{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T00:31:49Z","timestamp":1792801909646,"version":"4.5.0"},"reference-count":37,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2025,5,12]],"date-time":"2025-05-12T00:00:00Z","timestamp":1747008000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000061","name":"Fogarty International Center","doi-asserted-by":"publisher","award":["D43TW012733-02"],"award-info":[{"award-number":["D43TW012733-02"]}],"id":[{"id":"10.13039\/100000061","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:p>Pakistan is at high-risk for Crimean-Congo Hemorrhagic Fever (CCHF) outbreaks due to its geographic location and disease burden in bordering countries. We aimed to study the spatio-temporal distribution of human CCHF cases in Pakistan and to observe its correlation with temperature, precipitation and seasonal variation. Retrospective data of test requests generated for CCHF at country-wide patient sample collection points (n\u2009=\u2009307) across Pakistan from 2012 to 2023 was extracted for analysis. Average monthly temperature and precipitation data was used in the Poisson regression method to examine the effect on the number of cases. A total of 2,559 patients were clinically suspected of CCHF in 39 cities with 547 confirmed positive for CCHF in 10 cities using real-time PCR assay, with a positivity rate of 21.37% and a male predominance (84.6%). Most of the confirmed cases (57.6%, n\u2009=\u2009315) were detected between 2016 and 2019 while 97.4% (n\u2009=\u2009533) detected in 3 cities. Highest number of cases were reported during summer (p\u2009&lt;\u20090.001) with 41.13% of confirmed cases reported in the months of August and September. A positive correlation of suspected cases with temperature was observed in Karachi and Quetta with a lag of zero months (p\u2009=\u20090.000), and a negative correlation was observed with precipitation for Karachi and Peshawar with a lag of 2 months (p\u2009=\u20090.000). Case fatality rate for CCHF patients admitted at Aga Khan University Hospital was 45.8%. CCHF is on the rise in Pakistan. Positive cases are concentrated within 3 cities where human and animal migration rates are high. Outbreak situations occur when multiple factors coincide. Seasonal and climatic patterns can be used as predictors of disease by policymakers for strict implementation on animal regulation, transport, and surveillance of animal migration to curtail outbreak situations in Pakistan.<\/jats:p>","DOI":"10.1371\/journal.pone.0320495","type":"journal-article","created":{"date-parts":[[2025,5,12]],"date-time":"2025-05-12T17:54:14Z","timestamp":1747072454000},"page":"e0320495","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":3,"title":["Spatio-temporal distribution of Crimean-Congo Hemorrhagic Fever and its relationship with climate factors in Pakistan: A decade-long experience from tertiary care laboratory network"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2440-4117","authenticated-orcid":true,"given":"Muhammad Abbas","family":"Abid","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joveria","family":"Farooqi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Najia","family":"Ghanchi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rabiya","family":"Owais","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ayesha","family":"Sadiqa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Humaira","family":"Shafaq","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7315-425X","authenticated-orcid":true,"given":"Erum","family":"Khan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,5,12]]},"reference":[{"key":"pone.0320495.ref001","unstructured":"Organization WH. Global vector control response 2017-2030. Global vector control response 2017-2030. 2017."},{"issue":"6","key":"pone.0320495.ref002","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1080\/20477724.2020.1783865","article-title":"The impact of climate change on mosquito-borne diseases in Africa","volume":"114","author":"C Giesen","year":"2020","journal-title":"Pathog Glob Health"},{"issue":"21","key":"pone.0320495.ref003","doi-asserted-by":"crossref","first-page":"1969","DOI":"10.1056\/NEJMra2200092","article-title":"Climate change and vectorborne diseases","volume":"387","author":"MC Thomson","year":"2022","journal-title":"N Engl J Med"},{"issue":"5","key":"pone.0320495.ref004","doi-asserted-by":"crossref","first-page":"928","DOI":"10.3390\/microorganisms10050928","article-title":"Epidemics of Crimean-Congo Hemorrhagic Fever (CCHF) in Sudan between 2010 and 2020","volume":"10","author":"A Ahmed","year":"2022","journal-title":"Microorganisms"},{"issue":"1","key":"pone.0320495.ref005","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1186\/s12879-019-3740-x","article-title":"Crimean Congo hemorrhagic fever serosurvey in humans for identifying high-risk populations and high-risk areas in the endemic state of Gujarat, India","volume":"19","author":"DT Mourya","year":"2019","journal-title":"BMC Infect Dis"},{"issue":"4","key":"pone.0320495.ref006","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1016\/S1473-3099(06)70435-2","article-title":"Crimean-Congo haemorrhagic fever","volume":"6","author":"O Erg\u00f6n\u00fcl","year":"2006","journal-title":"Lancet Infect Dis"},{"key":"pone.0320495.ref007","first-page":"411","volume-title":"Emerging pests and vector-borne diseases in Europe","author":"W Takken","year":"2023"},{"key":"pone.0320495.ref008","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1146\/annurev-animal-062922-060125","article-title":"Domestic animals as potential reservoirs of zoonotic viral diseases","volume":"11","author":"O Tomori","year":"2023","journal-title":"Annu Rev Anim Biosci"},{"issue":"2","key":"pone.0320495.ref009","doi-asserted-by":"crossref","first-page":"391","DOI":"10.20506\/rst.34.2.2365","article-title":"Crimean-Congo haemorrhagic fever","volume":"34","author":"C Peyrefitte","year":"2015","journal-title":"Rev Sci Tech"},{"issue":"6","key":"pone.0320495.ref010","doi-asserted-by":"crossref","first-page":"1507","DOI":"10.1084\/jem.20060208","article-title":"An Ixodes scapularis protein required for survival of Anaplasma phagocytophilum in tick salivary glands","volume":"203","author":"B Sukumaran","year":"2006","journal-title":"J Exp Med"},{"issue":"1","key":"pone.0320495.ref011","doi-asserted-by":"crossref","first-page":"286","DOI":"10.1186\/s13071-023-05870-6","article-title":"The current distribution of tick species in Inner Mongolia and inferring potential suitability areas for dominant tick species based on the MaxEnt model","volume":"16","author":"R Ma","year":"2023","journal-title":"Parasit Vectors"},{"issue":"2","key":"pone.0320495.ref012","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1007\/s10493-023-00778-3","article-title":"The climate niche of the invasive tick species Hyalomma marginatum and Hyalomma rufipes (Ixodidae) with recommendations for modeling exercises","volume":"89","author":"A Estrada-Pe\u00f1a","year":"2023","journal-title":"Exp Appl Acarol"},{"issue":"4","key":"pone.0320495.ref013","doi-asserted-by":"crossref","first-page":"785","DOI":"10.1007\/s10493-021-00641-3","article-title":"Rearing of Hyalomma marginatum (Acarina: Ixodidae) under laboratory conditions in Morocco","volume":"84","author":"L Elhachimi","year":"2021","journal-title":"Exp Appl Acarol"},{"issue":"4","key":"pone.0320495.ref014","doi-asserted-by":"crossref","first-page":"2014","DOI":"10.1016\/j.sjbs.2021.12.046","article-title":"Tick-borne haemoparasitic diseases in small ruminants in Pakistan: current knowledge and future perspectives","volume":"29","author":"A Khan","year":"2022","journal-title":"Saudi J Biol Sci"},{"issue":"9","key":"pone.0320495.ref015","doi-asserted-by":"crossref","first-page":"1488","DOI":"10.3390\/ani13091488","article-title":"First report of Rickettsia conorii in Hyalomma kumari ticks","volume":"13","author":"S Ullah","year":"2023","journal-title":"Animals"},{"issue":"3","key":"pone.0320495.ref016","first-page":"268","article-title":"Effect of meteorological factors on hyalomma species composition and their host preference, seasonal prevalence and infection status to crimean-congo haemorrhagic fever in Iran","volume":"13","author":"N Choubdar","year":"2019","journal-title":"J Arthropod Borne Dis"},{"issue":"1","key":"pone.0320495.ref017","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1016\/S1473-3099(22)00808-8","article-title":"Climate change and the increased burden of dengue fever in Pakistan","volume":"23","author":"MA Abid","year":"2023","journal-title":"Lancet Infect Dis"},{"key":"pone.0320495.ref018","article-title":"Climate change likely increased extreme monsoon rainfall, flooding highly vulnerable communities in Pakistan","author":"World Weather Attribution","year":"2022"},{"issue":"5","key":"pone.0320495.ref019","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1177\/17579139231180763","article-title":"The aftermath of floods in Pakistan: a public health emergency","volume":"143","author":"MA Abid","year":"2023","journal-title":"Perspect Public Health"},{"key":"pone.0320495.ref020","unstructured":"World Health Organization. Crimean-congo haemorrhagic fever. [12\/20\/2024]. Available from: https:\/\/www.who.int\/health-topics\/crimean-congo-haemorrhagic-fever#tab=tab_1"},{"key":"pone.0320495.ref021","unstructured":"World Health Organization. Crimean-congo haemorrhagic fever. 2022 May 23. [12\/20\/2024]. Available from: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/crimean-congo-haemorrhagic-fever"},{"key":"pone.0320495.ref022","article-title":"Which countries are taking in the most refugees in 2025?","author":"Concern Worldwide US","year":"2024"},{"issue":"1","key":"pone.0320495.ref023","doi-asserted-by":"crossref","DOI":"10.1002\/hsr2.1055","article-title":"Crimean-Congo hemorrhagic fever outbreak in Pakistan, 2022: a warning bell amidst unprecedented floods and COVID 19 pandemic","volume":"6","author":"S Tabassum","year":"2023","journal-title":"Health Sci Rep"},{"issue":"12","key":"pone.0320495.ref024","doi-asserted-by":"crossref","first-page":"1333","DOI":"10.1016\/S1473-3099(16)30452-2","article-title":"Crimean-Congo haemorrhagic fever in Pakistan","volume":"16","author":"S Haider","year":"2016","journal-title":"Lancet Infect 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Abbas","year":"2017","journal-title":"Int J Biometeorol"},{"key":"pone.0320495.ref036","article-title":"Karachi sets up Congo unit to deal with virus","author":"The Express Tribune","year":"2023"},{"key":"pone.0320495.ref037","article-title":"Pakistan: outbreak of CCHF reported in Balochistan province early November.","author":"Crisis 24"}],"updated-by":[{"DOI":"10.1371\/journal.pone.0341256","type":"correction","label":"Correction","source":"publisher","updated":{"date-parts":[[2026,1,20]],"date-time":"2026-01-20T00:00:00Z","timestamp":1768867200000}}],"container-title":["PLOS 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