Evaluation of Crimean-congo Hemorrhagic Fever (CCHF) Surveillance System in Iran

Background and Objectives: To provide an overview of the national program of Crimean-Congo hemorrhagic fever surveillance in Iran, its current achievements, and challenges.   Methods: In this mixed method study, the relevant reports, documents, and guidelines, as well as published literature and surveillance data were gathered and critically reviewed. The opinions of the key informants at local and governmental levels were assessed through structured interviews.   Results: The program was integrated into Iran’s primary healthcare (PHC) network in 1999. The involved organizations include CDC, medical universities, Pasteur Institute of Iran (PII), and Veterinary Organization. Case finding is based on standard definitions of suspected, probable, and confirmed cases. Laboratory confirmation is necessary for diagnosis and is provided within 48 hours after receipt of the specimen by the National Reference Laboratory of PII. CCHF treatment is primarily supportive. Antiviral therapy with ribavirin is also considered. Both therapeutic services are free. Education mainly focuses on high-risk groups and healthcare workers. Major achievements of the program include rapid diagnosis and treatment of cases, prevention of nosocomial transmission, identification of high-risk provinces and major transmission routes, improved outbreak preparedness, development of laboratory tests for detection of other arboviruses, and reduction of CCHF case fatality rate.   Conclusion: Program implementation has had a positive impact on early detection and proper control of annual outbreaks. However, some aspects of the program still need improvement, including promotion of the general and high-risk populations’ awareness and regional collaborations (especially among neighboring countries) for infection control in humans, livestock, and vectors.