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Epidemic Control Toolkit
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Crimean-Congo haemorrhagic fever (CCHF)
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Crimean-Congo haemorrhagic fever (CCHF)

Last update: 2025-05-09
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Key facts

  • The Crimean-Congo haemorrhagic fever (CCHF) virus causes severe viral haemorrhagic fever outbreaks.
  • Its outbreaks have a case fatality rate of up to 40%.
  • CCHF is endemic in many countries in Africa, the Middle East, Asia, and Eastern Europe.
  • There is no CCHF vaccine for humans or animals.

Transmission: vector-borne (ticks)

  • The virus is mainly transmitted to people through bites from infected ticks
  • Handling or butchering of infected animals, particularly livestock including cattle, sheep, and goats
  • Close contact with the blood, secretions, organs or other bodily fluids of infected persons
  • Transmission at healthcare facilities can also occur due to improper infection control and prevention practices

Most vulnerable to contracting the disease

  • Farmers, abattoir workers, and veterinarians due to increased exposure to livestock and ticks (which often infest the livestock animals)
  • People residing in or visiting areas where CCHF is endemic are at higher risk, particularly during tick activity seasons.
  • Healthcare workers, especially if proper protective measures are not followed while caring for an infected patient

Most vulnerable to severe disease

  • Elderly
  • People with pre-existing health issues, including weakened immune systems
  • Pregnant women

Symptoms 

  • Sudden onset of fever 
  • Dizziness 
  • Muscle pain 
  • Backache 
  • Neck pain and stiffness 
  • Photophobia (sensitivity to light) 
  • Diarrhea 
  • Sore eyes 
  • Sore throat 
  • Vomiting 
  • Headache 
  • Nausea 
  • Abdominal pain 
  • Mood swings 
  • Confusion 

Severe symptoms 

  • Jaundice (yellow skin and/or mucosae) 
  • Liver enlargement 
  • Bleeding from the skin, internal organs, and other body openings 
  • Severe bruising and uncontrolled bleeding 

What can you do to prevent and control an epidemic?

Reservoir control and prevention

  • Identify and isolate suspected livestock

Personal protection and hygiene

  • Promote handwashing with soap, especially:
    • After caring for or visiting sick people
    • After handling or slaughtering sick animals
  • Promote the use of:
    • personal protective equipment (PPE) when caring for sick people or when touching sick or dead animals, specifically gloves and mask
    • gloves and other protective clothing while handling animals or their tissues in endemic areas, particularly during slaughtering, butchering and culling procedures in abattoirs or at home
  • Discourage people from:
    • Unnecessary touching of sick or dead animals or things that might have been contaminated by their blood or body fluids
    • Close physical contact with CCHF-infected people
  • Encourage farmers and abattoir workers to quarantine animals before they enter slaughterhouses and routinely treat animals with pesticides two weeks prior to slaughter.

Vector control and prevention

  • Initiate elimination of ticks
    • Promote the use of approved acaricides (chemicals made to kill ticks) on clothing
  • Prevent tick bites by encouraging people to:
    • Use personal protection (application of repellents, wearing long sleeved clothes, wearing of light coloured clothing to aid the detection of ticks on clothes)
    • Regularly examine their clothes and skin for ticks; and promptly and safely remove it
    • Avoid areas where ticks are abundant and seasons when ticks are most active

Monitoring the community and identifying sick people  

  • Identify community members who have suspected CCHF infection based on the community case definition

Treatment and management

  • Rapidly detect and refer cases to health facilities early
  • Support contact tracing and follow-up of contacts
  • Provide psychosocial support to the sick person and their family members  

Social mobilisation and behaviour change

  • Find out the specific advice being given by health and other relevant authorities  
  • Model following this advice and inform community members of current health practice advice  
  • Offer support and encouragement to follow the advice  
    • Try to gain understanding about if and why health practice advice is not being followed  
    • With the guidance of your supervisor and health authorities, work with communities to overcome barriers to following health advice and recommended practices  

Immunization

  • Currently, there are no vaccines for CCFH 

Mapping and community assessment

  • Make a map of the community.
  • Mark the following information on the map:
    • How many people have fallen sick with CCHF? Where?
    • How many people have died? Where? When?
    • Who and where are the vulnerable people?
    • Where are the local health facilities and services? (include traditional healers)
  • Record the following information on the back of the map:
    • When did people start to fall sick with CCHF disease?  
    • How many people live in the affected community?  
      • How many are children under five years old?
      • Which people in the community have contact with livestock and ticks?
    • Do people cook meat thoroughly before eating it?
    • Are there handwashing facilities in the community, at animal markets and other areas where livestock is slaughtered? Are soap and water always available?
    • What are the community’s habits, practices and beliefs about handling and slaughtering animals, especially animals that are sick or dead?
    • What are the community’s habits, practices and beliefs about repellents and sprays?
    • What are the community’s habits, practices and beliefs about caring for and feeding sick people? Consider any differences in roles and responsibilities between men and women.
      • When babies and infants are sick, do women continue to breastfeed them?
    • Are children badly affected by the CCHF? Are there other groups (specific ages, occupations, geographic areas, etc.) that are badly affected?  
    • Is a social mobilization or health promotion programme in place?
    • Which sources do people use/trust the most for information?
      • Are there rumours or misinformation about CCHF? What are the rumours? 

Volunteer actions

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01. Community-based surveillance 02. Community mapping 03. Communicating with the community 04. Community referral to health facilities 05. Volunteer protection and safety 06. Personal protection equipment (PPE) for highly infectious diseases 19. Psychosocial support 20. Isolating sick people 34. Handwashing with soap 35. Handwashing in a highly infectious epidemic 36. Vector and reservoir control 41. Handling and slaughtering animals 43. Social mobilization and behaviour change 44. Dealing with rumors 45. Psychological First Aid (PFA)

Other resources