"Infection
Control for Viral Haemorrhagic Fevers
In the African Health Care Setting"
Section 2: Identify Suspected
Cases of VHF
This
section describes how to:
- In a non-outbreak
situation, suspect VHF in patients with fever, severe illness, and signs
of unexplained bleeding.
- Alert relevant
health facility staff and begin VHF Isolation Precautions as soon as
VHF is suspected.
- Report the suspected
case to designated health authorities.
In an
outbreak situation, several cases occur around the same time. They may
be grouped together, and there may be person-to-person transmission. An
initial diagnosis of a VHF can be made based on the signs and symptoms
of the specific VHF.
Suspecting
a VHF during a non-outbreak situation in a single case is more difficult.
The early symptoms of a VHF include high fever and headache. These are
also symptoms for many infections seen at the health facility.
Most
patients who present with fever do not have a VHF. Their fever is more
often caused by malaria, typhoid fever, dysentery, severe bacterial infection
or other fever-producing illnesses usually seen in the area.
The
health worker probably will not suspect a VHF until more severe signs
develop and the patient does not respond to recommended treatment for
other illnesses.
However,
health workers should be aware of the possibility for suspecting a VHF
in a non outbreak situation. As soon as a VHF is suspected, VHF Isolation
Precautions should begin. This will help reduce the number of people exposed
to the VHF
| 2.1
Use Information from Previous Outbreaks to Suspect a VHF |
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When
a patient presents with fever, use the available diagnostic tools in your
health facility to identify or exclude the cause of fever. For example,
do a malaria smear or take a stool culture as soon as possible.
- Treat the most
likely cause of the fever according to the appropriate treatment guidelines.
- If the fever continues
after 3 days of recommended treatment, and if the patient has signs
such as bleeding or shock, consider a VHF.
- Review the patient's
history for any contact with someone who was ill with fever and bleeding
or who died from an unexplained illness with fever and bleeding.
- If no other cause
is found for the patient's signs and symptoms, suspect a VHF. Begin
VHF Isolation Precautions.
The flowchart on the next page shows how to
- Suspect a VHF
and
- Decide to use
VHF Isolation Precautions.
The flowchart applies to a non-outbreak situation. Annex
4 gives examples of VHF case definitions in outbreak situations.
Use
Isolation Precautions for Suspected VHF Cases
- Severe
illness with weakness and fatigue
- Measured
fever (38.5°C or 101°F) for more than 72 hours
and less than 2 weeks
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Diagnose
and treat for likely cause of fever in area (such as malaria,
typhoid fever, dysentery, severe bacterial infection)
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If
no response to antimalarial and antibiotic treatment
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Does
patient have one or more of the following?
- Unexplained
bleeding from
-mucous membranes (gum, nose, or vagina)
-skin (puncture sites, petechiae)
-conjunctiva (red eyes due to swollen blood vessels)
-gastrointestinal system (vomiting blood; dark
or bloody stools)
- Shock:
blood pressure <90mm Hg or rapid, weak pulse
- Contact
in the 3 weeks prior to onset of illness with anyone who
had an unexplained illness with fever and bleeding or
who died after an unexplained severe illness with fever
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Suspect
a VHF
and
Begin VHF Isolation Precautions
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If VHFs have occurred
in the area before:
Talk with the district or national surveillance officer about VHFs that
have been reported in your area.4 Use the information
when making a diagnosis of a suspected VHF case.
Record here the case
definitions for VHFs that have been reported in your area:
4. Annex
2 provides more information about VHFs seen in the area of your health
facility
| 2.2
Begin VHF Isolation Precautions |
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Every
health facility has its own procedures for responding to an urgent situation.
Adapt VHF Isolation Precautions as needed. Designate the health officer
who will coordinate VHF Isolation Precautions. How to select a VHF Coordinator
is described in Section 9.1. As soon as a health
care worker suspects a VHF, he or she should notify the health facility
administrator and the VHF Coordinator who will:
- Refer the patient
to the isolation area and take the necessary steps to begin VHF Isolation
Precautions (See Section 3).
- Limit the number
of health facility staff and visitors in the patient's room.
- Limit the use
of invasive procedures and reduce the number of injectable medications.
Important! Between the time when VHF is suspected and when the
patient is received in the isolation area, there is a risk for disease
transmission from the patient's blood and other body fluids (stool, urine,
vomit). Prevent disease transmission to other patients, visitors and health
staff in the waiting area by placing the suspected VHF patient apart from
other patients. Make every effort to reduce this waiting time.
| 2.3
Alert Health Facility Staff About Specific Risks for VHF Transmission |
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As soon as a VHF
is suspected, alert the relevant health staff who should begin using VHF
Isolation Precautions, especially:
- Doctors or nurses
providing direct patient care
- Cleaning, laundry,
and waste disposal staff who clean and disinfect contaminated material
and supplies
- Laboratory staff
who handle samples from the suspected VHF cases
- Medical or support
staff who prepare or handle deceased VHF patients.
Explain how VHF transmission can occur in the health facility and the
risks to health facility staff.5 Remind the staff that
VHF is a highly infectious disease. They must use VHF Isolation Precautions
whenever they have contact with the VHF patient, the patient's blood or
other body fluids, or contaminated supplies and equipment.
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Fig.
7. An example of VHF Isolation Precautions poster
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 For
easy-print version of the poster, please refer to the PDF format of Annex
10.
5
The chart on page 4 of the Introduction summarizes the risk of VHF transmission
in the health care setting.
| 2.4
Report the Suspected Case to the Health Authorities |
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Report suspected
cases of VHF according to national level surveillance guidelines.
If your district
is conducting special surveillance activities for a VHF, the district
officer will provide specific information about whom you should contact
and how. If serum samples are needed, the contact person will give you
special instructions for collecting and shipping serum samples. The table
below can be used to record information about whom to contact if a VHF
is suspected.
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Contact
Person
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Agency
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Telephone
and/or Fax Number
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Information
to Report
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Samples
to Collect
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| 2.5
Identify Patient's Contacts and Travel History |
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Ask the patient (or
a family member who can answer for the patient):
- Where do you live?
- When did the symptoms
begin?
- Who else is sick
in your family (or village)?
- Where have you
traveled recently?
Use the answers to
identify others who had contact with the patient. Provide them with information
about VHF and when to seek care.
Section 8 describes the steps for giving information
to the community about VHF and preventing VHF transmission.
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