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The Institute of Public Health of the Republic of North Macedonia reported of a confirmed case of Crimean-Congo hemorrhagic fever (CCHF) in  a 27-year-old woman from the village of Kuchica, municipality of Karbinci, Štip.

North Macedonia/Image CIA

The patient presented with initial symptoms of the disease (high temperature up to 38.6°C, severe headache, malaise and vomiting) started on July 21. It was reported she had a tick bite two days earlier.

She was hospitalized in the infectious department of KB Shtip from July 23-25. Due to the deterioration of the condition, the patient was referred and hospitalized at the KIBFS in Skopje.

The disease progressed quickly and on July 27 in the evening the patient died, a few hours after the result of  Crimean-Congo hemorrhagic fever was confirmed.

Expert teams from the Department of Epidemiology of Infectious Diseases at the IJZ, in cooperation with a competent epidemiologist from the CJZ Shtip, immediately went to the field on 28.07.2023, during which a field epidemiological survey was conducted in KB Shtip, the Emergency Medical Service in Shtip and in the village. Kuchica, where the patient lived. At the same time, another expert team did an epidemiological inspection of the KIBFS in Skopje, where the patient was treated and where she died.

The 2 teams, in Shtip and in Skopje, searched the contacts between the family members and the health workers in all the health institutions where the patient stayed and who were in contact with the confirmed case. All contacts have been surveyed and their appropriate classification of disease risk has been made.

Out of a total of 67 identified contacts, five people were assessed as high risk, 24 medium and 38 low risk.

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According to the WHO guide, material (blood) was taken for testing from four of the contacts identified as high risk, the material was transported and immediately tested at the Department of Virology at the PHI, where a negative result for KKHT was obtained for all 4 materials.

Crimean-Congo hemorrhagic fever (CCHF) is a naturally endemic disease that is transmitted by ticks and is caused by a virus (Nairovirus) from the Bunyaviridae family. The CCHF virus can cause severe outbreaks of viral hemorrhagic fever. The disease has a high mortality that reaches up to 40%. The virus is transmitted to humans, primarily through ticks on domestic animals. Human-to-human transmission is possible as a result of close contact with the blood, secretions, organs or other body fluids of infected persons. CKHT is endemic in Africa, the Balkans, the Middle East and Asia. There is no vaccine for humans and animals, and treatment is symptomatic.

The first described epidemic of this disease in the Republic of North Macedonia was a family epidemic in 1971, in a family in the village of Chiflik – Tetovo, in which 13 people – members of the family – fell ill, and the disease ended with death in two of them (mortality was 15.3%). After this epidemic, one case was laboratory confirmed in 2010. Considering that in Macedonia there are other natural hotspots where the disease circulates in nature among ticks, wild and domestic animals and birds, this disease represents a potential danger because there is a possibility that a person can be infected by the bite of an infected tick.

Of the neighboring countries, the disease is endemic in Kosovo, and sporadic cases have been registered in several other European countries.

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