21 Jun 2022

Crimean-Congo haemorrhagic fever: raising awareness for travellers to endemic countries

International travellers are reminded of the risk of Crimean-Congo haemorrhagic fever when visiting countries where the infection occurs Crimean-Congo haemorrhagic fever: raising awareness for travellers to endemic countries

Crimean Congo Haemorrhagic Fever (CCHF) is caused by a virus, usually transmitted by the bite of an infected Hyalomma tick. The virus can also be transmitted to humans through direct contact with blood, tissues, or body fluids of infected animals. Human-to-human transmission has been reported following close contact with blood, secretions, or other bodily fluids of infected persons.

CCHF is endemic in all of Africa, the Middle East, western and south-central Asia and Eastern Europe [1, 2]. CCHF is not present in the UK, nor are there any identified established populations of Hyalomma ticks [3]. Most cases occur in people living in tick-infested areas with occupational exposure to livestock including farmers, slaughterhouse staff and vets [4]. Cases have been reported in health workers caring for infected people [4, 5].

Studies suggest that over 80% of people infected with CCHF virus do not develop any symptoms. For those that do develop symptoms, these may include headache, fever, back and joint pain, abdominal pain, and vomiting, Symptomatic disease may develop into a severe haemorrhagic fever and a case fatality rate of up to 40% has been reported in previous epidemics [1].

In the United Kingdom (UK) no licensed human CCHF vaccine is available [3].

Country specific information can be found on our Country Information pages and Outbreak Surveillance database.

Advice for travellers

The risk of CCHF for travellers in endemic areas is mainly due to tick bite exposure during outdoor activities. The risk to the majority of those travelling to areas where CCHF is known or presumed to occur is very low, if the following precautions are followed:

  • Avoid areas where ticks are abundant at times when they are most active, usually in spring and summer months.
  • Wear long sleeved clothing and use tick repellent on any areas of exposed skin.
  • Regularly check clothing and skin carefully for ticks and remove them promptly and safely; see our insect and tick bite avoidance factsheet for details.
  • If working with animals in endemic areas, it is advised that you wear gloves/protective clothing to prevent skin contact with infected tissues/blood [3].

Healthcare workers, working in affected regions, should wear appropriate Personal Protective Equipment (PPE) and discard waste according to local Infection Protection and Control (IPC) guidelines [4].

If you become unwell after travel abroad, you should seek advice from your GP or call NHS111.

Advice for health professionals

Health professionals should remain alert for travellers returning from CCHF affected areas who develop symptoms compatible with CCHF.

Health professionals should practise strict universal precautions, including barrier nursing, when caring for patients presenting with haemorrhagic fever syndrome, including when there is suspicion of CCHF [6].

Guidance and information about high consequence infectious disease and their management in England and further information about CCHF is available from the UK Health Security Agency.


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