Skip to main content
Virologica Sinica logoLink to Virologica Sinica
. 2013 Jul 22;28(4):193–201. doi: 10.1007/s12250-013-3327-4

Crimean-Congo hemorrhagic fever: An overview

Serkan Öncü 1,
PMCID: PMC8208362  PMID: 23913177

Abstract

Crimean-Congo hemorrhagic fever (CCHF) is a zoonotic viral infection that is a serious threat to humans. The disease is widely distributed in Africa, Asia, and Europe and has developed into a serious public health concern. Humans become infected through the bites of ticks, by contact with a patient with CCHF, or by contact with blood or tissues from viremic livestock. Microvascular instability and impaired hemostasis are the hallmarks of the infection. Infection in human begins with nonspecific febrile symptoms, but may progress to a serious hemorrhagic syndrome with high mortality rates. Enzyme-linked immunoassay (ELISA) and polymerase chain reaction (PCR) are the most used and specific tests for the diagnosis. The mainstay of treatment is supportive. Although definitive studies are not available, ribavirin is suggested to be effective especially at the earlier phase of the infection. Uses of universal protective measures are the best way to avoid the infection. In this review, all aspects of CCHF are overviewed in light of the current literature.

Keywords: Crimean-Congo Hemorrhagic Fever, Epidemiology, Transmission, Pathogenesis, Diagnosis, Treatment, Prevention

References

  1. Anagnostou V, Papa A. Evolution of Crimean-Congo Hemorrhagic Fever virus. Infect Genet Evol. 2009;9:948–954. doi: 10.1016/j.meegid.2009.06.018. [DOI] [PubMed] [Google Scholar]
  2. Appannanavar S B, Mishra B. An update on crimean congo hemorrhagic Fever. J Glob Infect Dis. 2011;3:285–292. doi: 10.4103/0974-777X.83537. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Ascioglu S, Leblebicioglu H, Vahaboglu H, Chan K A. Ribavirin for patients with Crimean-Congo haemorrhagic fever: a systematic review and meta-analysis. J Antimicrob Chemother. 2011;66:1215–1222. doi: 10.1093/jac/dkr136. [DOI] [PubMed] [Google Scholar]
  4. Atkinson B, Chamberlain J, Logue C H, Cook N, Bruce C, Dowall S D, Hewson R. Development of a real-time rt-PCR assay for the detection of crimean-congo hemorrhagic Fever virus. Vector Borne Zoonotic Dis. 2012;12:786–793. doi: 10.1089/vbz.2011.0770. [DOI] [PubMed] [Google Scholar]
  5. Bajpai S, Nadkar M Y. Crimean Congo hemorrhagic fever: requires vigilance and not panic. J Assoc Physicians India. 2011;59:164–167. [PubMed] [Google Scholar]
  6. Bakir M, Ugurlu M, Dokuzoguz B, Bodur H, Tasyaran M A, Vahaboglu H. Crimean-Congo haemorrhagic fever outbreak in Middle Anatolia: a multicentre study of clinical features and outcome measures. J Med Microbiol. 2005;54:385–389. doi: 10.1099/jmm.0.45865-0. [DOI] [PubMed] [Google Scholar]
  7. Bakir M, Engin A, Gozel M G, Elaldi N, Kilickap S, Cinar Z. A new perspective to determine the severity of cases with Crimean-Congo hemorrhagic fever. J Vector Borne Dis. 2012;49:105–110. [PubMed] [Google Scholar]
  8. Bangash S A, Khan E A. Treatment and prophylaxis with ribavirin for Crimean-Congo Hemorrhagic Fever—is it effective? J Pak Med Assoc. 2003;53:39–41. [PubMed] [Google Scholar]
  9. Bente D A, Alimonti J B, Shieh W J, Camus G, Stroher U, Zaki S, Jones S M. Pathogenesis and immune response of Crimean-Congo hemorrhagic fever virus in a STAT-1 knockout mouse model. J Virol. 2010;84:11089–11100. doi: 10.1128/JVI.01383-10. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Bodur H, Akinci E, Ascioglu S, Onguru P, Uyar Y. Subclinical infections with Crimean-Congo hemorrhagic fever virus, Turkey. Emerg Infect Dis. 2012;18:640–642. doi: 10.3201/eid1804.111374. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Bodur H, Akinci E, Onguru P, Uyar Y, Basturk B, Gozel M G, Kayaaslan B U. Evidence of vascular endothelial damage in Crimean-Congo hemorrhagic fever. Int J Infect Dis. 2010;14:e704–707. doi: 10.1016/j.ijid.2010.02.2240. [DOI] [PubMed] [Google Scholar]
  12. Bodur H, Erbay A, Akinci E, Onguru P, Bayazit N, Eren S S, Kubar A. Effect of oral ribavirin treatment on the viral load and disease progression in Crimean-Congo hemorrhagic fever. Int J Infect Dis. 2011;15:e44–47. doi: 10.1016/j.ijid.2010.09.009. [DOI] [PubMed] [Google Scholar]
  13. Burt F J, Leman P A, Abbott J C, Swanepoel R. Serodiagnosis of Crimean-Congo haemorrhagic fever. Epidemiol Infect. 1994;113:551–562. doi: 10.1017/S0950268800068576. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Cevik M A, Erbay A, Bodur H, Eren S S, Akinci E, Sener K, Onguru P, Kubar A. Viral load as a predictor of outcome in Crimean-Congo hemorrhagic fever. Clin Infect Dis. 2007;45:e96–100. doi: 10.1086/521244. [DOI] [PubMed] [Google Scholar]
  15. Cherenov I V, Galimzianov K M, Sologub T V, Romantsov M G, Lokteva O M, Kovalenko A L. Efficacy of antiviral agents in the treatment of Crimean hemorrhagic fever. Klin Med (Mosk) 2012;90:59–62. [PubMed] [Google Scholar]
  16. Chinikar S, Ghiasi S M, Hewson R, Moradi M, Haeri A. Crimean-Congo hemorrhagic fever in Iran and neighboring countries. J Clin Virol. 2010;47:110–114. doi: 10.1016/j.jcv.2009.10.014. [DOI] [PubMed] [Google Scholar]
  17. Deyde V M, Khristova M L, Rollin P E, Ksiazek T G, Nichol S T. Crimean-Congo hemorrhagic fever virus genomics and global diversity. J Virol. 2006;80:8834–8842. doi: 10.1128/JVI.00752-06. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Drosten C, Gottig S, Schilling S, Asper M, Panning M, Schmitz H, Gunther S. Rapid detection and quantification of RNA of Ebola and Marburg viruses, Lassa virus, Crimean-Congo hemorrhagic fever virus, Rift Valley fever virus, dengue virus, and yellow fever virus by real-time reverse transcription-PCR. J Clin Microbiol. 2002;40:2323–2330. doi: 10.1128/JCM.40.7.2323-2330.2002. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Duh D, Nichol S T, Khristova M L, Saksida A, Hafner-Bratkovic I, Petrovec M, Dedushaj I, Ahmeti S, Avsic-Zupanc T. The complete genome sequence of a Crimean-Congo hemorrhagic fever virus isolated from an endemic region in Kosovo. Virol J. 2008;5:7. doi: 10.1186/1743-422X-5-7. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Duygu F, Kaya T, Baysan P. Re-evaluation of 400 crimean-congo hemorrhagic Fever cases in an endemic area: is ribavirin treatment suitable? Vector Borne Zoonotic Dis. 2012;12:812–816. doi: 10.1089/vbz.2011.0694. [DOI] [PubMed] [Google Scholar]
  21. Elaldi N, Bodur H, Ascioglu S, Celikbas A, Ozkurt Z, Vahaboglu H, Leblebicioglu H, Yilmaz N, Engin A, Sencan M, Aydin K, Dokmetas I, Cevik M A, Dokuzoguz B, Tasyaran M A, Ozturk R, Bakir M, Uzun R. Efficacy of oral ribavirin treatment in Crimean-Congo haemorrhagic fever: a quasi-experimental study from Turkey. J Infect. 2009;58:238–244. doi: 10.1016/j.jinf.2009.01.014. [DOI] [PubMed] [Google Scholar]
  22. Erduran E, Cakir M. Reactive hemophagocytic lymphohistiocytosis and Crimean-Congo hemorrhagic fever. Int J Infect Dis. 2010;14(Suppl3):e349. doi: 10.1016/j.ijid.2009.08.011. [DOI] [PubMed] [Google Scholar]
  23. Ergonul O. Crimean-Congo haemorrhagic fever. Lancet Infect Dis. 2006;6:203–214. doi: 10.1016/S1473-3099(06)70435-2. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Ergonul O. Treatment of Crimean-Congo hemorrhagic fever. Antiviral Res. 2008;78:125–131. doi: 10.1016/j.antiviral.2007.11.002. [DOI] [PubMed] [Google Scholar]
  25. Ergonul O. Crimean-Congo hemorrhagic fever virus: new outbreaks, new discoveries. Curr Opin Virol. 2012;2:215–220. doi: 10.1016/j.coviro.2012.03.001. [DOI] [PubMed] [Google Scholar]
  26. Ergonul O, Tuncbilek S, Baykam N, Celikbas A, Dokuzoguz B. Evaluation of serum levels of interleukin (IL)-6, IL-10, and tumor necrosis factor-alpha in patients with Crimean-Congo hemorrhagic fever. J Infect Dis. 2006;193:941–944. doi: 10.1086/500836. [DOI] [PubMed] [Google Scholar]
  27. Ergonul O, Celikbas A, Dokuzoguz B, Eren S, Baykam N, Esener H. Characteristics of patients with Crimean-Congo hemorrhagic fever in a recent outbreak in Turkey and impact of oral ribavirin therapy. Clin Infect Dis. 2004;39:284–287. doi: 10.1086/422000. [DOI] [PubMed] [Google Scholar]
  28. Ertugrul B, Kirdar S, Ersoy O S, Ture M, Erol N, Ozturk B, Sakarya S. The seroprevalence of Crimean-Congo haemorrhagic fever among inhabitants living in the endemic regions of Western Anatolia. Scand J Infect Dis. 2012;44:276–281. doi: 10.3109/00365548.2011.621445. [DOI] [PubMed] [Google Scholar]
  29. Ertugrul B, Uyar Y, Yavas K, Turan C, Oncu S, Saylak O, Carhan A, Ozturk B, Erol N, Sakarya S. An outbreak of Crimean-Congo hemorrhagic fever in western Anatolia, Turkey. Int J Infect Dis. 2009;13:e431–436. doi: 10.1016/j.ijid.2009.02.011. [DOI] [PubMed] [Google Scholar]
  30. Fisher-Hoch S P, Khan J A, Rehman S, Mirza S, Khurshid M, McCormick J B. Crimean Congo-haemorrhagic fever treated with oral ribavirin. Lancet. 1995;346:472–475. doi: 10.1016/S0140-6736(95)91323-8. [DOI] [PubMed] [Google Scholar]
  31. Geisbert T W, Jahrling P B. Exotic emerging viral diseases: progress and challenges. Nat Med. 2004;10:S110–121. doi: 10.1038/nm1142. [DOI] [PubMed] [Google Scholar]
  32. Hewson R, Chamberlain J, Mioulet V, Lloyd G, Jamil B, Hasan R, Gmyl A, Gmyl L, Smirnova S E, Lukashev A, Karganova G, Clegg C. Crimean-Congo haemorrhagic fever virus: sequence analysis of the small RNA segments from a collection of viruses world wide. Virus Res. 2004;102:185–189. doi: 10.1016/j.virusres.2003.12.035. [DOI] [PubMed] [Google Scholar]
  33. Heyman P, Cochez C, Hofhuis A, van der Giessen J, Sprong H, Porter S R, Losson B, Saegerman C, Donoso-Mantke O, Niedrig M, Papa A. A clear and present danger: tick-borne diseases in Europe. Expert Rev Anti Infect Ther. 2010;8:33–50. doi: 10.1586/eri.09.118. [DOI] [PubMed] [Google Scholar]
  34. Humolli I, Dedushaj I, Zupanac T A, Mucaj S. Epidemiological, serological and herd immunity of Crimean-Congo haemorrhagic fever in Kosovo. Med Arh. 2010;64:91–93. [PubMed] [Google Scholar]
  35. Ibrahim S M, Aitichou M, Hardick J, Blow J, O’Guinn M L, Schmaljohn C. Detection of Crimean-Congo hemorrhagic fever, Hanta, and sandfly fever viruses by real-time RT-PCR. Methods Mol Biol. 2011;665:357–368. doi: 10.1007/978-1-60761-817-1_19. [DOI] [PubMed] [Google Scholar]
  36. Izadi S, Salehi M. Evaluation of the efficacy of ribavirin therapy on survival of Crimean-Congo hemorrhagic fever patients: a case-control study. Jpn J Infect Dis. 2009;62:11–15. [PubMed] [Google Scholar]
  37. Jameson L J, Morgan P J, Medlock J M, Watola G, Vaux A G. Importation of Hyalomma marginatum, vector of Crimean-Congo haemorrhagic fever virus, into the United Kingdom by migratory birds. Ticks Tick Borne Dis. 2012;3:95–99. doi: 10.1016/j.ttbdis.2011.12.002. [DOI] [PubMed] [Google Scholar]
  38. Kebede S, Duales S, Yokouide A, Alemu W. Trends of major disease outbreaks in the African region, 2003–2007. East Afr J Public Health. 2010;7:20–29. doi: 10.4314/eajph.v7i1.64672. [DOI] [PubMed] [Google Scholar]
  39. Keshtkar-Jahromi M, Kuhn J H, Christova I, Bradfute S B, Jahrling P B, Bavari S. Crimean-Congo hemorrhagic fever: current and future prospects of vaccines and therapies. Antiviral Res. 2011;90:85–92. doi: 10.1016/j.antiviral.2011.02.010. [DOI] [PubMed] [Google Scholar]
  40. Koksal I, Yilmaz G, Aksoy F, Aydin H, Yavuz I, Iskender S, Akcay K, Erensoy S, Caylan R, Aydin K. The efficacy of ribavirin in the treatment of Crimean-Congo hemorrhagic fever in Eastern Black Sea region in Turkey. J Clin Virol. 2010;47:65–68. doi: 10.1016/j.jcv.2009.11.007. [DOI] [PubMed] [Google Scholar]
  41. Kubar A, Haciomeroglu M, Ozkul A, Bagriacik U, Akinci E, Sener K, Bodur H. Prompt administration of Crimean-Congo hemorrhagic fever (CCHF) virus hyperimmunoglobulin in patients diagnosed with CCHF and viral load monitorization by reverse transcriptase-PCR. Jpn J Infect Dis. 2011;64:439–443. [PubMed] [Google Scholar]
  42. Leblebicioglu H. Crimean-Congo haemorrhagic fever in Eurasia. Int J Antimicrob Agents. 2010;36(Suppl1):S43–46. doi: 10.1016/j.ijantimicag.2010.06.020. [DOI] [PubMed] [Google Scholar]
  43. Leblebicioglu H, Bodur H, Dokuzoguz B, Elaldi N, Guner R, Koksal I, Kurt H, Senturk G C. Case management and supportive treatment for patients with crimean-congo hemorrhagic Fever. Vector Borne Zoonotic Dis. 2012;12:805–811. doi: 10.1089/vbz.2011.0896. [DOI] [PubMed] [Google Scholar]
  44. Mardani M, Keshtkar-Jahromi M. Crimean-Congo hemorrhagic fever. Arch Iran Med. 2007;10:204–214. [PubMed] [Google Scholar]
  45. Mardani M, Rahnavardi M, Rajaeinejad M, Naini K H, Chinikar S, Pourmalek F, Rostami M, Shahri M H. Crimean-Congo hemorrhagic fever among health care workers in Iran: a seroprevalence study in two endemic regions. Am J Trop Med Hyg. 2007;76:443–445. [PubMed] [Google Scholar]
  46. Marty A M, Jahrling P B, Geisbert T W. Viral hemorrhagic fevers. Clin Lab Med. 2006;26:345–386. doi: 10.1016/j.cll.2006.05.001. [DOI] [PubMed] [Google Scholar]
  47. Mofleh J, Ahmad Z. Crimean-Congo haemorrhagic fever outbreak investigation in the Western Region of Afghanistan in 2008. East Mediterr Health J. 2012;18:522–526. doi: 10.26719/2012.18.5.522. [DOI] [PubMed] [Google Scholar]
  48. Mourya D T, Yadav P D, Shete A M, Gurav Y K, Raut C G, Jadi R S, Pawar S D, Nichol S T, Mishra A C. Detection, isolation and confirmation of Crimean-Congo hemorrhagic fever virus in human, ticks and animals in Ahmadabad, India, 2010–2011. PLoS Negl Trop Dis. 2012;6:e1653. doi: 10.1371/journal.pntd.0001653. [DOI] [PMC free article] [PubMed] [Google Scholar]
  49. Ozkurt Z, Kiki I, Erol S, Erdem F, Yilmaz N, Parlak M, Gundogdu M, Tasyaran M A. Crimean-Congo hemorrhagic fever in Eastern Turkey: clinical features, risk factors and efficacy of ribavirin therapy. J Infect. 2006;52:207–215. doi: 10.1016/j.jinf.2005.05.003. [DOI] [PubMed] [Google Scholar]
  50. Ozturk B, Tutuncu E, Kuscu F, Gurbuz Y, Sencan I, Tuzun H. Evaluation of factors predictive of the prognosis in Crimean-Congo hemorrhagic fever: new suggestions. Int J Infect Dis. 2012;16:e89–93. doi: 10.1016/j.ijid.2011.06.005. [DOI] [PubMed] [Google Scholar]
  51. Papa A, Papadimitriou E, Christova I. The Bulgarian vaccine Crimean-Congo haemorrhagic fever virus strain. Scand J Infect Dis. 2011;43:225–229. doi: 10.3109/00365548.2010.540036. [DOI] [PubMed] [Google Scholar]
  52. Papa A, Bino S, Velo E, Harxhi A, Kota M, Antoniadis A. Cytokine levels in Crimean-Congo hemorrhagic fever. J Clin Virol. 2006;36:272–276. doi: 10.1016/j.jcv.2006.04.007. [DOI] [PubMed] [Google Scholar]
  53. Purnak T, Selvi N A, Altundag K. Global warming may increase the incidence and geographic range of Crimean-Congo Hemorrhagic Fever. Med Hypotheses. 2007;68:924–925. doi: 10.1016/j.mehy.2006.09.020. [DOI] [PubMed] [Google Scholar]
  54. Putilina N G, Azarian A R, Trusova I N, Mal’kov P M, Grishanova A P, Kovtunov A I, Shendo G L, Dzharkenov A F, Arshba T E, Larichev V F, Butenko A M. Use of RT-PCR and enzyme immunoassays for the specific diagnosis of Crimean hemorrhagic fever. Vopr Virusol. 2011;56:34–38. [PubMed] [Google Scholar]
  55. Saijo M, Tang Q, Shimayi B, Han L, Zhang Y, Asiguma M, Tianshu D, Maeda A, Kurane I, Morikawa S. Possible horizontal transmission of crimean-congo hemorrhagic Fever virus from a mother to her child. Jpn J Infect Dis. 2004;57:55–57. [PubMed] [Google Scholar]
  56. Saijo M, Tang Q, Shimayi B, Han L, Zhang Y, Asiguma M, Tianshu D, Maeda A, Kurane I, Morikawa S. Antigen-capture enzyme-linked immunosorbent assay for the diagnosis of crimean-congo hemorrhagic fever using a novel monoclonal antibody. J Med Virol. 2005;77:83–88. doi: 10.1002/jmv.20417. [DOI] [PubMed] [Google Scholar]
  57. Sanchez-Seco M P, Navarro J M. Infections due to Toscana virus, West Nile virus, and other arboviruses of interest in Europe. Enferm Infecc Microbiol Clin. 2005;23:560–568. doi: 10.1157/13080267. [DOI] [PubMed] [Google Scholar]
  58. Sharifi-Mood B, Metanat M, Ghorbani-Vaghei A, Fayyaz-Jahani F, Akrami E. The outcome of patients with Crimean-Congo hemorrhagic fever in Zahedan, southeast of Iran: a comparative study. Arch Iran Med. 2009;12:151–153. [PubMed] [Google Scholar]
  59. Shepherd A J, Swanepoel R, Leman P A, Shepherd S P. Comparison of methods for isolation and titration of Crimean-Congo hemorrhagic fever virus. J Clin Microbiol. 1986;24:654–656. doi: 10.1128/jcm.24.4.654-656.1986. [DOI] [PMC free article] [PubMed] [Google Scholar]
  60. Soares-Weiser K, Thomas S, Thomson G, Garner P. Ribavirin for Crimean-Congo hemorrhagic fever: systematic review and meta-analysis. BMC Infect Dis. 2010;10:207. doi: 10.1186/1471-2334-10-207. [DOI] [PMC free article] [PubMed] [Google Scholar]
  61. Tasdelen Fisgin N, Ergonul O, Doganci L, Tulek N. The role of ribavirin in the therapy of Crimean-Congo hemorrhagic fever: early use is promising. Eur J Clin Microbiol Infect Dis. 2009;28:929–933. doi: 10.1007/s10096-009-0728-2. [DOI] [PubMed] [Google Scholar]
  62. Tekin S, Bursali A, Mutluay N, Keskin A, Dundar E. Crimean-Congo hemorrhagic fever virus in various ixodid tick species from a highly endemic area. Vet Parasitol. 2012;186:546–552. doi: 10.1016/j.vetpar.2011.11.010. [DOI] [PubMed] [Google Scholar]
  63. Tezer H, Sucakli I A, Sayli T R, Celikel E, Yakut I, Kara A, Tunc B, Ergonul O. Crimean-Congo hemorrhagic fever in children. J Clin Virol. 2010;48:184–186. doi: 10.1016/j.jcv.2010.04.001. [DOI] [PMC free article] [PubMed] [Google Scholar]
  64. Tignor G H, Hanham C A. Ribavirin efficacy in an in vivo model of Crimean-Congo hemorrhagic fever virus (CCHF) infection. Antiviral Res. 1993;22:309–325. doi: 10.1016/0166-3542(93)90040-P. [DOI] [PMC free article] [PubMed] [Google Scholar]
  65. Turkdogan K A, Zorlu A, Engin A, Guven F M, Polat M M, Turgut O O, Yilmaz M B. C-type natriuretic peptide is associated with the severity of Crimean-Congo hemorrhagic fever. Int J Infect Dis. 2012;16:e616–620. doi: 10.1016/j.ijid.2012.04.009. [DOI] [PubMed] [Google Scholar]
  66. Vanhomwegen J, Alves M J, Zupanc T A, Bino S, Chinikar S, Karlberg H, Korukluoglu G, Korva M, Mardani M, Mirazimi A, Mousavi M, Papa A, Saksida A, Sharifi-Mood B, Sidira P, Tsergouli K, Wolfel R, Zeller H, Dubois P. Diagnostic assays for crimean-congo hemorrhagic fever. Emerg Infect Dis. 2012;18:1958–1965. doi: 10.3201/eid1812.120710. [DOI] [PMC free article] [PubMed] [Google Scholar]
  67. Vassilenko S M, Vassilev T L, Bozadjiev L G, Bineva I L, Kazarov G Z. Specific intravenous immunoglobulin for Crimean-Congo haemorrhagic fever. Lancet. 1990;335:791–792. doi: 10.1016/0140-6736(90)90906-L. [DOI] [PubMed] [Google Scholar]
  68. Watts D M, Ussery M A, Nash D, Peters C J. Inhibition of Crimean-Congo hemorrhagic fever viral infectivity yields in vitro by ribavirin. Am J Trop Med Hyg. 1989;41:581–585. doi: 10.4269/ajtmh.1989.41.581. [DOI] [PubMed] [Google Scholar]
  69. Whitehouse C A. Crimean-Congo hemorrhagic fever. Antiviral Res. 2004;64:145–160. doi: 10.1016/j.antiviral.2004.08.001. [DOI] [PubMed] [Google Scholar]
  70. Xia H, Li P, Yang J, Pan L, Zhao J, Wang Z, Li Y, Zhou H, Dong Y, Guo S, Tang S, Zhang Z, Fan Z, Hu Z, Kou Z, Li T. Epidemiological survey of Crimean-Congo hemorrhagic fever virus in Yunnan, China, 2008. Int J Infect Dis. 2011;15:e459–463. doi: 10.1016/j.ijid.2011.03.013. [DOI] [PubMed] [Google Scholar]
  71. Yen Y C, Kong L X, Lee L, Zhang Y Q, Li F, Cai B J, Gao S Y. Characteristics of Crimean-Congo hemorrhagic fever virus (Xinjiang strain) in China. Am J Trop Med Hyg. 1985;34:1179–1182. [PubMed] [Google Scholar]
  72. Zeller H. Laboratory Diagnosis of Crimean-Congo Hemorrhagic Fever. In: Ergonul O, Whitehouse C A, editors. Crimean-Congo Hemorrhagic Fever: A Global Perspective. Dordrecht: Springer; 2007. pp. 233–243. [Google Scholar]

Articles from Virologica Sinica are provided here courtesy of Wuhan Institute of Virology, Chinese Academy of Sciences

RESOURCES