Does greater purchasing power of Supplemental Nutrition Assistance Program improve children's development?

Crimean-Congo hemorrhagic fever (CCHF) is a tick-borne illness caused by infection with the CCHF virus (CCHFV; ), with clinical manifestations ranging from mild disease to severe, potentially fatal illness []. It is estimated that 10,000–15,000 cases of CCHF occur annually with 88% of cases believed to be subclinical or unrecognized []. CCHF is the most widely distributed tick-borne viral disease in humans [,]. Disease was first recognized in the 1940s in the Crimean region of the former Soviet Union and subsequently isolated in the 1950s in the Belgian Congo (presently DRC). The virus has since been found to be endemic to Africa, the Middle East, Asia, and Europe []. This transcontinental distribution reflects the broad and expanding geographic range of ixodid tick reservoirs and the wide distribution of their wild vertebrate hosts that serve as amplifying hosts for CCHFV []. CCHFV is an enveloped negative-sense, tri-segmented, single-stranded RNA virus belonging to the genus in the family of the order [,]. The virus is maintained in nature through vertical and horizontal transmission in ticks and can be transmitted from these infected ticks to their avian or mammalian hosts during blood meals []. Besides transmission through tick bites, infection in humans can also occur through contact with patients during the acute phase of illness [,] or with blood or tissues of viremic animals [,]. Notably, cases of possible sexual transmission have also been reported [,]. Humans can demonstrate a spectrum of disease ranging from mild clinical symptoms to nonspecific febrile syndrome characterized by vascular leak and hemorrhage, multiorgan failure, disseminated intravascular coagulation (DIC), and shock []. The case fatality rate ranges from 5% to greater than 30% []. To date there are no licensed medical countermeasures. Treatment is primarily supportive in conjunction with the off-label use of Ribavirin with uncertain efficacy []. This review synthesizes the current understanding of CCHFV pathogenesis and virulence, highlighting insights gained from both clinical research and experimental models. We first contextualize disease processes within the broader enzootic cycle involving the tick vector and reservoir, vertebrate hosts, and humans. We then examine the identified and proposed molecular mechanisms associated with disease in humans. Finally, we highlight key knowledge gaps and research priorities that are critical to advancing our understanding of CCHFV pathogenesis.