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al haemorrhagic fevers

Viral haemorrhagic fevers

– A d o z en d iseases with d ifferent aetio lo gies and d ifferent m o d es o f transm issio n are
gro up ed und er this nam e as they p resent with sim ilar clinical signs.

– D engue h aem o rrh agic fever is a viral h aem o rrh agic fever th at is d escribed o n
p age 2 0 1 .

Clinical features

– C o m m o n sy nd ro m e (C S ):
• fever higher than 3 8 .5 °C
• sho rt rem issio n o n D ay 3 o r D ay 4
• haem o rrhagic sy m p to m s (p urp ura, ep istaxis, haem atem esis, m elaena etc.)

– Th e clinical signs are o ften no n- sp ecific, th e severity varies d ep end ing o n th e
aetio lo gy (see table, p age 2 0 6 ).

Laboratory

– S end a sam p le o f who le blo o d to a reference labo rato ry (eg. the P asteur Institute) fo r
sero lo gical d iagno sis. A ttach a clinical d escrip tio n o f the p atient.

– W ear p ro tective clo th ing wh ile tak ing o r h and ling th e sam p le ( glo ves, p ro tective
glasses etc.).

– U se a trip le p ack aging sy stem fo r ship m ent. The tube co ntaining the blo o d sp ecim en
is p laced in a p rim ary w atertigh t, rigid co ntainer enclo sing abso rbent m aterial
between it and the tube co ntaining the blo o d sp ecim en (1 ). There m ust be eno ugh
abso rbent m aterial to so ak up the entire blo o d sam p le in the event o f a leak . Th is
p rim ary co ntainer is then p laced in a seco nd rigid co ntainer ap p ro p riately sealed fo r
transp o rt o f infectio us m aterials (2 ). This seco nd co ntainer is p laced in a secure carto n
bo x that has a visible infectio us substance (bio haz ard ) label (3 ).

– The sam p le m ay also be sent o n filter p ap er. I t is easier to transp o rt, but the sm all
vo lum e o f blo o d o nly allo ws a lim ited num ber o f aetio lo gies to be tested .

Management

Suspicion of haemorrhagic fever (isolated case of fever with haemorrhagic
symptoms in an endemic area):
– Iso latio n: iso latio n ward (o r failing that screens/ p artitio ns); restrict visito rs (p ro vid e

p ro tective clo thing: go wns, glo ves, m ask s).
– S tand ard p recautio ns:

The general rules o f hy giene m ust alway s be resp ected . The m ajo rity o f intra-ho sp ital
infectio ns h ave o ccurred d ue to a lack o f resp ect fo r these sim p le rules.
• wear glo ves fo r tak ing sam p les
• wear go wns d uring co nsultatio ns and care
• wear thick rubber glo ves to hand le so iled laund ry
• frequent hand washing
• resp ect safe injectio n p ractices
– I n ad d itio n to these no n-sp ecific m easures wear m ask s and glo ves while exam ining
the p atient and p ro tective glasses when there is a risk o f sp lashing.
Confirmed cases of Ebola, Marburg, Lassa, Crimean-Congo haemorrhagic fevers or
epidemics of unknown origin:
– M o re sp ecific m easures:
• strict iso latio n in a reserved area sep arate fro m o ther p atient areas, with a changing

ro o m at the entrance/ exit

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