Crimean-Congo Hemorrhagic Fever Geographic and Environmental Risk Assessment in the Balkan and Anatolian Peninsulas

ABSTRACT

Crimean-Congo hemorrhagic fever (CCHF) is a severe, life-threatening viral zoonotic pathogen transmitted to humans primarily by ticks of the genus Hyalomma. The virus is geographically diverse and found throughout a number of countries in central and southwest Asia, Africa, and Eastern Europe. Throughout the Balkan and Anatolian Peninsulas, sporadic outbreak events have been reported since the 1950s. Human infection is found in high-risk occupations ranging from agricultural and livestock workers to health care practitioners and veterinarians. The virus is highly pathogenic and recognized as the most medically important tick-borne disease affecting people. This study incorporated both maximum entropy modeling (Maxent) and spatial scan statistics (SaTScan) to map potential disease transmission risk, and to further explore the spatiotemporal distribution of confirmed human cases from 1954 to 2013. These findings provide evidence of the preferred environmental geography of CCHF and highlight the importance of integrating dynamic disease surveillance systems with geospatial technologies.

KEYWORDS:

• Crimean-Congo hemorrhagic fever (CCHF)
• Maxent
• medical geography
• SaTScan

Acknowledgments

Special thanks to my colleague David Mills, Dr. Alberto Giordano, and the anonymous reviewers for their thoughtful and constructive comments.