Hemorrhagic Fever - Continued CCHF ranging in titer from 1:16 to 1:4096; five of 20 cows tested from the farmer's original herd had demonstrable antibodies ranging in titer from 1:32 to 1:512. No Hyalomma ticks (common carriers of CCHF virus) were seen on cattle in May, but partially engorged Rhipicephalus evertsi and Boophilus decoloratus were removed from the cattle and are being tested for the presence of virus. Cases 6 and 7: A 46-year-old man became ill in November 1983 with fever, severe headache, rash, and epistaxis. IFA testing of his serum confirmed the diagnosis of CCHF. The patient lived in Germiston, near Johannesburg, but kept cattle at a farm near Bronkhorstspruit, northeast of Pretoria. Shortly before onset of illness, he had been involved in dehorning and castrating cattle. He did not recall being bitten by ticks. The last patient, a 32-year-old farmer from Danielskuil, west of Kimberley in the Cape province, became ill on February 2, 1984, with a severe influenza-like illness and rash. Sera obtained on March 14 and March 23 demonstrated respective IFA titers to CCHF of 1:1024 and 1:4096. The patient had slaughtered sheep shortly before his illness began. Reported by R Swanepoel, AJ Shepherd, MJ Erasmus, National Institute for Virology, Dept of Health and Welfare, Transvaal, Dr MPJ van Rensburg, R Wessels, Regional Health Svcs, Orange Free State, Dr S Hattingh, Professor BD Middlecote, Bloemfontein; Dr Schutte, Dr van der Lingen, Dr van Rensburg, Dr Venter, Frankfort, Dr D van Coller, Germiston; Dr JD van Rensburg, Kimberley; Dr B Miller, Rietfontein Hospital, Johannesburg, Dr KD McDonald, Dr SP Taylor, Dr HGV Kustner, National Epidemiological Svc, Pretoria, Republic of South Africa; Special Pathogens Br, Div of Viral Diseases, Center for Infectious Diseases, CDC. Editorial Note: The first indigenous case of CCHF in South Africa was reported in 1981. CCHF antibodies have since been found to be common in cattle but not in man, in the interior of the country. In a serosurvey, only 17 of 1,108 sera from people who had spent their entire lives on farms in the interior were positive (1). CCHF is a distinct clinical entity caused by a tick-borne member of the Bunyaviridae family. The disease, which occurs in eastern Europe, central Asia, the Middle East, and Africa, has a relatively short incubation period (3-6 days) and an abrupt onset characterized by fever, chills, headache, myalgia, abdominal pain, nausea, liquid stools, and anorexia. Conjunctivitis, enanthema of the oral mucosa, leukopenia, and severe thrombocytopenia may also be present. Hemorrhagic manifestations may occur by the fourth day, followed by hypotension and shock. Mortality ranges from about 10% to about 50%. Diagnosis is confirmed by serology or by isolation of virus from blood or tissues obtained at autopsy (2). CCHF is classically transmitted by the bite of an ixodid tick, most often of the Hyalomma genus. The virus seems to be maintained in nature by trans-ovarial and trans-stadial (from larva to nymph to adult) passage among ticks and by transmission from ticks to asymptomatic wild and domestic mammals, such as cattle, sheep, goats, camels, hares, and hedgehogs (2-4). Agricultural workers are at highest risk for contracting CCHF. Contacts of patients have also contracted the disease, either in homes or in hospitals via blood or bloody discharges. CCHF virus, the presence of which was unrecognized in South Africa before 1981, now appears to be widespread in animal reservoirs throughout much of the country (1,5). It is still uncommon among humans, and immunity appears to be rare. Thus, there is a large susceptible population, and the risk of infection exists for livestock workers, veterinarians, and others who live, work, or play in rural environments. (Continued on page 548) Final 1983 Reports of Notifiable Diseases The following table summarizes final data reported for 1983, which will be published in more detail in the MMWR Annual Summary 1983. NOTIFIABLE DISEASES-Reported cases, by geographic division and area, Estimates from the US Bureau of the Census, Current Population Reports, Series P-25, No 944. NN NN NN NN NN NN (not notifiable) NA (not available) 112 སཿ--༑༑༑༑༑༑ སྣུ་ ་ཎྜ ་ ་ ་ ་གྲ ་ ་ ་ NOTIFIABLE DISEASES- Reported cases, by geographic division and area, |