Chinikar S1, Ghiasi SM1, Moradi M1, Goya MM2, Shirzadi MR2, Zeinali M2, Meshkat M3 & Bouloy M4.
1 Arboviruses and Viral Hemorrhagic Fevers Laboratory (National Ref. Lab), Pasteur Institute of Iran, Tehran, Iran.
2 Center for Disease Control (CDC), Ministry of Health, Tehran, Iran.
3 Veterinary Organization, Tehran, Iran.
4 Unité de Génétique Moléculaire des Bunyavirus, Institute Pasteur of Paris, Paris, France.
Vector-Borne and Zoonotic Diseases. September 2010, 10(7): 705-708. doi:10.1089/vbz.2009.0247.

Crimean-Congo hemorrhagic fever (CCHF) is viral hemorrhagic fever caused by CCHF virus, which belongs to the family Bunyaviridae and the genus Nairovirus. The virus is transmitted to humans via contact with blood and tissue from infected livestock, a tick bite, or contact with an infected person. Since 2000, we have shown the disease to be prevalent in 23 out of 30 provinces of Iran. Among those, Sistan-va-Baluchistan, Isfahan, Fars, Tehran, Khorasan, and Khuzestan demonstrated the highest infection, respectively. Notably, Sistan-va-Baluchistan province, southeast of Iran, has the highest prevalence of CCHF, and has shown to be present since at least 2000. Phylogenetic study of the CCHF virus genome isolated from Iranian patients showed a close relationship with the CCHF Matin strain (Pakistan). Our epidemiological data in the last decade have implied that the severity and fatality rate of the disease has ranged variably in different provinces of Iran. More pathogenesis and phylogenetic studies should therefore be investigated to clarify these differences.

Read the article: "Geographical distribution and surveillance of Crimean-Congo hemorrhagic fever in Iran"

VBORNET comment: 2010-12-22
This article provides a timely update on the current status of Crimean-Congo haemorrhagic fever in Iran and clearly demonstrates the wide distribution of CCHF cases across the country. Of particular interest is the reported lack of transmission via ticks to humans. Even in countries with a high rate of nosocomial transmission or where there are many cases through direct contact with infected blood a proportion of cases are attributable to either crushing of ticks or tick bites. It is briefly mentioned that ticks are collected from livestock in high risk areas, however no further discussion is given to the identification of tick species or their host preference, which may elucidate why humans are not infected via this route. The authors themselves acknowledge this area requires further investigation. All cases discussed were reported between June 2000 and December 2009 with a total of 635 confirmed of which 89 were fatal (14.5%). More males (77.5%) than females (22.5%) were infected and in keeping with findings from other CCHF countries professions involving the handling of blood and organs of potentially infected livestock were identified as a risk factor. However, a considerable proportion of cases (141) were in unrelated professions including carpenter, cook, baker, barber and mason; further discussion of the potential sources of their infection would have added much value to the paper.