Scientific letter
Autochthonous Crimean-Congo haemorrhagic fever in Spain: So much to learn
Fiebre hemorrágica de Crimea-Congo autóctona de España: tanto que aprender
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Arribas" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Marta" "apellidos" => "Mora-Rillo" "email" => array:1 [ 0 => "marta.mora@salud.madrid.org" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Marta" "apellidos" => "Díaz-Menéndez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Clara" "apellidos" => "Crespillo-Andujar" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "Jose R." "apellidos" => "Arribas" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Hospital Universitario La Paz-Carlos III, Infectious Diseases Unit, Internal Medicine Department, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Hospital Universitario La Paz-Carlos III, Tropical Medicine Unit, Internal Medicine Department, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Fiebre hemorrágica de Crimea-Congo autóctona de España: tanto que aprender" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">In August 2016, autochthonous Crimean-Congo Haemorrhagic fever (CCHF) in Spain was reported for the first time in a man who got infected in Ávila through a tick bite. A nurse was secondarily infected while caring for the index case.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> The occurrence of these autochthonous cases is somewhat surprising since Palomar et al.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> recently reported the absence of CCHF virus (CCHFV) in ticks captured between 2013 and 2015 in 18 Spanish provinces. Authors analysed more than 2000 ticks (mainly <span class="elsevierStyleItalic">Hyalomma marginatum</span>) obtained from vegetation, cattle and sheep with negative results for CCHFV, suggesting low risk of human cases.</p><p id="par0010" class="elsevierStylePara elsevierViewall">After the diagnosis of past year autochthonous cases, a new sampling of more than 9000 ticks confirmed the presence of CCHFV in ticks from Extremadura, Castilla-La Mancha, Castilla y León and Madrid.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> Infected ticks belonged mainly to the <span class="elsevierStyleItalic">H. lusitanicum</span> species and were captured exclusively from wild animals. None of the ticks captured from domestic animals were positive for CCHFV. We believe that methodological differences could explain the different results reported by Palomar et al.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> and CCAES<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a>: the different types of animals sampled (domestic vs wild) and the different species of ticks analysed (<span class="elsevierStyleItalic">H. marginatum</span> vs <span class="elsevierStyleItalic">H. lusitanicum</span>).</p><p id="par0015" class="elsevierStylePara elsevierViewall">To adequately respond to the challenge of an emergent infection such as CCHF in Spain it is critical to have a complete knowledge of the disease. Although much progress has been made, there is still much to learn about CCHF.</p><p id="par0020" class="elsevierStylePara elsevierViewall">All CCHFV identified in Spain belong to African 3 lineage.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> While there is considerable knowledge about the clinical aspects of the European 5 lineage, which is autochthonous in Turkey, very little has been published about the clinical characteristics of the disease caused by the African 3 lineage that is autochthonous mainly in South Africa, Mauritania and Sudan. It is possible that the natural history of CCHF caused by the African 3 linage and the European 5 linages could be different.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Another insufficiently known aspect is if survivors of CCHF can have long-term sequelae. Although no frequent sequelae have been reported after just 30 days of follow-up in Turkey,<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> a number of studies have suggested the possibility of long-term auditory impairment and posttraumatic stress.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">4,5</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">There are scarce data about the presence and infectivity of the CCHFV in different body fluids and environmental surfaces. CCHFV RNA has been detected in urine and saliva samples.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> Evidence on CCHF RNA presence in tears is not conclusive.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> Data of the persistence of CCHFV in the environment of patients are lacking. To our knowledge there are only two reports suggesting the possibility of sexual transmission of CCHF.<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">8,9</span></a> However, the presence of CCHFV RNA in semen samples has not ever been studied. Sexual transmission of CCHF could be potentially important in terms of community transmission, as it has been shown for other haemorrhagic fevers such as Ebola virus disease. Finally, it is still not clear if the discharge criteria for patients with CCHF applied in Turkey can be extrapolated to our health care system. In Turkey patients are routinely discharged after clinical and laboratory improvement without confirming clearance of viraemia.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> For other haemorrhagic fevers WHO recommends discharge after confirming a negative blood PCR.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Last year firsts autochthonous cases of CCHF in Spain, as well as the recent detection of infected ticks in areas previously unaffected, suggests that CCHFV circulation in Spain is greater than expected. The Spanish medical and scientific community has to be prepared to care for new cases of CCHF and to fill in the important current gaps of knowledge about this disease.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Ministerio de Sanidad, Servicios Sociales e Igualdad: Informe de Situación y Evaluación del riesgo de Transmisión de Fiebre Hemorrágica de Crimea-Congo (FHCC) en España (April 2017) [consulted 1 May 2017] Available in: <a id="intr0005" class="elsevierStyleInterRef" href="http://www.msssi.gob.es/profesionales/saludPublica/enfermedadesEmergentes/Crimea_Congo/docs/ACTUALIZACION_ER_FHCC_20.04.2017.pdf">www.msssi.gob.es/profesionales/saludPublica/enfermedadesEmergentes/Crimea_Congo/docs/ACTUALIZACION_ER_FHCC_20.04.2017.pdf</a>" ] ] ] 1 => array:3 [ "identificador" => "bib0060" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "[Epub ahead of print]" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Molecular (ticks) and serological (humans) study of Crimean-Congo hemorrhagic fever virus in the Iberian Peninsula, 2013–2015" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A.M. Palomar" 1 => "A. Portillo" 2 => "S. Santibáñez" 3 => "L. García-Álvarez" 4 => "A. Muñoz-Sanz" 5 => "F.J. Márquez" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:2 [ "tituloSerie" => "Enferm Infecc Microbiol Clin" "fecha" => "2017" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0065" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Multi-center prospective evaluation of discharge criteria for hospitalized patients with Crimean-Congo Hemorrhagic Fever" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "H. Leblebicioglu" 1 => "M. Sunbul" 2 => "S. Barut" 3 => "S.A. Buyuktuna" 4 => "Z. Ozkurt" 5 => "D. Yapar" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.antiviral.2016.07.010" "Revista" => array:6 [ "tituloSerie" => "Antiviral Res" "fecha" => "2016" "volumen" => "133" "paginaInicial" => "9" "paginaFinal" => "13" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27424492" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0070" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Health-related quality of life and the prevalence of post-traumatic stress disorder among Crimean-Congo hemorrhagic fever survivors" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "S. Gul" 1 => "E.U. Gul" 2 => "M. Yesilyurt" 3 => "B. Ozturk" 4 => "F. Kuscu" 5 => "O. Ergonul" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Jpn J Infect Dis" "fecha" => "2012" "volumen" => "65" "paginaInicial" => "392" "paginaFinal" => "395" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22996211" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0075" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical investigation of the transient evoked otoacoustic emission test in Crimean–Congo hemorrhagic fever" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "A. Engin" 1 => "A. Yildirim" 2 => "T. Kunt" 3 => "M. Bakir" 4 => "I. Dokmetas" 5 => "L. Ozdemir" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ijid.2007.06.003" "Revista" => array:6 [ "tituloSerie" => "Int J Infect Dis" "fecha" => "2008" "volumen" => "12" "paginaInicial" => "162" "paginaFinal" => "165" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17714968" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0080" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Detection of Crimean-Congo hemorrhagic fever virus genome in saliva and urine" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "H. Bodur" 1 => "E. Akinci" 2 => "P. Ongürü" 3 => "A. Carhan" 4 => "Y. Uyar" 5 => "A. Tanrici" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ijid.2009.04.018" "Revista" => array:6 [ "tituloSerie" => "Int J Infect Dis" "fecha" => "2010" "volumen" => "14" "paginaInicial" => "e247" "paginaFinal" => "e249" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19656706" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0085" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Investigation of the presence of Crimean-Congo hemorrhagic fever virus RNA in tears of eleven infected patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "H. Erdogan" 1 => "A. Engin" 2 => "A.T. Kalaycioglu" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "J Clin Exp Ophthalmol" "fecha" => "2011" "volumen" => "02" "paginaInicial" => "185" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0090" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Possible sexual transmission of Crimean-Congo hemorrhagic fever" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "N.Y. Pshenichnaya" 1 => "I.S. Sydenko" 2 => "E.P. Klinovaya" 3 => "E.B. Romanova" 4 => "A.S. Zhuravlev" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ijid.2016.02.1008" "Revista" => array:6 [ "tituloSerie" => "Int J Infect Dis" "fecha" => "2016" "volumen" => "45" "paginaInicial" => "109" "paginaFinal" => "111" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26972040" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0095" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Potential sexual transmission of Crimean-Congo hemorrhagic fever infection" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "O. Ergonul" 1 => "I. Battal" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Jpn J Infect Dis" "fecha" => "2014" "volumen" => "67" "paginaInicial" => "137" "paginaFinal" => "138" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24647261" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0100" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Jacob S. Clinical management of patients with viral haemorrhagic fever: a pocket guide for the Front-line Health Worker. World Health Organization 2016, pp. 1–203 [consulted 1 May 2017]. Available in: <a id="intr0010" class="elsevierStyleInterRef" href="http://apps.who.int/medicinedocs/documents/s22501en/s22501en.pdf">http://apps.who.int/medicinedocs/documents/s22501en/s22501en.pdf</a>" ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack335879" "titulo" => "Acknowledgements" "texto" => "<p id="par0040" class="elsevierStylePara elsevierViewall">The clinical research team acknowledges the support provided by Red de Investigación Cooperativa de Enfermedades Tropicales RICET (RD16/0027/0002).</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/0213005X/0000003600000003/v1_201803020437/S0213005X17301659/v1_201803020437/en/main.assets" "Apartado" => array:4 [ "identificador" => "8590" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Cartas científicas" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/0213005X/0000003600000003/v1_201803020437/S0213005X17301659/v1_201803020437/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0213005X17301659?idApp=UINPBA00004N" ]
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| 2021 July | 37 | 13 | 50 |
| 2021 June | 45 | 9 | 54 |
| 2021 May | 41 | 9 | 50 |
| 2021 April | 60 | 27 | 87 |
| 2021 March | 74 | 11 | 85 |
| 2021 February | 45 | 19 | 64 |
| 2021 January | 45 | 9 | 54 |
| 2020 December | 53 | 14 | 67 |
| 2020 November | 44 | 15 | 59 |
| 2020 October | 26 | 8 | 34 |
| 2020 September | 47 | 8 | 55 |
| 2020 August | 32 | 9 | 41 |
| 2020 July | 20 | 12 | 32 |
| 2020 June | 25 | 22 | 47 |
| 2020 May | 28 | 17 | 45 |
| 2020 April | 21 | 7 | 28 |
| 2020 March | 26 | 5 | 31 |
| 2020 February | 21 | 7 | 28 |
| 2020 January | 24 | 12 | 36 |
| 2019 December | 50 | 9 | 59 |
| 2019 November | 23 | 7 | 30 |
| 2019 October | 42 | 14 | 56 |
| 2019 September | 25 | 3 | 28 |
| 2019 August | 28 | 5 | 33 |
| 2019 July | 41 | 24 | 65 |
| 2019 June | 51 | 24 | 75 |
| 2019 May | 133 | 18 | 151 |
| 2019 April | 65 | 17 | 82 |
| 2019 March | 6 | 5 | 11 |
| 2019 February | 12 | 5 | 17 |
| 2019 January | 9 | 9 | 18 |
| 2018 December | 2 | 5 | 7 |
| 2018 November | 12 | 9 | 21 |
| 2018 October | 32 | 7 | 39 |
| 2018 September | 12 | 7 | 19 |
| 2018 August | 3 | 0 | 3 |
| 2018 July | 2 | 0 | 2 |
| 2018 June | 1 | 0 | 1 |
| 2018 May | 4 | 0 | 4 |
| 2018 April | 7 | 4 | 11 |
| 2018 March | 60 | 52 | 112 |
| 2018 January | 1 | 6 | 7 |
| 2017 December | 3 | 5 | 8 |
| 2017 November | 3 | 3 | 6 |
| 2017 October | 3 | 3 | 6 |
| 2017 September | 0 | 1 | 1 |
| 2017 August | 0 | 1 | 1 |
| 2017 July | 0 | 3 | 3 |
| 2017 June | 0 | 2 | 2 |
Show all
