Viral Hemorrhagic Fever

The term Viral Hemorrhagic Fever (VHF) refers to a group of serious illnesses caused by particular viruses. There are four VHFs that are of major concern from an Infection Control Perspective as they can be transmitted directly from humans to humans, and are a hazard for staff handling blood samples. These are:

  • Lassa fever
  • Congo-Crimean HF
  • Ebola
  • Marburg

If one of these VHFs is suspected seek immediate advice from the on-call consultant infectious diseases physician and consultant medical microbiologist. Do Not send ANY blood samples to the laboratory.


What are the symptoms?

Signs and symptoms vary by the type of VHF, but initial signs and symptoms often include fever, fatigue, dizziness, muscle aches, loss of strength and exhaustion. Patients with severe cases of VHF often show signs of bleeding under the skin, in internal organs or from body orifices like the mouth, eyes or ears. Some severe cases may also show signs of shock, nervous system malfunction, coma delirium and seizures.

VHF should be considered in a patient who has visited an endemic area within the past 21 days, or who has had close contact with a patient with suspected VHF within 21 days.



The viruses causing VHF are transmitted to humans via infected hosts such as monkeys, rodents or insects. Person to person spread may occur as a result of direct contact with blood and body fluids.



  • If a VHF is suspected in a patient who is still at home, then the on-call infectious diseases consultant must visit the patient at their home. The patient should not be admitted to hospital unless critically ill.
  • If VHF is suspected in a patient in hospital then the on-call infectious diseases consultant and consultant medical microbiologist must be contacted straight away. The patient should be taken straight to a negative-pressure sideroom on Nightingale 2.Absolutely NO blood samples must be sent to the laboratory until the situation has been assessed.


The commonest diagnosis in patients with suspected VHF is malaria

The on-call CCDC must also be contacted immediately.

Strict Precautions are required for nursing patients with VHF.

VHF is a Notifiable diseases


Other VHFs include

  • Argentine HF (Junin)
  • Bolivian HF (Machupo)
  • Chikungunya HF
  • Dengue
  • Haemorrhagic fever with renal syndrome (Hantaan)
  • Kyasanur Forest disease
  • Omsk HF
  • Rift Valley disease

These are less of a concern from an Infection Control perspective. Standard isolation precautions and good laboratory practice are sufficient (wearing gloves for taking and handling blood samples and avoidance of sharps injuries).

The Trust policy for dealing with VHF can be found via the Infection Prevention and Control website.