Crimean-Congo Hemorrhagic Fever Outbreak in Refugee Settlement during COVID-19 Pandemic, Uganda, April 2021

C rimean-Congo hemorrhagic fever (CCHF) is caused by CCHF virus (CCHFV).CCHF is a zoonotic disease that infects mainly livestock, and CCHFV is transmitted by ticks, primarily Hyalomma species.Humans are typically infected through contact with body fluids of infected livestock or through bites from infected ticks; human-to-human transmission of CCHFV has been documented (1), making early detection and infection prevention and control practices vital.The disease is distributed mainly in Central Asia, sub-Saharan Africa, and some parts of Europe (2).Uganda first reported a case of CCHF in 2013 in Agago district; subsequent sporadic cases have been detected throughout the country, especially within the cattle corridor (3-6).Serologic evidence indicates widespread infection among livestock in Uganda (7).We report the findings of epidemiolog-ic and laboratory investigations conducted within a refugee settlement in the Albertine Graben region of Uganda after 2 human CCHF cases were confirmed during the COVID-19 pandemic and provide recommendations to reduce future transmission of CCHFV.The Study On April 27, 2021, a 16-year-old girl (patient 1) living in Kyangwali Refugee Settlement, Kikuube district, Uganda (Figure 1), sought care at a local health facility; clinical manifestations were a 2-day history of fever (38.1°C), headache, fatigue, hematemesis, and epistaxis.The patient had no history of recent travel outside the settlement and had stopped schooling because of national COVID-19 restrictions.The patient had been self-medicating for malaria without improvement; upon the onset of hemorrhagic signs, attending clinicians suspected a viral hemorrhagic fever because of the presence of epistaxis and hematemesis and implemented infection prevention and control measures, including patient isolation and use of personal protective equipment.A blood sample was collected and transported to Uganda Virus Research Institute the same day.Results revealed the patient was positive for CCHFV by realtime reverse transcription PCR (rRT-PCR) and had detectable CCHFV IgM and IgG on a US Centers for Disease Control and Prevention in-house ELISA specific to CCHFV (3).On April 30, 2021, a 13-year-old boy (patient 2) from the same village was seen at the same health facility; symptoms were a 2-day history of fever that progressed into hemoptysis and epistaxis.