Severe fever with thrombocytopaenia syndrome (SFTS) first emerged in China in 2009 and is caused by the SFTS virus (SFTSV), also known as Huaiyangshan banyangvirus. SFTS is a tick-borne infection, but human-to-human transmission can also occur in rare cases, through direct contact with infected blood or bodily fluids. The illness often begins with flu-like symptoms and fever.
Most infections occur in rural areas where there is an increased presence of ticks. Human cases were first identified in Central and Eastern China and further cases have been identified in Japan, South Korea and Taiwan. Additionally, SFTSV has been detected in stored blood samples from patients with thrombocytopaenia in Vietnam. There have also been reports of SFTS infection in Pakistan.
Researchers class it as a public health threat with pandemic potential as the carrier of the disease – the tick – has spread around the world.
The key features of SFTS are high fever and a low platelet count. The illness often starts with flu-like symptoms and fever, which lasts for about seven days. The incubation period is usually between seven and 14 days, typically around nine days.
Other symptoms may include gastrointestinal problems such as abdominal pain, vomiting and diarrhoea.
Some patients may experience only a mild illness, which resolves spontaneously.
In cases of progressive disease, severe illness typically develops in the second week. Reported complications include:
In those who survive severe illness, signs of recovery usually emerge around days eight to 11 of illness, accompanied by a decrease in blood viral load and recovery of the platelet count. Case fatality rates have varied between 5.2 per cent in China to 32.6 per cent in South Korea.
The disease is contracted via the bite of an infected tick, usually the Asian long-horned tick, Haemaphysalis longicornis, but other types of tick can also transmit. Sheep, goat and other kinds of mammal are also carriers.
The disease can be passed from human to human via close contact – but precisely how this occurs is unclear. Spread of the infection has also been reported in A&E and intensive care departments.
There is no proven, specific treatment for SFTS, and there is no vaccine. Treatment is focused on relieving symptoms. Any patient with SFTS in the UK would be treated in a high level critical care unit. The antiviral ribavirin has been administered but it is unclear how effective it is.
Travellers who are hiking or doing other outdoor activities in endemic areas may be at increased risk and if travelling in areas where the disease has been reported to avoid tick bites. You should stay out of long grass and apply insect repellent, including on clothing and any equipment such as camping gear.
SFTS cases have occurred in Central and Eastern China, Western Japan, and rural areas of the Republic of Korea.
SFTS first emerged in China in 2009 and rapidly spread around the country. Since then cases have been reported in Japan, Korea, Vietnam and Taiwan. From 2010 to 2019, a total of 13,824 SFTS cases (8,899 lab-confirmed and 4,925 probable cases) were reported in mainland China. This includes 713 deaths.
It is unclear how the disease emerged but it is likely to be due to increased contact between humans and wildlife; and/or via migratory birds, who carry the tick as a parasite.
Researchers class this emerging disease as having the potential for pandemic spread.
gov.uk/severe-fever-with-thrombocytopaenia-syndrome
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