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)

• 1910 Subpart H, Hazardous materials [related topic page]
  • 1910.120, Hazardous waste operations and emergency response [related topic page]
    • 1910.120(q), Emergency response program to hazardous substance releases

• 1910 Subpart I, Personal protective equipment
  • 1910.132, General requirements [related topic page]
  • 1910.134, Respiratory protection [related topic page]
    • Appendix A, Fit testing procedures (Mandatory)
    • Appendix B-1, User seal check procedures (Mandatory)
    • Appendix B-2, Respiratory cleaning procedures (Mandatory)
    • Appendix C, OSHA respirator medical evaluation questionnaire (Mandatory)
    • Appendix D, Information for employees using respirators when not required under standard (Mandatory)
      
      
• 1910 Subpart Z, Toxic and hazardous substances [related topic page]
  • 1910.1030, Bloodborne pathogens [related topic page]

Preambles to final rules

• Hazardous Waste Operations and Emergency Response (1989)
  • Intro to 29 CFR Part 1910, Hazardous Waste Operations and Emergency Response
  • I. Background
  • II. Summary and Explanation of the Standard
  • VII. State Plan States
  • VIII. Federal and State Coverage of the Public Sector and Volunteers
    
    
• Search all available preambles to final rules.

Directives

• Inspection Procedures for 29 CFR 1910.120 and 1926.65, Paragraph (q): Emergency Response to Hazardous Substance Releases. CPL 02-02-073, (2007, August 27). Also available as a 444 KB PDF, 119 pages. Updates enforcement procedures for compliance officers who need to conduct inspections of emergency response operations. It defines additional terms and expands on training requirements for emergency responders and other groups such as skilled support personnel. This OSHA instruction revises CPL 02-02-059, issued April 24, 1998.
  
  
• Search all available 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

• 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, (2008, August 25). 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.
  
  
• Disease Information. Centers for Disease Control and Prevention (CDC), Special Pathogens Branch, (2011, April 25). 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:
  • Viral Hemorrhagic Fevers. (2011, November 22).
  • Arenaviruses. (2005, August 22).
  • Lassa Fever. (2004, December 3).
  • Filoviruses. (2010, May 4).
  • Ebola Hemorrhagic Fever. (2011, November 22).
  • Marburg Hemorrhagic Fever. (2011, November 22).
  • Rift Valley Fever. (2011, September 15).
    
    
• 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.
  • Yellow fever. Fact Sheet No. 100, (2011, January).
  • Ebola haemorrhagic fever. Fact Sheet No. 103, (2008, December).
  • Lassa fever. Fact Sheet No. 179.
  • Rift Valley fever. Fact Sheet No. 207, (2010, May).

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 comprhensive 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.

• Training. Northwest Center for Public Health Practice (NWCPHP).University of Washington. Provides training that educates the public workforce in relevant aspects of bioterrorism preparedness and response.
  • Preparing for and Responding to Bioterrorism: Information for Primary Care Clinicians
  • Preparing for and Responding to Bioterrorism - Information for the Public Health Workforce
    
  • Braden, J. B. and J. Duchin. Tularemia and Viral Hemorrhagic Fevers [797 KB PDF, 42 pages]. (2002, July). Provides information for primary care clinicians (Instructor manual 6).
    
    
• Lazarus, Ross, et al. "Use of Automated Ambulatory-Care Encounter Records for Detection of Acute Illness Clusters, Including Potential Bioterrorism Events." Emerging Infectious Diseases 8.8(2002, August). Centers for Disease Control and Prevention (CDC). Describes a monitoring system that complements emergency room- and hospital-based surveillance by adding the capacity to rapidly identify clusters of illness, including potential bioterrorism events.
  
  
• Infection Control for Viral Haemorrhagic Fevers In the African Health Care Setting. Centers for Disease Control and Prevention (CDC), Special Pathogens Branch, (2005, April 27). Links to a manual developed by the CDC using practical, hospital-based guidelines. The manual can help health care facilities recognize cases and prevent further hospital-based disease transmission by using locally available materials and few financial resources.

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.

• Viral Hemorrhagic Fever. University of Minnesota, Center for Infectious Disease Research and Policy (CIDRAP), Academic Health Center. Includes news, an overview, links to images, and resources.
  • Clinical Pathway: Viral Hemorrhagic Fever [263 KB PDF, 4 pages]. (2002). Provides step-by-step procedures for patient evaluation and treatment.
    
    
• Notice to Readers Update: Management of Patients with Suspected Viral Hemorrhagic Fever -- United States. Centers for Disease Control and Prevention (CDC) Morbidity and Mortality Weekly Report (MMWR) 44(25); 475-479, (1995, June 30). Provides an update to the recommendations given in the document listed below. Focuses on measures designed to control the spread of infection in VHF patients.

Control and Prevention

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

• VHF Resource List. University of Minnesota, Center for Infectious Disease Research and Policy (CIDRAP), Academic Health Center. 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

• Biological Agents
  
  
• Bioterrorism
  
  
• Emergency Preparedness and Response

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.

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