Viral hemorrhagic fevers

Key Info

Signs and Symptoms: Viral hemorrhagic fevers (VHF) are illnesses characterized by fever and bleeding diathesis. Manifestations of VHF often include flushing of the face and chest, petechiae, frank bleeding, edema, hypotension, and shock. Malaise, myalgias, headache, vomiting, and diarrhea occur frequently.

Diagnosis: Definitive diagnosis is usually made at a reference laboratory with advanced biocontainment capability. An early clinical diagnosis is crucial. Any patient with a compatible clinical syndrome should suggest the possibility of a viral hemorrhagic fever.

Treatment: Intensive supportive care may be required. Antiviral therapy with intravenous ribavirin may be useful in Bunyaviridae and Arenaviridae infections (specifically Lassa fever, Rift Valley fever, Crimean-Congo hemorrhagic fever, and hemorrhagic fever with renal syndrome due to Old World Hantavirus infection) and should be used only under an investigational new drug (IND) protocol. Convalescent plasma may be effective in Argentine or Bolivian hemorrhagic fevers (available only as IND).

Prophylaxis: The only licensed VHF vaccine is the 17D yellow fever vaccine. Experimental vaccines for other VHF are not readily available. Prophylactic ribavirin may be effective for some Bunyaviridae and Arenaviridae infections (available only as IND).

Isolation and Decontamination: All VHF patients should be cared for using strict contact precautions, including hand hygiene double gloves, gowns, shoe and leg coverings, and faceshield or goggles. Airborne precautions should be instituted to the maximum extent possible. At a minimum, a fit-tested, HEPA filter-equipped respirator (such as an N-95 mask), a battery-powered, air-purifying respirator, or a positive pressure supplied air respirator should be worn by personnel sharing an enclosed space with or coming within six feet of a VHF patient. Multiple patients should be cohorted to a separate building or a ward with an isolated air-handling system. Ideally, VHF patients should be isolated in a negative pressure isolation room with 6-12 air exchanges per hour. Environmental decontamination is accomplished with hypochlorite or phenolic disinfectants.
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