title: Health care response to CCHF in US soldier and nosocomial transmission to health care providers, Germany, 2009.
abstract: In 2009, a lethal case of Crimean-Congo hemorrhagic fever (CCHF), acquired by a US soldier in Afghanistan, was treated at a medical center in Germany and resulted in nosocomial transmission to 2 health care providers (HCPs). After his arrival at the medical center (day 6 of illness) by aeromedical evacuation, the patient required repetitive bronchoscopies to control severe pulmonary hemorrhage and renal and hepatic dialysis for hepatorenal failure. After showing clinical improvement, the patient died suddenly on day 11 of illness from cerebellar tonsil herniation caused by cerebral/cerebellar edema. The 2 infected HCPs were among 16 HCPs who received ribavirin postexposure prophylaxis. The infected HCPs had mild or no CCHF symptoms. Transmission may have occurred during bag-valve-mask ventilation, breaches in personal protective equipment during resuscitations, or bronchoscopies generating infectious aerosols. This case highlights the critical care and infection control challenges presented by severe CCHF cases, including the need for experience with ribavirin treatment and postexposure prophylaxis.
authors.forename: Nicholas G
authors.initials: NG
authors.lastname: Conger
authors.forename: Kristopher M
authors.initials: KM
authors.lastname: Paolino
authors.forename: Erik C
authors.initials: EC
authors.lastname: Osborn
authors.forename: Janice M
authors.initials: JM
authors.lastname: Rusnak
authors.forename: Stephan
authors.initials: S
authors.lastname: Günther
authors.forename: Jane
authors.initials: J
authors.lastname: Pool
authors.forename: Pierre E
authors.initials: PE
authors.lastname: Rollin
authors.forename: Patrick F
authors.initials: PF
authors.lastname: Allan
authors.forename: Jonas
authors.initials: J
authors.lastname: Schmidt-Chanasit
authors.forename: Toni
authors.initials: T
authors.lastname: Rieger
authors.forename: Mark G
authors.initials: MG
authors.lastname: Kortepeter
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use; D003428:Cross Infection; D017809:Fatal Outcome; D005858:Germany; D006479:Hemorrhagic Fever, Crimean / Q000175:diagnosis* / Q000635:transmission; D006801:Humans; D017758:Infectious Disease Transmission, Patient-to-Professional; D008297:Male; D008889:Military Personnel; D012254:Ribavirin / Q000627:therapeutic use; D014481:United States / Q000208:ethnology; D055815:Young Adult
chemical_list: D000998:Antiviral Agents; D012254:Ribavirin