Crimean-Congo haemorrhagic fever (CCHF)

The virus circulates in ticks, particularly Hyalomma species, and in domestic and wild animals such as cattle, sheep and hares without making them visibly ill. TravelHealthPro describes human infection through tick bites, crushing infected ticks with bare fingers, and contact with infected blood or tissues, for instance during animal slaughter or in a healthcare setting. Spread between people happens through blood and body fluids, so care of patients needs infection control precautions.

The geographic range is wide and expanding. TravelHealthPro states the first locally acquired cases were reported in Spain in 2013 and in Portugal in 2024, which illustrates how the tick range is changing across southern Europe.

After an incubation period that TravelHealthPro puts at typically 3 to 7 days and up to 14 days, mild disease causes fever, headache, diarrhoea and vomiting, sore eyes and confusion. Some patients progress after several days to a haemorrhagic phase with bruising, nosebleeds, gum bleeding and bleeding into the gut or skin, together with liver and kidney problems and shock. Many infections are mild or asymptomatic.

Case fatality across reported cases ranges between 5 and 40 per cent according to TravelHealthPro, with considerable variation by country and access to intensive care. Survivors usually recover completely, although recovery can take weeks.

• Sudden fever, headache and muscle pain.

• Nausea, vomiting, diarrhoea and abdominal pain.

• Sore or red eyes and light sensitivity; confusion in some.

• Bleeding and bruising in severe disease.

TravelHealthPro describes the risk to typical tourists as minimal. Cases predominantly occur among farmers, veterinarians, slaughterhouse workers and livestock owners in endemic areas, and among healthcare workers exposed to blood. Walkers and campers in tick-infested rural areas could also be bitten, particularly in warmer months when Hyalomma ticks are active.

In the UK, anyone with fever after travel to an endemic region is assessed for malaria and other common causes, and if a viral haemorrhagic fever is plausible the UKHSA risk-assessment pathway guides isolation and testing. Laboratory diagnosis uses PCR on blood, and confirmed cases are managed in specialist units.

TravelHealthPro states there is currently no vaccine and no specific treatment for CCHF. Management focuses on supportive care, including fluids, replacement of blood products where needed, treatment of organ problems and close monitoring.

Avoid tick bites by using repellents, wearing long clothing, checking the skin and removing ticks with appropriate tools such as fine tweezers rather than bare fingers, as TravelHealthPro advises. Avoid contact with the blood or tissues of livestock and do not handle slaughtered animals without protective equipment. Healthcare workers use standard and transmission-based precautions.

If you develop fever within about two weeks of tick exposure, animal contact or travel to an affected area, contact NHS 111 or an urgent care service by phone and give your travel history. Call 999 for bleeding, confusion, collapse or severe breathlessness.