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Abstract
<p xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="first" dir="auto"
id="d3947868e376">Crimean-Congo haemorrhagic fever (CCHF) virus (CCHFV) is a tick-borne
zoonotic pathogen
that can cause a lethal haemorrhagic disease in humans. Although the virus appears
to be endemically established in the Iberian Peninsula, CCHF is an emerging disease
in Spain. Clinical signs of CCHFV infection are mainly manifested in humans, but the
virus replicates in several animal species. Understanding the determinants of CCHFV
exposure risk from animal models is essential to predicting high-risk exposure hotspots
for public health action. With this objective in mind, we designed a cross-sectional
study of Eurasian wild boar (Sus scrofa) in Spain and Portugal. The study analysed
5,291 sera collected between 2006 and 2022 from 90 wild boar populations with a specific
double-antigen ELISA to estimate CCHFV serum prevalence and identify the main determinants
of exposure probability. To do so, we statistically modelled exposure risk with host-
and environment-related predictors and spatially projected it at a 10 × 10 km square
resolution at the scale of the Iberian Peninsula to map foci of infection risk. Fifty-seven
(63.3 %) of the 90 populations had at least one seropositive animal, with seroprevalence
ranging from 0.0 to 88.2 %. Anti-CCHFV antibodies were found in 1,026 of 5,291 wild
boar (19.4 %; 95 % confidence interval: 18.3-20.5 %), with highest exposure rates
in southwestern Iberia. The most relevant predictors of virus exposure risk were wild
boar abundance, local rainfall regime, shrub cover, winter air temperature and soil
temperature variation. The spatial projection of the best-fit model identified high-risk
foci as occurring in most of western and southwestern Iberia and identified recently
confirmed risk foci in eastern Spain. The results of the study demonstrate that serological
surveys of CCHFV vector hosts are a powerful, robust and highly informative tool for
public health authorities to take action to prevent human cases of CCHF in enzootic
and emergency settings.
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Summary Crimean-Congo haemorrhagic fever (CCHF) is an often fatal viral infection described in about 30 countries, and it has the most extensive geographic distribution of the medically important tickborne viral diseases, closely approximating the known global distribution of Hyalomma spp ticks. Human beings become infected through tick bites, by crushing infected ticks, after contact with a patient with CCHF during the acute phase of infection, or by contact with blood or tissues from viraemic livestock. Clinical features commonly show a dramatic progression characterised by haemorrhage, myalgia, and fever. The levels of liver enzymes, creatinine phosphokinase, and lactate dehydrogenase are raised, and bleeding markers are prolonged. Infection of the endothelium has a major pathogenic role. Besides direct infection of the endothelium, indirect damage by viral factors or virus-mediated host-derived soluble factors that cause endothelial activations and dysfunction are thought to occur. In diagnosis, enzyme-linked immunoassay and real-time reverse transcriptase PCR are used. Early diagnosis is critical for patient therapy and prevention of potential nosocomial infections. Supportive therapy is the most essential part of case management. Recent studies suggest that ribavirin is effective against CCHF, although definitive studies are not available. Health-care workers have a serious risk of infection, particularly during care of patients with haemorrhages from the nose, mouth, gums, vagina, and injection sites. Simple barrier precautions have been reported to be effective.
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