Crimean-Congo Hemorrhagic Fever Knowledge, Attitudes, Practices, Risk Factors, and Seroprevalence in Rural Georgian Villages with Known Transmission in 2014

Abstract

In 2014 the highest annual case count of Crimean-Congo hemorrhagic fever (CCHF) was detected in Georgia since surveillance began in 2009. CCHF is a high-fatality hemorrhagic syndrome transmitted by infected ticks and animal blood. In response to this immediate public health threat, we assessed CCHF risk factors, seroprevalence, and CCHF-related knowledge, attitudes, and practices in the 12 rural villages reporting a 2014 CCHF case, to inform CCHF prevention and control measures. Households were randomly selected for interviewing and serum sample collection. Data were weighted by non-response and gender; percentages reflect weighting. Among 618 respondents, median age was 54.8 years (IQR: 26.5, range: 18.6–101.4); 215 (48.8%) were male. Most (91.5%) participants reported ≥1 CCHF high-risk activity. Of 389 participants with tick exposure, 286 (46.7%) participants handled ticks bare-handed; 65/216 (29.7%) knew the risk. Of 605 respondents, 355 (57.9%) reported animal blood exposure; 32/281 (12.7%) knew the risk. Of 612 responding, 184 (28.8%) knew protective measures against CCHF and tick exposures, but only 54.3% employed the measures. Of 435 serum samples collected, 12 were anti-CCHF IgG positive, indicating a weighted 3.0% seroprevalence. Most (66.7%) seropositive subjects reported tick exposure. In these villages, CCHF risk factors are prevalent, while CCHF-related knowledge and preventive practices are limited; these findings are critical to informing public health interventions to effectively control and prevent ongoing CCHF transmission. Additionally, CCHF seroprevalence is higher than previously detected (0.03%), highlighting the importance of this disease in the South Caucuses and in supporting ongoing regional investigations.

Seroprevalence of Crimean-Congo hemorrhagic fever in humans in the World Health Organization European region: A systematic review

“…Russia and western Asia. Georgia shows a prevalence similar to that in eastern European countries (2.8%, [52]), while the Russian Federation (11.1%, [53]) and Kazakhstan (12.7%, [51]) show a prevalence closer to that found in Turkish areas, with a moderate/high prevalence.…”

“…Major risk factors, such as occupations associated with animal husbandry (especially of sheep and goats) [6,29,31,45,[47][48][51][52] and agricultural and agropastoral activities [4,6,32,45,50,52] were identified in this study (no matter the geographical zone). Also another major risk https://doi.org/10.1371/journal.pntd.0008094.g002…”

“…factor was the tick exposure; tick exposure includes direct physical contact, tick bites, tick removal from people and animals and exposure to ticks around the working and home environments [12,31,33,[35][36][37]39,43,45,[47][48]52]. To a lesser extent, health care workers (physicians and nurses), veterinarians [38,44,[48][49] and individuals with slaughtering-associated jobs [6,30,31] were also more likely to have the presence of CCHFV IgG antibodies.…”

“…Major risk factors have been well documented to be associated to tick exposure [12,31,33,[35][36][37]39,43,45,[47][48]52] in endemic regions, especially in the individuals involved in ungulate husbandry [6,29,31,45,[47][48][51][52] and/or agropastoral activities [4,6,32,45,50,52]. The outbreaks emerge mainly in the spring and summer (May to October) [1].…”

“…PRISMA flowchart of identified and selected studies in the systematic review.https://doi.org/10.1371/journal.pntd.0008094.g001PLOS NEGLECTED TROPICAL DISEASESarticles[51][52][53]. Even though the geographical origin was diverse, most studies were performed in Turkey (central Europe) (13 articles)[4,34,[37][38][39][41][42][44][45][47][48][49][50] and in Greece (western Europe) (7 articles)[6,26,[29][30][31][32][33].…”