Haemorrhagic Fever
the Western Hemisphere — North and
ETIOLOGY
Viral haemorrhagic fevers include a
spectrum of relatively mild to severe life-
threatening diseases characterized by
sudden onset of muscle and joint pain,
fever, bleeding and shock from loss of
blood (WHO).
RNA viruses that are enveloped in a
lipid coating.
Viruses implicated in viral hemorrhagic
fevers and the diseases they cause are
grouped by the family of viruses:
• Arenaviridae
• Bunyaviridae
• Filoviridae
• and Flaviviridae
SOURCE OF INFECTION
Arenaviridae are associated with
rodent-borne diseases
The types of rodents that spread
arenaviruses are located across much of
the world, including Europe, Asia,
Africa, and the Americas.
divided into two groups: New
World and Old World
Old World viruses occur in the
Eastern Hemisphere — Africa, Europe,
and Asia.
New World viruses are found in
South America.
-Bunyaviridae are transmitted via
arthropods and rodents.
-The family virus in Bunyavirales that
cause viral hemorrhagic fevers include:
-Phenuiviridae - mosquito-borne virus
present in nearly all sub-Saharan
African countries.
-Nairoviridae - is spread by infected
ticks or livestock, and person-to-person
transmission
-Hantaviridae - rodent-borne viruses
primarily found in Europe and Asia
-Filoviridae are zoonotic, meaning they
are transmitted from animals to people.
-can cause severe hemorrhagic
fever in people and nonhuman primates
(such as monkeys and gorillas) and may
spread in other animals, such as bats.
-Flaviviridae can cause a range of
different diseases and can be
transmitted via arthropods (primarily
ticks and mosquitoes), and can
occasionally infect human.
Hemorrhagic fever description
The term “viral hemorrhagic fever” refers
to a condition that affects many organ
systems of the body, damages the
overall cardiovascular system, and
reduces the body's ability to function on
its own.
-It is a clininal multi-system illness
associated with fever & bleeding
diathesis.
mode of transmission 6 days following the onset of flu-
ke symptoms
VHF are zoonosis: animal hosts
-Hantavirus: 7-21 days s
(rodents) and anthropod vectors are
followed by a clinical phase of 3-5
main reservoirs.
days.
A. Natural Infection on Human
-Filoviridae: 4-10 days, followed
-bite of infected anthropod (ticks
by abrupt onset of fever, chills,
or mosquitos)
malaise, and myalgia. The patient
-aerosol from infected rodent
rapidly deteriorates and
excreta
-progresses to multisystem
-direct contact with infected
failure.
animals/ carcasses or fomites
-Flaviviridae
-DFV:2-5 days, but will
B. Human to Human &
quickly progress to a hemorrhagic
Nosocomial Transmission
syndrome.
-direct contact with infected blood
-Yellow Fever: 3-6 days,
and body fluids (Hospital
clinical manifestations can range
Acquired Infections)
from mild to severe signs.
-mucous membrane contact
-aerosolized
Incubation period
-semen, vomitus, and sweat
SIGNS AND SYMPTOMS
Incubation period
Signs and symptoms of
viral hemorrhagic fevers vary by
• If you travel to an area where a
disease. In general, early signs
particular hemorrhagic fever is
and symptoms can include:
common, you can be infected
• Fever
there but not develop symptoms
• Fatigue, weakness or
until after you return home.
general feeling of being
• Depending on the type of virus, it
unwell
can take from 2 to 21 days for
• Dizziness
symptoms to develop.
• Muscle, bone or joint
• Arenaviridae: 10-14 days, aches
disease onset begins with a fever • Nausea and vomiting
and general malaise for 2-4 days. • Diarrhea
More-severe symptoms include:
• Bunyaviridae • Bleeding under the skin, in
-RVF: 2-5 days, in 0.5% of cases, internal organs, or from the
hemorrhagic fever will develop - mouth, eyes or ears
following the initial febrile stage • Nervous system
-CCHF: 3-7 days, most patients malfunctions
will develop hemorrhagic fever 3- • Coma
• Delirium
 • Kidney failure
• Respiratory failure
• Liver failure
period of communicability,
susceptability, resistance,
and occurrence
-Ebola and Marburg are communicable
as long as blood and secretions contain
virus.
-Dengue hemorrhagic fever, the
mosquito becomes infective 8–12 days
after the viraemic blood-meal and
remains so for life. There is no person-
person transmission of dengue.
-Lassa fever, person to person spread
may theoretically occur during the acute
febrile phase when virus is present in
secretions and excretions.
-Virus can be excreted in urine for 3–9
weeks from onset of illness and can be
spread by sexual contact through semen
for up to 3 months after infection.
period of communicability,
susceptability, resistance,
and occurence
-All ages are susceptible. Recovery from
infection with one dengue virus serotype
provides lifelong homologous immunity
but only short-term protection against
other serotypes and may exacerbate
disease upon subsequent infections
potentially leading to Dengue
Hemorrhagic Fever (as opposed to
Dengue Fever).
period of communicability,
susceptability, resistance,
and occurrence
-Patients infected with a VHF receive
supportive therapy, with special
attention paid to maintaining fluid and
electrolyte balance, circulatory volume,
blood pressure and treating for any
complicating infections.
-There is no other established treatment
-While there are no antiviral drugs
approved by the U.S Drug
Administration (FDA) for treatment of
VHF’s. Ribavirin, has been effective in
treating some individuals with
Arenaviridae and Bunyaviridae but has
not shown success against Filoviridae or
Flaviviridae infections
period of communicability,
susceptability, resistance,
and occurrence
-Outbreaks of VHFs occur sporadically
and irregularly, and their occurrence can
be difficult to predict. Prevention is more
difficult when the animal host is
unknown or challenging to control (such
as rodents or ticks). Strong risk
communication and health education
efforts are required, focusing on
exposure prevention for communities
and infection control for healthcare
providers.
method of prevention and control
Avoid contact with host species
− Rodents
ƒ Control rodent populations
ƒ Discourage rodents from entering or
living in human populations
ƒ Safe clean up of rodent nests and
droppings
− Insects
ƒ Use insect repellents
ƒ Proper clothing and bed nets
ƒ Window screens and other barriers to
insects
-Vaccine available for Yellow fever
-Experimental vaccines under study
− Argentine HF, Rift Valley Fever,
Hantavirus and Dengue HF
• If human case occurs
− Decrease person-to-person
transmission
− Isolation of infected individuals
• Protective clothing
− Disposable gowns, gloves, masks and
shoe covers, protective eyewear when
splashing might occur, or if patient is
disoriented or uncooperative
• WHO and CDC developed manual
− “Infection Control for Viral
Hemorrhagic Fevers In the African
Health Care Setting”
• Anyone suspected of having a VHF
must use a chemical toilet
• Disinfect and dispose of instruments
− Use a 0.5% solution of sodium
hypochlorite (1:10 dilution of bleach)
phn responsibility
-Patients should be educated
regarding the geographical distribution
of these viruses and practice infection
prevention measures when traveling to
areas where these diseases are
endemic.
-The Centers for Disease Control,
the World Health Organization, and the
United States Department of State
provide a list of resources regarding
current areas with ongoing epidemics as
well as travel notices and restrictions
-Health care outcomes can be
improved with an interprofessional team
approach whenever viral hemorrhagic
fevers are suspected. Effective
communication between clinicians,
nurses, epidemiologists, virologists, and
ecologists is necessary to help prevent
any further spread of disease.
-Healthcare workers caring for
patients with VHF must have received
comprehensive training and
demonstrated competency in performing
VHF-related infection control practices
and procedures.
-PPE that covers the clothing and
skin and completely protects mucous
membranes is required when caring for
patients with VHF.
-An onsite manager must
supervise personnel providing care to
these patients at all times. A trained
observer must also supervise each step
of every PPE donning/doffing procedure
to ensure established PPE protocols are
completed correctly.
-Individuals unable or unwilling to
adhere to infection control and PPE use
procedures should not provide care for
patients with VHF.
Nursing care
-The challenge of managing patients
with VHF is to provide the highest quality of
care with the least risk of transmitting
infection.
-Patients require close supervision,
and some will need modern intensive-care
facilities. Since pathogenesis is not entirely
understood and antiviral therapy is limited,
treatment is largely supportive.
-It is essential to give careful
attention to fluid and electrolyte balance.
In severe cases, therapy will be required
for shock and blood loss.
• The supportive care of patients
critically ill with VHF is the same
as the conventional care provided
to patients with other causes of
multisystem failure.
• Adult respiratory distress
syndrome, renal failure, seizures,
and coma may require specific
interventions, such as mechanical
ventilation, dialysis, and
neurologic intensive care.