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Viral Hemorrhagic Fevers (VHFs)

Viral hemorrhagic fevers (VHFs) are a group of diseases caused by ribonucleic acid (RNA) viruses from four distinct families. These diseases include Ebola Hemorrhagic Fever, Marburg Hemorrhagic Fever, Lassa fever, Hantavirus Pulmonary Syndrome, and Yellow Fever. Symptoms vary with the disease, but often include fever, fatigue, and muscle aches. There may be bleeding, although death from blood loss is rare. Severe cases can include shock and coma. Although some types of VHFs are relatively mild illnesses, many of them can cause severe, life-threatening disease with high fatality rates.

Along with smallpox, anthrax, plague, botulism, and tularemia, hemorrhagic fever viruses are among the six agents identified by the Centers for Disease Control and Prevention (CDC) as the most likely to be used as biological weapons. Many VHFs can cause severe, life-threatening disease with high fatality rates.

There are currently no specific OSHA standards or directives for VHFs.

OSHA Standards

This section highlights OSHA standards, preambles to final rules (background to final rules), and directives (instructions for compliance officers) generally applicable to emergency response activities associated with a bioterrorist attack. Refer to OSHA's Emergency Preparedness and Response Safety and Health Topics Page for additional information.

Note: Twenty-five states, Puerto Rico and the Virgin Islands have OSHA-approved State Plans and have adopted their own standards and enforcement policies. For the most part, these States adopt standards that are identical to Federal OSHA. However, some States have adopted different standards applicable to this topic or may have different enforcement policies.

General Industry (29 CFR 1910)

Preambles to final rules

Directives

Hazard Recognition

Risk factors for viral hemorrhagic fevers (VHFs) include travel to geographic areas where these diseases may naturally occur, handling of animal carcasses, contact with animals or people with the disease, and arthropod bites. The following references aid in recognizing disease characteristics and hazards associated with VHFs.

Disease Recognition

Bioterrorist Threat Evaluation

Factors that contribute to the bioterrorism potential of VHFs include infectious properties, morbidity and mortality, transmissibility by way of aerosol dissemination, and prior research and development as biological weapons. The following references provide information that may help evaluate the threat of viral hemorrhagic fevers being used as biological weapons.

  • Viral Hemorrhagic Fever (VHF) Overview. Center for Infectious Disease Research and Policy (CIDRAP). Offers comprehensive overview with links to a list of countries that have either weaponized VHFs or have conducted biological weapons research on these viruses. Also links to hemorrhagic fever viruses that pose serious threats as potential biological weapons.

  • Healthcare system not ready for attack with hemorrhagic fever viruses. Center for Infectious Disease Research and Policy (CIDRAP), (2002, May 8). Discusses a report released by the Journal of the American Medical Association (JAMA) regarding how poorly prepared the healthcare system is to combat a terrorist attack involving VHFs.

  • Borio, L., et al. "Hemorrhagic Fever Viruses as Biological Weapons." Journal of the American Medical Association (JAMA), 287.18(2002, May 8): 2391-2405. Contains information on the history of tularemia and its use in biowarfare, as well as epidemiology, clinical images, diagnosis, vaccination, treatment, and infection control.

Medical Response

It is a US Public Health Service requirement that all suspected viral hemorrhagic fever (VHF) cases be reported to state and local health departments and the diagnoses confirmed by the Centers for Disease Control and Prevention (CDC). The preparedness of hospitals depends on the biological agent used in an attack. In an emergency, local medical care capacity will be supplemented with federal resources. The following references focus on the preparedness and response of the medical community in the event of a terrorist attack involving VHFs.

Diagnosis and Treatment

Treatment is available for some, but not all, VHFs. In the event of an outbreak, routine infection control procedures, isolation, and decontamination are usually enough to stop transmission. Patients receive supportive therapy, but generally speaking, there is no other treatment or established cure for VHFs.

Control and Prevention

The following references provide information about the control and prevention of exposures to viral hemorrhagic fevers (VHFs).

  • VHF Resource List - Diagnosis and Management. Center for Infectious Disease Research and Policy (CIDRAP). Includes a variety of useful links on topics such as vaccines, laboratory issues and virology, public health, and infection control.

  • Peters, C.J. "Biosafety and Emerging Infections: Key Issues in the Prevention and Control of Viral Hemorrhagic Fevers." Proceedings of the 4th National Symposium on Biosafety. Centers for Disease Control and Prevention (CDC), Office of Health and Safety, (1997, January 2). Examines some of the biosafety considerations that surround work with agents such as VHFs.

Vaccination

An approved vaccine is available for Yellow Fever and there are experimental vaccine available for other VHF syndromes.

  • Fast-Acting Ebola Vaccine Protects Monkeys. US Department of Health and Human Services (DHHS), National Institutes of Health (NIH), (2003, August 6). Introduces the finding that a single shot of a fast-acting, experimental Ebola vaccine successfully protects monkeys from the deadly virus after only one month and discusses the potential benefits to control outbreaks in humans.

  • Yellow Fever Vaccination. Centers for Disease Control and Prevention (CDC). Discusses who should receive the vaccine and its side effects. Also provides links to updated vaccine recommendations by the CDC.

  • Notice to Readers: Fever, Jaundice, and Multiple Organ System Failure Associated With 17D-Derived Yellow Fever Vaccination, 1996 - 2001. Centers for Disease Control and Prevention (CDC) Morbidity and Mortality Weekly Report (MMWR) 50(30);643-5, (2001, August 3). Summarizes cases and describes a program designed to refine risk estimates and improve documentation of multiple organ system failure (MOSF) potentially associated with the vaccination.

Additional Information

Related Safety and Health Topics Pages

Other Resources

  • Report an Emergency. Centers for Disease Control and Prevention (CDC). Provides a list of health department websites and emergency notification procedures for use by health officials and healthcare providers.

  • Haemorrhagic fevers, Viral. World Health Organization (WHO). Provides links to descriptions of activities, reports, news and events, as well as contacts and cooperating partners in the various WHO programs and offices working on this topic. Also provides links to related web sites and topics.

  • Lassa fever. World Health Organization (WHO).

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