Healthcare Acquired Crimean Congo Hemorrhagic Fever in Turkey 2002-2012 - Low Risk of Transmission in Routine Diagnostic Laboratory Practice
Healthcare-related transmission of Crimean Congo Hemorrhagic Fever (CCHF) is a well- recognised hazard. We reviewed a decade of experience in Turkey, where CCHF is endemic, to determine the relative contributions of transmission in near patient settings and in diagnostic laboratories.
Physicians managing patients provided retrospective case details from clinical and public health records and details of their local infection control practices relevant to CCHF. Only virologically/serologically confirmed cases were included.
7192 cases of CCHF were notified to the Ministry of Health (MoH) in 2002-2012, with 359 deaths (5 %), of which 4 were identified as nosocomial. The details of 37 confirmed healthcare-related cases were obtained from 7 centres, including 27 (73%) women, with 3/37 (8.1%) overall mortality. 16 (43%) were physician trainees, 15 nurses, 2 physician specialists, 2 medical students and 2 other staff. The main routes of injury were needlestick in 28/37 (75.7%), other defined blood/secretion exposure in 8 (21.6%) and unidentified in 1 case. Post exposure ribavirin prophylaxis was administered after 18/28 (75.6%) needlestick and 0/9 other exposures. No possible or probable laboratory-related infections were noted. An estimated minimum of 20 000 samples from CCHF patients were analysed in routine haematology and biochemistry laboratories nationally in this period. The 7 reporting institutions are regional infectious disease centres, where CCHF cases are managed with standard blood and secretion precautions and staff are trained in safe sharps disposal. No special precautions are taken in routine haematology and biochemistry labs to handle diagnostic samples from CCHF patients in special cabinets.
Healthcare-related transmission of CCHF is dangerous but the incidence in Turkey is lower than in other reports, involving an estimated total of 50-60 staff in 7192 admissions (<0.1%) in a decade. Those at greatest risk are ward-based staff performing invasive procedures including cannulation and venepuncture, and these staff especially need adequate training and protection. Our data suggest that there is very little hazard from processing haematology and biochemistry blood samples while following routine laboratory procedures.
R. Guner, None
H. Bodur, None
C. Bulut, None
F. Duygu, None
N. Elaldi, None
G. Cicek Senturk, None
N. J. Beeching, None