Exposure of Health Care Workers to Crimean-Congo Hemorrhagic Fever inSenegal: An Investigation of Two Imported Cases

Introduction: Crimean Congo hemorrhagic fever (CCHF) is a potentially fatal arbovirus with a high risk for nosocomial transmission. The goals of this study were to describe two cases of imported CCHF in Senegal and to evaluate health care worker exposure during the hospitalization of these two cases. Methodology: Exposed health care workers were identified, administered a questionnaire, and kept were under clinical surveillance for 9 days. The level of risk associated with exposure was determined using the French National Institute of Health Surveillance (InVS) classification system. Results: Two cases of CCHF transferred to Senegal from Mauritania, were admitted to the Infectious Diseases Service at Fann Teaching Hospital. The first case was admitted with diffuse hemorrhage and coma; the second case was admitted with febrile gastroenteritis. Both cases were fatal. The length of hospitalization was 06 hours and 07 days respectively. A total of 60 health care workers were exposed, including 11 doctors, 13 medical students, 14 nurses, 11 support staff, 09 nursing students, and 2 administrative staff. The majority of health care workers had a high-risk exposure (n=43, 65.2%). Moderate-risk exposure occurred among 21.2% (n=14) and low-risk exposure occurred among 13.6% (n=9). The high- risk was particularly prevalent among physicians (91,7%), support staff (91.7%) and nurses (66.7%). None of the contacts had clinical signs of CCHF during the monitoring period and none received prophylaxis with ribavirin. There were no known cases of nosocomial transmission. Conclusion: Despite high-risk exposure among the majority of health workers, no secondary cases were identified. Important strategies were identified to decrease the risk of nosocomial transmission for future cases of viral hemorrhagic fever in our hospital.