Viral Hemorrhagic Fevers Fact Sheet

From: Subject: Viral Hemorrhagic Fevers Fact Sheet Date: Wed, 11 Dec 2002 07:05:44 +0200 MIME-Version: 1.0 Content-Type: multipart/related; boundary="----=_NextPart_000_006B_01C2A0E3.B915A8E0"; type="text/html" X-MimeOLE: Produced By Microsoft MimeOLE V6.00.2800.1106 This is a multi-part message in MIME format. ------=_NextPart_000_006B_01C2A0E3.B915A8E0 Content-Type: text/html; charset="iso-8859-1" Content-Transfer-Encoding: quoted-printable Content-Location: http://www.hopkins-biodefense.org/pages/agents/agentvhf.html Viral Hemorrhagic Fevers Fact Sheet <= /TABLE> ------=_NextPart_000_006B_01C2A0E3.B915A8E0 Content-Type: image/gif Content-Transfer-Encoding: base64 Content-Location: http://www.hopkins-biodefense.org/images/head_agents.gif R0lGODlhRAJPALMAAAAAALy8vJlMAD4+PpmZmYSEhP///2ZmZubm5iEZEdmMP7CwsMxmAFJSUuKp b9bOyCH5BAQUAP8ALAAAAABEAk8AAAT/EMhJq7046827/2AojmRpnmiqrmzrvnAsf0ISCnOu73zv /8CgcEhMJRi2UKJWbDqf0Kh0Sq26BAzcCJu0er/gsHhM9mK1JAayzG673/B4+7guYevyvH7P7/s/ 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<= FONT=20 size=3D2>Anthrax =B7 Bot= ulinum=20 Toxin =B7 Pl= ague =B7 = Smallpox =B7 Tularemia =B7 VHF

Viral Hemorrhagic Fevers = Fact=20 Sheet=20

Fact=20 Sheet Info

Background

Hemorrhagic fever viruses (HFVs) are a diverse group of=20 organisms, each of which belong to one of four distinct=20 families:

Filoviridae: Ebola and Marburg viruses=20
Arenaviridae: Lassa fever virus and a group of = viruses=20 referred to as the New World arenaviruses=20
Bunyaviridae: Crimean Congo hemorrhagic fever = virus,=20 Rift Valley fever virus, and a group of viruses known as = the=20 'agents of hemorrhagic fever with renal syndrome'=20
Flaviviridae: dengue, yellow fever, Omsk = hemorrhagic=20 fever, and Kyasanur Forest disease virus

Hemorrhagic fever viruses are all capable of causing a = clinical=20 diseases associated with fever and bleeding disorder, = classically=20 referred to as viral hemorrhagic fever (VHF). None of = these=20 viruses occurs naturally in the United States. Risk factors = for=20 these diseases include travel to certain geographic areas = where=20 these diseases may naturally occur (such as certain areas of = Africa,=20 Asia, the Middle East, and South America), handling of = animal=20 carcasses, contact with sick animals or people with the = disease, and=20 arthropod bites. The Working Group for Civilian Biodefense=20 identified a subset of these viruses that pose particularly = serious=20 threats as biological weapons, based on, among other=20 characteristics, their infectious properties, morbidity and=20 mortality, transmissibility by way of aerosol dissemination, = and=20 prior research and development as biological weapons. = Specifically,=20 these viruses are: Ebola, Marburg, Lassa fever, New World=20 arenaviruses, Rift Valley fever, yellow fever, Omsk = hemorrhagic=20 fever, and Kyasanur Forest disease. The history and = characteristics=20 of these viruses are described in detail in the full = consensus=20 statement.

Epidemiology

An understanding of the epidemiology, clinical = presentation, and=20 the recommended medical and public health response following = a=20 biological attack with any of the HFVs of greatest concern = could=20 substantially decrease the morbidity and mortality of such = an=20 event.

There is the potential for significant morbidity and = mortality if=20 hemorrhagic fever viruses were disseminated by aerosol = dispersal,=20 given the lack of readily available therapy and vaccines. = Some of=20 these viruses (namely, Ebola, Marburg, Lassa fever, New = World=20 arenaviruses, and Crimean-Congo hemorrhagic fever viruses) = are also=20 transmissible from person-to-person; this characteristic has = the=20 potential to amplify disease outbreaks.

Most of what is known regarding the epidemiology of these = diseases is derived from naturally occurring outbreaks. Rift = Valley=20 fever and the Flaviviridae are not transmissible from=20 person-to-person. For the remaining HFVs of concern, the = major mode=20 of transmission appears to be from direct contact with a = sick person=20 or contaminated items, such as syringes. Transmission via = the=20 airborne route appears to be rare but cannot be conclusively = ruled=20 out. All of these viruses, including Rift Valley fever and = the=20 Flaviviridae, may be transmitted to laboratory personnel by = way of=20 aerosol generated during specimen processing. For that = reason,=20 attempts to culture these viruses must be conducted in high=20 containment (BSL-4) laboratories. There are two such labs in = the US;=20 one is located at the Centers for Disease Control and = Prevention,=20 and the other at the United States Army Medical Research = Institute=20 of Infectious Diseases.

Clinical=20 Manifestations

Following an aerosol dissemination of any of these HFVs = of=20 concern, cases would likely appear 2-21 days following = exposure.=20 Patients would present with fever, rashes, body aches, = headaches,=20 and fatigue, and bleeding manifestations could occur later = in the=20 disease course. Suspected cases of viral hemorrhagic fevers = should=20 be immediately reported to local or state health department. = These=20 illnesses are not endemic in the U.S.; thus, were a case of = VHF to=20 be detected domestically in a person who does not have any = of the=20 risk factors for the disease, bioterrorism should be = considered as a=20 potential cause.

Health-care workers caring for patients with suspected or = confirmed VHF should take special protective measures. The = Working=20 Group recommends adherence to strict hand hygiene and the = donning of=20 double-gloves, impermeable gowns, leg and shoe coverings, = face=20 shields or goggles for eye protection, and either N-95 masks = or=20 powered air-purifying respirators (for airborne = precautions). In=20 addition, if resources are available, patients should be = cared for=20 in a negative pressure isolation room (used for the care of = patients=20 with tuberculosis).

Prophylaxis &=20 Treatment

Currently, there is no approved antiviral medication for = the=20 treatment of any of these diseases. Ribavirin, an antiviral=20 medication which, when used in combination with interferon, = is=20 approved for the treatment of chronic hepatitis C, is active = against=20 some of these viruses (the Arenaviridae and Bunyaviridae).=20 Unfortunately, no antiviral medications have been shown to = be useful=20 in the treatment of the other families of viruses (the = Filoviridae=20 and Flaviviridae).

A vaccine exists for only one of these viruses: yellow = fever. The=20 vaccine is very effective in protecting travelers to areas = where the=20 disease is endemic from acquiring yellow fever. This vaccine = would=20 not be useful following a bioterrorist attack because yellow = fever=20 has a very short incubation period, so that even if victims = were=20 vaccinated subsequent to a known exposure, they would likely = develop=20 the disease before they develop protective antibodies.

The Working Group recommends that ribavirin be = administered to=20 individuals believed to have VHF after a bioterrorist = attack, and to=20 those who develop symptoms after a VHF contact with other = sick=20 persons. However, if the causative virus is ultimately = identified as=20 a Filoviridae or a Flaviviridae, ribavirin will not be = useful and=20 should not be continued. Persons who may have been infected = by a=20 bioweapon disseminating HFVs should be followed closely by a = designated medical expert or public health official so they = may be=20 immediately treated if they develop symptoms. There is an = urgent=20 need for the development of rapid diagnostic tests, = effective=20 vaccines and drug therapy for the HFVs of greatest = concern.

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Copyright =A9 2002 The Johns Hopkins = University=20 on behalf of its Center for Civilian Biodefense Strategies. = All=20 rights reserved.