Viral Hemorrhagic Fever Initial Management of Suspected and Confirmed Cases

New guidelines are presented for the initial management of suspected and confirmed cases of viral hemorrhagic fever. Lassa, Ebola, Marburg, and Crimean-Congo hemorrhagic fever are the only hemorrhagic fevers with documented person-to-person transmission. Health professionals caring for patients, missionaries, and Peace Corps volunteers, ail serving in Africa, would be the likeliest travelers entering the United States to have been exposed to these diseases. The communicability of these viruses in the hospital setting may differ, but the consequences of such transmission may be severe as case-fatality rates in hospital outbreaks have been high. Because these viruses have nonspecific symptoms that may resemble those of other diseases, appropriate barrier techniques designed to prevent transmission may not be implemented until late in the course of the illness. Specific isolation techniques are discussed, including the use of a mobile laboratory. E V E R Y YEAR T H E possibility exists that travelers with viral hemorrhagic fever (VHF) transmissible from per-son to person—Lassa, Ebola, Marburg, or Crimean-Con-go hemorrhagic fever (CCHF)—may enter the United States. Among U.S. citizens, health professionals in-volved in the care of patients in Africa might be most likely to be exposed to agents of these diseases. Serologic studies have indicated, however, that missionaries and Peace Corps volunteers serving in Africa without obvious or frequent exposure to ill persons may also be exposed. Additionally, travelers may enter the United State