CRIMEAN-CONGO HEMORRHAGIC-FEVER TREATED WITH ORAL RIBAVIRIN

Crimean-Congo Haemorrhagic Fever (CCHF) is an often-lethal haemorrhagi c fever caused by a tick-borne virus. There are no published data on r ibavirin treatment of CCHF-infected patients, despite established in-v itro and in-vivo sensitivity. We report three health workers-two surge ons and a hospital worker-infected with CCHF Virus ill Pakistan who we re treated with oral ribavirin 4 g/day for four days, then 2.4 g/day f or six days. Intravenous ribavirin was unavailable. All three patients were severely ill with low platelet and white-cell counts, raised asp artate transaminase acid evidence of impaired haemostasis. Based on pu blished reports, all had an estimated probability of death of 90% or m ore. The patients became afebrile, and their haematological and bioche mical abnormalities returned to normal within 48 h of ribavirin treatm ent; all made a complete recovery, and developed IgG and IgM antibody to CCHF virus. Our experience with ribavirin treatment is encouraging, but does not constitute evidence of efficacy. Given the difficulties in gathering adequate treatment data, we propose a consensus protocol for both intravenous and oral treatment of CCHF. This protocol could b e distributed to key medical personnel in areas endemic for CCHF and u sed to provide a firm basis for effective treatment recommendations.