Crimean-Congo Hemorrhagic Fever Virus in Hyalommid Ticks, Northeastern Kenya

As part of ongoing arbovirus surveillance, we screened ticks obtained from livestock in northeastern Kenya in 2008 to assess the risk for human exposure to tick-borne viruses. Of 1,144 pools of 8,600 Hyalomma spp. ticks screened for Congo-Crimean hemorrhagic fever virus by reverse transcription PCR, 23 pools were infected, demonstrating a potential for human exposure.

As part of ongoing arbovirus surveillance, we screened ticks obtained from livestock in northeastern Kenya in 2008 to assess the risk for human exposure to tick-borne viruses. Of 1,144 pools of 8,600 Hyalomma spp. ticks screened for Congo-Crimean hemorrhagic fever virus by reverse transcription PCR, 23 pools were infected, demonstrating a potential for human exposure.
C rimean-Congo hemorrhagic fever virus (CCHFV), a member of the genus Nairovirus, family Bunyaviridae, causes hemorrhagic disease in humans with a >30% casefatality rate. The virus was fi rst described in 1944 in the Crimea in the former Soviet Union and later was found to be similar to a virus isolated in 1956 in the Belgian Congo (1).
Domestic ruminants are infected through tick bites and are able to infect more ticks to perpetuate the virus (2,3). The virus may be transmitted to humans by the bite of an infected tick or by contact with body fl uids from an infected animal or person (4). The main vectors of CCHFV are ticks in the genus Hyalomma, family Ixodidae, with other ixodid ticks and ticks from the family Argasidae also contributing to transmission (2). The virus is transovarially transmitted among ticks (2,3); consequently, ticks are also reservoirs of CCHFV.
In Kenya, CCHFV has been detected on only 2 occasions: in Rhipicephalus pulchellus ticks collected in the 1970s from a dying sheep in a veterinary laboratory in the town of Kabete outside Nairobi (2) and from a person with Crimean-Congo hemorrhagic fever in western Kenya in October 2000 (5). Evidence of CCHFV activity in Kenya is limited, and although tick-borne arbovirus surveillance in Kenya has demonstrated circulation of a range of viruses, to our knowledge, detection of CCHFV has not been reported (6,7).
Crimean-Congo hemorrhagic fever is a substantial public health threat because of the associated high mortality rate (30%-60%), the potential for person-to-person transmission, the unavailability of a licensed vaccine, and the limited treatment options for infected persons (3,4). Entomologic surveillance is valuable for assessing the risk for human exposure and for identifying so-called hot spots for focused preventive action to minimize the effects of virus outbreaks. As part of ongoing entomologic arbovirus surveillance conducted by the United States Army Medical Research Unit in Kenya and the Kenya Medical Research Institute, ticks were collected from livestock in the semiarid areas of Kenya, where intense pastoralist farming is practiced, to assess the risk to the community for tick-borne arbovirus exposure.

The Study
Ticks were sampled in the villages of Diiso and El-Humow and at the livestock market and abattoirs in Garissa District, North Eastern Province of Kenya, during April-May 2008 (Figure). Garissa District is in a semi-arid to arid ecologic zone that receives sporadic rainfall from March to May; vegetation consists primarily of Acacia-Commiphora bushes. Its population is largely composed of nomadic herders who travel between districts in northern Kenya in search of water and pasture (8).
Ticks were picked by hand from infested livestock, stored in labeled sterile vials, and transported in liquid nitrogen to the Kenya Medical Research Institute laboratory. In the laboratory, ticks were washed in sterile water, rinsed fi rst with 70% ethanol, and then rinsed with minimum essential medium containing antimicrobial agents (100 U/mL penicillin, 100 μg/mL streptomycin, and 1 μL/mL amphotericin B). They were identifi ed to species by using taxonomic keys (9,10) and pooled in groups of 2 to 10 by species, sex, collection date and site, and host. The tick pools were homogenized by using 90-mesh alundum sand in a prechilled, sterile mortar and pestle with 1.6 mL-2 mL ice-cold bovine albumin 1 medium (1× medium 199 with Earle salts, 1% bovine albumin, 100 U/mL penicillin, 100 μg/mL streptomycin, and 1 μL/mL amphotericin B) under high containment. The homogenates were clarifi ed by centrifugation at 1,500 rpm for 15 min at 4°C, and supernatants were stored at -80°C.
Electrophoresis of the PCR products was performed by using 1% agarose gels in Tris-acetate-EDTA buffer containing ethidium bromide; product bands were visualized and documented with the Canon UVP PhotoDoc-It gel imaging system (UVP, LLC, Upland, CA, USA) mounted with a digital camera. The PCR products of a subset of 4 of the CCHFV-positive homogenates were purifi ed by using the QIAquick PCR Purifi cation Kit (QIAGEN Sciences, Germantown, MD, USA), according to the manufacturer's instructions, and sequenced by using the BigDye Terminator version 3.1 Cycle Sequencing Kit (Applied Biosystems, Foster City, CA, USA) and the ABI 3730 and automated 3130xl Genetic Analyzer (Applied Biosystems). The sequences were analyzed by using the Basic Local Alignment Search Tool (BLAST; http://blast. ncbi.nlm.nih.gov/Blast.cgi) and the GenBank database to confi rm the identity of the virus. Data (including tick species, collection site, animal host, and virologic test results) were entered into an Excel database (Microsoft Corp., Redmond, WA, USA) and analyzed by using pivot tables. A total of 8,600 ticks, of 3 genera and 8 species, were sampled primarily from camels, cattle, goats, and sheep, principally Hyalomma rufi pes and Hy. truncatum. Ticks of the genus Hyalomma were sampled 3× more frequently in Diiso than in El-Humow (Table). CCHFV was detected in 23 Hyalomma spp. tick pools from Diiso and the Garissa slaughterhouse, including 4 pools of Hy. rufi pes (3 from cattle and 1 from a camel), 18 pools of Hy. truncatum (14 from cattle and 4 from camels), and 1 unidentifi ed Hyalomma species (Table) in which single DNA bands corresponding to the predicted 536-bp PCR product were detected.

Conclusions
The detection of CCHFV in pools of Hyalomma spp. ticks from Diiso village and the Garissa District slaughterhouse provides strong evidence of CCHFV presence in northeastern Kenya and indicates that CCHFV circulation in Kenya is underestimated. CCHFV was detected only in ticks collected from cattle and a camel. Livestock play a role in the amplifi cation of the virus because the animals become viremic for 7 days (2,3), during which time they can infect more ticks. Our fi ndings indicate that CCHFV circulates in northeastern Kenya with substantial involvement of camels and cattle. The detection of CCHFV in ticks from camels at the slaughterhouse also suggests the potential of exposure for abattoir workers. The presence of CCHFV among hyalommid ticks in northern Kenya highlights the risk to the resident population and requires the assessment of human exposure. Health care workers must therefore help create awareness among the population and take steps to prepare for and prevent outbreaks.