INTRODUCTION:
Crimean-Congo hemorrhagic fever (CCHF) is a high-fatality tick-borne viral disease endemic in Pakistan, posing recurrent threats to public health and occupational safety. This case series describes the epidemiological and clinical characteristics of CCHF cases reported in Khyber Pakhtunkhwa (KP) province in 2025, highlighting gaps and lessons in surveillance and response.

METHODS:
We analyzed line-listed data of all suspected and confirmed CCHF cases reported to the Integrated Disease Surveillance and Response (IDSR) system in KP between April and July 2025. Demographic, occupational, clinical, and laboratory variables were summarized, and public health response activities were reviewed.

RESULTS:
A total of 11 confirmed cases were reported from multiple districts, with clustering in Nowshera, Peshawar, and Karak. The median age was 30 years (range 22–70), and 82% were male. High-risk occupational groups included livestock handlers (27%) and butchers (18%). Sporadic cases among individuals without direct livestock exposure indicated possible secondary transmission. The overall case fatality ratio was 27%. Delays in diagnosis and incomplete documentation were frequent. Rapid response teams were deployed for case investigation, contact tracing, and community sensitization.

CONCLUSIONS:
CCHF transmission in KP remains predominantly occupational and seasonal, reflecting close human–animal interaction and inadequate vector control. Strengthening integrated surveillance, expanding diagnostic capacity, and promoting community-level awareness through a One Health framework are essential to prevent future outbreaks.