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Volume 41 Issue 3
June 2026
    Citation: Mohammad Fereidouni(محمد فریدونی), Jens H. Kuhn, David B. Pecor, Dmitry A. Apanaskevich(Апанаскевич Дмитрий Александрович), Kurtesh Sherifi f, Jelena Protić(Jелена Протић), Teodora Karevska(Теодора Каревска), Golubinka Boshevska(Голубинка Бошевска), María Paz Sánchez-Seco, Anna Papa(Άννα Παπά), Maryam Keshtkar-Jahromi(مریم کشتکار جھرمی). Crimean-Congo hemorrhagic fever: An emerging threat in Europe .VIROLOGICA SINICA, 2026, 41(3) : 493-512.  http://dx.doi.org/10.1016/j.virs.2025.12.006
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    Crimean-Congo hemorrhagic fever: An emerging threat in Europe

    • a. Zoonoses Research Center, Jahrom University of Medical Sciences (دانشگاه علوم پزشكي خدمات بهداشتی درمانی جهرم), P. O. Box 193, Jahrom, Fars Province, 74148-46199, Iran;

    • b. Integrated Research Facility at Fort Detrick, Division of Clinical Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, B-8200 Research Plaza, Fort Detrick, Frederick, MD 21702, USA;

    • c. Entomology Branch, Walter Reed Army Institute of Research, 503 Robert Grant Ave., Silver Spring, MD 20910, USA;

    • d. U. S. National Tick Collection, The James H. Oliver Jr. Institute for Coastal Plain Science, Georgia Southern University, P. O. Box 7982, Statesboro, GA 30458, USA;

    • e. Department of Biology, Georgia Southern University, 1332 Southern Drive, Statesboro, GA 30458, USA;

    • f. Department of Veterinary Medicine, Faculty of Agriculture and Veterinary, University of Prishtina, Str. "George Bush", No. 31, 10 000 Prishtinë;

    • g. Institut za virusologiju, vakcine i serume „Torlak" (Институт за вирусологиjjу, вакцине и серуме „Торлак"), 458 Vojvode Stepe, 11152 Belgrade, Serbia;

    • h. Laboratory of Virology, Institute of Public Health (Институт за јjавно здравjjе на Република Северна Македониjа), 50th Division No. 6, 1000 Skopje, Republic of North Macedonia;

    • i. Faculty of Medical Sciences, Goce Delcev University (Факултет за медицински науки, Универзитет „Гоце Делчев"), Stip, Republic of North Macedonia;

    • j. Centro Nacional de Microbiología, Instituto de Salud Carlos III, 28029 Madrid, Spain;

    • k. Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Instituto de Salud Carlos III, Ministry of Science, Innovation and Universities, Sinesio Delgado Street 10, 28029 Madrid, Spain;

    • l. Department of Microbiology, School of Medicine, Aristotle University of Thessaloniki, 54124, Thessaloniki, Greece;

    • m. Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Mason F. Lord Bldg., Center Tower, Suite 381, 5200 Eastern Avenue, Baltimore, MD 21224, USA

    • Corresponding author: Jens H. Kuhn, jenshkuhn@comcast.net
      Maryam Keshtkar-Jahromi(مریم کشتکار جھرمی), maryam.keshtkar@jhmi.edu
    • Received Date: 01 April 2025
      Accepted Date: 04 December 2025
      Available online: 15 December 2025
    • Crimean-Congo hemorrhagic fever (CCHF), caused by Crimean-Congo hemorrhagic fever virus (CCHFV), is endemic in Africa, Asia, and Europe. However, CCHF epidemiology and epizootiology have been poorly defined in Europe. Here, we summarize the current knowledge of CCHFV distribution in (non-Russian) Europe, including countries previously not considered to be at risk. We collected data on CCHF cases, human/vertebrate animal anti-CCHFV seroprevalence, CCHFV vector (Hyalomma tick), and CCHFV isolation from ticks and classified countries into five risk levels using a One Health approach. From 1944 through Feb 2025, more than 2000 recorded CCHF cases were identified in Europe, mostly from southern/eastern countries/regions, primarily Bulgaria (at least 1623), Kosovo (at least 339), Ukraine (at least 336), Croatia (at least 200), Albania (at least 146), and Republic of Moldova (at least 60). Albania, Bulgaria, Greece, Kosovo, and Spain were categorized as level 1 (reported CCHF cases, presence of robust surveillance systems). North Macedonia, Portugal, and Ukraine/Crimea were assigned to level 2 (reported CCHF cases in the absence of robust established surveillance). Bosnia and Herzegovina, Croatia, France, Hungary, Italy, Montenegro, Republic of Moldova, Romania, and Slovenia were assigned to level 3 due to evidence of CCHFV circulation in absence of recent CCHF cases. Thirty-four countries were assigned to level 4 (presence of Hyalomma ticks) or level 5 (no data). This work provides information on CCHFV distribution and burden with list of at-risk areas to inform international and local public health agencies to establish or strengthen surveillance systems.
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      Crimean-Congo hemorrhagic fever: An emerging threat in Europe

        Corresponding author: Jens H. Kuhn, jenshkuhn@comcast.net
        Corresponding author: Maryam Keshtkar-Jahromi(مریم کشتکار جھرمی), maryam.keshtkar@jhmi.edu
      • a. Zoonoses Research Center, Jahrom University of Medical Sciences (دانشگاه علوم پزشكي خدمات بهداشتی درمانی جهرم), P. O. Box 193, Jahrom, Fars Province, 74148-46199, Iran;
      • b. Integrated Research Facility at Fort Detrick, Division of Clinical Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, B-8200 Research Plaza, Fort Detrick, Frederick, MD 21702, USA;
      • c. Entomology Branch, Walter Reed Army Institute of Research, 503 Robert Grant Ave., Silver Spring, MD 20910, USA;
      • d. U. S. National Tick Collection, The James H. Oliver Jr. Institute for Coastal Plain Science, Georgia Southern University, P. O. Box 7982, Statesboro, GA 30458, USA;
      • e. Department of Biology, Georgia Southern University, 1332 Southern Drive, Statesboro, GA 30458, USA;
      • f. Department of Veterinary Medicine, Faculty of Agriculture and Veterinary, University of Prishtina, Str. "George Bush", No. 31, 10 000 Prishtinë;
      • g. Institut za virusologiju, vakcine i serume „Torlak" (Институт за вирусологиjjу, вакцине и серуме „Торлак"), 458 Vojvode Stepe, 11152 Belgrade, Serbia;
      • h. Laboratory of Virology, Institute of Public Health (Институт за јjавно здравjjе на Република Северна Македониjа), 50th Division No. 6, 1000 Skopje, Republic of North Macedonia;
      • i. Faculty of Medical Sciences, Goce Delcev University (Факултет за медицински науки, Универзитет „Гоце Делчев"), Stip, Republic of North Macedonia;
      • j. Centro Nacional de Microbiología, Instituto de Salud Carlos III, 28029 Madrid, Spain;
      • k. Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Instituto de Salud Carlos III, Ministry of Science, Innovation and Universities, Sinesio Delgado Street 10, 28029 Madrid, Spain;
      • l. Department of Microbiology, School of Medicine, Aristotle University of Thessaloniki, 54124, Thessaloniki, Greece;
      • m. Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Mason F. Lord Bldg., Center Tower, Suite 381, 5200 Eastern Avenue, Baltimore, MD 21224, USA
      • Received Date: 01 April 2025
      • Accepted Date: 04 December 2025

      Abstract: Crimean-Congo hemorrhagic fever (CCHF), caused by Crimean-Congo hemorrhagic fever virus (CCHFV), is endemic in Africa, Asia, and Europe. However, CCHF epidemiology and epizootiology have been poorly defined in Europe. Here, we summarize the current knowledge of CCHFV distribution in (non-Russian) Europe, including countries previously not considered to be at risk. We collected data on CCHF cases, human/vertebrate animal anti-CCHFV seroprevalence, CCHFV vector (Hyalomma tick), and CCHFV isolation from ticks and classified countries into five risk levels using a One Health approach. From 1944 through Feb 2025, more than 2000 recorded CCHF cases were identified in Europe, mostly from southern/eastern countries/regions, primarily Bulgaria (at least 1623), Kosovo (at least 339), Ukraine (at least 336), Croatia (at least 200), Albania (at least 146), and Republic of Moldova (at least 60). Albania, Bulgaria, Greece, Kosovo, and Spain were categorized as level 1 (reported CCHF cases, presence of robust surveillance systems). North Macedonia, Portugal, and Ukraine/Crimea were assigned to level 2 (reported CCHF cases in the absence of robust established surveillance). Bosnia and Herzegovina, Croatia, France, Hungary, Italy, Montenegro, Republic of Moldova, Romania, and Slovenia were assigned to level 3 due to evidence of CCHFV circulation in absence of recent CCHF cases. Thirty-four countries were assigned to level 4 (presence of Hyalomma ticks) or level 5 (no data). This work provides information on CCHFV distribution and burden with list of at-risk areas to inform international and local public health agencies to establish or strengthen surveillance systems.

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