Viral Hemorrhagic Fevers

Jill E. Holdsworth, MS, CIC Infection Control Practitioner

Inova Mount Vernon Hospital
Alexandria, VA

October 16, 2016


Viral hemorrhagic fever (VHF) describes a spectrum of illness ranging from fever with minor evidence of coagulopathy to a syndrome of hemorrhagic diathesis, multiorgan system failure with severe shock, and death. It is typical to see overall vascular system damage, hemorrhage and overall impairment of the body's ability to regulate. The etiologic agents of VHF constitute four distinct families: (1) Flaviviridae (yellow fever virus [YFV], dengue fever); (2) Bunyaviridae (Crimean-Congo hemorrhagic fever, hantavirus including Sin Nombre, Rift Valley fever); (3) Filoviridae (Marburg, Ebola); and (4) Arenaviridae (Lassa, New World arenaviruses). Combined, these viruses have both a significant and varied geographic distribution and are often zoonotic. Residence in or travel to endemic areas, nosocomial transmission, and bioterrorist attacks are all potential risks of these diseases. Once suspicious of an index case, appropriate transmission-based precautions, reporting, and preemptive treatment should be initiated. Confirmation is established in Biosafety Level 4 (BSL4) laboratories. Many agents of VHF lack effective prevention or treatment. Infection prevention measures are imperative for containment and the protection of healthcare workers (HCWs) and others. Development of effective treatments and vaccines remain the subject of intensive study.