Deadly nose-bleed fever: What we know so far

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.

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:

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.

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.

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.

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.

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

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

(Source: US CDC)

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

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.

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

European CDC estimates the following:

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.

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.

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.

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

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.

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.

(With inputs from AFP, Agencies)