Crimean-Congo haemorrhagic fever (CCHF) is a widespread disease caused by a tick-borne virus of the genus Nairovirus. The CCHF virus (CCHFV) causes severe haemorrhagic fever outbreaks. The transmission is possible either by bite from infected ticks of the family Ixodidae and genus Hyalomma that are the principal vectors,nevertheless a number of tick genera is capable of becoming infected with virus (Estrada-Pena et al., 2012). CCHFV can also be transmitted by direct contact with blood or tissues from viremic livestock (Ftika et al., 2013; Leblebicioglu et al., 2016). The hosts of CCHFV include a wide range of wild and domestic animals such as cattle, sheep and goats. Animals generally become infected by the bite of infected ticks.

People involved in livestock industry, such as veterinarians, slaughterhouse workers and agricultural workers, constitute the most exposed category to CCHFV. Person-to-person and nosocomial transmission is occasional but not unusual for CCHFV infection when risk is higher for the higher viral loads during the later stages of the disease (Celikbas et al., 2014; Parlak et al., 2015).

In Africa, Balkans, Middle East and Asian countries, where CCHF is endemic, seven genotypes have been recognized by genetic analysis. In the European Union countries,sporadic cases have been reported in Bulgaria and Greece (ECDC 2013; Papa et al., 2008), while in the Balkans CCHFV has a widespread distribution. In the World Health Organization (WHO) European Region, Turkey remains the most affected country.

The incubation period ranges may be different according to the type of transmission and viral load (Vorou et al., 2007; Nabeth et al. 2007). After tick bite transmission the incubation period is almost one to three days, while after exposure to infected blood or bodily fluids may range between three and seven days. This period can be shorter depending to viral load from infected blood (Naderi et al., 2013). Symptoms of CCHF in humans include high fever, muscle pain, dizziness, photophobia, abdominal pain, diarrhoea, vomiting and, in severe cases, systemic haemorrhage (ECDC, 2016).

On 31 August 2016, two cases of infection with CCHFV were reported in Madrid, giving the first evidence of the disease in Spain. The first case was a man of 62 years who likely got infected through a tick-bite while hiking around the community of San Juan del Molinillo (Avilla). Interestingly, the virus was identified in Hyalomma lusitanicum in western Spain, close to the border with Portugal. (Estrada-Pena et al., 2012).

After first symptoms, the man was admitted to the intensive care unit (ICU) of the Infanta Leonor Hospital in Madrid. Afterwards, the man was transferred to a high-level isolation ICU at the Gregorio Marañón Hospital in Madrid where he died on 25 August 2016 (Figure 1). 

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