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Management of patients with suspected viral hemorrhagic fever

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  • Alternative Title:
    MMWR. Morbidity and mortality weekly report
  • Description:
    The term viral hemorrhagic fever (VHF) refers to the illness associated with a number of geographically restricted viruses. This illness is characterized by fever and, in the most severe cases, shock and hemorrhage (1). Although a number of other febrile viral infections may produce hemorrhage, only the agents of Lassa, Marburg, Ebola, and Crimean-Congo hemorrhagic fevers are known to have caused significant outbreaks of disease with person-to-person transmission. Therefore, the following recommendations specifically address these four agents. The increasing volume of international travel, including visits to rural areas of the tropical world, provides opportunity for the importation of these infections into countries with no endemic VHF, such As the United States. Since most physicians have little or no experience with these viruses, uncertainty often arises when VHF is a diagnostic possibility. Lassa, Marburg, and Ebola viruses are restricted to sub-Saharan Africa, and the differential diagnosis of VHF will most often be made for illness in travelers to this region. Since 1976, no imported cases of VHF have been confirmed in the United States, but every year there are approximately five to 10 suspected cases. These guidelines review the clinical and epidemiologic features of these diseases; provide recommendations on diagnosis, investigation, and care of patients; and suggest measures to prevent secondary transmission. This document updates earlier recommendations, issued in 1983 (2), for the management of suspected and confirmed cases of VHF. Accumulated evidence shows that transmission of these viruses does not occur through casual contact; thus, some earlier recommendations for preventing secondary transmission have been relaxed. Similarly, therapy recommendations have taken into account recent knowledge of the effects of antiviral drugs.
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