Report on two cases of Crimean-Congo haemorrhagic fever

11 January 2017
The NICD has confirmed the diagnosis of Crimean-Congo haemorrhagic fever (CCHF) in two unrelated cases in the Western Cape and Northern Cape provinces over the past week.
 The first case occurred in a 53-year-old cattle farmer in the Western Cape Province. He presented at a local clinic and was transferred to an academic hospital in Cape Town where the disease was suspected. The diagnosis was made on Friday 6th January. The patient is recovering, and has been discharged from hospital.
 The second case, a 58-year old sheep farmer from Northern Cape Province presented at a hospital in Kimberley five days after symptom onset with severe illness and bleeding. The patient passed away on Sunday 8th January.
 Both cases reported having been bitten by a tick prior to falling ill.
Health care workers and other persons who had contact with the patients are being monitored by health officials. No secondary cases have been identified to date. CCHF is a rare viral infection that is transmitted by ticks, commonly the Hyalomma ‘bont-poot’ tick, or through exposure to the blood of infected animals, usually cattle. Persons who work with animals, farmers and abattoir workers are most at risk of infection. Rarely, person- to-person transmission may occur through direct contact with infected blood and secretions of sick patients.

CCHF carries a 30% mortality. Patient care is mainly supportive as antiviral treatment has a limited effect. CCHF may be prevented through avoidance of tick bites by using DEET-containing insect repellents on exposed skin and clothing. When caring for patients diagnosed with CCHF, health care workers should observe universal precautions and infection control and prevention measures. No vaccines are available for prevention.
CCHF has been reported in South Africa since 1981 with an average of five cases per year identified since then. Cases tend to occur in the semi-arid parts of the Free State, Northern Cape and Western Cape provinces. Cases of CCHF are to be expected this year as no cases of CCHF were identified in South Africa in 2016. These two cases are not related, and no additional public health measures need be taken.
CCHF is not to be confused with tick bite fever (TBF) – a far more common, mild and easily treatable infection related to exposure to a different kind of tick. Persons with tick bite fever present with a headache, fever and occasional rash often with a black ‘scab’ at the site of the tick bite, and large, tender lymph nodes in the area draining the bite site. Treatment with antibiotics almost always leads to recovery and complications are rare.
For more information on CCHF and TBF in South Africa please visit the NICD website: