Key facts

  • Crimean-Congo haemorrhagic fever (CCHF) is a widespread disease caused by a tick-borne virus (Nairovirus) of the Bunyaviridae
  • The Crimean-Congo haemorrhagic fever (CCHF) virus causes severe viral haemorrhagic fever outbreaks.
  • CCHF outbreaks have a case fatality rate of up to 40%.
  • The virus is primarily transmitted to people from ticks and livestock animals. Human-to-human transmission can occur resulting from close contact with the blood, secretions, organs or other bodily fluids of infected persons.
  • CCHF is endemic in Africa, the Balkans, the Middle East and Asia, in countries south of the 50th parallel north.
  • There is no vaccine available for either people or animals.


The CCHF virus is transmitted to people either by tick bites or through contact with infected animal blood or tissues during and immediately after slaughter. The majority of cases have occurred in people involved in the livestock industry, such as agricultural workers, slaughterhouse workers and veterinarians.

Human-to-human transmission can occur resulting from close contact with the blood, secretions, organs or other bodily fluids of infected persons. Hospital-acquired infections can also occur due to improper sterilization of medical equipment, reuse of needles and contamination of medical supplies.


Signs and symptoms

The length of the incubation period depends on the mode of acquisition of the virus. Following infection by a tick bite, the incubation period is usually one to three days, with a maximum of nine days. The incubation period following contact with infected blood or tissues is usually five to six days, with a documented maximum of 13 days.

Onset of symptoms is sudden, with fever, myalgia, (muscle ache), dizziness, neck pain and stiffness, backache, headache, sore eyes and photophobia (sensitivity to light). There may be nausea, vomiting, diarrhoea, abdominal pain and sore throat early on, followed by sharp mood swings and confusion.

The mortality rate from CCHF is approximately 30%, with death occurring in the second week of illness. In patients who recover, improvement generally begins on the ninth or tenth day after the onset of illness.

The first described epidemic of this disease in the Republic of Macedonia was in 1971, when 13 people with two deaths in one family in the village Chiflik – Tetovo. After this epidemic, one case in 2010 has been laboratory tested. Given that there are conditions for natural hotspots and other areas in our republic and thuis disease poses a potential danger. From neighboring countries, the disease is endemic in Kosovo, and sporadic cases have been reported in several other European countries.

Prevention and control

Public health advice should focus on several aspects.

  • Reducing the risk of tick-to-human transmission:
    • wear protective clothing (long sleeves, long trousers);
    • wear light coloured clothing to allow easy detection of ticks on the clothes;
    • use approved acaricides (chemicals intended to kill ticks) on clothing;
    • use approved repellent on the skin and clothing;
    • regularly examine clothing and skin for ticks; if found, remove them safely;
    • seek to eliminate or control tick infestations on animals or in stables and barns; and
    • avoid areas where ticks are abundant and seasons when they are most active.
  • Reducing the risk of animal-to-human transmission:
    • wear gloves and other protective clothing while handling animals or their tissues in endemic areas, notably during slaughtering, butchering and culling procedures in slaughterhouses or at home;
    • quarantine animals before they enter slaughterhouses or routinely treat animals with pesticides two weeks prior to slaughter.
  • Reducing the risk of human-to-human transmission in the community:
    • avoid close physical contact with CCHF-infected people;
    • wear gloves and protective equipment when taking care of ill people;
    • wash hands regularly after caring for or visiting ill people.