Crimean-Congo Hemorrhagic Fever (CCHF) in Afghanistan: A retrospective single center study

Background: Crimean-Congo Hemorrhagic Fever (CCHF) is a particular regional concern because of endemicity in Afghanistan and many neighboring countries. The prevalence of CCHF has been increasing in this region. These concerns are compounded because there is no vaccine or therapeutic for CCHF and Afghanistan lacks adequate public health infrastructure in preventing, detecting, and containing cases. This investigation aimed to study the epidemiological, clinical, and laboratory features of CCHF in Afghanistan that might be useful in prevention and case detection, particularly in a limited resource setting. Method: A descriptive and analytic retrospective study of epidemiological, clinical, and laboratory features of confirmed patients (enzyme-linked immunosorbent assay (ELISA)-positive for CCHF) who were admitted to referral infectious center of Afghanistan from March 2017, to December 2018, was carried out. Results: There were 51 ELISA-confirmed CCHF patients, comprised of 14 females and 37 males. The mean age was 30 years of age, and there were 11 deaths. The case fatality rate (CFR) was 21.6% and was not significant between sexes (p = 0.8). Most cases were recorded from June to September, which is the period containing Eid-al-Adha. With regard to occupation, 13.7% and 11.8% of subjects were butchers and shepherds, respectively. The leading clinical manifestations were fever, hemorrhage, and myalgia. The mean time between onset of symptoms and admission to the hospital was 4.9 days in recovered cases and 4.7 days for expired cases. Conclusion: The prevalence of CCHF is increasing in Afghanistan. The majority of cases visited the hospital during the late phase of infection. This delay can negatively affect the efficacy of treatment and lead to severe health outcomes. Our findings reveal that impaired Alanine aminotransferase (ALT), hemorrhagic manifestations (including epistaxis), and impaired consciousness were factors associated with a higher mortality rate. These biomarkers may provide a clue to possible early effective interventions and increasing the chance of survival of the patients. (c) 2020 Published by Elsevier Ltd on behalf of International Society for Infectious Diseases. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Automated summary

The prevalence of CCHF is increasing in Afghanistan, with a majority of cases seeking medical care during the late phase of infection, which could negatively impact treatment efficacy. Impaired Alanine aminotransferase (ALT), hemorrhagic manifestations (including epistaxis), and impaired consciousness were factors associated with a higher mortality rate, potentially providing clues for early effective interventions.