title: Crimean-Congo hemorrhagic fever in pregnancy: A systematic review and case series from Russia, Kazakhstan and Turkey.
abstract: BACKGROUND
  Crimean-Congo hemorrhagic fever (CCHF) is acute viral infection and a major emerging infectious diseases threat, affecting a large geographical area. There is no proven antiviral therapy and it has a case fatality rate of 4-30%. The natural history of disease and outcomes of CCHF in pregnant women is poorly understood.
  
  
  OBJECTIVE
  To systematically review the characteristics of CCHF in pregnancy, and report a case series of 8 CCHF cases in pregnant women from Russia, Kazakhstan and Turkey.
  
  
  METHODS
  A systematic review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement protocol. PubMed, SCOPUS, Science Citation Index (SCI) were searched for reports published between January 1960 and June 2016. Two independent reviewers selected and reviewed studies and extracted data.
  
  
  RESULTS
  Thirty-four cases of CCHF in pregnancy were identified, and combined with the case series data, 42 cases were analyzed. The majority of cases originated in Turkey (14), Iran (10) and Russia (6). There was a maternal mortality of 14/41(34%) and fetal/neonatal mortality of in 24/41 cases (58.5%). Hemorrhage was associated with maternal (p=0.009) and fetal/neonatal death (p<0.0001). There was nosocomial transmission to 38 cases from 6/37 index pregnant cases.
  
  
  CONCLUSIONS
  Cases of CCHF in pregnancy are rare, but associated with high rates of maternal and fetal mortality, and nosocomial transmission.
authors.affiliation: Rostov State Medical University, Department of Infectious Diseases, Rostov-on-Don, Russia.
authors.forename: Natalia Yurievna
authors.initials: NY
authors.lastname: Pshenichnaya
authors.affiliation: Ondokuz Mayis University, Department of Infectious Diseases and Clinical Microbiology, Samsun, Turkey.
authors.forename: Hakan
authors.initials: H
authors.lastname: Leblebicioglu
authors.affiliation: Ondokuz Mayis University, Department of Infectious Diseases and Clinical Microbiology, Samsun, Turkey.
authors.forename: Ilkay
authors.initials: I
authors.lastname: Bozkurt
authors.affiliation: Stavrapol State Medical University, Department of Infectious Diseases and Tuberculosis, Stavropol, Russia.
authors.forename: Irina Viktorovna
authors.initials: IV
authors.lastname: Sannikova
authors.affiliation: South-Kazakhstan State Pharmaceutical Academy, Department of Infectious Diseases and Dermatovenerology, Shymkent, Kazakhstan.
authors.forename: Gulzhan Narkenovna
authors.initials: GN
authors.lastname: Abuova
authors.affiliation: First State Medical University «I. M. Sechenov», Research Department, Moscow, Russia.
authors.forename: Andrey Sergeevich
authors.initials: AS
authors.lastname: Zhuravlev
authors.affiliation: Gaziosmanpasa University, Tokat, Turkey.
authors.forename: Sener
authors.initials: S
authors.lastname: Barut
authors.affiliation: Turkestan Central City Hospital, Department of Infectious Diseases,Turkestan, Kazakhstan.
authors.forename: Mutabar Bekovna
authors.initials: MB
authors.lastname: Shermetova
authors.affiliation: Ondokuz Mayis University, Department of Infectious Diseases and Clinical Microbiology, Samsun, Turkey; Liverpool School of Tropical Medicine, Liverpool, United Kingdom. Electronic address: tomfletcher@doctors.org.uk.
authors.forename: Tom E
authors.initials: TE
authors.lastname: Fletcher
mesh_terms: D021821:Communicable Diseases, Emerging / Q000453:epidemiology* / Q000401:mortality; D003428:Cross Infection; D005260:Female; D003225:Hemorrhagic Fever Virus, Crimean-Congo; D006479:Hemorrhagic Fever, Crimean / Q000453:epidemiology* / Q000401:mortality; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007623:Kazakhstan / Q000453:epidemiology; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology* / Q000401:mortality; D012426:Russia / Q000453:epidemiology; D014421:Turkey / Q000453:epidemiology
keywords: Crimean-Congo hemorrhagic fever; healthcare associated infection; pregnancy; viral hemorrhagic fever