Viral hemorrhagic fever : initial management of suspected and confirmed cases
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  • Journal Article:
    MMWR. Surveillance summaries : Morbidity and mortality weekly report. Surveillance summaries;HHS publication;
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    Every year the possibility exists that travelers with viral hemorrhagic fever (VHF) transmissible from person to person —Lassa, Ebola, Marburg, or Crimean-Congo hemorrhagic fever (CCHF) —may enter the United States. Among U.S. citizens, health professionals involved in the care of patients in Africa might be most likely to be exposed to agents of these diseases. Serologic studies have indicated, however, that missionaries and Peace Corps volunteers serving in Africa without obvious or frequent exposure to ill persons may also be exposed. Additionally, travelers may enter the United States asymptomatically infected with one of these viruses. Laboratory-acquired infection also remains a possibility in research or diagnostic facilities. Since guidelines concerning the approach to suspected cases of VHF were last published, in 1 980 (1), approximately four cases of illness suspected of being VHF have occurred in the United States each year. None have been confirmed as VHF.

    Although the source in nature of two (Ebola and Marburg) of the four viruses discussed in this document remains unknown, all four are capable of being transmitted from person to person, especially in the hospital setting. The communicability of these viruses in hospitals may vary considerably; however, the consequences of such transmission may be severe since case-fatality rates in hospital outbreaks have been high. The potential danger is increased by the fact that these illnesses begin with nonspecific symptoms that may be confused with other diseases. Therefore, appropriate barrier techniques designed to prevent transmission may not be instituted until late in the course of these illnesses, if at all. Finally, the lack of experience with these agents in the United States understandably results in confusion and anxiety on the part of physicians and other hospital personnel when a suspected importation occurs.

    Since the earlier guidelines were published, additional clinical and laboratory observations have produced new information on the agents causing VHF and the illnesses they produce. Also, new information is available on treating patients with VHF. These guidelines are therefore offered to provide up-to-date information on these diseases, an organized approach to the suspected case of VHF, and guidelines concerning the handling of specimens and the care of patients. Also, a current list of persons available for consultation at CDC is included below. Because Lassa, Ebola, Marburg, and CCHF are the only hemorrhagic fevers for which person- to-person transmission has been documented, these guidelines will be limited to these four diseases.


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