One health investigation following a cluster of Crimean–Congo haemorrhagic fever, North Macedonia, July to November 2023

Dejan Jakimovski, Pavle Banović, Katerina Spasovska, Goran Rangelov, Marija Cvetanovska, Fadil Cana, Verica Simin, Ivana Bogdan, Dragana Mijatović, Aleksandar Cvetkovikj, Igor Djadjovski, Iva Christova, Eleftherios Meletis, Polychronis Kostoulas, Brigitta Zana, Zsófia Lanszki, Tamás Görföl, Zsófia Tauber and Gabor Kemenesi

In 2023, North Macedonia reported three cases of Crimean-Congo hemorrhagic fever (CCHF), marking the disease's return after more than five decades. A comprehensive One Health investigation was initiated to assess the virus's presence among healthcare workers, livestock, and ticks in the affected region.

Key Findings:

• Healthcare Workers: Out of 52 healthcare workers tested, four had antibodies against CCHF virus (CCHFV), indicating prior exposure

• Livestock: Antibodies were detected in 10 of 17 sheep and goats, suggesting active circulation of the virus among small ruminants.

• Ticks: While 24 Rhipicephalus bursa ticks were collected, none tested positive for CCHFV.

• Virus Strain: Genetic analysis revealed that the virus strain from the index patient closely resembled strains from neighboring Kosovo, belonging to the Europe-1 lineage (genotype V).

These findings confirm that CCHFV is endemic in North Macedonia. The study underscores the necessity for heightened awareness among healthcare professionals, robust diagnostic methods, and continuous surveillance to prevent and control future outbreaks.

For a detailed account of the investigation, refer to the full study published in Eurosurveillance.