viral hemorrhagic fever. overview organism organism history history epidemiology epidemiology...
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OverviewOverview OrganismOrganism HistoryHistory EpidemiologyEpidemiology TransmissionTransmission Disease in HumansDisease in Humans Disease in AnimalsDisease in Animals Prevention and ControlPrevention and Control
What is Viral Hemorrhagic What is Viral Hemorrhagic Fever?Fever?
Severe multisystem syndrome Severe multisystem syndrome Diffuse Damage to overall vascular Diffuse Damage to overall vascular
systemsystem Symptoms often accompanied by Symptoms often accompanied by
hemorrhagehemorrhage Rarely life threatening in itselfRarely life threatening in itself Includes conjunctivitis, petechia, echymosisIncludes conjunctivitis, petechia, echymosis
Relatively high mortalityRelatively high mortality
Quick Overview: Who are Quick Overview: Who are they?they? VHFs are:VHFs are:
Enveloped Lipid-encapsulated Single-strand RNASingle-strand RNA Zoonotic (animal-borne) Zoonotic (animal-borne) Geographically restricted by hostGeographically restricted by host Persistent in nature (rodents, bats, mosquitoes, Persistent in nature (rodents, bats, mosquitoes,
ticks, livestock, monkeys, and primatesticks, livestock, monkeys, and primates)) Survival dependent on an animal or insect Survival dependent on an animal or insect
host, for the natural reservoirhost, for the natural reservoir
Quick Overview: Who are Quick Overview: Who are they?they?
ArenaviridaArenaviridaee Lassa FeverLassa Fever Argentine HF (Junin)Argentine HF (Junin) Bolivian HF (Machupo)Bolivian HF (Machupo) Brazilian HF (Sabia)Brazilian HF (Sabia) Venezuelan HF (Guanarito)Venezuelan HF (Guanarito)
BunyaviridaBunyaviridaee Rift Valley Fever (RVF)Rift Valley Fever (RVF) Crimean Congo HF (CCHF)Crimean Congo HF (CCHF) Hantavirus (Hemorrhagic Fever Hantavirus (Hemorrhagic Fever
with Renal Syndrome (HFRS))with Renal Syndrome (HFRS)) Hantavirus Pulmonary Hantavirus Pulmonary
Syndrome (HPS)Syndrome (HPS)
FiloviridaeFiloviridae MarburgMarburg EbolaEbola
FlaviviridaeFlaviviridae Yellow FeverYellow Fever Dengue FeverDengue Fever Omsk HFOmsk HF Kyasanur Forest DiseaseKyasanur Forest Disease
Quick Overview: How do we Quick Overview: How do we get infected?get infected?
Rodents & Arthropods, both reservoir & Rodents & Arthropods, both reservoir & vectorvector
Bites of infected mosquito or tickBites of infected mosquito or tick Inhalation of rodent excretaInhalation of rodent excreta Infected animal product exposureInfected animal product exposure
Person-to-PersonPerson-to-Person Blood/body fluid exposureBlood/body fluid exposure Airborne potential for some arenaviridae, Airborne potential for some arenaviridae,
filoviridaefiloviridae
ArenaviridaeArenaviridae
• Junin virusJunin virus• Machupo virusMachupo virus• Guanarito virusGuanarito virus• Lassa virusLassa virus• Sabia virusSabia virus
Arenaviridae HistoryArenaviridae History First isolated in 1933First isolated in 1933 1958: Junin virus - Argentina 1958: Junin virus - Argentina
First to cause hemorrhagic feverFirst to cause hemorrhagic fever Argentine hemorrhagic feverArgentine hemorrhagic fever
1963: Machupo virus – Bolivia1963: Machupo virus – Bolivia Bolivian hemorrhagic feverBolivian hemorrhagic fever Guanarito (Venezuela)Guanarito (Venezuela)
Sabia (Brazil)Sabia (Brazil) 1969: Lassa virus – Nigeria1969: Lassa virus – Nigeria
Lassa feverLassa fever
Arenavirus StructureArenavirus Structure
Single-stranded, bi-segmented Single-stranded, bi-segmented RNA genomeRNA genome
Large segment (7200nt), small Large segment (7200nt), small one (3500nt)one (3500nt)
Lipid envelope with Lipid envelope with
8-10nm club-shaped 8-10nm club-shaped
projectionsprojections
Arenaviridae TransmissionArenaviridae Transmission Virus transmission and amplification Virus transmission and amplification
occurs in rodentsoccurs in rodents Shed virus through urine, feces, and Shed virus through urine, feces, and
other excretaother excreta Human infection Human infection
Contact with excretaContact with excreta Contaminated materialsContaminated materials Aerosol transmissionAerosol transmission
Person-to-person transmissionPerson-to-person transmission
Arenaviridae in HumansArenaviridae in Humans
Incubation period 10–14 daysIncubation period 10–14 days Fever and malaise 2–4 daysFever and malaise 2–4 days Hemorrhagic stageHemorrhagic stage
Hemorrhage, leukopenia, Hemorrhage, leukopenia, thrombocytopeniathrombocytopenia
Neurologic signsNeurologic signs
Arenaviridae: Lassa FeverArenaviridae: Lassa Fever First seen in Lassa, Nigeria in 1969. First seen in Lassa, Nigeria in 1969. Now in all countries of West AfricaNow in all countries of West Africa
5-14% of all hospitalized febrile illness5-14% of all hospitalized febrile illness Rodent-borne (Rodent-borne (Mastomys natalensisMastomys natalensis)) Interpersonal transmissionInterpersonal transmission
Direct ContactDirect Contact SexSex Breast FeedingBreast Feeding
Lassa Fever VirusLassa Fever Virus
BackgroundBackground Discovered in 1969 Discovered in 1969
when two missionary when two missionary nurses died in Lassa, nurses died in Lassa, Nigeria, W. AfricaNigeria, W. Africa It expands to Guinea, It expands to Guinea,
Liberia, Sierra LeoneLiberia, Sierra Leone 100 to 300 thousand 100 to 300 thousand
cases per year with cases per year with approx. 5,000 deathsapprox. 5,000 deaths
Lassa FeverLassa Fever
Distinguishing FeaturesDistinguishing Features Gradual onsetGradual onset Retro-sternal painRetro-sternal pain Exudative pharyngitisExudative pharyngitis Hearing loss in 25% may be Hearing loss in 25% may be
persistentpersistent Spontaneous abortionSpontaneous abortion
Mortality 1-3% overall (up to 50% in Mortality 1-3% overall (up to 50% in epidemics)epidemics)
Therapy: RibavirinTherapy: Ribavirin
BunyaviridaeBunyaviridae• Rift Valley Fever virusRift Valley Fever virus
• Crimean-Congo Hemorrhagic Fever Crimean-Congo Hemorrhagic Fever virusvirus
• HantavirusHantavirusL-segment codes for an L-protein (the RNA dependent RNA polymerase); M segment codes for two surface glycoproteins G1 and G2 which form the envelope spikes; S segment codes for an N-protein (nucleocapsid protein).
BunyaviridaeBunyaviridae Rift Valley Fever (RVF)Rift Valley Fever (RVF) Crimean-Congo Hemorrhagic Fever Crimean-Congo Hemorrhagic Fever
(CCHF)(CCHF) HantavirusHantavirus
Old World: Hemorrhagic fever with renal Old World: Hemorrhagic fever with renal syndrome (HFRS)syndrome (HFRS)
New World: Hantavirus pulmonary New World: Hantavirus pulmonary syndrome (HPS)syndrome (HPS)
5 genera with over 350 viruses5 genera with over 350 viruses
Bunyaviridae TransmissionBunyaviridae Transmission Arthropod vectorArthropod vector
Exception – HantavirusesException – Hantaviruses RVF – RVF – AedesAedes mosquito mosquito CCHF – Ixodid tickCCHF – Ixodid tick Hantavirus – RodentsHantavirus – Rodents Less commonLess common
AerosolAerosol Exposure to infected animal tissue Exposure to infected animal tissue
BunyaviridaeBunyaviridae Transmission to humansTransmission to humans
Arthropod vector (RVF, CCHF)Arthropod vector (RVF, CCHF) Contact with animal blood or Contact with animal blood or
products of infected livestockproducts of infected livestock Rodents (Hantavirus)Rodents (Hantavirus) Laboratory aerosolLaboratory aerosol Person-to-person transmission with Person-to-person transmission with
CCHFCCHF
Rift Valley FeverRift Valley Fever
Predominantly a disease of sheep and Predominantly a disease of sheep and cattlecattle
1930: First identified in an infected 1930: First identified in an infected newborn lamb in Egyptnewborn lamb in Egypt
In livestock:In livestock: ~100% abortion~100% abortion 90% mortality in young90% mortality in young 5-60% mortality in adults5-60% mortality in adults
Rift Valley FeverRift Valley Fever Asymptomatic or mild illness in Asymptomatic or mild illness in
humanshumans Distinguishing CharacteristicsDistinguishing Characteristics
Hemorrhagic complications rare Hemorrhagic complications rare (<5%)(<5%)
Vision loss (retinal hemorrhage, Vision loss (retinal hemorrhage, vasculitis) in 1-10%vasculitis) in 1-10%
Overall mortality 1%Overall mortality 1% Therapy: Ribavirin?Therapy: Ribavirin?
Crimean-Congo Hemorrhagic Crimean-Congo Hemorrhagic FeverFever
Distinguishing featuresDistinguishing features Abrupt onset Abrupt onset Most humans infected will Most humans infected will
develop hemorrhagic feverdevelop hemorrhagic fever Profuse hemorrhageProfuse hemorrhage
Mortality 15-40%Mortality 15-40% Therapy: RibavirinTherapy: Ribavirin
Bunyaviridae: Bunyaviridae: Crimean-Congo Crimean-Congo HFHF
Transmission to humans:Transmission to humans: Ixodid, HyalommaIxodid, Hyalomma spp. ticks spp. ticks Contact with animal Contact with animal
blood/productsblood/products Person-to-personPerson-to-person Laboratory aerosolsLaboratory aerosols
Extensive geographical Extensive geographical distributiondistribution
Bunyaviridae: HantavirusesBunyaviridae: Hantaviruses
Transmission to humans:Transmission to humans: Exposure to rodent saliva and excretaExposure to rodent saliva and excreta InhalationInhalation BitesBites Ingestion in contaminated food/water (?)Ingestion in contaminated food/water (?) Person-to-person (Andes virus in Person-to-person (Andes virus in
Argentina)Argentina)
Hemorrhagic Fever with Hemorrhagic Fever with Renal Syndrome (HFRS)Renal Syndrome (HFRS)
Distinguishing FeaturesDistinguishing Features Insidious onsetInsidious onset Intense headaches, Intense headaches, Blurred visionBlurred vision kidney failure kidney failure
(causing severe fluid overload)(causing severe fluid overload)
Mortality: 1-15%Mortality: 1-15%
Bunyaviridae HumansBunyaviridae Humans RVF RVF
Incubation period – 2-5 daysIncubation period – 2-5 days 0.5% - Hemorrhagic Fever0.5% - Hemorrhagic Fever
CCHF CCHF Incubation period – 3-7 daysIncubation period – 3-7 days Hemorrhagic Fever - 3–6 days Hemorrhagic Fever - 3–6 days
following clinical signsfollowing clinical signs Hantavirus Hantavirus
Incubation period – 7–21 daysIncubation period – 7–21 days HPS and HFRSHPS and HFRS
Ebola
Marburg
EbolaEbola Ebola-ZaireEbola-Zaire Ebola-SudanEbola-Sudan Ebola-Ivory CoastEbola-Ivory Coast Ebola-BundibugyoEbola-Bundibugyo (Ebola-Reston)(Ebola-Reston)
MarburgMarburg
Filoviridae
Filoviridae HistoryFiloviridae History 1967: Marburg, Frankfurt, Belgrade1967: Marburg, Frankfurt, Belgrade
European laboratory workersEuropean laboratory workers 1976: Ebola virus1976: Ebola virus
Ebola ZaireEbola Zaire Ebola SudanEbola Sudan
1989 and 1992: Ebola Reston1989 and 1992: Ebola Reston USA and ItalyUSA and Italy Imported macaques from PhilippinesImported macaques from Philippines
1994: Ebola Côte d'Ivoire 1994: Ebola Côte d'Ivoire
Filoviridae Transmission Filoviridae Transmission
Reservoir is UNKNOWNReservoir is UNKNOWN Bats implicated with MarburgBats implicated with Marburg
Intimate contactIntimate contact Nosicomial transmissionNosicomial transmission
Reuse of needles and syringesReuse of needles and syringes Exposure to infectious tissues, excretions, Exposure to infectious tissues, excretions,
and hospital wastesand hospital wastes Aerosol transmissionAerosol transmission
PrimatesPrimates
Filoviridae: EbolaFiloviridae: Ebola
Rapidly fatal febrile hemorrhagic illnessRapidly fatal febrile hemorrhagic illness Transmission:Transmission:
bats implicated as reservoirbats implicated as reservoir Person-to-personPerson-to-person NosocomialNosocomial
Five subtypesFive subtypes Ebola-Zaire, Ebola-Sudan, Ebola-Ivory Ebola-Zaire, Ebola-Sudan, Ebola-Ivory
Coast, Ebola-Bundibugyo, Ebola-RestonCoast, Ebola-Bundibugyo, Ebola-Reston Ebola-Reston imported to US, but only Ebola-Reston imported to US, but only
causes illness in non-human primatescauses illness in non-human primates Human-infectious subtypes found only in Human-infectious subtypes found only in
AfricaAfrica
Filoviridae: EbolaFiloviridae: Ebola
Distinguishing features:Distinguishing features: Acute onsetAcute onset Weight loss/protrationWeight loss/protration
25-90% case-fatality25-90% case-fatality
Filoviridae: MarburgFiloviridae: Marburg Transmission:Transmission:
Animal host unknownAnimal host unknown Person-to-personPerson-to-person infected animal blood/fluid exposureinfected animal blood/fluid exposure
Indigenous to AfricaIndigenous to Africa UgandaUganda Western KenyaWestern Kenya ZimbabweZimbabwe Democratic Republic of CongoDemocratic Republic of Congo AngolaAngola
Filoviridae: MarburgFiloviridae: Marburg Distinguising featuresDistinguising features
Sudden onsetSudden onset Chest painChest pain Maculopapular rash on trunkMaculopapular rash on trunk PancreatitisPancreatitis JaundiceJaundice
21-90% mortality21-90% mortality
Filoviridae HumansFiloviridae Humans Most severe hemorrhagic feverMost severe hemorrhagic fever Incubation period: 4–10 daysIncubation period: 4–10 days Abrupt onsetAbrupt onset
Fever, chills, malaise, and myalgiaFever, chills, malaise, and myalgia Hemorrhage and DICHemorrhage and DIC Death around day 7–11Death around day 7–11 Painful recoveryPainful recovery
FlaviviridaeFlaviviridae
• Dengue virusDengue virus
• Yellow Fever virusYellow Fever virus
• Omsk Hemorrhagic Fever Omsk Hemorrhagic Fever virusvirus
• Kyassnur Forest Disease Kyassnur Forest Disease virusvirus
Flaviviridae HistoryFlaviviridae History 1648 : Yellow Fever described1648 : Yellow Fever described 1717thth–20–20thth century century
Yellow Fever and Dengue outbreaksYellow Fever and Dengue outbreaks 1927: Yellow Fever virus isolated1927: Yellow Fever virus isolated 1943: Dengue virus isolated1943: Dengue virus isolated 1947 Omsk Hemorrhagic Fever virus 1947 Omsk Hemorrhagic Fever virus
isolatedisolated 1957: Kyasanur Forest virus isolated1957: Kyasanur Forest virus isolated
Flaviviridae TransmissionFlaviviridae Transmission Arthropod vectorArthropod vector Yellow Fever and Dengue virusesYellow Fever and Dengue viruses
Aedes aegyptiAedes aegypti Sylvatic cycleSylvatic cycle Urban cycleUrban cycle
Kasanur Forest VirusKasanur Forest Virus Ixodid tickIxodid tick
Omsk Hemorrhagic Fever virusOmsk Hemorrhagic Fever virus Muskrat urine, feces, or bloodMuskrat urine, feces, or blood
Flaviviridae EpidemiologyFlaviviridae Epidemiology Yellow Fever Virus – Africa and AmericasYellow Fever Virus – Africa and Americas
Case fatality rate – variesCase fatality rate – varies Dengue Virus – Asia, Africa, Australia, and Dengue Virus – Asia, Africa, Australia, and
AmericasAmericas Case fatality rate – 1-10%Case fatality rate – 1-10%
Kyasanur Forest virus – IndiaKyasanur Forest virus – India Case fatality rate – 3–5%Case fatality rate – 3–5%
Omsk Hemorrhagic Fever virus – EuropeOmsk Hemorrhagic Fever virus – Europe Case fatlity rate – 0.5–3%Case fatlity rate – 0.5–3%
Flaviviridae HumansFlaviviridae Humans Yellow Fever Yellow Fever
Incubation period – 3–6 days Short Incubation period – 3–6 days Short remissionremission
Dengue Hemorrhagic FeverDengue Hemorrhagic Fever Incubation period – 2–5 daysIncubation period – 2–5 days Infection with different serotypeInfection with different serotype
Kyasanur Forest DiseaseKyasanur Forest Disease Omsk Hemorrhagic Fever Lasting Omsk Hemorrhagic Fever Lasting
sequelasequela
Yellow FeverYellow Fever Distinguishing featuresDistinguishing features
Biphasic infectionBiphasic infection Common hepatic Common hepatic involvement & jaundice involvement & jaundice
Mortality: 15-50%Mortality: 15-50%
Flaviviridae: DengueFlaviviridae: Dengue Dengue Fever (DF) /Fatality:Dengue Fever (DF) /Fatality: <1% <1% Dengue Hemorrhagic Fever (DHF)/ Fatality:Dengue Hemorrhagic Fever (DHF)/ Fatality: 5-6% 5-6% Dengue Shock Syndrome (DSS)Dengue Shock Syndrome (DSS) /Fatality 12- /Fatality 12-
44%44%
Four distinct serotypesFour distinct serotypes DEN-1, DEN-2, DEN-3, DEN-4DEN-1, DEN-2, DEN-3, DEN-4
Distinguishing FeaturesDistinguishing Features Sudden onsetSudden onset Eye painEye pain RashRash Complications/sequelae uncommonComplications/sequelae uncommon Illness less severe in younger childrenIllness less severe in younger children
Omsk Hemorrhagic FeverOmsk Hemorrhagic Fever
Distinguishing FeaturesDistinguishing Features Acute OnsetAcute Onset Biphasic infectionBiphasic infection ComplicationsComplications
Hearing lossHearing loss Hair lossHair loss Psycho-behavioral difficultiesPsycho-behavioral difficulties
Mortality: 0.5 – 3%Mortality: 0.5 – 3%
Flaviviridae: Kyanasur ForestFlaviviridae: Kyanasur Forest
Distribution: limited to Distribution: limited to Karnataka State, IndiaKarnataka State, India
Distinguishing FeaturesDistinguishing Features Acute onsetAcute onset BiphasicBiphasic
Case-fatality: 3-5% (400-500 Case-fatality: 3-5% (400-500 cases annually)cases annually)
Common PathophysiologyCommon Pathophysiology Small vessel involvementSmall vessel involvement
Increased vascular permeabilityIncreased vascular permeability Multiple cytokine activationMultiple cytokine activation
Cellular damageCellular damage Abnormal vascular regulation:Abnormal vascular regulation:
Early -> mild hypotensionEarly -> mild hypotension Severe/Advanced -> ShockSevere/Advanced -> Shock
ViremiaViremia Macrophage involvementMacrophage involvement
Inadequate/delayed immune Inadequate/delayed immune responseresponse
Common PathophysiologyCommon Pathophysiology Multisystem InvolvementMultisystem Involvement
Hematopoietic Hematopoietic NeurologicNeurologic PulmonaryPulmonary Hepatic (Ebola, Marburg, RVF, CCHF, Yellow Fever)Hepatic (Ebola, Marburg, RVF, CCHF, Yellow Fever) Renal (Hantavirus)Renal (Hantavirus)
Hemorrhagic complicationsHemorrhagic complications Hepatic damageHepatic damage Consumptive coagulopathyConsumptive coagulopathy Primary marrow injury to megakaryocytesPrimary marrow injury to megakaryocytes
Common Clinical Features: Common Clinical Features: Early/Prodromal SymptomsEarly/Prodromal Symptoms
FeverFever MyalgiaMyalgia MalaiseMalaise Fatigue/weaknessFatigue/weakness HeadacheHeadache
DizzinessDizziness ArthralgiaArthralgia NauseaNausea Non-bloody Non-bloody
diarrheadiarrhea
Common Clinical Features: Common Clinical Features: Progressive SignsProgressive Signs
ConjunctivitisConjunctivitis Facial & thoracic Facial & thoracic
flushingflushing PharyngitisPharyngitis ExanthemsExanthems Periorbital edemaPeriorbital edema Pulmonary edemaPulmonary edema
HemorrhageHemorrhage Subconjunctival Subconjunctival
hemorrhagehemorrhage EcchymosisEcchymosis PetechiaePetechiae But the But the
hemorrhage itself hemorrhage itself is rarely life-is rarely life-threatening.threatening.
SymptomsSymptoms Incubation period of 6-21 daysIncubation period of 6-21 days 80% of human infections are asyptomatic 80% of human infections are asyptomatic Onset is slow: fever, weakness, & malaiseOnset is slow: fever, weakness, & malaise Few days: headache, pharyngitis, muscle pain, retrostinal Few days: headache, pharyngitis, muscle pain, retrostinal
& abdominal pain, nausea, vomiting, conjunctivitis, & abdominal pain, nausea, vomiting, conjunctivitis, diarrhea, cough, & proteinuriadiarrhea, cough, & proteinuria
Severe casesSevere cases: : facial swelling, lung cavity fluid, hemorrhaging, hyopotension,facial swelling, lung cavity fluid, hemorrhaging, hyopotension, Neurological problems: tremors, encephalitis, hair loss, gait Neurological problems: tremors, encephalitis, hair loss, gait
disturbance, deafnessdisturbance, deafness 95% death rate among pregnant women & spontaneous 95% death rate among pregnant women & spontaneous
abortionabortion
Common Clinical Features: Common Clinical Features: Severe/End-stageSevere/End-stage
Multisystem compromiseMultisystem compromise Profuse bleedingProfuse bleeding Consumptive coagulopathy/DICConsumptive coagulopathy/DIC EncephalopathyEncephalopathy Shock Shock DeathDeath
Clinical SymptomsClinical Symptoms
More severe Bleeding under skinBleeding under skin
Petechiae, echymoses, conjunctivitisPetechiae, echymoses, conjunctivitis Bleeding in internal organsBleeding in internal organs Bleeding from orificesBleeding from orifices Blood loss rarely cause of deathBlood loss rarely cause of death
< 2 days after viral infection1.Cytolysis by perforin-granzyme2.IFN γ: protect uninfected cells and activate macrophages3.Mediate ADCC
1. Phagocytosis of virus and virus-infected cells2. Kill virus-infected cells3. Produce antiviral molecules: TNFα, NO, IFNα
Plasmcytoid DC21.A major IFNα producer after viral infection2. Toll-like receptor -3
IFNγ
Major antiviral cells in early phrase
ProtectionKilling
Adaptive (specific) immune response to viral infection
Neighboring uninfected
cells
IFNγ IFNα and IFNβ
1
2
34
5
6
7
8
9
Cambridge University Immunology Lectures (www)
Innate & Adaptive Immunity Timeline
Lab studiesLab studies Complete Blood CountComplete Blood Count
Leucopenia, leucocytosis, thrombocytopenia, Leucopenia, leucocytosis, thrombocytopenia, hemoconcentration, DIChemoconcentration, DIC
Liver enzymesLiver enzymes AlbAlb Proteinuria universalProteinuria universal Serological tests – Ab not detected acute phase; Serological tests – Ab not detected acute phase;
Direct examination blood/tissues for viral Ag Direct examination blood/tissues for viral Ag enzyme immunoassay.enzyme immunoassay. Immunohistochemical staining liver tissueImmunohistochemical staining liver tissue Virus isolation in cell cultureVirus isolation in cell culture RT-PCR sequencing of virusRT-PCR sequencing of virus
Electron microscopy specific and sensitiveElectron microscopy specific and sensitive
TreatmentTreatment Supportive care:Supportive care:
• Fluid and electrolyte managementFluid and electrolyte management• Hemodynamic monitoringHemodynamic monitoring• Ventilation and/or dialysis supportVentilation and/or dialysis support• Steroids for adrenal crisisSteroids for adrenal crisis• Anticoagulants, IM injectionsAnticoagulants, IM injections, , • Treat secondary bacterial infectionsTreat secondary bacterial infections
TreatmentTreatment
Manage severe bleeding complications• Cryoprecipitate (concentrated clotting factors)Cryoprecipitate (concentrated clotting factors)• PlateletsPlatelets• Fresh Frozen PlasmaFresh Frozen Plasma• Heparin for DICHeparin for DIC
Ribavirin in vitro activity vs.• Lassa feverLassa fever• New World Hemorrhagic feversNew World Hemorrhagic fevers• Rift Valley FeverRift Valley Fever• No evidence to support use in Filovirus or Flavivirus No evidence to support use in Filovirus or Flavivirus
infectionsinfections
PreventionPrevention Nosocomial: Complete equipment sterilization Nosocomial: Complete equipment sterilization
& protective clothing& protective clothing House to house rodent trappingHouse to house rodent trapping Better food storage & hygieneBetter food storage & hygiene Cautious handling of rodent if used as food Cautious handling of rodent if used as food
source source If human case occurs If human case occurs
Decrease person-to-person transmissionDecrease person-to-person transmission Isolation of infected individualsIsolation of infected individuals
Prevention and ControlPrevention and Control Avoid contact with host speciesAvoid contact with host species
RodentsRodents Control rodent populationsControl rodent populations Discourage rodents from entering or living in Discourage rodents from entering or living in
human populationshuman populations Safe clean up of rodent nests and droppingsSafe clean up of rodent nests and droppings
InsectsInsects Use insect repellentsUse insect repellents Proper clothing and bed netsProper clothing and bed nets Window screens and other barriers to insectsWindow screens and other barriers to insects
VaccinationVaccination Argentine and Bolivian HFArgentine and Bolivian HF
• PASSIVE IMMUNIZATIONPASSIVE IMMUNIZATIONTreat with convalescent serum containing Treat with convalescent serum containing
neutralizing antibody or immune globulinneutralizing antibody or immune globulin Yellow FeverYellow Fever
• ACTIVE IMMUNIZATIONACTIVE IMMUNIZATIONTravelers to Africa and South AmericaTravelers to Africa and South America
Experimental vaccines under studyExperimental vaccines under study Argentine HF, Rift Valley Fever, Argentine HF, Rift Valley Fever,
Hantavirus and Dengue HFHantavirus and Dengue HF
VHF Personal Protective EquipmentVHF Personal Protective Equipment
Airborne and Contact isolation for patients with respiratory symptoms• N-95 or PAPR mask• Negative pressure isolationNegative pressure isolation• GlovesGloves• GownGown• Fitted eye protection and shoe covers if going to be exposed to Fitted eye protection and shoe covers if going to be exposed to
splash body fluidssplash body fluids Droplet and Contact isolationDroplet and Contact isolation for patients for patients without respiratorywithout respiratory
symptomssymptoms• Surgical maskSurgical mask• GlovesGloves• GownGown• Fitted eye protection and shoe covers if going to be exposed to Fitted eye protection and shoe covers if going to be exposed to
splash body fluidssplash body fluids Environmental surfacesEnvironmental surfaces
• Cleaned with hospital approved disinfectantCleaned with hospital approved disinfectant• Linen incinerated, autoclaved, double-bagged for washLinen incinerated, autoclaved, double-bagged for wash
Why do VHFs make good Why do VHFs make good Bioweapons?Bioweapons?
Disseminate through aerosolsDisseminate through aerosols Low infectious doseLow infectious dose High morbidity and mortalityHigh morbidity and mortality Cause fear and panic in the publicCause fear and panic in the public No effective vaccineNo effective vaccine Available and can be produced in large quantityAvailable and can be produced in large quantity Research on weaponization has been conductedResearch on weaponization has been conducted