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Letter
Human Crimean-Congo Hemorrhagic
Fever, Sénégal
Pierre Nabeth,*
Moussa Thior,† Ousmane Faye,* and François Simon*
*Institut Pasteur de Dakar, Dakar, Sénégal; and †Centre de santé, Popenguine,
Sénégal
Suggested
citation for this article
To the Editor: Crimean-Congo hemorrhagic fever (CCHF) virus, genus
Nairovirus, family Bunyviridae, is transmitted to mammals
and birds by ticks. Hyalomma ticks, the primary vectors in CCHF
transmission, are widespread throughout Europe, Asia, the Middle East,
and Africa; evidence of CCHF virus has been found in all these regions.
CCHF in humans is an acute viral disease that is transmitted by the bite
of infected ticks, direct contact with blood or infected tissues from
viremic animals, and direct contact with the blood or secretions of an
infected person (1).
On January 26, 2003, a 22-year-old shepherd was treated at a health post
in the Popenguine District, 60 km south of Dakar, Sénégal; he reported
fever, epistaxis, arthralgia, myalgia of the lower limbs, and dark urine
for the past 2 days. Without biologic confirmation of the infection, he
was treated for malaria with two intravenous injections of quinine, followed
by oral administration of chloroquine.
On January 31, the patient had a temperature of 39°C, conjunctival
jaundice, bleeding gums, and was vomiting blood. He was seen again at
the health post and was given antimicrobial drugs, intravenous quinine,
and vitamin K; the next day, the bleeding stopped and the fever subsided.
A serum sample was sent to the World Health Organization Collaborative
Centre for Arboviruses and Viral Hemorrhagic Fevers at the Institut Pasteur,
Dakar. Tests for anti-CCHF specific immunoglobulin (Ig) M antibody by
enzyme-linked immunosorbent assay (ELISA) were positive, and CCHF virus
by isolation on cell cultures (AP61 and Vero cells) and reverse transcriptase-polymerase
chain reaction (RT-PCR) were negative. From January 31 to February 10,
the IgM titer increased from 1/3,200 to >1/12,800 and IgG titer increased
from 1/200 to 1/6,400.
Examination of the patient on February 10 showed he had recovered without
sequelae, and no trace of tick bites was found. The patient stated that
he had not traveled, noticed any tick bites, slaughtered any animals,
or been in contact with people with fever for several weeks before his
illness. He lived in close proximity to goats and cattle, but no blood
samples were taken from these animals. Although no ticks were found on
nearby goats, 10 Amblyomma and Hyalomma ticks were collected
from three cattle. Ticks were negative for CCHF virus isolation on suckling
mice and RT-PCR amplification.
No other case of fever accompanied by hemorrhage was reported in the
area, and none of the patient's 14 close contacts became ill. Of the four
close contacts from whom blood samples were taken, analyses for IgM and
IgG antibodies against CCHF virus were negative by ELISA.
While no clinical case of CCHF has ever been reported in Senegal, studies
dating from 1969 indicate that CCHF virus had been found in various locations
in the country (2,3). In the village of Bandia, in the
same district where the reported case was observed, a study conducted
from 1986 to 1988 showed a prevalence of anti-CCHF IgG of 3.2% in the
human population (4). Another study, conducted in the
same area from 1989 to 1992, showed seroconversions for several ruminants
and isolated the virus from ticks (5).
During CCHF outbreaks, an average of 30% of people who had the disease
died (case-fatality ratio). It is often discovered during nosocomial outbreaks,
as was the case in Mauritania, a country on Sénégal's northern border,
in 2003 (P. Nabeth, unpub. data). To prevent outbreaks of CCHF, public
awareness campaigns aimed at the populations most at risk—livestock farmers,
butchers, and health personnel—must be conducted, and the epidemiologic
alert systems must be strengthened. In addition, conditions that enhance
maintenance of the virus in nature and its transmission to humans must
be better understood so adequate control measures can be developed.
References
- Hoogstraal H. The
epidemiology of tick-borne Crimean-Congo hemorrhagic fever in Asia,
Europe and Africa. J Med Entomol. 1978;15:307–417.
- Chunikhin SP, Chumakov MP, Butenko AM, Smirnova SE, Taufflieb R, Camicas
JL, et al. Results from investigating human and domestic and wild animal
blood sera in the Sénégal Republic (western Africa) for antibodies to
Crimean hemorrhagic fever virus. Mater.16. Nauchn.Sess.Inst.Polio.Virus.Entsefalitov
(Moscow, October 1969) 2, 158–60. 1969. NAMRU3-T810 (in English).
- Wilson ML, LeGuenno B, Guillaud M, Desoutter D, Gonzalez JP, Camicas
JL. Distribution
of Crimean-Congo hemorrhagic fever viral antibody in Sénégal: environmental
and vectorial correlates. Am J Trop Med Hyg. 1990;43:557–66.
- Wilson ML, Gonzalez JP, LeGuenno B, Cornet JP, Guillaud M, Calvo MA,
et al. Epidemiology of Crimean-Congo hemorrhagic fever in Sénégal: temporal
and spatial patterns. Arch Virol.1990;Suppl 1:323–40
- Zeller HG, Cornet JP, Diop A, Camicas JL. Crimean-Congo
hemorrhagic fever in ticks (Acari: Ixodidae) and ruminants: field
observations of an epizootic in Bandia, Sénégal (1989–1992). J Med
Entomol. 1997; 4:511–6.
Suggested citation
for this article:
Nabeth P, Thior M,
Faye O, Simon F. Human Crimean-Congo hemorrhagic fever in Sénégal [letter].
Emerg Infect Dis [serial on the Internet]. 2004 Oct [date cited].
Available from http://www.cdc.gov/ncidod/EID/vol10no10/04-0586.htm
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