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Alkhurma Hemorrhagic Fever in Humans, Saudi Arabia | CDC EID
EID Journal Home > Volume 16, Number 12–December 2010
Volume 16, Number 12–December 2010
Alkhurma Hemorrhagic Fever in Humans, Najran, Saudi Arabia
Abdullah G. Alzahrani, Hassan M. Al Shaiban, Mohammad A. Al Mazroa, Osama Al-Hayani, Adam MacNeil, Pierre E. Rollin, and Ziad A. Memish Comments to Author
Author affiliations: Ministry of Health, Riyadh, Saudi Arabia (A.G. Alzahrani, H.M. Al Shaiban, M.A. Al Mazroa, O. Al-Hayani, Z.A. Memish); and Centers for Disease Control and Prevention, Atlanta, Georgia, USA (A. MacNeil, P.E. Rollin)
Suggested citation for this article
Alkhurma virus is a flavivirus, discovered in 1994 in a person who died of hemorrhagic fever after slaughtering a sheep from the city of Alkhurma, Saudi Arabia. Since then, several cases of Alkhurma hemorrhagic fever (ALKHF), with fatality rates up to 25%, have been documented. From January 1, 2006, through April 1, 2009, active disease surveillance and serologic testing of household contacts identified ALKHF in 28 persons in Najran, Saudi Arabia. For epidemiologic comparison, serologic testing of household and neighborhood controls identified 65 serologically negative persons. Among ALKHF patients, 11 were hospitalized and 17 had subclinical infection. Univariate analysis indicated that the following were associated with Alkhurma virus infection: contact with domestic animals, feeding and slaughtering animals, handling raw meat products, drinking unpasteurized milk, and being bitten by a tick. After multivariate modeling, the following associations remained significant: animal contact, neighboring farms, and tick bites.
Alkhurma virus (ALKV) was discovered in Saudi Arabia in 1995 in a butcher with suspected Crimean-Congo hemorrhagic fever. His fever developed after he had slaughtered a sheep from the city of Alkhurma. Diagnostic testing identified a flavivirus as the etiologic agent (1,2). Subsequently, ALKV was isolated from the blood of 6 male butchers in Jeddah, and another 4 cases were diagnosed serologically. This disease was named Alkhurma hemorrhagic fever (ALKHF) because the first case was reported from the Alkhurma governorate (1).
After initial virus identification, from 2001 through 2003, another 37 suspected ALKHF cases, of which 20 were laboratory confirmed, were reported in Alkhumra district, south of Jeddah (3). Among the 20 patients with confirmed cases, 11 had hemorrhagic manifestations and 5 died.
Full genome sequencing has indicated that ALKV is a distinct variant of Kyasanur Forest disease virus, a virus endemic to the state of Karnataka, India (4). Recently, ALKV was found by reverse transcription–PCR in Ornithodoros savignyi ticks collected from camels and camel resting places in 3 locations in western Saudi Arabia (5). ALKHF is thought to be a zoonotic disease, and reservoir hosts may include camels and sheep. Suggested routes of transmission are contamination of a skin wound with blood of an infected vertebrate, bite of an infected tick, or drinking of unpasteurized, contaminated milk (6).
Several studies have been conducted to describe the characteristics and determinants of ALKHF (1,3,5,6). We conducted a case–control study to assess associated risk factors.
Alzahrani AG, Al Shaiban HM, Al Mazroa MA, Al-Hayani O, MacNeil A, Rollin PE, et al. Alkhurma hemorrhagic fever in humans, Najran, Saudi Arabia. Emerg Infect Dis [serial on the Internet]. 2010 Dec [date cited]. http://www.cdc.gov/EID/content/16/12/1882.htm
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Ziad A. Memish, Ministry of Health, Riyadh 11117, Saudi Arabia; email: firstname.lastname@example.org
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