Pediatric Viral Hemorrhagic Fevers Follow-up

Updated: Apr 02, 2018
  • Author: Martha L Muller, MD; Chief Editor: Russell W Steele, MD  more...
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Follow-up

Further Inpatient Care

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

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Transfer

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

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Deterrence/Prevention

See the list below:

  • 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. [32]

  • 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. [50]

  • 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.

  • Vaccines are being sought. [51]

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Complications

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  • 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.

  • Acute liver failure, multiorgan failure, and cerebral edema may complicate Marburg infection. [52]

  • Infection with RVF may lead to blindness in as many as 20% of patients.

  • CCHF may be complicated by cardiac involvement [53] or pleural effusions and ascites. [54]

  • Nosocomial transmission of CCHF with fatal outcome has been reported. [55]

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Prognosis

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

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Patient Education

See the list below:

  • Discussing protective measures with prospective travelers is of utmost importance for avoidance of VHFs and many other infections.

  • For patient education resources, see the patient education article Ticks.

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