Crimean Congo Haemorrhagic Fever in Bulgaria

I. Christrova1*, T. Kantardjiev1, T. Gladnishka1, N. Kalvatchev1, R. Barthel2, A. Papa3, E. Mohareb2

1National Centre of Infectious and Parasitic Diseases, Sofia, Bulgaria; 2NAMRU#3, Cairo, Egypt;
3Aristotle University of Thessaloniki, Greece

This poster has been compiled with the financial support of the CCH Fever network (Collaborative Project) supported by the European Commission under the Health Cooperation Work Programme of the 7th Framework
Programme (Grant agreement n° 260427) and co-financed by the US Department of Defense, Division of GEIS Operations at the Armed Forces Health Surveillance Center, Research Plan C0602_12_RD.
Crimean-Congo hemorrhagic fever virus distribution
Turkmenistan
Azerbaijan Uzbekistan
Introduction and Purpose
Former Kyrgyzstan
Yugoslavia 60
Bulgaria Ukraine Kazakstan Crimean Congo hemorrhagic fever (CCHF) is a severe viral disease transmitted by ticks. CCHF is endemic in 54
Albania

Turkey Tajikistan
Southeast Europe, Africa, Middle East and Southwest Asia (1). The incidence and spread of the disease increased in 50 Number
of CCHF
Afghanistan
Greece
Armenia Iraq Iran Pakistan
recent years. 40
cases
Mauritania Egypt Saudi
Arabia In Bulgaria, CCHF was first described in 1952 (2). A total of 32 CCHF cases were reported in the last 5 years (2007- Number
of lethal
UAE
Oman 2011). The cases originated mainly from southeast Bulgaria. In 2008, a new focus in southwest Bulgaria became also 30
cases
Senegal

Guinea Ethiopia
active (3). 20
20
15
18 19 18
CAR 14
Burkina Faso Benin Uganda
To estimate the current situation on CCHF distribution, a seroprevalence study of healthy people was organized in 8
10
12 13
Kenya 10 6 7 6 6
Nigeria DRC
Tanzania endemic and non-endemic areas in Bulgaria. In addition, livestock in endemic areas was investigated for infection with the 4 3 2 1
5
2 2 2 31 1 1
4
0 0
Madagascar
CCHF virus. 0
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Namibia

South Africa
Zimbabwe
Material
Material and
and Methods
Methods
Serum samples from 1018 healthy persons, residents of 13 districts, were studied – 200 from district of Burgas, 116 from Sofia district, 100 from each district: Blagoevgrad and Ruse, 52 from Pazardjik, 36 from Stara
Zagora, 46 from Smolyan, 60 from Yambol, 108 from Haskovo, 50 from each district: Kardjali, Sliven, Shumen and Pleven. These serum samples were tested for the presence of IgG antibodies against CCHF virus
using a commercially available ELISA kit (Vector Best, Russia). A total of 150 serum samples were collected from sheep and cattle living in the most heavily endemic region found by the seroprevalence study.
Serologic testing was performed by an in-house ELISA using the IbAr 10200 strain of CCHF as antigen and horseradish peroxidase conjugated anti-species IgG (4).

Results
Distribution of CCHF sero-postive findings in healthy
people from various districts in Bulgaria IgG antibodies to CCHF virus were detected in 28 (2,8%) healthy persons. According to the
findings, the investigated districts could be divided to 4 different groups: ConclusIons
1) High endemic district – Burgas, East Bulgaria (7,6% seroprevalence);
2) Moderate endemic districts – districts of Kardjali, Pazardjik and Haskovo, Southeast and Obviously, CCHF can often appear as undifferentiated febrile
Southcentral Bulgaria (seroprevalence 6,0%; 5,8%; and 4,6% resp.); illness or even go asymptomatically. This might explain
3) Low endemic districts – district of Sliven, Southeast Bulgaria (2% seroprevalence), district presence of IgG antibodies in people from the endemic foci.
of Blagoevgrad, Southwest Bulgaria (1% seroprevalence), and district of Ruse, North Our data suggest that mainly Southeast but also Southwest
Bulgaria (1% seroprevalence). Bulgarian regions are areas of active CCHF virus
4) No anti-CCHF virus antibodies were found in people from districts of Sofia, Stara Zagora, transmission. This is of great importance for risk assessment.
Yambol, Shumen, and Pleven.  Due to increasing spread of CCHF virus in new foci, public
A total of 109/150 (72,67%) IgG sero-positive animals were found in the highly endemic health awareness is essential.
district of Burgas. Among cattle, the level of seropostivity was 70% (44/63), and among goats
was even higher – 75% (65/87).
1.Papa A. Crimean-Congo hemorrhagic fever and hantavirus infections. In: Maltezou H, Gikas A, editors. Tropical and Emerging Infectious Diseases. Kerala, India: Research Signpost; 2010, 49-73.
References
Conclusions 2. Nekliudov M. A case of hemorrhagic fever (Crimean). Savremenna medicina, Sofia, 1952, 5:92-95 (in Bulgarian).
3. Christova I, Di Caro A, Papa A, Castilletti C, Andonova L, Kalvatchev N, et al. Crimean-Congo hemorrhagic fever, southwestern Bulgaria. Emerg Infect Dis. 2009,15(6):983-5.
4. Mustafa ML, Ayazi E, Mohareb E, Yingst S, Zayed A, Rossi CA, Schoepp RJ, Mofleh J, Fiekert K, Akhbarian Z, Sadat H, Leslie T. Crimean-Congo hemorrhagic Fever, Afghanistan, 2009. Emerg
Infect Dis 2011,10:1940-1941.