Crimean-Congo hemorrhagic fever case reported in Mauritania

The Mauritania Ministry of Health has reported a confirmed case of Crimean-Congo hemorrhagic fever in Ould Yengé commune, Guidimaka region located in the southern-most part of the country.

The case-patient is a 58-year-old male herder from Elghabra locality who became ill on 16 April 2018 (reportedly) after tending to a sick cow days earlier. He presented to a private clinic the same day (16 April 2018) with high fever, arthralgia and headache. He was admitted, managed for an unspecified medical condition and discharged on 18 April 2018.

Twenty-four hours later (on 19 April 2018), he developed bleeding from the gums and nose, and was admitted to the regional hospital where he was transfused and subsequently discharged on 20 April 2018, following an apparent clinical improvement.

On 21 April 2018, the case-patient’s health deteriorated and he was taken to Guerou health centre, from where he was immediately referred. The case-patient was admitted to Cheikh Zayed hospital in Nouakchott on 22 April 2018 from where a blood specimen was obtained and shipped to the national public health laboratory. The test result released on 24 April 2018 was IgM positive for Crimean-Congo hemorrhagic fever.

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Thirty-two close contacts, including 10 health workers and four family members, have been listed and are being followed up. Efforts to identify other close contacts are ongoing. The case-patient used public transport and a taxi at various stages of his movement during the course of illness. Preliminary investigations also established that all the four healthcare facilities that managed the case-patient did not apply appropriate infection prevention and control measures, potentially indicating a higher number of contacts.

According to the WHO, Crimean-Congo hemorrhagic fever is a widespread disease caused by a tick-borne virus (Nairovirus) of the Bunyaviridae family. The CCHF virus causes severe viral hemorrhagic fever outbreaks, with a case fatality rate of 10–40%.

CCHF is endemic in Africa, the Balkans, the Middle East and Asian countries south of the 50th parallel north – the geographical limit of the principal tick vector. The hosts of the CCHF virus include a wide range of wild and domestic animals such as cattle, sheep and goats.

Animals become infected by the bite of infected ticks and the virus remains in their bloodstream for about one week after infection, allowing the tick-animal-tick cycle to continue when another tick bites. Although a number of tick genera are capable of becoming infected with CCHF virus, ticks of the genus Hyalomma are the principal vector.

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The CCHF virus is transmitted to people either by tick bites or through contact with infected animal blood or tissues during and immediately after slaughter. The majority of cases have occurred in people involved in the livestock industry, such as agricultural workers, slaughterhouse workers and veterinarians. Human-to-human transmission is possible.