⚠️ European resurgence 2022–2026

Crimean-Congo Haemorrhagic Fever (CCHF)

Complete clinical guide — patients & healthcare workers
Hyalomma ticks · Spain / Balkans / Turkey · Ribavirin IV

10–40%
CFR in hospitalised
Hyalomma
main vector
Spain
1st W. Europe case 2022
Ribavirin
IV treatment available
⚠️ Public information — Not a medical device. This page is an information tool based on official WHO, ECDC and national health agency data. It does not replace medical consultation. If in doubt, call 112 / emergency services.
🚨 If fever + tick contact / return from endemic area
Call immediately
112
Emergency services — 24/7
  • 1 Stay home — do NOT go to the emergency room without calling first
  • 2 Call 112 and mention the tick bite and the country visited
  • 3 Isolate in a separate room, avoid any contact with blood
  • 4 Wait for instructions from the emergency operator

🗺️ CCHF risk areas in 2026

🇪🇸 Spain (Extremadura)
First Western Europe case 2022. Elevated vigilance.
🇽🇰🇦🇱🇬🇷 Balkans
Kosovo, Albania, Greece — endemic.
🇹🇷 Turkey
Endemic — many cases each year.
🌍 Central Asia & Africa
Kazakhstan, Uzbekistan, Pakistan, sub-Saharan Africa.
🌡️ Climate change alert: The northward expansion of Hyalomma marginatum ticks is documented across Europe. Heightened vigilance for hikers and agricultural workers in southern regions.

🛡️ Prevention — Hyalomma ticks

Tick bite prevention is the only available protection (no approved vaccine).

👕 Covering clothing
Long sleeves, trousers tucked into socks. Light colours (ticks visible).
🧴 Skin repellents
DEET or Icaridin ≥ 20% on exposed areas. Reapply as directed.
👔 Permethrin clothing
Insecticide treatment of clothing. Effective through multiple washes.
🔍 Body check
Systematic inspection after returning from the field: armpits, groin, nape, behind ears.
🪤 Tick removal
Use tick remover tool (not fingers). Remove within 24h. Do NOT crush the tick.
🚫 Forbidden
Never crush a tick with your fingers — risk of contamination through blood.

📅 Day-by-day disease progression

CCHF — incubation 1 to 13 days after tick bite (median: 3–5 days)

Pre-haemorrhagic phase — sudden onset

  • Sudden onset (unlike Lassa) — fever ≥ 39°C
  • Intense headache
  • Diffuse myalgia, lower back pain
  • Dizziness, nausea
  • Facial flushing (characteristic red face)
  • Conjunctivitis frequent

⚠️ Resembles Ebola but with even more sudden onset. Epidemiological context (tick, area) is key.

Haemorrhagic phase — severity sign

  • Petechiae on skin and mucosae
  • Epistaxis (nosebleed)
  • Gum bleeding
  • Gastrointestinal haemorrhage
  • Haematuria
  • DIC, platelets < 20 G/L
  • Transaminases > 10 × upper limit of normal

⚠️ TYPICAL BIOLOGICAL SIGN: frank thrombocytopenia + leucopenia + AST > 10× ULN = CCHF until proven otherwise in the right epidemiological context.

❓ Frequently asked questions

Yes, the risk is real if you have a Hyalomma tick bite in Extremadura or other rural areas of Spain. Prevention relies on covering clothing and DEET/Icaridin repellents. Monitor yourself for 14 days after returning. If fever → call 112 immediately, mentioning the tick bite and the country.
Yes, but only through direct contact with blood or body fluids of an infected patient. There is no airborne transmission. Nosocomial clusters are documented (Kosovo 2001, Turkey 2008) but occur mainly without adequate PPE.
  1. Remove the tick with a tick removal tool (not your fingers)
  2. Note the date and location of the bite
  3. Monitor your temperature for 14 days
  4. If fever → call 112 immediately, mentioning the tick bite and the country visited
No, no vaccine is approved and available in Western Europe. A Bulgarian inactivated-virus vaccine exists but is not distributed outside Bulgaria and its efficacy has not been validated by modern trials. Prevention relies solely on tick protection.

📚 Official sources

Last updated: 19 June 2026 · By Dr Clément MÉDEAU, physician (La Rochelle, France)