Short Report: Viral Hemorrhagic Fever Cases in the Country of Georgia: Acute Febrile Illness Surveillance Study Results

Minimal information is available on the incidence of Crimean-Congo hemorrhagic fever (CCHF) virus and hantavirus infections in Georgia. From 2008 to 2011, 537 patients with fever ³ 38 °C for ³ 48 hours without a diagnosis were enrolled into a sentinel surveillance study to investigate the incidence of nine pathogens, including CCHF virus and hantavirus. Of 14 patients with a hemorrhagic fever syndrome, 3 patients tested positive for CCHF virus immunoglobulin M (IgM) antibodies. Two of the patients enrolled in the study had acute renal failure. These 2 of 537 enrolled patients were the only patients in the study positive for hantavirus IgM antibodies. These results suggest that CCHF virus and hantavirus are contributing causes of acute febrile syndromes of infectious origin in Georgia. These findings support introduction of critical diagnostic approaches and confirm the need for additional surveillance in Georgia. A variety of viruses can induce hemorrhagic manifestations during infection and are often categorized as viral hemor- rhagic fever (VHF) viruses. Members of the family of Bunyaviridae are included in the VHF viruses and cover a wide geographic area. 1 In this report, we describe cases of Crimean-Congo hemorrhagic fever (CCHF) and hemor- rhagic fever with renal syndrome caused by hantaviruses detected through an Acute Febrile Illness (AFI) Surveillance Study carried out in the country of Georgia from 2008 to 2011 (Figure 1 and Table 1). CCHF virus is primarily transmitted to humans by ticks of the genus Hyalomma. Human-to-human transmission can occur by direct contact with the blood or tissue of viremic patients. 2 For CCHF virus, case-fatality rates as high as 30% have been reported. 3 For hantavirus cases, most human infec- tions result from inhalation of aerosolized rodent excreta; rodent scratches and bites as well as contaminated food or water can also transmit the virus. 4 In addition to fever, vascu- lar leakage, and rapid development of shock typical for all the VHF viruses, including CCHF virus, Old World hantavirus infections may also cause significant impairment of renal function. 1 The pathogenic hantaviruses detected in Europe and Russia include but are not restricted to Puumala (PUUV) and Dobrava-Belgrade (DOBV) viruses, which cause mild to moderate and moderate to severe clinical manifestations, respectively. Case-fatality rates of 0.2% and 12% have been reported for PUUV and DOBV infections, respectively, whereas the case-fatality rates for other hantaviruses have been reported to be as high as 50%. 4-6 Of Georgia's neigh- boring countries, Russia has the highest number of reported hantavirus infection cases annually (10,000-12,000 cases per year). The district of Sochi located on the border with Georgia on the Black Sea coast is endemic for hantavirus. 6 Turkey has reported an outbreak of hantavirus infection from the Black Sea region in 2009. 7 Additionally, emergence of CCHF in southwest Russia and Turkey has been observed in the recent years. 8