Crimean-Congo haemorrhagic fever in pregnancy: clinical outcomes and public health implications

Abstract

Crimean-Congo haemorrhagic fever (CCHF) is the most widespread tick-borne viral disease of humans, with major public-health implications across western China, South Asia, the Middle East, south-eastern Europe, and Africa. Although uncommon, infection during pregnancy is often severe and associated with high maternal and fetal mortality. This mini review synthesizes 38 documented cases of CCHF in pregnancy to identify consistent patterns in clinical presentation, outcomes, and management. Maternal survival was recorded in 68% of cases, whereas fetal or neonatal survival was reported in only 39%. Ribavirin therapy has been associated with improved maternal outcomes in limited case reports, but its use in pregnancy remains restricted because of teratogenicity. Disease frequently mimicked obstetric emergencies such as HELLP syndrome, delaying diagnosis. CCHF during pregnancy presents substantial diagnostic and therapeutic challenges, including limited antiviral options and heightened risks of nosocomial transmission. Early recognition, timely virological confirmation, and strict infection-control measures are essential. Strengthening obstetric surveillance in endemic regions and developing pregnancy-safe therapeutics remain urgent priorities. Development of pregnancy-safe antivirals and integration of obstetric surveillance into endemic-area health systems are urgently needed.