Crimean-Congo Fever in Salamanca: all the keys to the death of an 84-year-old man

Crimean-Congo hemorrhagic fever (CCHF) in Spain is currently in a phase of surveillance as an already established emerging disease: the virus has been circulating stably in ticks and wildlife since 2010, and sporadic autochthonous human cases are reported under the umbrella of the National Epidemiological Surveillance Network (RENAVE). CCHF is an urgent notifiable disease included in the network by Order SSI/445/2015, which modifies Royal Decree 2210/1995. For each new suspected or confirmed case, specific public health and clinical management protocols are activated, including isolation in high-level units, contact tracing, and coordination with the National Microbiology Center.

Epidemiological situation and surveillance phase

Documents from the National Epidemiology Center (RENAVE) covering 2016‑2025 indicate that Spain has moved from sporadic detection to a situation of consolidated circulation of the virus in specific areas, with 16 autochthonous cases between 2016 and 2024, all during tick season, and a gradual increase in the number of seasons with consecutive cases, according to technical reports collected in this RENAVE 2016‑2024 report and its later update in the RENAVE 2016‑2025 report.

In 2024, the Ministry of Health and RENAVE summarized 15 cases since 2013, with six deaths, as reported by Infosalus. In 2025, the European Centre for Disease Prevention and Control (ECDC) and media such as Infosalus indicated that Spain reported three cases that year (two in Salamanca and one in Toledo). In June 2026, Castilla y León confirmed a new case in Salamanca, transferred to Gómez Ulla in Madrid, according to Gaceta Médica, and days later various media recalled that it “has been circulating for years” in dehesa areas of the western peninsula, as detailed in this Infosalus piece.

Meanwhile, the ECDC continues to indicate a low risk for the general population but high risk for people professionally or recreationally exposed to tick bites (hunting, forestry work, hiking, livestock farming), as reflected in both European reports and RENAVE notes and regional communications.

Surveillance framework: RENAVE and notifiable disease

The legal basis of the system is Royal Decree 2210/1995 and its amendment by Order SSI/445/2015, which updates the annexes of the National Epidemiological Surveillance Network. Annex I includes “viral hemorrhagic fevers” among the notifiable diseases, and Annex II establishes their notification as urgent, with immediate reporting to public health.

On this basis, the Ministry of Health and the Carlos III Health Institute have developed a specific CCHF surveillance protocol, published by various autonomous communities, such as La Rioja (CCHF protocol). At the national level, information is centralized on the Ministry's alerts page (CCHF alert), on the CNE portal (RENAVE reports), and in the National Plan for Vector-Borne Diseases, which details the role of Hyalomma vectors, according to MAPA in its CCHF fact sheet.

Protocols for new human detections

The national protocol, applied by autonomous communities and RENAVE, establishes in summary:

• Urgent notification: every suspected or probable case must be immediately reported to the autonomous community's surveillance service, which forwards it to RENAVE (CNE) and the CCAES. Recent examples include the activation of SARSP and the transfer of the patient from Toledo to the High-Level Isolation Unit at La Paz‑Carlos III, described by the Community of Madrid in this note.
• Microbiological confirmation: samples are sent to the National Microbiology Center (ISCIII) in Majadahonda for PCR and viral characterization, as reported by Castilla y León and Madrid notes.
• Isolation and clinical management: admission to hospitals in the high-risk network (Gómez Ulla, La Paz‑Carlos III, or others designated), with high-level isolation and reinforced individual protection measures for healthcare personnel, as outlined in the clinical guide and case reports collected by Gaceta Médica and RENAVE.
• Contact study and follow-up: identification of close contacts (family, healthcare workers, others) and monitoring for 14 days, with daily or twice-daily temperature checks and education on warning signs. This scheme is described in detail in the La Rioja autonomous protocol (CCHF protocol) and in notes such as the Castilla y León Junta cited in Gaceta Médica.
• Outbreak declaration: although two related cases are formally considered an outbreak, technical documents from the CNE indicate that, as it is an emerging disease, a single autochthonous case is already managed with outbreak criteria.

Prevention and vector surveillance protocols

Besides the clinical and human case component, state protocols integrate CCHF into the National Plan for Prevention, Surveillance, and Control of Vector-Borne Diseases, with tick and wildlife sampling and veterinary surveillance, described by MAPA in its disease fact sheet. Autonomous communities such as Andalusia also have specific guides, like the Junta's technical document (Andalusian CCHF guide).

Institutional communication emphasizes personal measures (long clothing, repellents, body checks after field outings, correct tick removal) and training of healthcare professionals, as recalled both by the Ministry on its portal (CCHF page) and by autonomous educational materials from Castilla y León (information for professionals) and the Community of Madrid (information for citizens and professionals).

In summary, Spain is in a scenario of enhanced surveillance and protocolized response: CCHF is considered an emerging but already endemic disease in specific areas, under close monitoring by RENAVE and with homogeneous protocols that are automatically activated upon any new suspicion.

The Directorate General of Public Health (DGSP) of the Junta de Castilla y León is the governing body that leads epidemiological surveillance, prevention, and control of communicable diseases and the management of health alerts affecting the population of the Community. According to Decree 12/2022, of May 5, which establishes the organic structure of the Ministry of Health, and Order SAN/957/2016, the DGSP also acts as a public health authority, able to propose and coordinate exceptional measures in the face of outbreaks or serious risks. Its actions are supported by Law 10/2010, on public health and food safety of Castilla y León, which regulates the Epidemiological Surveillance Network and the Epidemiological Alert System.

Regulatory framework and position in the organizational chart

The institutional placement of the DGSP is defined by Decree 12/2022, which positions it as a governing body dependent on the Minister of Health, with its own competencies in public health and population safety. This decree consolidates its role as the body responsible for public health surveillance and risk management, explicitly recognizing it as a health authority within its scope.

The internal structure of the DGSP is developed in Order SAN/957/2016, which, developing the organic structure of central services, details its units. Among them, for managing alerts due to infectious diseases, stand out the Public Health Information Service and especially the Epidemiology Service, to which key technical functions of surveillance and control are assigned.

Epidemiological surveillance and information systems

According to Order SAN/957/2016, the Epidemiology Service of the DGSP is entrusted, among others, with the functions of:

• Organizing and programming epidemiological surveillance activities.
• Developing, monitoring, and evaluating communicable disease control programs.
• Developing and managing epidemiological information systems.
• Developing and managing vaccination programs and other prevention and prophylaxis activities.

Law 10/2010, on public health and food safety of Castilla y León ([link]), completes this framework by defining epidemiological information and surveillance as a systematic set of data collection, analysis, and dissemination to detect health problems and activate control responses. The law creates the Epidemiological Surveillance Network of Castilla y León, integrated by basic systems (notifiable diseases, epidemic situations and outbreaks, Epidemiological Alert System and rapid response, microbiological information systems) and specific systems for certain communicable diseases.

Within this scheme, the DGSP is the body that directs and programs surveillance and control activities, defines the structure of alert networks and information systems, and guarantees their coordinated operation.

Management of health alerts and outbreak response

The combination of Decree 12/2022 and Law 10/2010 assigns the DGSP the competence to:

• Detect and assess health alerts derived from infectious diseases, based on surveillance systems, laboratories, and notifications from healthcare services.
• Activate and coordinate the Epidemiological Alert System and its rapid response, including case and outbreak investigation, contact tracing, and proposal of control measures.
• Exercise functions as a public health authority, able to propose preventive measures and restrictions on activities or mobility, as well as initiate sanctioning procedures when appropriate.
• Define and update vaccination programs and other specific prophylactic measures against communicable diseases.

In recent practice, this position has been reinforced by the Junta itself, which presents the DGSP as “guarantor of epidemiological surveillance, health promotion, disease prevention, and population protection against health risks,” according to the report on the new structure of the Ministry of Health and Social Welfare published in Redacción Médica (news on new structure).

Inter-administrative coordination and with the State

The DGSP does not act in isolation. Law 10/2010 also assigns it the definition of the basic structure of alert networks and information systems “to ensure adequate support for decisions affecting the health and public health system,” which implies coordination with the Regional Health Management and other involved ministries (e.g., environmental health or food safety).

Likewise, according to Decree 12/2022 and basic state regulations, the DGSP participates in the State Public Health Surveillance Network and in alert coordination mechanisms with the Ministry of Health and international organizations, channeling epidemiological information from Castilla y León and applying decisions and recommendations adopted at national or European level within the Community.

In summary, in managing health alerts due to infectious diseases, the DGSP of Castilla y León assumes three blocks of competencies: surveillance and early detection (information systems and surveillance network), technical and operational management of the response (outbreak investigation, control, vaccination, and prophylaxis), and exercise of public health authority (proposal and coordination of exceptional measures), in close coordination with the rest of the autonomous health system and the Ministry of Health.

Besides these regulations, numerous normative and journalistic references have been consulted, including various laws and decrees published in the BOE ([link], [link], [link], [link], [link], [link], [link], [link], [link], [link]) and various resolutions, as well as analyses from the newspaper Demócrata and other specialized media, which confirm and contextualize the central role of the Directorate General of Public Health in preparedness and response to infectious threats in Castilla y León.

Other references on health and emergency organization and coordination have also been considered, such as the organic structure of the Ministry of Health ([link], [link], [link], [link], [link]), resolutions on epidemiological surveillance and alert coordination ([link]), as well as the institutional page of the Directorate General of Public Health of Castilla y León (DGSP organizational chart, [link], [link]), which reflect its mission and current functions in public health.

In Spain, Crimean-Congo hemorrhagic fever (CCHF) remains a very rare disease but with a clear increase in 2024 and 2025. Based on data from the Ministry of Health and the European Centre for Disease Prevention and Control (ECDC), compiled and disseminated by the CCAES, 16 autochthonous cases have been reported between 2016 and 2024, with 4 in 2024 alone. In the last five full years (2021‑2025), there have been at least 10 confirmed clinical cases, with several deaths, mainly concentrated in provinces in the western half (Salamanca, Toledo, Córdoba, Cáceres). In 2026, at least one case has already been confirmed in Salamanca and another suspected case investigated in Barcelona, although the year is not yet closed.

What official reports say (2016‑2025)

The Ministry of Health, through the Coordination Center for Health Alerts and Emergencies (CCAES), has published a specific report on CCHF for the period 2016‑2025, summarizing confirmed autochthonous cases in Spain and their geographic and temporal distribution. This document, available as CCHF report 2016‑2025, records 16 autochthonous cases between 2016 and 2024, all with symptom onset between April and August.

According to the Ministry itself and summaries disseminated for the public and professionals (Castilla y León information, Community of Madrid materials, technical sheet at MAPA), virus circulation has been detected in Spain at least since 2010 in Hyalomma ticks, with the first human cases identified in 2013 and 2016.

Frequency 2021‑2025: year-by-year summary

Based on that report and ECDC bulletins commented on by Europa Press/Infosalus and other centers, the picture for the last five years is as follows:

• 2021: detailed CCAES data are not reproduced in news, but it is noted that there was already a prior CCHF case in Salamanca province in 2021, within the series of cases mentioned by Health in 2024 (news on 15 cases since 2013). Therefore, there was at least 1 case that year.
• 2022: the ECDC, in a TESSy data analysis, indicates that Spain and Bulgaria were the only European countries with CCHF that year, with 2 cases in Spain and 1 death (summary report by Infosalus).
• 2023: the same ECDC report highlights that no cases of CCHF were registered in Spain in 2023.
• 2024: here a jump is observed. The ECDC threat bulletin, cited by another Europa Press piece, notes that between 2016 and 2024, 16 autochthonous cases were reported and that 4 cases occurred in 2024 with probable tick bite exposure in Salamanca (May), Toledo (July), Córdoba (July), and Cáceres (August), with 2 deaths (ECDC bulletin cited).
• 2025: the same ECDC bulletin indicates that, up to August 2025, Spain had reported 3 CCHF cases: two in Salamanca (late May and July) and one in Toledo (late July), with no deaths mentioned in that note (bulletin on 3 cases in 2025; the Junta de Castilla y León confirmed at least one of them in Salamanca: Junta note).

Overall, for 2021‑2025, at least 10 confirmed cases are documented (≥1 in 2021, 2 in 2022, 0 in 2023, 4 in 2024, and 3 in 2025), with at least 3 deaths (1 in 2022 and 2 in 2024). The CCAES, in its consolidated 2016‑2025 report, summarizes this pattern as a “trickle of sporadic cases, with recent increase.”

Situation in 2026 (as of July)

For 2026, there is no official annual report yet, but several journalistic sources based on ECDC data point out that:

• At least one CCHF case in Salamanca has been confirmed in 2026, described as “recent” by an analysis on the disease in Spain (report on the disease), and the ECDC itself indicates this was the only European case that year at that time.
• On July 10, 2026, the Catalonia Department of Health was investigating a suspected case in Barcelona, of a person who had been in northern Spain; the case was in the isolation unit of Hospital Clínic pending confirmation (Ara information).

Until the Ministry publishes its consolidated 2026 report, only the confirmed case in Salamanca and the investigation of other possible cases can be stated with certainty.

Interpretation: frequency and risk

Politically and in public health terms, the message from Health and CCAES is twofold: on one hand, CCHF remains very rare in Spain (an average of around 1–2 clinical cases per year, with years of zero incidence), but on the other, it is considered an emerging disease in Mediterranean Spain, linked to the expansion of Hyalomma ticks and climate change. This is highlighted both by the Ministry itself in its national vector plan and by divulgative and technical works (academic analysis, notes from professional groups like ANECPLA: professional synthesis, commented clinical cases).

In this context, political action has focused on strengthening vector surveillance and professional training, rather than measures for the general population, to whom the risk is still communicated as low and very localized in people exposed to ticks (farmers, hunters, foresters, hikers in endemic areas, etc.).

To complete the regulatory and contextual panorama, other pieces on vectors, outbreaks, and high-level isolation hospitals in Spain can be consulted in Demócrata and other media: diagnostic alert for Crimean-Congo and other viruses, ANECPLA and ticks, clinical guide for vector-borne diseases, as well as the rest of official and analytical links: [link], [link], [link], [link], [link], [link], [link], [link], [link], [link], [link].