Germany has high-security laboratories while Kosovo has Hyalomma ticks and experience with the deadly Crimean-Congo hemorrhagic fever. Working together, German and Kosovar scientists are fighting the disease and its vectors.

It can spot its prey from up to 200 meters (about 650 feet) away — but unlike many of its fellow species, it doesn't lurk in the grass waiting for its victim to come closer. Instead it runs after it, chasing animals and humans alike.

The Hyalomma tick, often called "the great hunting tick," was previously found mostly in Africa, Asia, and southern Europe. But climate change means it can now survive further north and it has already been spotted in Germany and various Eastern European countries. Kosovo, in southeastern Europe, has been a hot spot for the tick for some time now.

The Hyalomma tick is also a vector of the highly pathogenic virus for Crimean-Congo hemorrhagic fever, a potentially deadly disease with a high fatality rate. Symptoms of the disease are comparable to those of Ebola fever or the Marburg virus. These are capable of destroying blood and lymphatic vessels, which can lead to internal bleeding and death.

Kurtesh Sherifi first read about Crimean-Congo hemorrhagic fever in the newspaper in 2005, when he was completing his studies as a veterinarian in Berlin. The article said that 11 people in his homeland, Kosovo, had contracted the disease and five had died. He was already interested in pathogens that can be transmitted between animals and humans, known as zoonoses, and Crimean-Congo fever intrigued him.

Back home, Sherifi started work with the faculty of agriculture and veterinary medicine at the University of Pristina. But the budget for research was tight. Kosovo, a small country with only about 1.6 million citizens, didn't have a high-security laboratory or the equipment necessary for investigating the Crimean-Congo fever virus.

Sherifi got in touch with Germany's largest institution for study in this area, the Bernhard Nocht Institute for Tropical Medicine in Hamburg. One of the researchers was Petra Emmerich, a virologist and expert on what are known as Risk Group 4 viruses — viruses that cause severe, often fatal, diseases and usually have no widely available treatment. The Crimean-Congo virus is in that risk group.

Emmerich also acts as a reservist in the German military, which is especially interested in viruses that could be used as biological weapons. She was sent to Kosovo in 2009, which is when she met Sherifi.

A lively exchange began between the researchers. In Kosovo, a structure was established to monitor the spread of the Hyalomma tick and the virus. In 2013, the researchers' joint work began to receive funding through the German Biosecurity Program, run by the country's Foreign Ministry and "intended to help partner countries tackle biological threats."

"It's give and take," said Emmerich of the scientific partnership. "We have the diagnostic expertise and the necessary resources but we don't have the patients." Doctors from Germany regularly come to Kosovo with Emmerich where they can exchange information with their counterparts there.

Raising public awareness is another important pillar of the Germany-Kosovo cooperation. Farmers in Kosovo are particularly susceptible to infection — and not solely due to ticks biting them, but because they often use their bare hands to remove ticks from animals. If infected blood from the animals gets into a small wound on the human hand, the virus can be transmitted to the human.

"This is quite likely how a large proportion of the [infected] population in Kosovo got infected," Sherifi explained. He and Emmerich have visited schools to educate students about the dangers of the virus and how to protect against it. For example, certain tick repellents help, as do long pants and sturdy shoes.

Not all Hyalomma ticks carry the virus, and most people who are bitten by a Hyalomma tick do not become ill. However, the larger problem is that there is neither a vaccine nor any specific course of treatment for those who do end up suffering from Crimean-Congo fever.

"If you do get sick, it's particularly severe," Emmerich explained. The disease begins with nonspecific, flu-like symptoms including fever, chills, aches and headaches. In severe cases, a patient will begin bleeding from the skin, nose and gums and may also experience gastrointestinal bleeding. The worst causes can result in organ failure.

Patients require intensive care and isolation because they are highly contagious. Much of the treatment in intensive care focuses on maintaining a patient's vital functions, but they are also given the antiviral drug, ribavirin. But, as Emmerich said, "ribavirin is not all that effective in acutely ill patients." That is something the scientists have seen firsthand with cases in Kosovo.

The best answer is prevention, which is why it's also very important for the researchers to monitor the spread of the Hyalomma ticks and for them to recommend avoiding certain areas where the ticks are prevalent, if possible. Over the years, the researchers have not only collected thousands of the ticks but they have also conducted so-called seroprevalence studies. These use blood tests to find antibodies from past infections. This allows the scientists to determine whether humans or animals have come in contact with the virus.

Farm animals are particularly suitable for this type of study, Sherifi said, as the virus doesn't affect them. And unlike wild animals and humans, they usually remain in a clearly defined area. That means that if antibodies are detected in the blood of these animals, it's clear the virus is circulating in that area.

In Kosovo, the number of serious infections has dropped drastically in the past decade, amounting to just five cases in total. In the previous decade, there were about 100 cases. Sherifi and Emmerich believe this indicates how successful their work has been.

Of course, that doesn't mean the ticks and the virus won't spread further in Europe, and the researchers both expect this to happen. Hyalomma ticks with the Crimean-Congo virus have just been detected in France although, so far, no humans have been infected there.

"Over the past 13 years, Hyalomma ticks have spread geographically," said Emmerich. "As a virologist, that's something to think about, and it needs to be closely monitored." This is why it's important for the German and Kosovar scientists to pass on what they've learned to countries that haven't yet had as much experience monitoring the Hyalomma ticks, such as Macedonia and Albania.

Source: www.dw.com