Crimean-Congo Hemorrhagic Fever affects 1,000 people annually

Although Crimean-Congo Hemorrhagic Fever (CCHF), which is transmitted by tick bites, is still not sufficiently known in Turkey, we are the country where the disease is most frequently seen in the world. So much so that we are known as one of the most experienced countries in the world, as we make the most diagnoses.

CCHF, which makes the news with the increase in the number of cases in the summer months, is a serious, potentially fatal disease that, as of yesterday (27.06.2024), saw one child in Erzurum and 5 people in Tokat receiving hospital treatment. It manifests itself with symptoms such as fever, weakness, chills, shivering, headache, and muscle pain, as in upper respiratory tract infections, and rarely with nausea, vomiting, abdominal pain, and diarrhea.

CCHF, whose presence was first detected in Turkey in 2002 and whose incidence has increased significantly over the years, has recently been on Europe's agenda as well. Even though it has not yet been seen in humans in France, the detection of CCHF in ticks has been met with concern. French scientists have even already made their preparations by taking various precautions against possible cases.

It is not possible to say that the same importance is given to the disease, which is perceived as a threat in European countries, in our country, despite the increasing number of cases. Doctors dealing with CCHF complain that data on the disease, which is so important for Turkey, has not been disclosed for the last few years.

MORE THAN 12 THOUSAND CASES REPORTED BETWEEN 2002-2019

CCHF, which continues to be a significant public health problem, causes death at a rate of 5 – 10 percent when not detected early and not intervened in time. The disease, which frequently appears in people engaged in agriculture and animal husbandry, is seen in many provinces in the north of Central Anatolia, the Middle Black Sea, and the north of Eastern Anatolia. Health workers serving in these regions also constitute the second group at risk.

Hundreds of patients apply to emergency services every year with complaints of tick attachment, but the Ministry of Health has not been sharing reliable data on these cases in recent years.

In the information provided on the Ministry of Health's website; “The highest number of cases occurred in 2009 with 1318 cases. Although 343 CCHF cases were detected in 2017, it still maintains its importance in our country,” it is stated.

However, the number of cases after 2017 is not mentioned. As additional information, it is stated that efforts to develop a vaccine against the disease are ongoing and that information campaigns regarding protective measures are being carried out intensively.

The World Health Organization also points out that there is no protective vaccine against the disease, noting that the only way to reduce infection is to raise awareness about risk factors. It recommends that risk groups be educated about the precautions they can take against the virus.

THE MINISTRY HAS NOT SHARED DATA FOR 2-3 YEARS

Prof. Dr. Önder Ergönül, a member of the Board of Directors of the Turkish Society of Clinical Microbiology and Infectious Diseases (KLİMİK) and a faculty member at Koç University, says regarding the disease, which was first seen in Turkey in 2002 and has shown an increase over the years: “We know that there are at least 1000 cases on average per year. This number even exceeds a thousand. However, the data for recent years is not being disclosed.”

Prof. Dr. Ergönül emphasizes that Turkey is the country where the disease is most common in the world, and therefore summarizes why the number of cases and the spread in which region should be known by everyone with the following words:

“In our country, the number of Crimean-Congo Hemorrhagic Fever patients used to be easily shared by the ministry. Unfortunately, it has not been shared for 2-3 years. However, we can estimate the numbers. We can understand how many there are thanks to the efforts of our colleagues working selflessly in the region. We have to know this. This is a necessity because Turkey has the distinction of being the country where such a serious disease is most common in the world. It is everyone's right to know in which region there is a spread and how. We were previously able to show the possible numbers with mathematical models. We did this study and published it with the ministry. We want to continue similar studies, but we are not getting a response.”

Prof. Dr. Ergönül provides information that although Crimean-Congo Hemorrhagic Fever appears in places other than where it was previously seen, it is concentrated in the south of the Black Sea and the northern parts of Central Anatolia, extending to Çorum, Yozgat, Sivas, Erzurum, and Artvin, which is called the Kelkit Valley, the region where the epidemic is located.

“MORE FATAL THAN THE COVID-19 VIRUS!”

I ask Prof. Dr. Önder Ergönül, who says, “The disease is undoubtedly more fatal than the COVID-19 virus. The mortality rate is between 5 – 10 percent,” “Does the Ministry of Health's attitude regarding data sharing prevent the disease from being taken seriously?”

He answers as follows:

“Because information is not shared, the perception of risk drops. Sensitivity decreases as if the disease does not exist, and it is acted upon as if there is no such risk in society.

Unfortunately, it is not possible to make progress in this way. The scientific approach is about knowing the truth and pursuing it. This is how we learned, and that is why we say our most important guide is science. Otherwise, saying there is no such problem and covering it up is not a scientific approach.”

“FRANCE IS ON ALERT, WE ARE ACTING AS IF IT DOES NOT EXIST”

Explaining that although no cases have been reported in France yet, they are ready for the possibility of cases, Prof. Dr. Ergönül says, “Ticks carrying CCHF have been detected in France. Our French colleagues think that since there are ticks and there is a virus inside the tick, it is a matter of time before human cases emerge. That is why they are acting more carefully. Can you imagine, they are taking this very seriously even though there are no cases yet. Hundreds of people are working for this. There are thousands of patients in Turkey, but it is acted upon as if there is no problem in this sense.”

GLOBAL WARMING IS THOUGHT TO BE EFFECTIVE

In the scientific world, it is emphasized in recent years that CCHF cases show a parallel with the increase in global warming. It is thought that the change in temperature both changes the maturation characteristics of ticks and affects the migration routes of birds, creating new habitats for ticks, and thus the disease can spread to different regions.

Prof. Dr. Ergönül's assessment on this subject is as follows:

“The role of climate change in the increase of cases is indeed present. With the change in temperature, an increase is observed in both the number of ticks and CCHF cases. The route of migratory birds also has an effect, of course. In fact, the first cases appeared at the stopover points of birds migrating from Crimea towards Africa.”

NEW HOPES IN DIAGNOSIS AND TREATMENT

Prof. Dr. Önder Ergönül also provided information about the research they are working on at the Koç University İş Bank Infectious Diseases Research Center (KUISCID), where he serves as director.

Prof. Dr. Ergönül said that thanks to the PCR test they developed, especially for the early diagnosis of the disease, very rapid diagnosis and thus early treatment could be possible.

He described their efforts to work with colleagues dealing with CCHF in Anatolia to produce solutions to the disease with the following words: “We are trying to develop alternative treatments together. At the same time, we are continuing our research on issues that will affect the immune system.

We have promising options, and these excite us. We want to share these as soon as possible when we put them into practice.”