There has never been a reported endemic or imported case of VHF in New Zealand, but it is possible that a sick traveller will bring the disease to New Zealand, where it may spread from person to person.
Note: Dengue haemorrhagic fever under Arboviral Diseases and yellow fever are discussed in separate chapters. The clinical course varies among the VHFs, but a typical case might experience a prodrome of fever, headache, myalgia, facial flushing, conjunctival suffusion and malaise that lasts 3—4 days, followed by worsening of these symptoms with prostration, evidence of capillary leak non-dependent oedema, effusions , haemorrhage, shock and impaired consciousness.
Low platelets, disseminated intravascular coagulopathy DIC and liver damage are common. These tests are not available in New Zealand. Diagnosis is made by viral isolation or serology. Attending medical practitioners or laboratories must immediately notify the local medical officer of health of suspected cases.
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Notification should not await confirmation. Table 2 summarises the incubation period, mode of transmission and period of communicability of VHFs. Obtain a history of travel, contact with animals, insect bites, possible contacts with infected cases, needle-stick accidents, occupation, recreational activities and any other at-risk activities. Laboratory samples from Crimea-Congo haemorrhagic fever, Lassa fever and Marburg, Ebola virus cases should be kept to a minimum as they represent a significant biohazard.
All samples should be handled with gloves and in a biological safety cabinet. Disinfect all surfaces in contact with samples.
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Cases with Crimea-Congo haemorrhagic fever, Lassa fever and Marburg, Ebola virus may transmit infection through close contact for weeks after illness. Cases should be advised not to have sex for 3 months after illness. For Lassa fever, intravenous ribavirin reduces mortality, especially if given within the first week of illness. Ribavirin may also be effective in Crimea-Congo haemorrhagic fever.
Advise the case and their caregivers of the nature of the infection and its mode of transmission. Advise on measures to reduce transmission to household or other close contacts. Cases must not donate blood for 3 months.
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Limit contact with other people for example, work, school for a full incubation period after last contact with the case. Consider a media release and direct communication with local health professionals to encourage prompt reporting of symptoms. In communications with doctors, include recommendations regarding diagnosis, treatment and infection control. On receiving a notification, medical officers of health should immediately notify the Director of Public Health at the Ministry of Health. If the case may have acquired a VHF in New Zealand, the Ministry of Health will notify the appropriate staff in the Ministry for Primary Industries so that further investigation of the source can be undertaken.
Skip to main content. Viral haemorrhagic fevers. Part of the Communicable Disease Control Manual. Chapter last reviewed and updated in May Contents Epidemiology in New Zealand Case definition Notification procedure Spread of infection Management of case Management of contacts Other control measures Reporting Epidemiology in New Zealand Viral haemorrhagic fevers VHF are caused by viruses from four taxonomic families Arenaviridae, Bunyaviridae, Filoviridae and Flaviviridae and share the following features.
All are enveloped RNA viruses. Most have animal usually a rodent or arthropod hosts; humans are not a natural reservoir. All are geographically restricted by the distribution of the host species. All cause sporadic and irregular cases or outbreaks in humans. When viral hemorrhagic fevers occur in the United States, they're usually found in people who've recently traveled internationally. Viral hemorrhagic fevers are spread by contact with infected animals, people or insects. No current treatment can cure viral hemorrhagic fever.
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The antiviral drug ribavirin Rebetol, Virazole, others may help shorten the course of some infections and prevent complications in some cases. Vaccinations exist for only a few types of viral hemorrhagic fevers. Until additional vaccines are developed, the best approach is prevention. Signs and symptoms of viral hemorrhagic fevers vary by disease.
In general, initial signs and symptoms may include:. Severe cases of some types of viral hemorrhagic fevers may cause bleeding, but people rarely die of blood loss. Bleeding may occur:. The best time to see a doctor is before you travel to a developing country to ensure you've received any available vaccinations and pre-travel advice for staying healthy. If you develop signs and symptoms once you return home, consult a doctor, preferably one who focuses on international medicine or infectious diseases. A specialist may be able to recognize and treat your illness faster.
Be sure to let your doctor know what areas you've visited. The viruses that cause viral hemorrhagic fevers live naturally in a variety of animal and insect hosts — most commonly mosquitoes, ticks, rodents or bats. Each of these hosts typically lives in a specific geographic area, so each particular disease usually occurs only where that virus's host normally lives. Some viral hemorrhagic fevers also can be transmitted from person to person, and can spread if an infected person travels from one area to another.
The route of transmission varies by specific virus. Some viral hemorrhagic fevers are spread by mosquito or tick bites. Others are transmitted by contact with infected blood or semen. A few varieties can be inhaled from infected rat feces or urine. If you travel to an area where a particular hemorrhagic fever is common, you may become infected there and then develop symptoms after you return home.
It can take up to 21 days for symptoms to develop. Simply living in or traveling to an area where a particular viral hemorrhagic fever is common will increase your risk of becoming infected with that particular virus. Several other factors can increase your risk even more, including:. Preventing viral hemorrhagic fevers, especially in developing nations, presents enormous challenges. Many of the social, economic and ecological factors that contribute to the sudden appearance and spread of infectious diseases — war, displacement, destruction of habitat, lack of sanitation and proper medical care — are problems that have no easy solutions.
If you live in, work in or travel to areas where viral hemorrhagic fevers are common, take precautions to protect yourself from infection.
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This may include using appropriate protective barriers such as gloves, eye and face shields, and gowns when contact with blood or body fluids is expected. Precautions also may include careful handling, disinfection and disposal of laboratory specimens and waste. The yellow fever vaccine is generally considered safe and effective, although in rare cases, serious side effects can occur.
Check with the Centers for Disease Control and Prevention about the status of the countries you're visiting — some require certificates of vaccination for entry. The yellow fever vaccine isn't recommended for children under 9 months of age or for pregnant women, especially during the first trimester.
Vaccines for several less common types of viral hemorrhagic fevers are currently in development.