Bunyavirues (Crimean Congo Hemorrhagic Fever Virus (CCHFV))
Boston University
Research Occupational Health Program (ROHP)
617-358-7647
Agent
Bunyaviruses. Crimean Congo Hemorrhagic Fever virus (CCHFV) is a segmented negative-sense RNA viruses that belongs to the family Nairoviridae within the order Bunyavirales. CCHFV is transmitted mainly from ticks to humans but person to person transmission can occur with close contact to body fluids and in nosocomial setting. CCHF manifests as a sudden febrile illness with photophobia and muscle aches and can progress to a hemorrhagic disease.
Disease/Infection
Crimean Congo Hemorrhagic Fever (CCHF)
Pathogenicity
CCHF case fatality rate is estimated to be between 9 and 50%.
Risk Group/BSL
Risk group 4
Biosafety level: BSL4
Modes of Transmission
| Transmission | |
| Skin Exposure (Needlestick, bite, or scratch): | Yes |
| Mucous Membrane Splash to Eye(s), Nose or Mouth: | Yes |
| Inhalation: | Transmission via inhalation of droplets. |
| Ingestion: | Unlikely in laboratory setting |
Host Range/Reservoir
The main natural hosts of CCHFV are hares and hedgehogs (for immature ticks); and cattle, sheep, goats, horses, swine, and birds (for adult ticks).
Humans are accidental hosts.
Symptoms
CCHFV causes a febrile illness with body aches and can be associated with nausea, vomiting, diarrhea. CCHF can progress more readily to hemorrhagic fever with multiorgan failure. Blood work may show leukopenia and thrombocytopenia. Symptoms of hemorrhaging may begin with jaundice and other signs of liver impairment, followed by vomiting blood, bloody stool, or bleeding from gums, skin, nose, and injection sites.
Incubation Period
CCHF: 1 to 12 days.
Viability
Bunyaviruses are inactivated by glutaraldehyde, formalin, and paraformaldehyde; chlorine-based disinfectants, such as 1% sodium hypochlorite; and by 70% alcohol, hydrogen peroxide, peracetic acid, and iodophor compounds.
Survival Outside Host
CCHFV: under wet conditions for 7 hours at 37 °C, 11 days at 20 °C, and 15 days at 4 °C, under dry conditions between 9-24 hours.
Information for Lab Workers
Laboratory PPE
One-piece positive pressure ventilated suit with life support system is utilized. Long sleeve scrubs will be worn under the positive pressure suit with inner gloves providing added protection against outer glove tear.
Containment
All work with infectious virus must be performed in BSL-4/ABSL-4 containment.
PRIMARY HAZARDS:
- Accidental parenteral inoculation, respiratory exposure to infectious droplets, and/or direct contact with broken skin or mucous membranes.
SPECIAL HAZARDS:
- Work with, or exposure to, infected non-human primates, rodents, or their carcasses represents a risk of human infection; use of sharps when handling virus-containing material.
In Case of Exposure/Disease
Immediately after exposure, lab workers should follow the HIGH AND MAXIMUM CONTAINMENT MEDICAL INCIDENT RESPONSE PLAN (ERP C.1) as provided on site and during training.
- For all lab exposures which involve BSL-4 pathogens (needle sticks, punctures, cuts, scratches, etc.) and for all medical events which require immediate evaluation and treatment (traumatic injury, heart attack, stroke, seizure, etc.):
- Medical Campus: call or have a coworker call the Control Center at 4–6666. You will be referred to or transported to the appropriate health care location by the emergency response team.
- The Control Center operator will activate a communication tree which includes the BU Research Occupational Health Program (ROHP) Officer will help guide the response.
- To reach the ROHP directly use the 24/7 hour number (617-358-ROHP (7647)).
- You will be connected with the BU Research Occupational Health Program (ROHP) medical officer. ROHP will refer you the appropriate health care location.
- Under any of these scenarios, always inform the physician of your work in the laboratory and the agent(s) that you work with.
- Present the Medical Surveillance Card that every BSL-4 researcher has been provided by ROHP, this wallet size card identifies the agents that the researcher works with; provide the ID card to the treating physician.
Vaccination
There are no FDA approved vaccinations for CCHFV.
Information for First Responders/Medical Personnel
Public Health Issues
After exposure: Immediately after an exposure to CCHFV, the lab worker is not considered infectious. He/she can be cared for with standard PPE. On campus exposures will be escorted directly from NEIDL triage room to the Special Pathogens Unit (SPU) at Boston Medical Center (BMC) where lab workers will be received by a team of physicians and nurses. In case of a lab worker presenting to BMC ED or other outside medical facility, either the exposed or the caring physicians should immediately contact ROHP for further instructions.
In case of (suspected) illness: Lab worker should contact ROHP directly and when possible, transport will be arranged to bring the patient to BMC’s Patient Isolation Unit. Patient should prevent close contact with household members pending evaluation, if possible. If the worker presents to BMC ED or other outside medical facility, caring physicians should contact ROHP for further instructions and ROHP will consult infectious diseases specialists at SPU.
Person-to-person transmission is reported via close personal contact with an infected individual or their body fluids during the late stages of the infection. PPE requirements for care of this patient are listed below.
PPE: SPU staff use advanced PPE including coveralls, fluid proof aprons, PAPR’s, and double gloves. CDC recommendations: Airborne, Droplet Precautions plus Contact Precautions, with face/eye protection, emphasizing safety sharps and barrier precautions when blood exposure likely. Avoid aerosol-generating procedures.
Other guidance for outside providers: No blood work should be drawn until contact is made with ROHP.
Specimen should be handled with extreme care and enclosed in appropriate shatter-proof and leak-proof packing for transport to lab. Diagnostic laboratory staff should be notified of suspicion of infection, and tests should be performed under proper containment. Please contact ROHP immediately for further details.
Public health officials will be notified.
Diagnosis/Surveillance
These viruses can be detected by PCR in bodily fluids. Acute and convalescent serologies are to be drawn.
Potential alternate diagnoses with similar presentation should be considered, such as influenza or other respiratory viruses.
First Aid/Post Exposure Prophylaxis
General procedure is to follow patients for the incubation period under observation. No post exposure prophylaxis is available.
Additional medical countermeasures maybe available post exposure through CDC and public health bodies and will be done in coordination with the SPU program.
Treatment
Treatment is aggressive supportive care, and is directed at maintaining renal function and electrolyte balance, addressing coagulopathy and combating hemorrhage and shock.
References
Biosafety in Microbiological and Biomedical Laboratories (BMBL) 5th Edition. US Government Printing Office, Washington, 2007.
Public Health Agency of Canada. Material Safety Data Sheets. Infectious Substances. Crimean Congo Hemorrhagic Fever. https://www.canada.ca/en/public-health/services/laboratory-biosafety-biosecurity/pathogen-safety-data-sheets-risk-assessment/crimean-congo-haemorrhagic-fever-virus.html
Siegel JD, Rhinehart E, Jackson M, Chiarello L. 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Health Care Settings. American journal of infection control 2007 Dec;35(10 Suppl 2):S65-164.