Seroprevalence of Alkhurma and Other Hemorrhagic Fever Viruses, Saudi Arabia

Ziad A. Memish

, Ali Albarrak, Mohammad A. Almazroa, Ibrahim Al-Omar, Rafat Alhakeem, Abdullah Assiri, Shamsudeen Fagbo, Adam MacNeil, Pierre E. Rollin, Nageeb Abdullah, and Gwen Stephens

Author affiliations: Ministry of Health, Riyadh, Kingdom of Saudi Arabia (Z.A. Memish, M.A. Almazroa, I. Al-Omar, R. Alhakeem, A. Assiri, S. Fagbo, N. Abdullah, G. Stephens); Riyadh Military Hospital, Riyadh (A. Albarrak); Centers for Disease Control and Prevention, Atlanta, Georgia, USA (A. MacNeil, P.E. Rollin); University of British Columbia, Vancouver, British Columbia, Canada (G. Stephens)

Abstract

A 2009 deployment of military units from several Saudi Arabian provinces to Jazan Province, Saudi Arabia, enabled us to evaluate exposure to Alkhurma, Crimean-Congo, dengue, and Rift Valley hemorrhagic fever viruses. Seroprevalence to all viruses was low; however, Alkhurma virus seroprevalence was higher (1.3%) and less geographically restricted than previously thought.

Jazan is a Red Sea port city on Saudi Arabia’s southern border with Yemen and the capital of Jazan Province. The region serves as an east–west portal from sub-Saharan Africa at Djibouti and a south–north route across the Yemeni frontier. It is a heavily traveled corridor for humans and animals entering Saudi Arabia, particularly during the annual Hajj pilgrimage. Malaria is endemic, and arbovirus infections are well described, most notably a 2000–2001 Rift Valley fever (RVF) outbreak on the Saudi Arabia–Yemen frontier. More than 880 confirmed RVF cases were reported. This outbreak was also notable for a case-fatality rate of 14% (1). Sporadic infections caused by Crimean-Congo hemorrhagic fever virus (CCHFV) occur as well. The virus is endemic across a wide geographic range, from the Middle East to Africa and central Asia (2). Dengue virus (DENV), a pathogen well known for large outbreaks and global circulation, also causes seasonal outbreaks in Saudi Arabia’s western provinces; most outbreaks occur farther north in the urban centers of Jeddah and Makkah (3).

In contrast, Alkhurma hemorrhagic fever is an emerging infectious disease that has been described mostly in Saudi Arabia. The responsible virus, first isolated in Jeddah by A.M. Zaki, has since been characterized as a distinct lineage of Kyasanur Forest disease virus, a tick-borne member of the family Flaviviridae (4–6).
Epidemiologic studies of Alkhurma hemorrhagic fever virus (AHFV) have focused on Jeddah and Makkah, where outbreaks were first described; most were characterized by high rates of illness and death (6). Recent studies in Najran Province extended the spectrum of disease to include subclinical infection, which was far more frequent than severe disease (7,8). A recent report suggests wider geographic range for AHFV, with infections identified in 2 Italian tourists after they traveled to Egypt (9).

full-text:
Seroprevalence of Alkhurma and Other Hemorrhagic Fever Viruses, Saudi Arabia - Vol. 17 No. 12 - December 2011 - Emerging Infectious Disease journal - CDC

Suggested citation for this article: Memish ZA, Albarrak A, Almazroa MA, Al-Omar I, Alhakeem R, Assiri A, et al. Seroprevalence of Alkhurma and other hemorrhagic fever viruses, Saudi Arabia. Emerg Infect Dis [serial on the Internet]. 2011 Dec [date cited]. http://dx.doi.org/10.3201/eid1712.110658