Open Outbreak

克里米亚-刚果出血热

又称: CCHF, Crimean-Congo hemorrhagic fever

Crimean-Congo haemorrhagic fever, or CCHF, is a viral disease that mainly spreads from infected ticks and from contact with the blood or tissues of infected animals or people. It is one of the more widely distributed serious tick-borne viral diseases, with reports across parts of Africa, the Balkans, the Middle East, and Asia. Illness often starts suddenly with fever, muscle pain, headache, vomiting, and diarrhoea. Some patients go on to develop bleeding and organ failure. Severity varies by outbreak. In a WHO-reported outbreak in Iraq in 2022, 13 of 97 laboratory-confirmed patients died. There is no widely available approved vaccine for people in the sources used here. Care is mainly supportive, meaning treatment of dehydration, bleeding, and organ problems. Ribavirin has been used, but WHO noted in 2022 that randomized clinical trials had not shown it to be effective. Public-health concern is highest where people are exposed to Hyalomma ticks, livestock, or blood from infected patients without strong infection control.

关键事实

传播蜱虫叮咬、压碎受感染的蜱虫、接触带病毒血症牲畜的血液或组织，以及急性期直接接触受感染人的血液或组织。
潜伏期未知
病死率因疫情而异；WHO报告2022年伊拉克实验室确诊病例中病死率为13%（13/97），2021年伊拉克确诊病例中为39%（13/33）。这里使用的资料中没有单一的总体病死率数据。
再生数未知
疫苗WHO在2022年报告无针对人类或动物的可用疫苗。
治疗主要是支持性治疗。利巴韦林曾被使用，但WHO报告随机临床试验无证据显示其有效性。
宿主病毒在蜱虫，尤其是Hyalomma属蜱虫与包括牲畜在内的多种脊椎动物宿主之间循环，这些动物宿主通常无明显疾病表现。
流行地区非洲、巴尔干半岛、中东及亚洲部分地区，包括北纬50度以南国家；2020年综述还提及印度次大陆。

传播途径

克里米亚-刚果出血热通常通过三种主要方式感染人类。首先，受感染的蜱虫叮咬时可传播病毒。其次，处理带病毒血液的牲畜或动物组织时可能暴露。第三，急性期通过直接接触受感染者的血液或其他体液可发生人传人。WHO 2022年伊拉克报告指出，大多数确诊患者与动物有直接接触，许多是牲畜饲养者或屠夫。这与更广泛的综述证据一致，描述CCHF为与Hyalomma蜱虫相关的蜱传感染。该综述还指出压碎受感染蜱虫及与感染患者密切接触时可传播。普通的偶然接触资料中未显示为主要传播途径。风险最高的情况是暴露于蜱虫、动物屠宰或无防护照顾病人。

症状与严重性

CCHF often starts suddenly. The overview source lists fever, muscle pains, headache, vomiting, diarrhoea, and bleeding into the skin as possible symptoms. Complications can include liver failure. Illness does not look the same in every patient. Some people recover in about two weeks after symptoms begin, while others become severely ill and need intensive supportive care. The sources used here do not provide one reliable global fatality figure, so it is safer to describe severity as variable. WHO’s Iraq outbreak report gives one clear recent example: among 97 laboratory-confirmed cases reported from 2022-01-01 to 2022-05-22, 13 people died, a case fatality ratio of 13%. The same WHO report also noted that Iraq had reported 33 confirmed cases with 13 deaths in 2021, a much higher proportion that year. These figures show why CCHF is taken seriously, even though outcomes differ between places and outbreaks.

治疗与疫苗

CCHF的治疗主要是支持性治疗。通俗来说，就是在身体对抗感染期间处理患者的问题：补液、仔细监测、必要时输血制品，以及器官衰竭或休克的治疗。WHO 2022年疫情报告称，人类病例主要接受一般支持治疗。报告还提到利巴韦林作为抗病毒药物，口服和静脉注射均有使用。然而，WHO也指出随机临床试验未显示利巴韦林对CCHF治疗有效。这意味着某些地区可能仍使用该药，但证据有限。关于疫苗，资料明确：WHO 2022年报告无针对人类或动物的可用疫苗。对公众而言，预防仍主要依赖避免蜱虫叮咬、减少与动物血液或组织的高风险接触，以及在医疗中使用严格的感染控制措施。

分布区域

与其他严重蜱传病毒病相比，CCHF的地理分布范围广泛。2006年《柳叶刀》综述称其已在约30个国家被描述，其分布与Hyalomma蜱虫的已知范围密切匹配。2020年一项“一个健康”综述指出该病毒广泛分布于欧洲、亚洲、非洲、中东及印度次大陆。WHO 2022年疫情报告给出类似区域图景，称该病在非洲、巴尔干半岛、中东及北纬50度以南的亚洲国家为地方病。WHO特别将伊拉克描述为地方病国家。报告中2022年病例分布于伊拉克多个省份，Thiqar省病例较多。实际意义是CCHF不限于单一国家或短暂热点。只要蜱虫媒介和动物宿主存在，尤其是有牲畜养殖和人类经常暴露于蜱虫或动物血液的地区，疾病就会持续存在。

近期历史

On this site’s archive, Crimean-Congo haemorrhagic fever appears in 9 WHO-related event notices since 1996. The history results show notices from South Africa in 1996, Afghanistan and Pakistan in 1998, the Russian Federation in 1999, Kosovo in 2001, Mauritania in 2003, Turkey in 2006, Pakistan again in 2010, and Iraq in 2022. That pattern suggests repeated, scattered events rather than one single global wave. The most detailed recent WHO notice available here is Iraq on 2022-06-01. WHO reported 212 cases from 2022-01-01 to 2022-05-22, including 97 laboratory-confirmed cases and 27 deaths overall. WHO also said this was much higher than in 2021, when 33 confirmed cases were recorded in Iraq. In its risk assessment, WHO linked the rise in concern to livestock exposure, seasonal and holiday slaughter, and possible cross-border spread with population movement and animal trade. Recent history therefore points to recurring outbreaks, often tied to rural livestock settings.

关注要点

有几个信号会使克里米亚-刚果出血热更令人担忧。其一是传播到新的地区，尤其是先前未建立Hyalomma蜱虫的地区。对新兴蜱虫传播疾病的综述警告称，蜱虫分布范围可能发生变化，世卫组织已将克里米亚-刚果出血热描述为具有广泛的地方流行区。第二个警示信号是更有效的人际传播，特别是在医院或家庭中，因为现有证据强调血液和组织接触，而非日常轻易传播。第三是任何更强的证据表明治疗方案失败，或尽管试验证据薄弱仍依赖利巴韦林。第四是疫苗研发进展停滞，因为世卫组织报告称尚无针对人类或动物的疫苗。世卫组织对伊拉克的评估还强调了动物流动和屠宰增加的时期，这可能加剧暴露并提高跨境传播的可能性。简言之，应关注新的地理分布、医疗相关传播、诊断和防护设备的压力，以及任何增加牲畜处理或屠宰暴露的变化。

更新于