Epidemiology of Crimean-Congo hemorrhagic fever virus in Tunisia, North Africa: a One Health approach toward prevention and control

Abstract

The Crimean-Congo hemorrhagic fever virus (CCHFv) is the etiologic agent of CCHF, a tick-borne disease associated with high case fatality rates. Although CCHFv is mainly transmitted through ixodid tick bites, human infection may occur through direct contact with infected blood or tissues of livestock or humans. We initiated the first studies to assess the epidemiological risk of CCHF in Tunisia during the summer of 2014. Elevated titers of immunoglobulin M and immunoglobulin G anti-CCHFv were detected among patients with unexplained acute febrile and slaughterhouse workers, respectively. Subsequently, other studies performed in Tunisia have reported the detection of CCHFv RNA in ticks collected from dromedaries and varying seroprevalence rates in livestock, and in wildlife. These results substantiate our findings of human exposure to CCHFv in Tunisia. According to the proposed classification scheme for organizing countries into five categories by the level of evidence for CCHFv incidence, Tunisia is assigned level II based on serological cases. To consolidate this category, further studies are needed to detect, isolate, and characterize CCHFv in vectors, hosts, and humans within Tunisia. Therefore, there is an urgent need to develop a robust strategy to mitigate the risk of zoonotic spillover to humans through a One Health approach. • Antibodies anti-CCHFv were detected among patients, human at risk, and livestock. • CCHFv RNA was detected in ticks collected from livestock. • Tunisia is assigned level 2 by the level of evidence for CCHFv incidence. • Slaughtering activities during the Eid-al-Adha is a risk factor for CCHF outbreaks. • A One Health approach to mitigate the risk of zoonotic spillover to humans.