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.
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
Twenty-five states, Puerto Rico and the Virgin Islands have
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
General Industry (29
Preambles to final rules
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.
Infection Control for Viral Haemorrhagic Fevers (VHF) in the African Health Care Setting.
Developed by the Centers for Disease Control and Prevention (CDC) in conjunction with the World Health Organization (WHO). Provides resources for healthcare professionals.
- Known Cases and Outbreaks of Ebola Hemorrhagic Fever, in Chronological Order. Centers for Disease Control and Prevention (CDC), Special
Pathogens Branch. Provides a table that charts
the outbreaks of Ebola virus chronologically by year, country, Ebola subtype, reported number of
human cases, percentage of deaths and describes situation.
Information. Centers for Disease Control and Prevention (CDC), Special
Pathogens Branch. Provides an explanation of the types of VHFs that the CDC Special Pathogens Branch primarily deals with. The
following links provide specific disease information including symptoms,
occurrence, and transmission:
- The World Health Organization (WHO) provides the following fact sheets
about viral hemorrhagic fevers. Each fact sheet includes a history,
symptoms, transmission, therapy, and containment.
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.
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
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.
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.
An approved vaccine is available for Yellow Fever and
there are experimental vaccine available for other VHF syndromes.
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.
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
Related Safety and Health Topics Pages
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
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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