Transmission in a hospital setting

Lassa virus is transmitted by accidental inoculation of blood or body fluids, intimate personal contact, and close exposure to pharyngeal secretions. It can be excreted in body fluids up to a few months after recovery.

Ebola virus is transmitted by contact with infected blood or body fluids. Aerosol transmission has been queried, but has not yet been recorded in a clinical setting.

Marburg virus is transmitted by contact with infected blood or body fluids. Although aerosol transmission is not recorded from a clinical setting, the possibility should not be disregarded in a seriously ill patient with lung involvement.

Crimean/Congo hemorrhagic fever is transmitted by contact with infected blood or body fluids. Secondary causes have followed resuscitation. It should be noted that taking and handling laboratory specimens is the most common cause of nosocomial viral hemorrhagic fevers. United Kingdom guidelines

Management of viral hemorrhagic fevers should be undertaken in a designated high-security infectious diseases unit (HSIDU) where there is a concentration of appropriate expertise and designated laboratory facilities. Patients known or suspected to be suffering from a viral hemorrhagic fever should not be admitted to a general ICU, but managed in an HSIDU.

Risk assessment

Where a patient has been admitted to an ICU and viral hemorrhagic fever is subsequently thought to be a possibility, the head of the ICU in conjunction with the infection control doctor and a specialist in tropical or infectious diseases should assess the following:

1. which viral hemorrhagic fever may be responsible;

2. how likely the patient is to have a viral hemorrhagic fever;

3. if infection takes place, the severity of the viral hemorrhagic fever;

4. the likely location of the virus (e.g. on equipment, in waste, in body fluids from the patient, etc.);

5. the routes by which staff members may become exposed;

6. an estimate of likely exposure.

Patient categorization

Epidemiological evidence is very important in this context, particularly as a firm diagnosis can seldom be made on clinical grounds alone. The United Kingdom guidelines assess risk as follows.

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