Crimean-Congo hemorrhagic fever in Herat province of Afghanistan, 2007-2021

Abstract

Crimean-Congo hemorrhagic fever (CCHF) is a geographically widespread tick-borne hemorrhagic disease
caused by the Crimean-Congo hemorrhagic fever virus (CCHFV). In Afghanistan, the first case of CCHF was
detected in Takhar province in 1998, after which no additional cases were reported for ten years. The aim of
this study is to report the analyses of the clinical and epidemiological features of confirmed CCHF cases that
were recorded in Herat province between 2007 and 2021. This prospective case series study was conducted at
Herat Regional Hospital between January 2007 and December 2021. Demographic and clinical data were
collected for each patient; all patients were hospitalized. Biochemical and hematological laboratory
examination, and the detection of CCHV IgM and viral RNA was performed for all patients. Statistical analyses
were performed in IBM SPSS Statistics (version 26). A total of 252 confirmed CCHF cases including 160
(63.5%) males and 91 (36.5%) females, with a mean age of 33.37±14.1 years were included in the study. The
majority of patients were in 11-50 age category, 32.9% were housewife, 38.4% were farmers, shephard, and
butchers. The most prevalent clinical presentations were fever (100%), headache (98.8%), body pain (96.4%),
Ecchymosis (48.0%), epistaxis (44.8%) and gum bleeding (33.3%). The majority of cases occurred between
April and October. The case fatality rate of CCHF in this study was 2.8%. Considering the significant social,
economic and health burden CCHF places on the community, enhanced public health measures are necessary
to control CCHF in Herat province and neighboring regions.