IAMAT |International Association of Medical Assistance to Travellers| IAMAT |International Association of Medical Assistance to Travellers|

Pakistan For Specific Travellers:
Crimean-Congo Hemorrhagic Fever

Pakistan has confirmed Crimean-Congo Hemorrhagic Fever (CCHF) in Khyber Pakhtunkhwa, Punjab, and Sindh. CCHF is endemic in Pakistan.

For the latest information on Crimean-Congo Hemorrhagic Fever outbreaks please go to: ProMED-mail. Crimean-Congo hem. Fever - Pakistan (19): (Khyber-Pakhtunkhwa, Sindh). ProMED-mail 2018; October 02: 20181002.6062753. <ProMED-mail>. Accessed on October 02, 2018.


Crimean-Congo Hemorrhagic Fever is an infection caused by Crimean-Congo Hemorrhagic Fever Virus (CCHFV), a Nairovirus belonging to the Bunyaviridae family. It is a zoonosis – an animal disease that can spread to humans – primarily affecting wild animals and domestic livestock. Humans become ill with CCHF when they are bitten by infected ticks or when coming into contact with infected animal blood or tissues.


The virus is typically found in Southern and Eastern Europe, Central Asia, Africa, Southeast Asia, and the Middle East. Travellers undertaking outdoor activities such as camping or hiking, especially during the peak transmission season from Spring to Fall, are at greater risk. Crimean-Congo Hemorrhagic Fever is an occupational disease among healthcare practitioners, agricultural workers, abattoir employees, and veterinarians.

Serological evidence suggests the presence of Nairovirus causing CCHF in Armenia, Azerbaijan, Bangladesh, Benin, Bosnia & Herzegovina, Botswana, Burkina Faso, Cameroon, Central African Republic, Republic of Congo, Cote d'Ivoire, Croatia, Egypt, Ethiopia, Gabon, Gambia, Georgia, Greece, Guinea, Guinea-Bissau, Hungary, India, Iraq, Kenya, Macedonia, Madagascar, Moldova, Namibia, Nigeria, Oman, Romania, Saudi Arabia, Senegal, South Sudan, Sudan, Syria, Tanzania, Turkmenistan, Uganda, Ukraine, and Zimbabwe.


Usually symptoms appear 1 to 9 days after the tick bite. If coming in direct contact with infected animal blood or tissues, symptoms usually appear after 5 or 6 days. Initial symptoms include a sudden high fever, aching muscles, abdominal, back and joint pain, headache, vomiting, diarrhea, dizziness, sore eyes and throat, and red spots on the palate (roof of the mouth). Other symptoms may include jaundice, mood swings, confusion, aggression, and sensitivity to light. The infection progresses to hemorrhaging (bruising, nosebleeds, blood in the urine and feces, and bleeding from the gums) which usually starts 2 to 4 days after the initial symptoms and lasts approximately two weeks. Crimean-Congo Hemorrhagic Fever may be fatal. Treatment includes supportive care of symptoms and eliminating secondary infections.


Travellers who hike, camp, or undertake outdoor activities in wooded regions of endemic areas should take measures to prevent tick bites.

  • Use a repellent containing 20%-30% DEET or 20% Picaridin. Re-apply according to manufacturer's directions.
  • Wear neutral-coloured (beige, light grey) and breathable garments, including long-sleeved shirts and pants. Tuck pants into socks.
  • If available, apply a permethrin spray or solution to clothing and gear.
  • When hiking in wooded areas, stay in the middle of the trail and avoid tall grasses and shrubs.
  • Use a tarp when sitting on the ground.
  • Carefully examine your body, clothing, gear, and pets for ticks before entering a dwelling.
  • Apply sunscreen first followed by the repellent (preferably 20 minutes later.)
  • More details on insect bite prevention.
  • Avoid coming into contact with the blood or tissues of animals. Healthcare practitioners should take appropriate infection control measures to prevent infection.

There is no effective commercially available vaccine or preventive medication against Crimean-Congo Hemorrhagic Fever.

Crimean-Congo Hemorrhagic Fever Virus images, life cycle, and distribution maps
Infection Landscapes

Health risk description last reviewed: June 21, 2016
Country information last updated: October 09, 2018


  • Ergonul O, Holbrook MR. Crimean-Congo Hemorrhagic Fever. In: Guerrant, R; Walker D; Weller P, eds. Tropical Infectious Diseases. 3rd ed. New York: Saunders Elsevier; 2011: 466-469.
  • Mathews CE, Fisher-Hoch S. Crimean-Congo Hemorrhagic Fever. In: McGill, A; Ryan, E; Hill, D; Solomon, T, eds. Hunter's Tropical Medicine and Emerging Infectious Diseases. 9th ed. New York: Saunders Elsevier; 2013: 311-314.
  • Wertheim, Heiman; Horby, Peter; Woodall, John, eds. Atlas of Human Infectious Diseases. Oxford: Wiley-Blackwell; 2012. 273 p.
  • Centers for Disease Control and Prevention: Crimean-Congo Hemorrhagic Fever
  • World Health Organization: Crimean-Congo Hemorrhagic Fever Factsheet No. 208

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