Crimean-Congo hemorrhagic fever in pregnancy: A systematic review and case series from Russia, Kazakhstan and Turkey

•CCHF in pregnancy is rare but has high rates of maternal (34%) and fetal mortality (59%).•Maternal hemorrhage is associated with maternal and fetal/neonatal death.•Nosocomial transmission of CCHF from 6/37 index pregnant cases resulted in 38 cases.•Early recognition and risk-assessment allows appropriate IP & C precautions and supportive care provision.

BackgroundCrimean-Congo hemorrhagic fever (CCHF) is acute viral infection and a major emerging infectious diseases threat, affecting a large geographical area. There is no proven antiviral therapy and it has a case fatality rate of 4-30%. The natural history of disease and outcomes of CCHF in pregnant women is poorly understood.ObjectivesTo systematically review the characteristics of CCHF in pregnancy, and report a case series of 8 CCHF cases in pregnant women from Russia, Kazakhstan and Turkey.MethodsA systematic review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement protocol. PubMed, SCOPUS, Science Citation Index (SCI) were searched for reports published between January 1960 and June 2016. Two independent reviewers selected and reviewed studies and extracted data.ResultsThirty-four cases of CCHF in pregnancy were identified, and combined with the case series data, 42 cases were analyzed. The majority of cases originated in Turkey (14), Iran (10) and Russia (6). There was a maternal mortality of 14/41(34%) and fetal/neonatal mortality of in 24/41 cases (58.5%). Hemorrhage was associated with maternal (p = 0.009) and fetal/neonatal death (p < 0.0001). There was nosocomial transmission to 38 cases from 6/37 index pregnant cases.ConclusionCases of CCHF in pregnancy are rare, but associated with high rates of maternal and fetal mortality, and nosocomial transmission.