Health officials in Spain have reported two locally acquired Crimean-Congo hemorrhagic fever (CCHF) cases, a first in the country, according to a Ministry of Health announcement Thursday (computer translated).


According to officials, the initial case was a patient who was treated at a Madrid hospital. The individual has since died. The second case is a female ICU nurse who treated the initial case. The National Center for Microbiology Carlos III Institute of Health confirmed the diagnosis of CCHF.

The Ministry of Health, Social Services and Equality is working in the Madrid community and has activated the protocol established by the National Network of Epidemiological Surveillance and coordination mechanisms with all regions.

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.

In 2010, Spanish researchers detected the virus in ticks from Cáceres, Spain.

Hyalomma tick Image/ CDC
Hyalomma tick
Image/ CDC

These are not the first CCHF cases reported in Europe. The European CDC (ECDC) notes that human infections have been reported from Albania, Armenia, Bulgaria, Kazakhstan, Kosovo, Russia, Serbia, Tajikistan, Turkey, Turkmenistan, Ukraine, and Uzbekistan. In June 2008, a first case was diagnosed in Greece.

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.

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.