Viral hemorrhagic fevers

Transmission

Modes of Transmission for Selected Hemorrhagic Fever Virusesa

Agent

Modes of Transmission

Ebola virusb,c

—Person-to-person (most likely through contact with blood or body fluids)
—Percutaneous through reuse of needles or accidental needlesticks
—Contact with cadavers during preparation for burial
—Direct contact with infected nonhuman primates (eg, chimpanzees, gorillas)
—Possibly airborne through virus-containing aerosols (experimentally induced in monkeys)
—Contact with oral mucosa or conjunctivae through infectious droplets or direct contact (experimentally induced in monkeys; one healthcare worker may have become infected by touching eyes with contaminated glove)
—Sexual transmission (virus has been found in semen)

Marburg virusb,d

—Contact with blood, tissues, or tissue cultures from infected monkeys
—Person-to-person (most likely through contact with blood or body fluids)
—Percutaneous through accidental needlesticks
—Sexual transmission (virus has been found in semen)
—Contact with oral mucosa through infectious droplets, infectious aerosols, or direct contact (experimentally induced in monkeys)

Lassa virusb,e

—Predominantly airborne through virus-containing aerosols of rodent excreta
—Person-to-person (eg, contact with blood or body fluids)
—Percutaneous through accidental needlesticks or reuse of injection equipment
—Possibly person-to-person airborne (in at least one instance, transmission may have occurred in hospital setting from patient with extensive pulmonary involvement)
—Sexual transmission (virus has been found in semen)

New World arenaviruses:

    Juninb

Predominantly airborne through virus-containing aerosols of rodent excreta

    Machupof

—Predominantly airborne through virus-containing aerosols of rodent excreta
—Person-to-person transmission (as demonstrated in a limited number of nosocomial outbreaks)

    Guanaritog

Unknown, but presumably through aerosolized rodent excreta

    Sabiah

Unknown, although laboratory-acquired cases appear to have been contracted through aerosols

    Chapare

Unknown

    Whitewater
    Arroyo  virusi

Unknown, but presumably airborne through aerosolized rodent excreta

Rift Valley fever virusb

—Bite of infected mosquito
—Contact with blood or amniotic fluid of infected animals (through fomites, droplets, or aerosols)
—Airborne through virus-containing aerosols in the laboratory setting

Yellow fever virusb

—Bite of infected mosquito
—Laboratory infections through parenteral exposure or unexplained routes (presumably aerosols)

Kyasanur Forest disease virusb,j

—Bite of infected tick
—Airborne through virus-containing aerosols in laboratory setting

Omsk hemorrhagic fever virusb

—Bite of infected tick
—Possibly through direct contact with carcasses of infected animals (eg, muskrats)
—Waterborne and airborne transmission may occur, but direct evidence lacking

aOnly agents that are considered to be potential biological weapons are considered here.
bSee References: Borio 2002; LeDuc 1989; Leroy 2005; WHO 1985: Viral haemorrhagic fevers: report of a WHO expert committee; Youssef 2002.
cSee References: Dowell 1999; Formenty 1999; Guimard 1999; Jaax 1995; Jaax 1996; Johnson 1995; WHO 1978: Ebola hemorrhagic fever in Zaire.
dSee References: Martini 1971.
eSee References: Carey 1972; Fisher-Hoch 1995; McCormick 1987; WHO 2001: Lassa hemorrhagic fever.
fSee References: CDC 1974: Bolivian hemorrhagic feve; Peters 1974.
gSee References: Salas 1991.
hSee References: Armstrong 1999.
iSee References: CDC 2000: Fatal illnesses associated with a New World arenavirus.
jSee References: Banerjee 1979.

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