Background

Acute haemorrhagic fever syndromes can be attributable to Ebola and Marburg viral diseases (Filoviridae); Lassa fever (arenaviridae), Rift Valley fever (RVF) and Crimean-Congo haemorrhagic fever (CCHF) (Bunyaviridae); dengue (dengue haemorrhagic fever (DHF)) and yellow fever (Flaviviridae); and other viral, bacterial or rickettsial diseases with potential to produce epidemics.

All cases of acute haemorrhagic fever syndrome whether single or in clusters, should be immediately notified without waiting for the causal agent to be identified.

Surveillance goal

Early detection of acute haemorrhagic fever syndrome cases and outbreaks, rapid investigation, and early laboratory verification of the cause of all suspected cases. Investigation of all suspected cases with contact tracing. During epidemics, most infected patients do not show haemorrhagic symptoms and a specific case definition according to the suspected or confirmed disease should be used (e.g. case definitions for Ebola-Marburg, CCHF, RVF, Lassa, DHF, and yellow fever).

Standard case definition

Suspected case: Acute onset of fever of less than 3 weeks duration in a severely ill patient/ or a dead person AND any 2 of the following; haemorrhagic or purpuric rash; epistaxis (nose bleed); haematemesis (blood in vomit); haemoptysis (blood in sputum); blood in stool; other haemorrhagic symptoms and no known predisposing factors for haemorrhagic manifestations OR clinical suspicion of any of the viral diseases.

Probable case: A suspected case with epidemiologic link to confirmed cases or outbreak, but laboratory specimens are not available or awaited

Confirmed case: A suspected case with laboratory confirmation.

Note: During an outbreak, case definitions may be changed to correspond to the local event. It is important to note that during outbreaks, most cases might not show haemorrhagic manifestation, a proper history taking is crucial

Respond to alert threshold

If a single case is suspected:

  • Report case-based information immediately to the appropriate levels.
  • Suspected cases should be isolated from other patients/people and strict infection prevention procedures should be implemented. Standard precautions should be enhanced throughout the health care setting and in communities.
  • Treat and manage the patient with supportive care.
  • Collect the appropriate specimen while observing strict infection prevention and control procedures to confirm the case.
  • Complete a laboratory request form, use triple packaging of the specimens (see detailed SOP for triple packaging) and mark well the containers to warn of a potential laboratory biosafety risk.
  • Conduct case-contact tracing and follow-up and active case search for additional cases (See detailed SOP for contact tracing and follow up).
  • Begin or enhance death reporting and surveillance; as well as screening procedures for fever and VHD related symptoms

Respond to action threshold

If a single case is confirmed:

  • Maintain strict viral haemorrhagic disease (VHD) infection prevention and control (IPC) practices* throughout the outbreak.
  • Mobilize the community for early detection and care and conduct community education about how the disease is transmitted and how to implement IPC in the home care setting and during funerals and burials. Consider social distancing strategies.
  • Conduct case-contact follow-up and active searches for additional cases that may not come to the health care setting.
  • Request additional help from other levels as needed.
  • Establish an isolation ward or treatment centre to handle additional cases that may come to the health centre and ensure strict IPC measures to avoid transmission in health care settings.
  • Suspected cases should be isolated and treated for more common conditions with similar symptoms, which might include malaria, typhoid, louse borne typhus, relapsing fever or leptospirosis. Ensure a barrier is instituted between suspected and confirmed cases.
  • Provide psychosocial support for the family, community and staff.
  • Consider quarantine for high risk contacts with home support during the incubation period and ensure daily follow up of their movements.
  • There are promising vaccine candidates under development for some VHDs that might be useful to be used in the event of outbreak in a ring vaccination approach and for health care workers.
  • Treat conservatively the symptoms which might be presented; severe cases require intensive support care; if dehydrated ensure fluid replacement with fluids that contain electrolytes.
  • A range of potential treatment options including blood products, immune therapies, and drug therapies are currently being evaluated,

Analyse and interpret data

Person: Implement immediate case-based reporting of cases and deaths. Analyse age and sex distribution. Assess risk factors and plan outbreak response interventions accordingly.

Time: Graph cases and deaths daily/weekly. Construct an epidemic curve during the outbreak.

Place: Map locations of cases’ households and work sites. If you have a GPS gadget, this will add to understand exact location of the cases; as well as contacts.

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