eMedicine Specialties > Pediatrics: General Medicine > Infectious Disease

Viral Hemorrhagic Fevers: Follow-up

Author: Robert W Tolan Jr, MD, Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine
Coauthor(s): Michelle L Whitner, PA-C, Physician Assistant, pediatrics, Parker Pediatrics and Adolescents
Contributor Information and Disclosures

Updated: Jan 27, 2009

Follow-up

Further Inpatient Care

  • Intensive care treatment, when available, is most likely required for viral hemorrhagic fevers (VHFs).

Transfer

  • Transfer to another facility is appropriate when the required level of care and specialists are not available locally.

Deterrence/Prevention

  • The most important measure for preventing viral hemorrhagic fever is avoidance of insect bites from the vectors and exposure to rodent sources of infection.
  • Immunization with live attenuated Junin virus in Argentina has reduced the incidence of disease to fewer than 100 cases in recent years.4
  • Elimination of specific reservoir rodents from towns is practical and effective for most South American HFs. Care should be taken before entering or cleaning closed buildings with potential rodent infestation.
  • Infection with one of the Bunyaviridae leads to full immunity.
  • Since 1994, live, attenuated, and inactivated Rift Valley fever (RVF) virus vaccines have been available for domestic livestock and an experimental inactivated RVF virus vaccine is available for human use.5
  • Avoidance of ticks and slaughtering of acutely infected animals may eliminate much of the risk of RVF and Crimean-Congo hemorrhagic fever (CCHF). Tick-borne flaviviruses may be suppressed by postexposure prophylaxis with virus-specific IgG.
  • Barrier nursing and needle sterilization in African hospitals are of particular importance to eliminate epidemics of Ebola and Marburg diseases, as is avoidance of close contact with infected patients. Promising vaccines against these viruses are in preliminary primate studies.
  • Careful evaluation of all sick primates should also be undertaken.

Complications

  • Hearing deficits have been reported in up to one third of patients with severe Lassa fever.
  • Uveitis, orchitis, transverse myelitis, and recurrent hepatitis are late complications of Ebola and Marburg infections.
  • Infection with RVF may lead to blindness in as many as 20% of patients.

Prognosis

  • Individuals who survive and do not experience specific sequelae typically return to their premorbid state.

Patient Education

  • Discussing protective measures with prospective travelers is of utmost importance for avoidance of VHFs and many other infections.
  • For excellent patient education resources, visit eMedicine's Bites and Stings Center. Also, see eMedicine's patient education article Ticks.

Miscellaneous

Medicolegal Pitfalls

  • Failure to consider the diagnosis of viral hemorrhagic fever (VHF) in a traveler or resident from an endemic region
  • Failure to institute proper protective isolation for caretakers
 


More on Viral Hemorrhagic Fevers

Overview: Viral Hemorrhagic Fevers
Differential Diagnoses & Workup: Viral Hemorrhagic Fevers
Treatment & Medication: Viral Hemorrhagic Fevers
Follow-up: Viral Hemorrhagic Fevers
References
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Further Reading

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Keywords

viral hemorrhagic fever, VHF, Alkhurma, Arenaviridae, Argentine hemorrhagic fever, AHF, Bayou virus, Black Creek Canal virus, Bolivian hemorrhagic fever, Brazilian hemorrhagic fever, Bunyaviridae, Chapare virus, Crimean-Congo hemorrhagic fever, CCHF, dengue, dengue fever, dengue hemorrhagic fever, dengue shock syndrome, Dobrava/Belgrade virus, Ebola, Ebola hemorrhagic fever, Filoviridae, Flaviviridae, Four Corners virus, Guanarito virus, Hantaan virus, Hantavirus, Hantavirus pulmonary syndrome, HPS, hemorrhagic fever with renal syndrome, HFRS, Junin virus, Kyasanur Forest disease, Lassa fever, Machupo virus, Marburg virus disease, Muleshoe virus, New York virus, Omsk hemorrhagic fever, Puumala virus, Rift Valley fever, RVF, Sabia virus, Seoul virus, Sin Nombre virus, tropical viral infection, Venezuelan hemorrhagic fever, yellow fever

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Contributor Information and Disclosures

Author

Robert W Tolan Jr, MD, Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine
Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility
Disclosure: GlaxoSmithKline Honoraria Speaking and teaching; MedImmune Honoraria Consulting; MedImmune Honoraria Speaking and teaching; Merck Honoraria Speaking and teaching; Novartis Honoraria Speaking and teaching; sanofi pasteur Grant/research funds Unrestricted research grant; sanofi pasteur  Consulting; sanofi pasteur Honoraria Speaking and teaching; Tap Honoraria Speaking and teaching; Baxter Healthcare Honoraria Speaking and teaching

Coauthor(s)

Michelle L Whitner, PA-C, Physician Assistant, pediatrics, Parker Pediatrics and Adolescents
Michelle L Whitner, PA-C is a member of the following medical societies: American Academy of Physician Assistants
Disclosure: Nothing to disclose.

Medical Editor

Glenn J Fennelly, MD, MPH, Director, Division of Pediatric Infectious Diseases, Jacobi Medical Center; Associate Professor, Department of Pediatrics, Albert Einstein College of Medicine
Glenn J Fennelly, MD, MPH is a member of the following medical societies: Pediatric Infectious Diseases Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Leslie L Barton, MD, Professor, Program Director, Department of Pediatrics, University of Arizona School of Medicine
Leslie L Barton, MD is a member of the following medical societies: American Academy of Pediatrics, Association of Pediatric Program Directors, Infectious Diseases Society of America, and Pediatric Infectious Diseases Society
Disclosure: Nothing to disclose.

CME Editor

Daniel Rauch, MD, FAAP, Director, Pediatric Hospitalist Program, Associate Professor, Department of Pediatrics, New York University School of Medicine
Daniel Rauch, MD, FAAP is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, and Society of Hospital Medicine
Disclosure: Baxter Honoraria Consulting; Pfizer Honoraria Consulting

Chief Editor

Russell W Steele, MD, Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine
Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association
Disclosure: None None None

 
 
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