Viral hemorrhagic fevers


The 17D live attenuated yellow fever vaccine is the only licensed vaccine available for any of the hemorrhagic fever viruses. The Candid 1 vaccine for Argentine hemorrhagic fever is a live, attenuated, investigational vaccine developed at USAMRIID. It was highly efficacious in a randomized, controlled trial in Argentinean agricultural workers, and it appears to protect against Bolivian hemorrhagic fever in non-human primates. Unfortunately, Candid 1 is no longer manufactured and is not available. Both inactivated and live-attenuated RVF vaccines are currently under investigation. There are presently no vaccines for the other VHF agents available for human use in the United States. Several local vaccines for OHF, KFD, HFRS and CCHF are used in endemic areas, but they have not been rigorously studied.

Persons with percutaneous or mucocutaneous exposure to blood, body fluids, secretions, or excretions from a patient with suspected VHF should immediately wash the affected skin surfaces with soap and water. Mucous membranes should be irrigated with copious amounts of water or saline.

Close personal contacts or medical personnel exposed to blood or secretions from VHF patients (particularly Lassa fever, CCHF, and filoviral diseases) should be monitored for symptoms, fever, and other signs during the established incubation period. After a presumed BW attack with an unknown VHF virus, any fever of 101 degrees F or greater should prompt patient evaluation and consideration for immediate treatment with intravenous ribavirin. However, the utility of post-exposure, pre-symptomatic ribavirin prophylaxis is questionable. The DOD IND protocol for ribavirin therapy of CCHF and Lassa fever may allow for prophylactic treatment of exposed personnel, in consultation with protocol investigators. Most patients will tolerate this regimen well, but should be under surveillance for breakthrough disease (especially after drug cessation) or adverse drug effects (principally anemia).

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