating among people these days. Noting that tick-transmitted viral
diseases have been around for a long time, Vatansever said: "This
particular virus has existed for a long time, but we didn't know about it.
We didn't notice it because there were so few cases. Then we really became
aware because the number of cases shot up. There is a considerable level of
ecological regeneration going on in Turkey -- from forestry projects to an
increase in the number of wild animals. In addition to all this, there is
the ongoing migratory trend from villages to cities and towns. The fact
that fields are not being fully used and worked has created an ideal
environment for wild animals and the ticks that feed off of them. If we
look at the ecological regeneration going on since the 1990s, it is much
easier for us to understand so much here."

Vatansever also noted that how a person removes a tick from his or her body
is not the important thing, but that the real question in terms of the
disease entering the body is how long the tick has been feeding off the
blood of that person. He said: "If you are able to remove the tick within
the 1st 6 to 12 hours, then the risk of contracting a disease is at its
lowest. But the longer the tick is attached to your body, the more time
there is for the virus to be transmitted into the bloodstream, and thus the
risk rises."

--
communicated by:
ProMED-mail rapporteur Susan Baekeland

[This newspaper article contains some interesting statistics which differ
from some available previously. The following table appeared as a footnote:
CCHF cases and deaths in Turkey by year:
- 2002-2003: 150 reported cases and 6 deaths
- 2004: 249 reported cases and 13 deaths
- 2005: 266 reported cases and 13 deaths
- 2006: 438 reported cases and 27 deaths
- 2007: 717 cases and 33 deaths
- 2008: 1315 reported cases and 135 deaths
- 2009: (1st 5 months) 5 deaths so far.

The HealthMap/ProMED-mail interactive map of Turkey is available at
<http://healthmap.org/r/00bZ>, and a map of the provinces of Turkey at
<http://www.mapsofworld.com/turkey/turke ... l-map.html>. - Mod.CP]