Germany and Kosovo Join Forces to Combat Deadly Tick-Borne Virus

It can detect 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 actively 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 Crimean-Congo hemorrhagic fever virus, 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 pathogens are capable of destroying blood and lymphatic vessels, which can lead to internal bleeding and death.

Ticks are spreading

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Kurtesh Sherifi first read about Crimean-Congo hemorrhagic fever in a newspaper in 2005, when he was completing his studies as a veterinarian in Berlin. The article reported that 11 people in his homeland, Kosovo, had contracted the disease and five had died. Already interested in zoonoses — pathogens transmissible between animals and humans — Sherifi found Crimean-Congo fever particularly intriguing.

Back home, Sherifi began working with the faculty of agriculture and veterinary medicine at the University of Pristina. However, the research budget was tight. Kosovo, a small country with only about 1.6 million citizens, lacked a high-security laboratory and the equipment necessary for investigating the Crimean-Congo fever virus.

Seeking German Cooperation

Sherifi reached out to Germany’s largest institution in this field, the Bernhard Nocht Institute for Tropical Medicine in Hamburg.

One of the researchers he contacted was Petra Emmerich, a virologist and expert on Risk Group 4 viruses — pathogens that cause severe, often fatal diseases and typically lack widely available treatments. The Crimean-Congo virus falls into that risk group.

Emmerich also serves as a reservist in the German military, which maintains a particular interest in viruses that could potentially be used as biological weapons. She was deployed to Kosovo in 2009, where she met Sherifi.

A productive exchange began between the researchers. In Kosovo, a monitoring structure was established to track the spread of the Hyalomma tick and the virus. In 2013, their joint work began receiving 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 travel to Kosovo with Emmerich, where they exchange information with their local counterparts.

Raising public awareness represents 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 enters a small wound on the human hand, the virus can be transmitted to the person.

“This is quite likely how a large proportion of the [infected] population in Kosovo got infected,” Sherifi explained.

Patients Require Intensive Care and Isolation

He and Emmerich have visited schools to educate students about the dangers of the virus and how to protect against it. Certain tick repellents help, as do long pants and sturdy shoes.

Not all Hyalomma ticks carry the virus, and most people 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 develop 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 cases 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, though they are also administered the antiviral drug ribavirin. However, as Emmerich noted, “ribavirin is not all that effective in acutely ill patients.” The scientists have observed this firsthand through cases in Kosovo.

Prevention remains the best approach, which is why monitoring the spread of Hyalomma ticks and recommending that people avoid areas where the ticks are prevalent are so important.

Successful Tick Tactics

Over the years, the researchers have not only collected thousands of ticks but have also conducted so-called seroprevalence studies. These blood tests detect antibodies from past infections, allowing scientists to determine whether humans or animals have come into contact with the virus.

Farm animals are particularly suitable for this type of study, Sherifi explained, because the virus doesn’t affect them. And unlike wild animals and humans, livestock typically remain in a clearly defined area. This means that if antibodies are detected in the blood of these animals, it’s clear the virus is circulating in that region.

In Kosovo, the number of serious infections has dropped drastically over the past decade, amounting to just five cases in total. In the previous decade, there were about 100 cases. Sherifi and Emmerich consider this a strong indicator of 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 expect this to happen.

Hyalomma ticks carrying the Crimean-Congo virus have recently been detected in France, although no human infections have been reported there so far.

“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 share what they’ve learned with countries that haven’t yet had as much experience monitoring Hyalomma ticks, such as North Macedonia and Albania.

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