Crimean Congo Hemorrhagic Fever

Overview

Crimean-Congo haemorrhagic fever (CCHF) is a rare illness caused by a virus. It is spread mainly by ticks — small blood-sucking creatures that live on animals such as sheep, goats, cattle and camels. People can also catch it by touching the blood or body fluids of infected animals or, less often, of an infected person. 'Haemorrhagic' means it can, in serious cases, cause bleeding. Most people who catch CCHF get a sudden fever and feel very unwell, and many recover with good hospital support. A small number become seriously ill, so early medical care matters.

CCHF is rare. Cases are reported in a limited number of countries, and even there the total number of infections each year is small. People living in or travelling to affected regions who work with animals or spend time in countryside areas have the most exposure. For most people in the UK and other non-affected countries, the risk is extremely low.

It can affect anyone exposed to infected ticks or infected animal blood and tissue. This mostly means farmers, shepherds, abattoir and veterinary workers, and people who camp or walk in affected rural areas. Healthcare workers caring for infected patients without proper protective equipment are also at risk. Children can be affected too, usually after playing or being outdoors in an affected area.

Symptoms

Common symptoms

• Sudden high fever
• Headache, often severe
• Muscle aches and back pain
• Neck stiffness and sore, light-sensitive eyes
• Feeling sick, vomiting and diarrhoea
• Sore throat and tummy pain
• Mood changes, irritability or confusion
• Later on: small purple-red spots or bruises on the skin, and bleeding from the nose, gums or where a needle has been

Symptoms in children

• Fever and irritability, sometimes with a lot of crying
• Refusing feeds or eating much less than usual
• Vomiting and loose stools
• Being sleepier or harder to wake than usual
• A rash of small spots or easy bruising
• Children may not describe headaches or muscle pain clearly, so behaviour changes matter

Symptoms in older adults

• Symptoms can come on quickly and become serious sooner
• More chance of dehydration and confusion
• Bleeding and bruising may be more noticeable, especially if the person takes blood-thinning medicines
• Existing heart, lung or kidney conditions can make the illness harder to cope with

Causes

Main causes

• A bite from an infected tick — the most common route
• Crushing an infected tick with bare hands, or getting tick blood or fluids on broken skin
• Touching the blood, organs or body fluids of infected livestock, especially during slaughter, butchering or birthing
• Contact with the blood, vomit, stools or other body fluids of an infected person, which is a risk mainly for carers and healthcare staff without protective equipment
• Drinking unpasteurised milk or eating raw meat from infected animals (a less common route)

Risk factors

• Living, working or travelling in areas where CCHF occurs (parts of Africa, the Middle East, the Balkans, central Asia and the Indian subcontinent)
• Farming, shepherding, abattoir or veterinary work
• Walking, camping or working in long grass or scrubland where ticks live
• Caring for someone who is infected without gloves, gown, mask and eye protection
• Handling animals or animal products without protective clothing

When to see a doctor

See a doctor urgently if:

• You have a fever and have had a tick bite in the last two weeks
• You have a fever within two weeks of travelling to a country where CCHF is found
• You have a fever after close contact with animals or animal blood in an affected area
• You develop bruising, small red or purple spots, or any unusual bleeding
• You feel very drowsy, confused or much more unwell than a normal cold or flu

Book a routine appointment if:

• You are planning travel to an affected region and want advice on tick protection
• You work with livestock or in an abattoir and want to know how to reduce your risk
• You have been bitten by a tick and want it removed or checked, even if you feel well
• You are worried about symptoms after returning from abroad and are not sure who to ask

Diagnosis

A doctor will start by asking about your symptoms, any tick bites, contact with animals, and where you have travelled or worked in the last two weeks. That travel and contact history is often the clue that points towards testing. Because the early symptoms look like many other illnesses, laboratory tests on blood are needed to confirm CCHF and to rule out similar infections such as malaria.

Tests that may be done

• Blood tests to check how your liver, kidneys and blood-clotting system are working
• A specific blood test that looks for the virus's genetic material (a PCR test), usually early in the illness
• Blood tests that look for the body's immune response (antibodies), which show up a bit later
• Tests to rule out other infections with similar symptoms, such as malaria or other fevers spread by ticks
• Tests are usually done in a specialist laboratory because of the safety precautions needed

What to expect at your appointment

If CCHF is suspected, you will usually be cared for in a single room in hospital while tests are done. Staff will wear protective clothing when they come near you. This can feel strange or isolating, but it is a routine safety step and does not mean your case is hopeless. Test results may take a day or more, and you will be monitored closely in the meantime. Ask the team to explain what is happening — you are entitled to know.

Treatment

There is no simple cure for CCHF. Care focuses on supporting your body while your immune system fights the virus. Most people are looked after in hospital, often in a specialist unit, with close monitoring and treatment for any problems as they arise. The earlier supportive care starts, the better.

Self-care at home

• Rest and take fluids as advised — hydration matters a lot with fever and vomiting
• Follow your care team's advice about isolation until you are told it is safe to be around others
• Tell staff immediately about any new bleeding, breathlessness or feeling faint
• Once home, build your strength back slowly; tiredness after a serious viral illness can last weeks
• Keep any follow-up appointments so your liver, kidneys and blood clotting can be checked

Medical treatments

Hospital care is supportive, meaning it treats the problems the virus causes rather than the virus itself. This can include fluids given through a drip to keep you hydrated, close monitoring of blood pressure, oxygen and urine output, oxygen if needed, and blood products such as platelets or clotting factors if bleeding is a problem. Some antiviral medicines have been studied for CCHF, but the evidence is limited and your specialist team will decide whether any are appropriate. Pain relief and treatment for nausea are also part of care.

When is surgery considered?

Surgery is not a treatment for CCHF itself. In rare cases, a procedure may be needed if there is serious internal bleeding, but this is decided case by case by the specialist team.

Living with this condition

Recovery from CCHF can take time. Many people feel very tired for several weeks after the fever settles, and some notice poor appetite, low mood or difficulty concentrating. Plan for a gradual return to work, school or normal routines, and accept help with shopping, meals and childcare while you build strength. Keep a note of any new symptoms so you can raise them at follow-up.

Lifestyle tips

• Wear gloves and protective clothing when handling animals or animal blood, even after recovery
• Check yourself, children and pets for ticks after time outdoors in affected areas
• Avoid raw or unpasteurised animal products in areas where CCHF occurs
• Sleep and eat regularly — your body needs fuel to rebuild after a serious infection
• Avoid alcohol while your liver is recovering, and ask your doctor when it is safe again

Diet and exercise

Eat small, regular meals with a mix of protein, vegetables, fruit and starchy foods to help rebuild strength, and drink water steadily through the day. Gentle activity — short walks, light housework, stretching — is a good way back into movement once the fever has gone. Build up slowly over weeks rather than days, and stop if you feel dizzy or exhausted. Ask your care team when it is safe to return to sport, heavy lifting or physical work.

Mental health and emotional wellbeing

A serious infection, time in isolation, and the worry of waiting for test results can leave people feeling anxious, low or shaken. Flashbacks to being unwell, disturbed sleep, and fear of passing the illness to family are common and usually ease with time and support. Talk to someone you trust, and tell your doctor or nurse if these feelings are not settling — help is available and asking for it is a sign of strength.

Prevention

Yes, the risk can be greatly reduced. The two main steps are avoiding tick bites and protecting your skin when handling animals or animal blood. There is no vaccine that is widely available for people, although a vaccine is used in a small number of countries for people at high occupational risk. In healthcare settings, strict infection control — gloves, gowns, masks and eye protection — protects staff and other patients.

Vaccines

There is no widely licensed vaccine against CCHF for general use. A vaccine has been produced in one country for people in high-risk jobs, but it is not available internationally and its protection is not fully established. Researchers are working on new vaccines. Ask your travel health adviser if you have specific questions about your situation.

Screening programmes

There is no routine screening test for CCHF. Testing is done when someone has symptoms plus a relevant history, such as a tick bite or travel to an affected area.

Complications

If left untreated

• Severe dehydration from fever, vomiting and diarrhoea
• Liver and kidney problems
• Bleeding problems caused by the virus affecting blood clotting, which can lead to serious internal bleeding
• Low blood pressure and shock
• In the most serious cases, failure of several organs
• Longer-term tiredness and slower recovery after the acute illness

Long-term outlook

Most people who get supportive hospital care do recover, though the illness can be serious and recovery can be slow. The earlier someone is assessed and treated, the better the chances. Many people are back to normal activities within a few weeks to a couple of months, though tiredness can linger. If you or someone you know is being tested for CCHF, try to take things one step at a time and lean on the hospital team for honest updates.

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