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Crimean-Congo Hemorrhagic Fever in South Africa

The following background data are abstracted from Gideon and the Gideon e-book series. [1,2]

Time and Place:
The first indigenous case of Crimean-Congo hemorrhagic fever (CCHF) in South Africa was reported in 1981 – fatal infection acquired in Transvaal.
– At the time of the report, 7% of persons in the area were found to be seropositive.
– Highest incidence is reported in the Karoo, the Western Free State, the Northern Cape and North West Province.
– Most patients are farmers, farm laborers, hunters or abattoir workers.
– 101 cases were reported during 1981 to 1992; 81 during 1993 to 2010.
– 16 outbreaks were reported among animals during 1981 to 1986.
– Imported cases were reported in 1985 (from Democratic Republic of Congo) and 1986 (from Tanzania).

CCHF: Reported cases and deaths per year – see graph [3] :


Seroprevalence surveys:
100% of giraffe (Giraffa camelopardalis), 54% of rhinoceros (Ceratotherium simium and Diceros bicornis), 46% of eland (Taurotragus oryx), 19.5% of buffalo (Syncerus caffer), 22% of kudu (Tragelaphus strepsiceros), 17% of zebra (Equus burchelli), 6.0% of domestic dogs, 13.7% of hares, 1.7% of rodents and 0% of primates (South Africa and Zimbabwe, 1987 publication)
28% of cattle (1987 publication)

– The principal vector is Hyalomma truncatum.
– H. marginatum rufipes and H. m. turanicum have also been incriminated.

Notable outbreaks:
1984 – An outbreak (5 cases, 1 fatal) of Crimean-Congo hemorrhagic fever was reported in Orange Free State.
1985 – An outbreak (6 cases, 1 fatal) was reported at a hospital near Cape Town, among health-care workers who had contact with an index patient or his secretions.
1996 – An outbreak (32 suspect cases, 17 confirmed; one fatal) was reported at an ostrich abattoir in Oudtshoorn (Western Cape).

1. Berger SA. Infectious Diseases of South Africa, 2012. 436 pages, 95 graphs, 1942 references. Gideon e-books,
2. Berger SA. Crimean-Congo Hemorrhagic Fever: Global Status. 2012. 36 pages, 18 graphs, 505 references. Gideon e-books,
3. 3. Gideon Graph Tool, see tutorial at

Note featured on ProMED

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