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Crimean-Congo haemorrhagic fever virus (CCHFV) is considered an emerging or even a probable re-emerging pathogen in southern Europe. Presence of this virus had been reported previously in Spain in 2010.


We aimed to evaluate the potential circulation of CCHFV in western Spain with a serosurvey in asymptomatic adults (blood donors).


During 2017 and 2018, we conducted a CCHFV serosurvey in randomly selected asymptomatic blood donors from western Spain. Three assays using specific IgG antibodies against CCHFV were performed: the VectoCrimea ELISA test, an in-house ELISA and indirect immunofluorescence (EuroImmun) test with glycoprotein and nucleoprotein.


A total of 516 blood donors participated in this cross-sectional study. The majority of the study participants were male (68.4%), and the mean age was 46.3 years. Most of the participants came from rural areas (86.8%) and 68.6% had contact with animals and 20.9% had animal husbandry practices. One in five participants (109/516, 21.1%) were engaged in at-risk professional activities such as agriculture and shepherding, slaughtering, hunting, veterinary and healthcare work (mainly nursing staff and laboratory technicians). A total of 15.3% of the participants were bitten by ticks in the days or months before the date of sampling. We detected anti-CCHFV IgG antibodies with two diagnostic assays in three of the 516 individuals and with one diagnostic assay in six of the 516 individuals.


Seroprevalence of CCHFV was between 0.58% and 1.16% in Castile-León, Spain. This is the first study in western Spain that showed circulation of CCHFV in healthy people.


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  1. Ballinger MJ, Medeiros AS, Qin J, Taylor DJ. Unexpected differences in the population genetics of phasmavirids (Bunyavirales) from subarctic ponds. Virus Evol. 2017;3(1):vex015.  https://doi.org/10.1093/ve/vex015  PMID: 28744370 
  2. Leblebicioglu H, Eroglu C, Erciyas-Yavuz K, Hokelek M, Acici M, Yilmaz H. Role of migratory birds in spreading Crimean-Congo hemorrhagic fever, Turkey. Emerg Infect Dis. 2014;20(8):1331-4.  https://doi.org/10.3201/eid2008.131547  PMID: 25062428 
  3. Spengler JR, Bente DA. Crimean-Congo hemorrhagic fever in Spain - New arrival or silent resident? N Engl J Med. 2017;377(2):106-8.  https://doi.org/10.1056/NEJMp1707436  PMID: 28700846 
  4. Estrada-Peña A, de la Fuente J. The ecology of ticks and epidemiology of tick-borne viral diseases. Antiviral Res. 2014;108:104-28.  https://doi.org/10.1016/j.antiviral.2014.05.016  PMID: 24925264 
  5. Bente DA, Forrester NL, Watts DM, McAuley AJ, Whitehouse CA, Bray M. Crimean-Congo hemorrhagic fever: history, epidemiology, pathogenesis, clinical syndrome and genetic diversity. Antiviral Res. 2013;100(1):159-89.  https://doi.org/10.1016/j.antiviral.2013.07.006  PMID: 23906741 
  6. Aslam S, Latif MS, Daud M, Rahman ZU, Tabassum B, Riaz MS, et al. Crimean-Congo hemorrhagic fever: Risk factors and control measures for the infection abatement. Biomed Rep. 2016;4(1):15-20.  https://doi.org/10.3892/br.2015.545  PMID: 26870327 
  7. Kasi KK, Sas MA, Sauter-Louis C, Gethmann JM, Groschup MH, Conraths FJ. Risk factors for Crimean-Congo hemorrhagic fever virus infection in Livestock in Pakistan. Int J Infect Dis. 2019;79:137.  https://doi.org/10.1016/j.ijid.2018.11.335 
  8. Sidira P, Maltezou HCC, Haidich A-BA-B, Papa A. Seroepidemiological study of Crimean-Congo haemorrhagic fever in Greece, 2009-2010. Clin Microbiol Infect. 2012;18(2):E16-9.  https://doi.org/10.1111/j.1469-0691.2011.03718.x  PMID: 22192082 
  9. World Health Organization (WHO). 2017 Annual review of diseases prioritized under the Research and Development Blueprint. Meeting report. Geneva, Switzerland: Informal consultation 24-25 Jan 2017. Available from: https://www.who.int/blueprint/what/research-development/2017-Prioritization-Long-Report.pdf?ua=1
  10. World Health Organization (WHO). An R&D Blueprint for Action to Prevent Epidemics: Plan of Action. Geneva: WHO; 2016. Available from: https://www.who.int/blueprint/about/r_d_blueprint_plan_of_action.pdf
  11. World Health Organization (WHO). Blueprint for R&D preparedness and response to public health emergencies due to highly infectious pathogens. Funding & coordination models for preparedness and response. Geneva: WHO; 2016. Available from: https://www.who.int/blueprint/what/improving-coordination/workstream_5_document_on_financing.pdf
  12. Gunes T, Engin A, Poyraz O, Elaldi N, Kaya S, Dokmetas I, et al. Crimean-Congo hemorrhagic fever virus in high-risk population, Turkey. Emerg Infect Dis. 2009;15(3):461-4.  https://doi.org/10.3201/eid1503.080687  PMID: 19239765 
  13. Midilli K, Gargili A, Ergonul O, Sengöz G, Ozturk R, Bakar M, et al. Imported Crimean-Congo hemorrhagic fever cases in Istanbul. BMC Infect Dis. 2007;7(1):54.  https://doi.org/10.1186/1471-2334-7-54  PMID: 17553137 
  14. Eurosurveillance editorial team. Increase in cases of Crimean-Congo haemorrhagic fever, Turkey, 2006. Euro Surveill. 2006;11(7):E060720.2.  PMID: 16966763 
  15. Papa A, Maltezou HC, Tsiodras S, Dalla VG, Papadimitriou T, Pierroutsakos I, et al. A case of Crimean-Congo haemorrhagic fever in Greece, June 2008. Euro Surveill. 2008;13(33):18952.  https://doi.org/10.2807/ese.13.33.18952-en  PMID: 18761893 
  16. Christova I, Younan R, Taseva E, Gladnishka T, Trifonova I, Ivanova V, et al. Hemorrhagic fever with renal syndrome and Crimean-Congo hemorrhagic fever as causes of acute undifferentiated febrile illness in Bulgaria. Vector Borne Zoonotic Dis. 2013;13(3):188-92.  https://doi.org/10.1089/vbz.2011.0938  PMID: 23421884 
  17. Roth C. Outbreak of Crimean-Congo haemorrhagic fever in Kosovo – update. Euro Surveill. 2001;5(25):1731.  https://doi.org/10.2807/esw.05.25.01731-en 
  18. Papa A, Bino S, Llagami A, Brahimaj B, Papadimitriou E, Pavlidou V, et al. Crimean-Congo hemorrhagic fever in Albania, 2001. Eur J Clin Microbiol Infect Dis. 2002;21(8):603-6.  https://doi.org/10.1007/s10096-002-0770-9  PMID: 12226691 
  19. Dreshaj S, Ahmeti S, Ramadani N, Dreshaj G, Humolli I, Dedushaj I. Current situation of Crimean-Congo hemorrhagic fever in Southeastern Europe and neighboring countries: a public health risk for the European Union? Travel Med Infect Dis. 2016;14(2):81-91.  https://doi.org/10.1016/j.tmaid.2016.03.012  PMID: 27044611 
  20. Tall A, Sall AA, Faye O, Diatta B, Sylla R, Faye J, et al. [Two cases of Crimean-Congo haemorrhagic fever (CCHF) in two tourists in Senegal in 2004]. Bull Soc Pathol Exot. 2009;102(3):159-61. PMID: 19739410 
  21. Jauréguiberry S, Tattevin P, Tarantola A, Legay F, Tall A, Nabeth P, et al. Imported Crimean-Congo hemorrhagic fever. J Clin Microbiol. 2005;43(9):4905-7.  https://doi.org/10.1128/JCM.43.9.4905-4907.2005  PMID: 16145173 
  22. Barr DA, Aitken C, Bell DJ, Brown CS, Cropley I, Dawood N, et al. First confirmed case of Crimean-Congo haemorrhagic fever in the UK. Lancet. 2013;382(9902):1458.  https://doi.org/10.1016/S0140-6736(13)61718-3  PMID: 24243135 
  23. Filipe AR, Calisher CH, Lazuick J. Antibodies to Congo-Crimean haemorrhagic fever, Dhori, Thogoto and Bhanja viruses in southern Portugal. Acta Virol. 1985;29(4):324-8. PMID: 2864836 
  24. Estrada-Peña A, Palomar AM, Santibáñez P, Sánchez N, Habela MA, Portillo A, et al. Crimean-Congo hemorrhagic fever virus in ticks, Southwestern Europe, 2010. Emerg Infect Dis. 2012;18(1):179-80.  https://doi.org/10.3201/eid1801.111040  PMID: 22261502 
  25. Negredo A, de la Calle-Prieto F, Palencia-Herrejón E, Mora-Rillo M, Astray-Mochales J, Sánchez-Seco MP, et al. Autochthonous Crimean-Congo hemorrhagic fever in Spain. N Engl J Med. 2017;377(2):154-61.  https://doi.org/10.1056/NEJMoa1615162  PMID: 28700843 
  26. Cajimat MNB, Rodriguez SE, Schuster IUE, Swetnam DM, Ksiazek TG, Habela MA, et al. Genomic characterization of Crimean-Congo hemorrhagic fever virus in hyalomma tick from Spain, 2014. Vector Borne Zoonotic Dis. 2017;17(10):714-9.  https://doi.org/10.1089/vbz.2017.2190  PMID: 28836897 
  27. Sierra MJ, García San Miguel L, García M, Vila B, Suárez B, Monge S, et al. Informe de situación y evaluación del riesgo de transmisión de Fiebre Hemorrágica de Crimea-Congo (FHCC) en España. [Status report and risk assessment of transmission of Crimean-Congo haemorrhagic fever (CCHF) in Spain]. Madrid: Centro de Coordinación de Alertas y Emergencias Sanitarias, Ministerio de Sanidad, Consumo y Bienestar Social; 2019. Spanish. Available from: https://www.mscbs.gob.es/profesionales/saludPublica/ccayes/analisisituacion/doc/ER_FHCC.pdf
  28. Negredo A, Habela , Ramírez de Arellano E, Diez F, Lasala F, López P, et al. Survey of Crimean-Congo hemorrhagic fever enzootic focus, Spain, 2011-2015. Emerg Infect Dis. 2019;25(6):1177-84.  https://doi.org/10.3201/eid2506.180877  PMID: 31107219 
  29. Spengler JR, Estrada-Peña A. Host preferences support the prominent role of Hyalomma ticks in the ecology of Crimean-Congo hemorrhagic fever. PLoS Negl Trop Dis. 2018;12(2):e0006248.  https://doi.org/10.1371/journal.pntd.0006248  PMID: 29420542 
  30. Palomar AM, Portillo A, Santibáñez S, García-Álvarez L, Muñoz-Sanz A, Márquez FJ, et al. Molecular (ticks) and serological (humans) study of Crimean-Congo hemorrhagic fever virus in the Iberian Peninsula, 2013-2015. Enferm Infecc Microbiol Clin. 2017;35(6):344-7.  https://doi.org/10.1016/j.eimc.2017.01.009  PMID: 28291670 
  31. National Statistics Institute (INE). España en cifras 2019. Población. [Spain in numbers. Population]. Madrid: INE; 2019. Spanish. Available from: https://www.ine.es/prodyser/espa_cifras/2019/10/#zoom=z
  32. Dowall SD, Richards KS, Graham VA, Chamberlain J, Hewson R. Development of an indirect ELISA method for the parallel measurement of IgG and IgM antibodies against Crimean-Congo haemorrhagic fever (CCHF) virus using recombinant nucleoprotein as antigen. J Virol Methods. 2012;179(2):335-41.  https://doi.org/10.1016/j.jviromet.2011.11.020  PMID: 22155577 
  33. Tezer H, Polat M. Diagnosis of Crimean-Congo hemorrhagic fever. Expert Rev Anti Infect Ther. 2015;13(5):555-66.  https://doi.org/10.1586/14787210.2015.1021782  PMID: 25746112 
  34. Burt FJ. Laboratory diagnosis of Crimean-Congo hemorrhagic fever virus infections. Future Virol. 2011;6(7):831-41.  https://doi.org/10.2217/fvl.11.47 
  35. Németh V, Oldal M, Egyed L, Gyuranecz M, Erdélyi K, Kvell K, et al. Serologic evidence of Crimean-Congo hemorrhagic fever virus infection in Hungary. Vector Borne Zoonotic Dis. 2013;13(4):270-2.  https://doi.org/10.1089/vbz.2012.1011  PMID: 23421895 
  36. Papa A, Dalla V, Papadimitriou E, Kartalis GNN, Antoniadis A. Emergence of Crimean-Congo haemorrhagic fever in Greece. Clin Microbiol Infect. 2010;16(7):843-7.  https://doi.org/10.1111/j.1469-0691.2009.02996.x  PMID: 19845692 
  37. Vanhomwegen J, Alves MJ, Zupanc TA, Bino S, Chinikar S, Karlberg H, et al. Diagnostic assays for Crimean-Congo hemorrhagic fever. Emerg Infect Dis. 2012;18(12):1958-65.  https://doi.org/10.3201/eid1812.120710  PMID: 23171700 
  38. de Ory F, Guisasola M-E, Balfagón P, Sanz JC. Comparison of commercial methods of immunoblot, ELISA, and chemiluminescent immunoassay for detecting type-specific herpes simplex viruses-1 and -2 IgG. J Clin Lab Anal. 2018;32(1):e22203.  https://doi.org/10.1002/jcla.22203  PMID: 28332725 
  39. Stramer SL, Hollinger FB, Katz LM, Kleinman S, Metzel PS, Gregory KR, et al. Emerging infectious disease agents and their potential threat to transfusion safety. Transfusion. 2009;49(Suppl 2):1S-29S.  https://doi.org/10.1111/j.1537-2995.2009.02279.x  PMID: 19686562 
  40. European Centre for Disease Control and Prevention ECDC). Rapid risk assessment: Crimean–Congo haemorrhagic fever in Spain. Stockholm: ECDC; 2016. Available from: https://www.ecdc.europa.eu/en/publications-data/rapid-risk-assessment-crimean-congo-haemorrhagic-fever-spain-9-september-2016
  41. Mertens M, Schmidt K, Ozkul A, Groschup MH. The impact of Crimean-Congo hemorrhagic fever virus on public health. Antiviral Res. 2013;98(2):248-60.  https://doi.org/10.1016/j.antiviral.2013.02.007  PMID: 23458713 
  42. López-Vélez R, Molina Moreno R. [Climate change in spain and risk of infectious and parasitic diseases transmitted by arthropods and rodents]. Rev Esp Salud Publica. 2005;79(2):177-90.  PMID: 15913053 
  43. Brady OJ, Gething PW, Bhatt S, Messina JP, Brownstein JS, Hoen AG, et al. Refining the global spatial limits of dengue virus transmission by evidence-based consensus. PLoS Negl Trop Dis. 2012;6(8):e1760.  https://doi.org/10.1371/journal.pntd.0001760  PMID: 22880140 
  44. Yactayo S, Staples JE, Millot V, Cibrelus L, Ramon-Pardo P. Epidemiology of chikungunya in the Americas. J Infect Dis. 2016;214(suppl 5):S441-5.  https://doi.org/10.1093/infdis/jiw390  PMID: 27920170 
  45. de La Rocque S, Balenghien T, Halos L, Dietze K, Claes F, Ferrari G, et al. A review of trends in the distribution of vector-borne diseases: is international trade contributing to their spread? Rev Sci Tech. 2011;30(1):119-30.  https://doi.org/10.20506/rst.30.1.2018  PMID: 21809758 
  46. Kilpatrick AM, Randolph SE. Drivers, dynamics, and control of emerging vector-borne zoonotic diseases. Lancet. 2012;380(9857):1946-55.  https://doi.org/10.1016/S0140-6736(12)61151-9  PMID: 23200503 

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