Rare disease strikes Turkey

The tick-borne virus CCHF has already claimed 53 lives this year.

ISTANBUL // Like much of the rest of the world, Turkey is busy trying to prevent a major outbreak of swine flu, scanning arriving passengers at airports and ordering millions of doses of vaccine. But away from the spotlight, another deadly disease is on the march in central Anatolia: Crimean-Congo Hemorrhagic Fever, or CCHF, which is spread by ticks and has already killed more than 50 people this year.

News of the rising death toll has alerted the public. "CCHF is more dangerous than swine flu," a headline in a Turkish newspaper said recently. But as CCHF continues to claim lives, some experts said the government is not doing enough to counter the threat. "If there had been almost 60 deaths from a disease in Germany, that would be a sensation, but in Turkey, it's hardly on the agenda," Mehmet Alkan, president of the Turkish Union of Veterinary Doctors, said yesterday. "Authorities have been doing something, but it's not enough."

According to official figures released last week, 53 people have died from CCHF since January. There have been more than 3,000 cases since the disease first appeared in Turkey in 2002, with at least 208 deaths. There were 63 fatal cases last year, statistics posted on the website of the health ministry in Ankara show. CCHF is transmitted by a virus found in ticks. According to the World Health Organisation, or WHO, the disease was named after Crimea, where it was first described in 1944, and after the Congo, where it was identified a decade later. Countries at risk stretch from China to Africa and south-western Europe and include the Arabian Peninsula, the WHO said.

Symptoms of CCHF, which has been compared to Ebola and Lassa fever, include a sudden high fever, vomiting and bleeding. There is no vaccine. According to the Centres for Disease Control and Prevention in the US, mortality rates in hospitalised cases vary between nine per cent and 50 per cent. "Unfortunately, CCHF is a disease without a vaccine and without a specific treatment," Turan Buzgan, a senior health ministry official in Ankara, told reporters last week.

Doctors said the most effective ways to fight CCHF are precautions such as wearing long-sleeved shirts, and tucking trouser legs into socks while out in the field, as well as a quick and professional removal of ticks from the body. In Turkey, rural regions in the northern part of central Anatolia have been most severely hit. Although there has been a case of a young nurse dying from the disease after she was infected by the blood of a CCHF patient, most of the victims have been farmers who were bitten by ticks while working on their fields. Officials say 95 per cent of cases have occurred in 1,200 villages.

Dr Alkan said the fact that most cases had occurred in poor rural areas had contributed to a lack of attention for the problem. "Poor people are the victims, not the ones in luxury homes in the cities." If ticks ever entered the villas of the rich, "more would be done. I am not saying that in an ideological sense but from a humanitarian point of view". In some parts of the country, suspected cases of CCHF have triggered panic. When an elderly man was brought to hospital in the western town of Balikesir after allegedly being bitten by a tick last month, medical personnel were given face masks and the clinic stopped accepting other patients. The CCHF suspicion later turned out to be unfounded.

Dr Alkan called for a comprehensive effort to tackle CCHF. That plan should include different ministries as well as scientists and should be regarded as a long-term effort to defeat the disease. "At the moment, there is no well-planned approach," he said. Instead, Turkey's health authorities have focused their attention on swine flu. There are 240 confirmed cases in the country, according to the latest official count, but there have not been any deaths. Ten million people are to be vaccinated against the flu before the end of the year, while another 10 million doses of vaccine are expected to arrive in the country early next year.

Measures to prevent the spread of the flu have been in place for months. Passengers flying into Turkey have to fill out forms to inform authorities how they can be contacted in case another person from the same flight is diagnosed with swine flu. Infra-red cameras have been installed in arrival halls of major airports to identify passengers suffering from high fever. Recep Akdag, the health minister, rejected accusations that the fight against CCHF was being overshadowed by efforts to prevent a mass outbreak of swine flu. CCHF was not connected to a worldwide pandemic such as swine flu, the minister told reporters in June.