Doctors are closely watching about 200 people in Spain after a patient at a hospital in Madrid died of Crimean-Congo hemorrhagic fever, the first time the disease has been found in Western Europe in someone who had not traveled to an endemic area.

The patient apparently caught the virus after being bitten by a tick, and then passed it to a nurse before he died. It has been known for five years that some ticks in Spain harbored the virus.

Crimean-Congo hemorrhagic fever is fatal in about 30 percent of cases, according to the World Health Organization. It is normally found in Africa, the Middle East, the Balkans and Central Asia south of Kazakhstan. It killed 20 people in Pakistan this year.

It usually strikes herders, slaughterhouse workers and others in contact with tick-covered animals, but it can also be passed in human blood and bodily fluids.