Table 2.

Evidence supporting Crimean-Congo hemorrhagic fever virus endemicity in European countries/regions.

Country/region	CCHF cases reported (year)	Human serology year (positive %)	Nonhuman vertebrate serology year (positive %)	Hyalomma ticks	CCHFV isolation or detection in ticks (year)	Risk level
Albania	1985 (Eltari et al., 1987), 1986–1990∗ (Dreshaj et al., 2016), 2001 (Papa et al., 2002; Harxhi et al., 2005; Zehender et al., 2013), 2003–2010 (Papa et al., 2007b; Papa et al., 2008a; Zehender et al., 2013; Biberaj, 2015), 2013–2015 (Krasniqi and Bino, 2016a, 2016b), 2017 (Muco et al., 2018; Ndreu et al., 2018)	1985–1989 (ND), (Eltari et al., 1987, 1993), 2003–2006 (17.6%, 32.2%) (Papa et al., 2006; Papa et al., 2007a)	2003 (20%) (Papa et al., 2009), 2010–2014 (4%, 5.5%, 57%, 4.4%,23%, 43.4%, 42.1%, 67.1%) (Lugaj et al., 2014a; Lugaj et al., 2014b; Lugaj et al., 2014c; Lugaj et al., 2014d; Schuster et al., 2016; Lugaj et al., 2017a; Lugaj et al., 2017b; Kadriaj et al., 2018a)	Yes (Eltari et al., 1987; Papa et al., 2017b; Kadriaj et al., 2018b; Sherifi et al., 2018)	2007–2015 (Papa et al., 2017b; Sherifi et al., 2018)	1
Andorra	ND	ND	ND	ND	ND	5
Austria	ND	ND	ND	Yes (Duscher et al., 2018, 2022)	ND	4
Belarus	ND	ND	ND	ND	ND	5
Belgium	ND	ND	ND	Yes (European Centre for Disease Prevention and Control, 2023b)	ND	4
Bosnia and Herzegovina	ND	ND	2018–2019 (14.9%, 9.65%) (Goletic et al., 2022; Satrovic et al., 2022), 2021 (14.9%) (Goletic et al., 2022)	Yes (Omeragic, 2011; Goletic et al., 2022; Omeragić et al., 2022; European Centre for Disease Prevention and control, 2023b)	2019 (Goletic et al., 2022), 2021 (Goletic et al., 2022)	3
Bulgaria	1946–2021 (Неклюдов 1952; Миронов, 1953; Митов, 1953; Неклюдов and Бохосян, 1954; Василенко и др., 1971; Василенко и др., 1972a; Vasilenko, 1973; Hoogstraal, 1979; Монев, 1994; Papa et al., 2004; Christova et al., 2009; Комитова и др., 2010; Kalvatchev and Christova, 2012; Vescio et al., 2012; Christova et al., 2013b; Единакова и др., 2013; Lumley et al., 2014; Дойчева и др., 2014; Papa et al., 2016a; Панайотова 2016; Петрова, 2016; Papa et al., 2018a; Komitova et al., 2020; European Centre for Disease Prevention and control, 2021b; Kevorkyan et al., 2022; European Centre for Disease Prevention and control, 2023a), 2022–2023 (personal communications)	1954–1972 (30.7%, 10.4%, 10%, 5.1%, 5.9%, 65.7%) (Василенко и др., 1968; Василенко, 1971; Василенко и др., 1971; Василенко и др., 1972b; Vasilenko, 1973; Hoogstraal, 1979), 2008–2012 (2.7%, 2.4%, 3.1%) (Christova et al., 2013a; Christova et al., 2013b; Gergova and Kamarinchev, 2014), 2014–2015 (3.4%, 3.6%) (Панайотова 2016; Christova et al., 2017a)	1968–1972 (50%, 36.4%, 11.4%, 29.2%) (Василенко и др., 1968; Василенко, 1971; Василенко и др., 1971; Vasilenko, 1973), 1974 (85.7%) (Mertens et al., 2016), 2006–2014 (7.8%, 71.9%, 26%) (Gergova and Kamarinchev, 2013; Barthel et al., 2014; Mertens et al., 2016), 2014–2015 (17.8%,18.3%) (Панайотова 2016; Christova et al., 2018), 2017∗∗ (71.9%) (Christova et al., 2017b), 2022∗∗ (23.3%) (Belij-Rammerstorfer et al., 2022)	Yes (Дренски, 1960; Тодоров1966; Чумаков и др., 1968; Леви, 1972; Леви and Василенко, 1972; Георгиева и др., 1990; Панайотова and Христова, 2015; Панайотова, 2016)	1968–1972 (Василенко и др., 1971; Vasilenko, 1973; Hoogstraal, 1979), 1990∗∗ (Kamarinchev et al., 1991), 2006–2010 (Gergova et al., 2012; Gergova and Kamarinchev, 2013), 2010–2014 (Панайотова and Христова, 2015; Panayotova et al., 2016; Hua et al., 2020), 2017∗∗ (Christova et al., 2017b),	1
Croatia	1988 (Defense Pest Management Information Analysis Center, 1993)	ND	ND	Yes (Vesenjak et al., 1975; Krčmar, 2012; Krčmar et al., 2022)	ND	3
Czechia	ND	ND	ND	Yes (Hubálek et al., 2020; Lesiczka et al., 2022; European Centre for Disease Prevention and control, 2023b)	ND	4
Denmark	ND	ND	ND	ND	ND	5
Estonia	ND	ND	ND	ND	ND	5
Faroe Islands	ND	ND	ND	ND	ND	5
Finland	ND	ND	ND	Yes (Nuorteva and Hoogstraal, 1963; Hoogstraal, 1979; European Centre for Disease Prevention and control, 2023b)	ND	4
France	ND	2022–2023 (0.1%) (Welch et al., 2024)	2008–2023 (9.1%, 2.3%, 2%) (Grech-Angelini et al., 2020; Welch et al., 2024; Bernard et al., 2025)	Yes (Rageau, 1972; Macaigne and Perez-Eid, 1993; Morel, 2003; Grech-Angelini et al., 2016a; Vial et al., 2016; European Centre for Disease Prevention and control, 2021a; Reynard et al., 2021; Bah et al., 2022; Bernard et al., 2022; Bernard et al., 2024; Kiwan et al., 2024)	2022–2024 (Bernard et al., 2024; Kiwan et al., 2024)	3
Germany	2009∗∗∗ (Conger et al., 2015)	ND	ND	Yes (Kampen et al., 2007; Rumer et al., 2011; Chitimia-Dobler et al., 2016, 2019)	ND	4
Gibraltar	ND	ND	ND	ND	ND	5
Greece∗∗∗∗∗	2008 (International Society for Infectious Diseases, 2008; Papa et al., 2008b; Papa et al., 2010)	1980–1988 (6.1%, 1%) (Antoniadis and Casals, 1982; Antoniadis et al., 1990), 2008–2012 (3.1%, 4.2%, 14.4%, 2.1%, 6%) (Papa et al., 2004; Sidira et al., 2012; Papa et al., 2013; Sidira et al., 2013; Papa et al., 2014)	2012–2013 (50%, 5.1%) (Papa et al., 2014; Schuster et al., 2017), 2015 (42.1%) (Papa et al., 2018b)	Yes (Pavlidou et al., 2008; Papa et al., 2011a; Hoffman et al., 2021)	1978 (Antoniadis and Casals, 1982), 2012–2015 (Papa et al., 2014; Papa et al., 2018b), 2017∗∗ (Fernández de Mera et al., 2017)	1
Guernsey	ND	ND	ND	ND	ND	5
Hungary	ND	1972–1975 (2.8%) (Horváth, 1976), 2019∗∗ (0.3%) (Magyar et al., 2021)	1972–1973 (3.4%, 2.8%) (Horváth, 1974; Хорват, 1975), 2008–2009 (6%) (Németh et al., 2013), 2011–2013 (0.9%) (Földes et al., 2019), 2017 (0.5%) (Deézsi-Magyar et al., 2024)	Yes (Hornok and Horváth, 2012; Földvári et al., 2022; Földvári et al., 2024)	1972 (Molnár, 1982)	3
Iceland	ND	ND	ND	ND	ND	5
Ireland	ND	ND	ND	ND	ND	5
Isle of Man	ND	ND	ND	ND	ND	5
Italy	ND	ND	2021 (1.8%) (Fanelli et al., 2022)	Yes (Manilla, 1982; Mancini et al., 2013; De Liberato et al., 2018; Mancuso et al., 2019; Pascucci et al., 2019; Battisti et al., 2020; Rollins et al., 2021; Toma et al., 2021)	2017–2019 (Mancuso et al., 2019, 2022)	3
Jersey	ND	ND	ND	ND	ND	5
Kosovo	1954–2016 (Hoogstraal, 1979; Defense pest management information analysis center, 1993; Avsic-Zupanc et al., 1999; Ђокић и др., 2000; Tegnell et al., 2001; World Health Organization, 2001; Avšič-Županc et al., 2002; Boutin et al., 2002; Drosten et al., 2002; Humolli, 2003; Ahmeti and Raka, 2006; Ramadani et al., 2007; Thomas et al., 2012; Самарджич и др., 2012; Ahmeti et al., 2014; Ajazaj-Berisha et al., 2014; Papa et al., 2015; Ahmeti et al., 2019; Korva et al., 2019; Rackow et al., 2019; Ajazaj-Berisha et al., 2025), 2017–2023 (personal communications)	1995–2009 (6.8%, 5.3%) (Tomanović et al., 1996; Humolli et al., 2010), 2012–2016 (3.9%, 5%) (Fajs et al., 2014; Emmerich et al., 2021)	2008 (3.7%) (Sherifi et al., 2016), 2012 (16.2%, 10.9%) (Fajs et al., 2014; Dreshaj et al., 2016), 2018 (17.1%) (Zhabari and Xhekaj, 2022)	Yes (Heneberg et al., 1967; Heneberg et al., 1968; Hoogstraal, 1979; Fajs et al., 2014; Sherifi et al., 2018; European Centre for Disease Prevention and Control, 2023c)	2001 (Duh et al., 2006), 2012–2019 (Sherifi et al., 2014; Sherifi et al., 2018; MBDC2023-Team, 2023)	1
Latvia	ND	ND	ND	ND	ND	5
Liechtenstein	ND	ND	ND	ND	ND	5
Lithuania	ND	ND	ND	ND	ND	5
Luxembourg	ND	ND	ND	Yes (European Centre for Disease Prevention and control, 2023b)	ND	4
Malta	ND	ND	ND	Yes (European Centre for Disease Prevention and control, 2023b)	ND	4
Monaco	ND	ND	ND	ND	ND	5
Montenegro	ND	ND	1970 (ND) (Stamatović et al., 1971)	ND	ND	3
Netherlands	ND	ND	ND	Yes (Uiterwijk et al., 2021; European Centre for Disease Prevention and control, 2023b)	ND	4
North Macedonia	1970 (Stamatović et al., 1971; Defense Pest Management Information Analysis Center, 1993), 1976 (Vesenjak-Hirjan et al., 1991), 2010 (Welch et al., 2024), 2023 (Jakimovski et al., 2023; Boshevska et al., 2024; Бошевска и др., 2024), 2024 (Jakimovski et al., 2025)	2023 (7.6%) (Jakimovski et al., 2025)	2009–2011 (14%, 14.5%, 49%) (Obradović et al., 1978; Mertens et al., 2015; Schuster et al., 2016), 2023 (58.8%) (Jakimovski et al., 2025)	Yes (Obradović, 1985; Mertens et al., 2015)	1973 (Gligić et al., 1977)	2
Norway	ND	ND	ND	Yes (European Centre for Disease Prevention and control, 2023b)	ND	4
Poland	ND	ND	No (Bażanów et al., 2017)	Yes (Siuda, 1991; European Centre for Disease Prevention and control, 2023b)	No (Bażanów et al., 2017)	4
Portugal	2024 (Zé-Zé et al., 2024)	1985 (0.7%) (Filipe et al., 1985)	2006–2022 (0.4%, 19.3%) (Mesquita et al., 2022; Baz-Flores et al., 2024)	Yes (European Centre for Disease Prevention and control, 2023b)	ND	2
Republic of Moldova	ND	ND	ND	Yes (Чумаков и др., 1974b)	1973–1974 (Чумаков и др., 1974b), 1978∗∗ (Скофертца и др., 1978)	3
Romania	ND	ND	2008 (27.8%) (Ceianu et al., 2012), 2019–2020 (37.6%) (Bratuleanu et al., 2022)	Yes (European Centre for Disease Prevention and control, 2023b)	ND	3
San Marino	ND	ND	ND	Yes (European Centre for Disease Prevention and control, 2023b)	ND	4
Serbia	ND	ND	ND	Yes (European Centre for Disease Prevention and control, 2023c)	ND	4
Slovakia	ND	ND	ND	Yes (Capek et al., 2014)	ND	4
Slovenia	ND	1992∗∗ (0.08%) (Avsic-Zupanc et al., 1992; Avšič-Županac et al., 1995)	Yes (Petrovec et al., 2004)	Yes (Trilar, 2014)	ND	3
Spain	2013–2022 (García, 2016; International Society for Infectious Diseases, 2016a; International Society for Infectious Diseases, 2016b; International Society for Infectious Diseases, 2017a; Negredo et al., 2017; International Society for Infectious Diseases, 2018; Mora-Rillo et al., 2018; International Society for infectious diseases, 2020b; International Society for infectious diseases, 2020a; International Society for infectious diseases, 2021; Monsalve Arteaga et al., 2021; Negredo et al., 2021a; Negredo et al., 2021b; International Society for infectious diseases, 2022; European Centre for Disease Prevention and control, 2023a; Lorenzo Juanes et al., 2023), 2024 (Álvarez, 2024)	2017–2018 (0%, 21.1%, 2.2%) (Latasa et al., 2020; Monsalve Arteaga et al., 2020, 2021), 2023 (0.6%) (Lorenzo Juanes et al., 2025)	2005–2022 (1.3%, 43.4%, 59.6%, 25.4%, 19.3%, 40.9%, ND) (Sierra et al., 2019; Espunyes et al., 2021; Carrera-Faja et al., 2022; Cuadrado-Matías et al., 2022a, 2022b; Baz-Flores et al., 2024; Welch et al., 2024)	Yes (Gale et al., 2010; Hubálek and Rudolf, 2012; Palomar et al., 2016; Hoffman et al., 2021; Castillo-Contreras et al., 2022; Cuadrado-Matías et al., 2022a, 2024; Vieira Lista et al., 2022)	2010–2018 (International Society for Infectious Diseases, 2011; Estrada-Peña et al., 2012; Cajimat et al., 2017; International Society for Infectious Diseases, 2017b; Negredo et al., 2019; Moraga-Fernández et al., 2021; Sánchez-Seco et al., 2022)	1
Svalbard and Jan Mayen islands	ND	ND	ND	ND	ND	5
Sweden	ND	ND	ND	Yes (Jaenson et al., 1994; Grandi et al., 2020)	ND	4
Switzerland	ND	ND	ND	Yes (European Centre for Disease Prevention and control, 2023b)	ND	4
Ukraine/Crimea	1944–1947 (Домрачев, 1949; Hoogstraal, 1979), 1969 (Примаков, 1971), 2013 (Куличенко и др., 2016), 2015 (Куличенко и др., 2016)	1986–1989 (0.4%) (Маркешин и др., 1992b), 2020∗∗ (1.6%) (Lozynskyi et al., 2020)	1968–1969 (ND)(Александров and Кудрявцев, 1970), 1972–1973 (1.3%) (Чумаков и др., 1974a), 1984–1992 (0.2%) (Маркешин и др., 1992a)	Yes (Hoogstraal, 1979; Akimov and Nebogatkin, 2011; Celina et al., 2023)	1945–1946 (Чумаков и др., 1974a), 1972–1973 (Чумаков и др., 1974a; Маркешин и др., 1992b), 2015 (Куличенко и др., 2016)	2
United Kingdom of Great Britain and Northern Ireland	2012∗∗∗ (Barr et al., 2013), 2014∗∗∗ (Public Health England, 2014), 2022∗∗∗ (UK Health Security Agency, 2022)	ND	ND	Yes (Martyn, 1988; Jameson et al., 2012a; Hansford et al., 2019; McGinley et al., 2021)	ND	4
Åland islands	ND	ND	ND	ND	ND	5

Notes: ∗ Suspected or confirmed cases. ∗∗ Year uncertain. ∗∗∗ Imported CCHF cases. ∗∗∗∗ A retrospective diagnosis was made in 2020 for the patient. ∗∗∗∗∗ Aigai virus, previously referred to as CCHFV genotype VI, is now classified as a distinct virus (Papa et al., 2022) and is not considered here. CCHF, Crimean-Congo hemorrhagic fever; CCHFV, Crimean-Congo hemorrhagic fever virus; ND, no data available.