A Systematic Review of Treatment Strategies Including Future Novel Therapies in Crimean-Congo Hemorrhagic Fever

Abstract

Introduction: Crimean-Congo hemorrhagic fever (CCHF) is an acute fetal illness the case fatality rate (CFR), which without treatment is between 26% to more than 80%. Despite the administration of ribavirin as a specific antiviral drug for the treatment of CCHF from many years ago, its clinical efficacy is still controversial. Objectives: This systematic review aimed to evaluate the clinical efficacy of ribavirin, favipiravir, and other treatment options for CCHF, including steroids, immunoglobulin, etc. Method: This systematic review included 31 articles, three factsheet from WHO, CDC, and ECDC, two editorial letters, and two textbooks from 2002 to 2020. The following databases were searched: Google Scholar, PubMed, Medscape, Cochrane, WHO, CDC, and ECDC. Results: The selected results of the above articles were concentrated on the different options of supportive treatment, including steroids, immunoglobulin, etc., as well as the efficacy of antiviral drugs, especially ribavirin and favipiravir. While some studies confirmed the clinical efficacy of ribavirin in the treatment of CCHF, some other studies did not confirm its efficacy. All studies justified that supportive therapies are the mainstay of treatment. Conclusions: The cornerstone of therapy of CCHF is supportive treatment. The clinical efficacy of ribavirin for CCHF treatment is questionable, and further randomized case-control clinical trials are required to confirm and recommend it for CCHF treatment. Also, other treatment strategies, including administration of steroids, immunoglobulin, and monoclonal antibodies (mAbs) require more conclusive data. The promising antiviral drug for CCHF treatment is favipiravir.