1. Home
  2. Infectious disease topics
  3. Crimean-Congo haemorrhagic fever
  4. Surveillance and updates
  5. Cases in the EU/EEA, 2013–present

Cases of Crimean–Congo haemorrhagic fever infected in the EU/EEA, 2013–present

Crimean-Congo haemorrhagic fever (CCHF) is a viral disease caused by CCHF orthonairovirus, which is endemic in regions of Africa, the Balkans, the Middle East and western and south-central Asia [1,2]. The virus has caused major outbreaks in EU/EEA neighbouring regions, principally in the Balkan region, Turkey and Russia [3]. CCHF orthonairovirus is typically spread via the bites of ticks of the Hyalomma genus. These ticks are widely distributed across southern and eastern Europe [4]. CCHF orthonairovirus can also be transmitted via direct or indirect contact with blood or the organs of viraemic hosts (animals or humans). Therefore, healthcare workers attending to CCHF patients may be exposed to the virus if they do not take appropriate protective measures.

CCHF was first diagnosed in Bulgaria in the mid-1950s and became endemic in some regions of the country. In Greece, the first and so far only autochthonous case was reported in 2008 [3,5,6]. In 2016, Spain reported its first autochthonous cases in the province of Ávila, Castile-León. A retrospective study, conducted in 2020 and published in 2021, showed that a case of CCHF had occurred in the same province in 2013 [7].

Details of CCHF cases infected in the EU/EEA since 2013 are presented below.

Year of onsetReporting countryNumber of casesPlace of exposureOther informationReferences
2013Bulgaria 8Shumen, Yambol, Haskovo, Kardzhali and Blagoevgrad provinces, Bulgaria

Transmission: via tick bite.

Outcome: 2 deaths.

[8]
Spain1Ávila province, Castile-León, Spain

Transmission: via tick bite.

Onset of symptoms: May.

Outcome: recovered.

Other: Case detected retrospectively (in 2020).

[7]
2014Bulgaria8Haskovo, Kardzhali, Blagoevgrad, Plovdiv and Burgas provinces, Bulgaria

Transmission: via tick bite.

Outcome: 1 death.

[9,10]
United Kingdom1Burgas province, Bulgaria

Transmission: via tick bite.

Exposure: travel-related, during a stay in Bulgaria.

Onset of symptoms: June. 

Outcome: recovered.

[9,11]
2015Bulgaria4Blagoevgrad, Haskovo and Yambol provinces, Bulgaria

Transmission: via tick bite.

Outcome: 2 deaths.

[12,13]
2016Bulgaria4Blagoevgrad, Kardzhali and Yambol provinces, Bulgaria

Transmission: via tick bite.

Outcome: recovered.

[14,15]
Spain2Ávila province, Castile-León, Spain

Transmission: via tick bite.

Exposure: during a hike in August.

Onset of symptoms: August.

Outcome: died.

[15-17]
Madrid province, Madrid, Spain

Transmission: nosocomial transmission. 

Exposure: healthcare worker who cared for the index case. 

Onset of symptoms: August. Outcome: recovered.

[15-17]

 

2017Bulgaria2Kardzhali and Haskovo provinces, Bulgaria

Transmission: via tick bite.

Outcome: recovered.

[18,19]
2018Bulgaria6Kardzhali and Plovdiv provinces, Bulgaria

Transmission: via tick bite.

Outcome: 1 death.

[20,21]
Greece1Blagoevgrad province, Bulgaria

Transmission: via tick bite.

Exposure: travel-related, during a stay in Bulgaria. 

Onset of symptoms: May.

Outcome: recovered.

[21,22]
Spain2Badajoz province, Extremadura, Spain

Transmission: via tick bite.

Exposure: during a hunt in July. 

Onset of symptoms: July. Outcome: died.

[21]
Salamanca province, Castile-León, Spain

Transmission: via tick bite.

Exposure: contact with farm animals.

Onset of symptoms: August.

Outcome: recovered.

[23]
2019Bulgaria2Kardzhali province, Bulgaria

Transmission: via tick bite.

Outcome: recovered.

[24,25]
2020Bulgaria1Burgas province, Bulgaria

Transmission: via tick bite.

Outcome: recovered.

[26]
Spain3Salamanca province, Castile-León, Spain

Transmission: via tick bite.

Onset of symptoms: May.

Outcome: recovered.

[27,28]

Transmission: via tick bite.

Exposure: contact with farm animals.

Onset of symptoms: June.

Outcome: recovered.

[27]

Transmission: via tick bite.

Onset of symptoms: August.

Outcome: died.

[27,29]
2021Spain2Salamanca province, Castile-León, Spain

Transmission: via tick bite.

Exposure: contact with farm animals.

Onset of symptoms: April.

Outcome: recovered.

[30]
León province, Castile-León, Spain

Transmission: via tick bite.

Exposure: during a hike.

Onset of symptoms: Early June.

[31]

2022

 

Bulgaria2Zlatoustovo, Haskovo province, Bulgaria

Transmission: unknown, probably via tick bite.

Exposure: via farming.

Onset symptoms: April

Outcome: recovered. 

[32]
Kardzhali province, Bulgaria

Transmission: via tick bite

Exposure: unknown

Onset of symptoms: July

Outcome: died.

[32]
Spain 2 León province, Castile-León, Spain 

Transmission: via tick bite.

Exposure: during a hunt.

Onset of symptoms: July.

Outcome: recovered.

[33,34]

Transmission: via tick bite.

Exposure: working as forestry worker.

Onset of symptoms: June.

Outcome: died.

[34]
2023Bulgaria3Burgas, Plovdiv and Blagoevgrad provinces, Bulgaria

Transmission: unknown

Exposure: unknown

Onset of symptoms: June

Outcome: recovered.

Transmission: via tick bite

Exposure: unknown

Onset of symptoms: June.

Outcome: recovered.

Transmission: unknown

Exposure: unknown

Onset of symptoms: May

Outcome: recovered.

 

[35]
Spain1Salamanca province, Castile-León, Spain

Transmission: via tick bite

Exposure: unknown

Onset of symptoms: June

Outcome: recovered.

[36]
2024Bulgaria1Blagoevgrad province, Bulgaria

Transmission: unknown.

Exposure: unknown.

Onset of symptoms: August.

Outcome: discharged from the hospital.

[37,38]
Portugal1Bragança district (most likely), Terras de Trás‑os‑Montes intermunicipal community, North region

Transmission: via tick bite (most likely).

Exposure: working on agricultural land (most likely).

Onset of symptoms: July.

Outcome: died.

[39]
Spain4Salamanca province, Castile and León, Spain

Transmission: via tick bite.

Exposure: during a hike.

Onset of symptoms: April.

Outcome: died.

[40,41]
Toledo province, Castilla-La Mancha, Spain

Transmission: via tick bite.

Exposure: unknown.

Onset of symptoms: July.

Outcome: died.

[42,43]
Córdoba province (most likely), Andalusia, Spain

Transmission: unknown

Exposure: unknown

Onset of symptoms: July

Outcome: discharged from the hospital

[44,45]
Cáceres province, Extremadura, Spain

Transmission: via tick bite.

Exposure: unknown.

Onset of symptoms: August.

Outcome: the patient is admitted to the hospital.

[46,47]

NB - The table combines information published in official reports and in scientific literature with information that was provided by the public health institutes and/or the ministries of health in the affected countries. 

Regions of infection (in orange) for Crimean-Congo haemorrhagic fever cases infected via tick bites, EU/EEA, 2013–present

Crimean-Congo haemorrhagic fever cases infected via tick bites, EU/EEA, 2013–present
Regions of infection (in orange) for Crimean-Congo haemorrhagic fever cases infected via tick bites, EU/EEA, 2013–present
  1. World Health Organization (WHO). Factsheet Crimean-Congo haemorrhagic fever. Geneva: WHO. Available at: https://www.who.int/news-room/fact-sheets/detail/crimean-congo-haemorrhagic-fever
  2. Centers for Disease Control and Prevention. Crimean-Congo Hemorrhagic Fever (CCHF) distribution map. Atlanta: CDC. Available at:  https://www.cdc.gov/crimean-congo-hemorrhagic/about/index.html 
  3. Maltezou HC, Papa A. Crimean-Congo hemorrhagic fever: risk for emergence of new endemic foci in Europe? Travel Med Infect Dis. 2010 May;8(3):139-43. Available at: https://www.ncbi.nlm.nih.gov/pubmed/20541133
  4. Europena Centre for Disease Prevention and Control (ECDC), European Food Safety Authority (EFSA). Distribution maps of ticks. Stockholm: ECDC. Available at: https://www.ecdc.europa.eu/en/disease-vectors/surveillance-and-disease-data/tick-maps
  5. European Centre for Disease Prevention and Control (ECDC). Crimean-Congo haemorrhagic fever. In: ECDC. Annual epidemiological report for 2018. Stockholm: ECDC, 2019 
  6. European Centre for Disease Prevention and Control (ECDC). Surveillance atlas of infectious diseases - Dengue data. Stockholm: ECDC. Available at: http://atlas.ecdc.europa.eu/public/index.aspx?Dataset=27&HealthTopic=16
  7. Negredo A, Sanchez-Ledesma M, Llorente F, Perez-Olmeda M, Belhassen-Garcia M, Gonzalez-Calle D, et al. Retrospective Identification of Early Autochthonous Case of Crimean-Congo Hemorrhagic Fever, Spain, 2013. Emerg Infect Dis. 2021 Jun;27(6):1754-6. Available at: https://www.ncbi.nlm.nih.gov/pubmed/34013861
  8. National Center of Infectious and Parasitic Diseases. Crimean-Congo haemorrhagic fever. Sofia: NCIPD; 2013. Available at: https://www.ncipd.org/index.php?option=com_biuletin&view=view&layout=enversion&year=2013&month=50&lang=en
  9. European Centre for Disease Prevention and Control (ECDC). Annual Epidemiological Report – Crimean-Congo haemorrhagic fever. Stockholm: ECDC, 2014 
  10. National Center of Infectious and Parasitic Diseases. Crimean-Congo haemorrhagic fever. Sofia: NCIPD; 2014. Available at: https://www.ncipd.org/index.php?option=com_biuletin&view=view&layout=enversion&year=2014&month=52&lang=en
  11. Lumley S, Atkinson B, Dowall S, Pitman J, Staplehurst S, Busuttil J, et al. Non-fatal case of Crimean-Congo haemorrhagic fever imported into the United Kingdom (ex Bulgaria), June 2014. Euro Surveill. 2014 Jul 31;19(30) Available at: https://www.ncbi.nlm.nih.gov/pubmed/25108534
  12. National Center of Infectious and Parasitic Diseases. Crimean-Congo haemorrhagic fever. Sofia: NCIPD; 2015. Available at: https://www.ncipd.org/index.php?option=com_biuletin&view=view&layout=enversion&month=52&year=2015&lang=en
  13. European Centre for Disease Prevention and Control (ECDC). Annual Epidemiological Report – Crimean-Congo haemorrhagic fever. Stockholm: ECDC, 2015 
  14. National Center of Infectious and Parasitic Diseases. Crimean-Congo haemorrhagic fever. Sofia: NCIPD; 2016. Available at: https://www.ncipd.org/index.php?option=com_biuletin&view=view&layout=enversion&month=52&year=2016&lang=en
  15. European Centre for Disease Prevention and Control (ECDC). Annual Epidemiological Report – Crimean-Congo haemorrhagic fever. Stockholm: ECDC, 2016 
  16. Negredo A, de la Calle-Prieto F, Palencia-Herrejon E, Mora-Rillo M, Astray-Mochales J, Sanchez-Seco MP, et al. Autochthonous Crimean-Congo Hemorrhagic Fever in Spain. N Engl J Med. 2017 Jul 13;377(2):154-61. Available at: https://www.ncbi.nlm.nih.gov/pubmed/28700843
  17. European Centre for Disease Prevention and Control (ECDC). Rapid Risk Assessment - Crimean–Congo haemorrhagic fever in Spain, 8 September 2016. Stockholm: ECDC, 2018 
  18. National Center of Infectious and Parasitic Diseases. Crimean-Congo haemorrhagic fever. Sofia: NCIPD; 2017. Available at: https://www.ncipd.org/index.php?option=com_biuletin&view=view&layout=enversion&month=52&year=2017&lang=en
  19. European Centre for Disease Prevention and Control (ECDC). Annual Epidemiological Report – Crimean-Congo haemorrhagic fever. Stockholm: ECDC, 2017 
  20. National Center of Infectious and Parasitic Diseases. Crimean-Congo haemorrhagic fever. Sofia: NCIPD; 2018. Available at: https://www.ncipd.org/index.php?option=com_biuletin&view=view&layout=enversion&month=52&year=2018&lang=en
  21. European Centre for Disease Prevention and Control (ECDC). Annual Epidemiological Report – Crimean-Congo haemorrhagic fever. Stockholm: ECDC, 2018 
  22. Papa A, Markatou F, Maltezou HC, Papadopoulou E, Terzi E, Ventouri S, et al. Crimean-Congo haemorrhagic fever in a Greek worker returning from Bulgaria, June 2018. Euro Surveill. 2018 Aug;23(35) Available at: https://www.ncbi.nlm.nih.gov/pubmed/30180928
  23. Monsalve Arteaga L, Munoz Bellido JL, Negredo AI, Garcia Criado J, Vieira Lista MC, Sanchez Serrano JA, et al. New circulation of genotype V of Crimean-Congo haemorrhagic fever virus in humans from Spain. PLoS Negl Trop Dis. 2021 Feb;15(2):e0009197. Available at: https://www.ncbi.nlm.nih.gov/pubmed/33617538
  24. National Center of Infectious and Parasitic Diseases. Crimean-Congo haemorrhagic fever. Sofia: NCIPD; 2019. Available at: https://www.ncipd.org/index.php?option=com_biuletin&view=view&layout=enversion&month=52&year=2019&lang=en
  25. European Centre for Disease Prevention and Control (ECDC). Annual Epidemiological Report – Crimean-Congo haemorrhagic fever. Stockholm: ECDC, 2019 
  26. National Center of Infectious and Parasitic Diseases. Crimean-Congo haemorrhagic fever. Sofia: NCIPD; 2020. Available at: https://www.ncipd.org/index.php?option=com_biuletin&view=view&layout=enversion&month=52&year=2020&lang=en
  27. Coordination Centre for Health Alerts and Emergencies, Ministry of Health. Rapid risk assessment. Detection of Crimean-Congo hemorrhagic fever in Salamanca [in Spanish]. Madrid: 2020 
  28. Junta de Castilla y Léon. Public health confirms a cases of Crimean-Congo haemorrhagic fever in Salamanca [in Spanish: Salud pública confirma un caso de fiebre hemorrágica de Crimea-Congo en Salamanca], 11 June 2020. Valladolid: Consejería de Sanidad; 2020. Available at: https://comunicacion.jcyl.es/web/jcyl/Comunicacion/es/Plantilla100Detalle/1281372051501/NotaPrensa/1284960397145/Comunicacion
  29. Junta de Castilla y Léon. Authorities receive confirmation of a case of Crimean-Congo haemorrhagic fever in Salamanca [in Spanish: La junta recibe la confirmación de un caso de fiebre hemorrágica de Crimea-Congo en Salamanca], 13 August 2020. Valladolid: Consejería de Sanidad; 2020. Available at: https://comunicacion.jcyl.es/web/jcyl/Comunicacion/es/Plantilla100Detalle/1284877983892/NotaPrensa/1284976629219/Comunicacion
  30. Junta de Castilla y Léon. Public health confirms a cases of Crimean-Congo haemorrhagic fever in Salamanca [in Spanish: Salud pública confirma un caso de fiebre hemorrágica de Crimea-Congo en Salamanca], 26 April 2021. Valladolid: Consejería de Sanidad; 2021. Available at: https://comunicacion.jcyl.es/web/jcyl/Comunicacion/es/Plantilla100Detalle/1284877983892/NotaPrensa/1285048981232/Comunicacion
  31. Junta de Castilla y Léon. Public health confirms a cases of Crimean-Congo haemorrhagic fever in El Bierzo [in Spanish: Salud pública confirma un caso de fiebre hemorrágica de Crimea-Congo en El Bierzo], 10 June 2021. Valladolid: Consejería de Sanidad; 2021. Available at: https://comunicacion.jcyl.es/web/jcyl/Comunicacion/es/Plantilla100Detalle/1284877983892/NotaPrensa/1285065354547/Comunicacion
  32. Personal communication Head of National Reference Laboratory Vector-borne infections, Bulgaria, November 2023. Message 
  33. Junta de Castilla y Léon. Public health confirms a cases of Crimean-Congo haemorrhagic fever in el Bierzo [in Spanish: Salud pública confirma un caso de fiebre hemorrágica de Crimea-Congo en el Bierzo], 20 July 2022. Valladolid: Consejería de Sanidad; 2022. Available at: https://comunicacion.jcyl.es/web/jcyl/Comunicacion/es/Plantilla100Detalle/1281372051501/Comunicado/1285190509128/Comunicacion
  34. Ministerio de Sanidad. Detection of Crimean-Congo haemorrhagic fever cases in el Bierzo [in Spanish: Detección de casos de Fiebre hemorrágica de Crimea-Congo en el Bierzo], 5 August 2022. Madrid: Ministerio de Sanidad; 2022. Available at: https://www.sanidad.gob.es/profesionales/saludPublica/ccayes/alertasActual/Crimea_Congo/docs/20220805_Crimea_Congo_El_Bierzo.pdf
  35. Personal communication Head of National Reference Laboratory Vector-borne infections, Bulgaria, July 2024. Message 
  36. Centro Nacional de Epidemiología. Epidemiological report on the situation of Crimean-Congo hemorrhagic fever in Spain. Years 2016 to 2023. N [in Spanish: Informe epidemiológico sobre la situación de la fiebre hemorrágica de Crimea-Congo en España. Años 2016 a 2023], 6 March 2024. 2024. Available at: https://www.isciii.es/QueHacemos/Servicios/VigilanciaSaludPublicaRENAVE/EnfermedadesTransmisibles/Documents/archivos%20A-Z/Fiebre_Hemorr%C3%A1gica_Crimea_Congo/INFORME_RENAVE_FHCC%202016-2023_final.pdf
  37. National Centre of Infectious and Parasitic Diseases. Crimean-Congo haemorrhagic fever (Week 35, Year 2024). 2024. Available at: https://www.ncipd.org/index.php?option=com_biuletin&view=view&layout=enversion&year=2024&month=35&lang=en
  38. Communication in EpiPulse National Centre of Infectious and Parasitic Diseases of Bulgaria. Message 12 September 2024.
  39. Direção-Geral da Saúde. Crimean-Congo haemorrhagic fever case confirmed in Portugal [In Portuguese: Confirmação de caso de Febre Hemorrágica de Crimeia-Congo em Portugal]. 2024. Available at: https://www.dgs.pt/em-destaque/confirmacao-de-caso-de-febre-hemorragica-de-crimeia-congo-em-portugal-.aspx
  40. Falcón L. Public Health confirms a case of Crimean-Congo hemorrhagic fever in Salamanca [in Spanish: Salud Pública confirma un caso de fiebre hemorrágica de Crimea-Congo en Salamanca], 27 April 2024. El Español; 2024. Available at: https://www.elespanol.com/castilla-y-leon/region/salamanca/20240427/salud-publica-confirma-caso-fiebre-hemorragica-crimea-congo-salamanca/850914940_0.html
  41. COPE. Elderly man with Crimean-Congo haemorrhagic fever dies in Salamanca [in Spanish: Fallece en Salamanca el hombre de avanzada edad con fiebre hemorrágica de Crimea-Congo], 02 May 2024. Available at: https://www.cope.es/actualidad/sociedad/noticias/fallece-salamanca-hombre-avanzada-edad-con-fiebre-hemorragica-crimea-congo-20240502_3277630
  42. Comunidad de Madrid. The Regional Ministry of Health activates the action protocol after detecting the case of a citizen affected by Crimean-Congo hemorrhagic fever [In Spanish: Sanidad activa el protocolo de actuación tras detectar el caso de un ciudadano afectado por fiebre hemorrágica Crimea-Congo]. Madrid, Spain 2024. Available at: https://www.comunidad.madrid/noticias/2024/07/22/sanidad-activa-protocolo-actuacion-detectar-caso-ciudadano-afectado-fiebre-hemorragica-crimea-congo
  43. Ministerio de Sanidad. Health alert detection report 29/07/2024 [In Spanish: Informe de detección de alertas sanitarias 29/07/2024]. Madrid, Spain: 2024 
  44. Servicio Andaluz de Salud. Patient with Crimean-Congo hemorrhagic fever discharged [In Spanish: Dado de alta el paciente con fiebre hemorrágica Crimea-Congo]. 2024. Available at: https://www.sspa.juntadeandalucia.es/servicioandaluzdesalud/todas-noticia/dado-de-alta-el-paciente-con-fiebre-hemorragica-crimea-congo
  45. Servicio Andaluz de Salud. The Ministry of Health and Consumer Affairs informs of the activation of the protocol for a possible case of Crimean-Congo hemorrhagic fever [In Spanish: La Consejería de Salud y Consumo informa de la activación del protocolo por un posible caso de fiebre hemorrágica Crimea-Congo]. 2024. Available at: https://www.sspa.juntadeandalucia.es/servicioandaluzdesalud/todas-noticia/la-consejeria-de-salud-y-consumo-informa-de-la-activacion-del-protocolo-por-un-posible-caso-de
  46. Ministerio de Sanidad. Health alert detection report 23/08/2024 [In Spanish: Informe de detección de alertas sanitarias 23/08/2024]. Spain: 2024 
  47. Junta de Extremadura. The SES reports a case of Crimean-Congo virus hemorrhagic fever in the Plasencia Health Area [In Spanish: El SES informa sobre un caso de fiebre hemorrágica por virus Crimea-Congo en el Área de Salud de Plasencia]. 2024. Available at: https://www.juntaex.es/w/20240823-el-ses-informa-sobre-un-caso-de-fiebre-hemorragica-por-virus-crimea-congo
Page last updated 28 Aug 2024