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A health worker in Iraq's southern Dhi Qar province, holds a vial containing ticks that cause the Crimean-Congo haemorrhagic illness (CCHF). Image Credit: AFP


  • Iraq has reported an outbreak of “nosebleed fever” which causes some patients to bleed to death, local media reported.
  • Infection results in heavy nosebleeds
  • Disease is known Crimean-Congo haemorrhagic fever. It has a high mortality rate in humans.
  • It has so far claimed 19 deaths among 111 cases this year, according to the World Health Organisation.

An outbreak of the so-called “nosebleed fever” is Iraq has raised concern among veterinary and health authorities in the country.

The tick-borne viral disease results in a high mortality rate — nearly 2 out of 5 — in humans.

Crimean-Congo haemorrhagic illness (CCHF)  nose bleed
A worker from the health department disinfects the area around a house in the village of Al-Bojari in Iraq's southern Dhi Qar province during the country's worst detected outbreak of the illness.

It’s not yet fully understood what’s behind the spike in cases, which has greatly  affected the livestock industry. The virus is known to cause severe bleeding both internally and externally — and especially from the nose.

“The number of cases recorded is unprecedented,” Haidar Hantouche, a health official in Dhi Qar province told the AFP.

Here’s what we know so far:

What is it?

Among epidemiologists, it is known as the Crimean-Congo haemorrhagic fever (CCHF).

The World Organisation for Animal Health (WOAH) defines CCHF as a “zoonotic disease transmitted by ticks with a high mortality rate in humans.”

“We’re closely following an outbreak in #Iraq , where veterinary authorities are investigating CCHF in ticks and livestock.

What causes it in humans?

It’s a viral disease. In humans, Crimean-Congo haemorrhagic fever is a disease caused by CCHF virus (CCHFV).

It is known to cause uncontrolled bleeding, intense fever and vomiting.

How is it transmitted?

CCHFV is transmitted by bites from infected ticks (mainly of the Hyalomma genus) or by direct contact with blood or tissues of infected ticks, viraemic (having a virus or viruses in the bloodstream) patients or viraemic livestock.

What’s the latest about CHHFV in Iraq?

The WHO, in an updated, stated that most cases are among farmers, slaughterhouse workers and veterinarians — people mainly get infected via ticks on livestock.

"Human-to-human transmission can occur resulting from close contact with the blood, secretions, organs or other bodily fluids of infected persons," the agency added.

The virus has also adversely affected meat consumption in the country, with many butchers saying cattle arriving for slaughter has fallen to half normal levels.

“People are afraid of red meat and think it can transmit infection,” said Fares Mansour, Director of Najaf Veterinary Hospital.

When was the nosebleed fever case first detected?

It was first documented there in 1979. Since then, there had been only a handful of cases reported each year.

What are the symptoms?

The onset of CCHF is sudden, with initial signs and symptoms including:

  • Headache
  • High fever
  • Back pain
  • Joint pain
  • Stomach pain
  • Vomiting
  • Red eyes
  • A flushed face
  • Red throat
  • Petechiae (red spots) on the palate.

(Source: US CDC)

How many cases have been reported so far?

Since the beginning of this year, cases have soared, with more than 100 reported in Iraq so far.

Kirkuk nosebleed fever
Veterinarians spray cattle with disinfectant in Kirkuk, a day after Iraq registered the first death this year from Crimean-Congo haemorrhagic fever. AFP Image Credit: AFP

In March, the UK Health Security Agency reported a case in England, following travel to Central Asia.

In the past, the virus has recorded major outbreaks in the European Union, Eastern European states, principally in the Balkans, Turkey and Russia, according to European CDC.

nosebleed fever = map
Image Credit: US CDC

Globally, CCHF is the most widespread viral tick-transmitted haemorrhagic fever.

European CDC estimates the following:

  • Up to “three billion people are at risk of infection globally, and 10 000 to 15 000 infections — 500 of them fatal — occur every year.
  • Cases have been reported in over 30 countries in Africa, Asia and Europe, in regions where Hyalomma spp. ticks are established.
  • CCHF nosocomial infections with "considerable" mortality rates have been observed in various countries.

How do infections spread?

Wild and domestic animals serve as hosts of CCHFV, as they support tick populations by providing blood meals and they can transmit the virus to both ticks and humans when they are “viraemic” — having a virus or viruses present in the bloodstream.

The EU CDC reported cases imported from "endemic" countries.

“Therefore, awareness should be raised among health practitioners that a patient’s travel history needs to be recorded in detail,” the agency stated.

What animals have been infected by nosebleed fever virus?

ECDC reported that CCHFV-specific antibodies have been detected in a variety of wild and domestic animals (e.g. livestock, horses, dogs, chickens, camels, ostriches, swine, hares, deer, buffalo and rhinoceroses).

In birds, antibodies have only been detected in guinea fowl and ostriches.

What explains the emergence of CCHFV in a particular country?

Several factors — both biotic (relating to life) and abiotic — play a role in the emergence and spread of CCHFV in a region.

Factors include certain climatic conditions that favour tick abundance, land fragmentation, legal or illegal livestock trade, and activities in abandoned agricultural areas that increase human exposure to ticks.

“Climatic changes may also redirect the route of migratory birds, and if they are infested with infected ticks, CCHFV can be introduced into new areas,” the European CDC stated in a brief.

How fast does it spread?

Onset of the disease can be “swift”, according to the US CDC.

Is there a cure for it?

The virus has no vaccine yet. The long-term effects of nosebleed fever infection have not been studied well enough in survivors to determine whether or not specific complications exist. However, recovery is slow, according to the agency.

What happens next?

The European CDC recommends that “seroprevalence studies” — to measure the level of a disease-causing agent in a population, as measured in blood serum —be conducted in humans, wild animals and domestic animals.

The agency also recommends screening of ticks for CCHFV infection, and sharing of useful information about the circulation of the virus in a particular region.

(With inputs from AFP, Agencies)