Nosocomial Outbreak of Crimean-Congo Hemorrhagic Fever (CCHF) among health workers in Kandahar Province, Afghanistan, 2023: A Case-Control Study

Background: Since 2008, more than 1600 cases of Crimean and Congo Hemorrhagic Fever (CCHF) have been reported in Afghanistan. We aimed to investigate the nosocomial outbreak of CCFH and its associated factors among health workers in Kandahar Province. Methods: This case-control study was conducted during CCHF outbreak in a private hospital during April 2023 in Kandahar Province with 1:3 ratio of cases to controls. Cases were confirmed for CCHF infection using PCR and ELISA tests. Controls were selected from health workers of the general population. Data were managed and were analyzed using Epi Info v7.2.5 and STATA MP17 with an alpha level of 0.05 as well as 95% confidence. Penalized Logistic Regression (PLR) with firth correction was used. Results: Fourteen cases and 43 controls were enrolled with mean age of 24±6.25 and 29±11.26 yr respectively. All the cases and two-third of controls were health workers while nine (64%) of cases and 39 (88%) of controls were male. Prominently, fever 64% and agitation/mood swings (64%) were recorded among cases. Multivariate analysis of the exposures showed that contact with CCHF suspected individual without considering Personal Protection Equipment (PPE) (OR 95%: 59.6, 6.02 – 589. 62P=0.001) was significantly associated with CCHF infection risk leading to emergence of this outbreak (P<0.05). Conclusion: CCHF outbreak in this setting was associated with negligence of preventive measures by health workers. It is recommended for healthcare facilities to ensure the availability and utilization of PPE and enforcement of infection control practices while undertaking health education programs on transmission routes and preventives measures of CCHF.