Rapid risk assessment: Crimean–Congo haemorrhagic fever in Spain, 9 September 2016

Risk assessment

European Centre for Disease Prevention and Control. Crimean–Congo haemorrhagic fever in Spain – 8 September 2016. Stockholm: ECDC; 2016.

​ECDC has assessed the risk associated with the occurrence of two cases of Crimean–Congo haemorrhagic fever in Spain. This is the first detection of autochthonous human cases of CCHF in Spain and the probability of further infections there remains low. However, additional sporadic cases may occur in the future.
The different risks associated with tick-borne transmission, nosocomial transmission and transmission via substances of human origin are outlined in the document, together with suggested options for response.​

Executive summary

On 31 August 2016 Spain reported two cases of infection with Crimean–Congo haemorrhagic fever (CCHF) virus. The primary case is a 62-year-old man with potential exposure to CCHF virus in the province of Ávila (Spain). The secondary case is a 50-year-old healthcare worker who attended the primary case during his admission to the intensive care unit. These are the first autochthonous clinical cases of CCHF in Spain and in south-western Europe, and accordingly ECDC has published a rapid risk assessment on the event.

Recent detection of CCHF virus in ticks from Extremadura in western Spain, indicates the circulation of CCHF virus among wildlife. Therefore, the occurrence of CCHF virus infection is not an unexpected event in Spain. Nosocomial transmission of CCHF can occur even in a non-endemic region when appropriate infection prevention and control measures have not been observed.The probability of CCHF virus infection in Spain is low. However, other sporadic cases are possible. The risk of further human-to-human transmission in hospital settings can be significantly reduced by applying timely appropriate infection prevention and control measures.

  • The rapid risk assessment outlines a range of options for risk reduction, including, among others: Enhanced awareness of the importance of early diagnosis and laboratory confirmation among healthcare providers in areas with potential circulation of CCHF virus.
  • Standard precautions, preferably combined with contact and droplet precautionary measures, should be taken when caring for patients presenting with haemorrhagic fever syndrome.
  • Laboratory tests on patient samples present a high risk of transmission and should only be conducted under appropriate biological containment conditions.
  • As a precautionary measure, risk groups should be informed about the mode of transmission and urged to comply with advice on the prevention of tick bites. 
  • In order to better target preventive measures and raise clinical awareness, areas with CCHF virus circulation and areas suitable for CCHF circulation in the Iberian Peninsula should be defined by multidisciplinary investigations.

No specific measures for the safety of substances of human origin (SoHO) are recommended at this stage.


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