Key points
- Viral hemorrhagic fevers (VHFs) are rare and deadly viral illness that are reportable in all U.S. states and territories.
- Be alert for and evaluate any patients that are suspected of having a VHF.
- If you suspect a VHF after screening, isolate the patient and notify your health department.
VHF Case Definitions
Suspect case
- Signs and symptoms compatible with a VHF
AND
- An epidemiological risk factor within 21 days (i.e., the incubation period) before the onset of symptoms.
Confirmed case
Laboratory-confirmed diagnostic evidence of a VHF (i.e., through molecular and/or serologic testing).
Screening guidelines
The majority of febrile patients presenting in U.S. healthcare facilities do not have a VHF, but early symptoms are similar to other febrile illnesses. It is important to systematically assess patients for the possibility of a VHF through a triage and evaluation process.
Identify potential exposures
Getting a thorough history is important for all patients exhibiting symptoms compatible with a VHF who may have had an exposure to the virus.
Important questions to ask to begin assessing exposure risk:
- Have you been in contact with a person with suspect or confirmed VHF in the past 21 days (for example touching, caring for, etc.)?
- Have you been to an area with an active VHF outbreak or where VHF is endemic in the past 21 days? Stay up to date on active .
Ask about VHF risk factors
Exposure risks for VHFs may include the following activities.
- Contact with a symptomatic person with a suspected or confirmed VHF, or any objects contaminated by their body fluids
- Experienced a breach in infection prevention and control precautions that result in the potential for contact with body fluids of a patient with a suspected or confirmed VHF
- Contact with semen from a person who has recovered from a VHF
- Participated in any of the following activities while in an area with an active VHF outbreak or where VHFs are endemic:
- Having contact with someone who was sick or died, or any objects contaminated by their body fluids
- Attending/participating in funeral rituals, including preparing bodies for funeral or burial
- Working in a healthcare facility or laboratory
- Visiting a healthcare facility or traditional healer
- Having contact with bats or wild animals
- Working or spending time in a mine/cave
- Having contact with someone who was sick or died, or any objects contaminated by their body fluids
Ask about signs or symptoms compatible with a VHF
Signs and symptoms of most VHFs are nonspecific and similar to many other common causes of febrile illness in returning travelers. Assess a patient's signs and symptoms along with their travel history and epidemiologic risk factors before initiating immediate infection control measures.
VHF symptoms can appear anywhere from 2 to 21 days after exposure to the virus.
Illness typically progresses from "dry" symptoms (fever, aches, fatigue) to "wet" symptoms (diarrhea, vomiting, and in some cases, bleeding). A person with a VHF is not contagious until the appearance of symptoms.
Primary signs and symptoms of VHFs often include some or several of the following:
- Fever (≥100.4°F/38.0°C)
- Aches and pains, such as severe headache and muscle and/or joint pain
- Weakness and fatigue
- Sore throat
- Loss of appetite
- Gastrointestinal symptoms including abdominal pain, diarrhea, and vomiting
- Unexplained hemorrhaging, bleeding or bruising
- Red eyes, skin rash, and hiccups
What to do next
If Patient Evaluation Indicates Possible Infection with a VHF, Take Action
Isolate
- Isolate the patient in a single room with a private bathroom or a covered bedside commode.
- Adhere to infection prevention and control procedures to prevent transmission through direct or indirect contact, including wearing appropriate PPE and using dedicated equipment.
- Use only essential healthcare workers trained in their designated roles for patient care and keep a log of everyone who enters and leaves the patient's room.
- Perform only necessary tests and procedures and avoid aerosol-generating procedures.
Inform
- Notify your facility's Infection Prevention and Control Program and other healthcare personnel of a suspect VHF case.
- Contact the local or state health department for consultation about VHF testing.
If the patient is not reporting signs and symptoms compatible with a VHF but concern remains, consult Local/State Health Department for additional guidance on testing recommendations.