Epidemiology and Clinical Outcomes of Pediatric Crimean-Congo Hemorrhagic Fever in Eastern Anatolia, Turkey: A Retrospective Cohort Study.

BACKGROUND

Crimean-Congo Hemorrhagic Fever (CCHF) is a zoonotic tick-borne disease endemic in Türkiye with expanding geographic distribution. Pediatric data remain limited.

METHODS

This retrospective cohort study included children (<18 years) with Polymerase chain reaction (PCR) and/or Immunoglobulin M (IgM)-confirmed CCHF hospitalized in a tertiary referral center in eastern Türkiye between January 2021 and December 2022. Demographic, epidemiological, clinical, and laboratory data were obtained from electronic medical records using a standardized data collection form. Patients were grouped according to ribavirin use.

RESULTS

Twenty-one children were included; 85% were male. The mean age was 164.7 ± 44.7 months. The mean duration of hospitalization was 10.1 ± 2.9 days. Most patients (90%) were involved in animal husbandry, and 57% reported self-removal of ticks. Generalized fatigue (100%), fever (95%), and headache/myalgia (66.7%) were the most common symptoms. The mean duration of fever was 2.62 ± 1.43 days. Hemorrhagic manifestations occurred in 42.9% of patients. Thrombocytopenia developed in 81% of cases. Ribavirin was administered in 72% of patients, with varying durations. No statistically significant difference was observed between ribavirin groups in terms of hospitalization duration or fever duration. However, a shorter duration of cytopenias was observed in the short-course (2-7 days) group. No patients required intensive care unit admission, and no mortality occurred.

CONCLUSIONS

Pediatric CCHF in endemic regions is strongly associated with environmental and behavioral exposures, particularly livestock contact and tick handling. The disease course appears milder compared to adults, with excellent outcomes under supportive care. Ribavirin use was not associated with improved clinical outcomes.