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Viral haemorrhagic fever guidelines – just in case!

VHF algorithmIt’s clearly extremely unlikely but, particularly if you work near an airport….

The patient has been hot in the last day, maybe with sore throat, vomiting and diarrhoea, and travelled to affected area in last 21 days, or knows someone who has? Risk assess further with this algorithm. But basically – double protection including FFPP3, discuss with high security ID unit, check for malaria, send EDTA & serum for VHF and follow these guidelines or equivalent. Alarmingly no help on actual therapy! Presumably support, and aggressively attend to coagulapathy.

 

 

More detail from recent reports (at 3/10/14):

Virology

  • 5 subtypes of Ebolavirus – this outbreak is the Zaire group. Possible animal (bat/pig/monkey) reservoir in West Africa.
  • Seemed to start in Gabon or Guinea, then Liberia, Congo, Sierra Leone, Nigeria, Senegal.
  • Transmission by physical contact and, less so, contact with body fluids (not airborne).

Symptoms

  • Approx 80% – fever, fatigue,
  • 40-70% – loss of appetite, vomiting , severe diarrhoea, headache, abdominal pain
  • <10% haemorrhage.
  • 95% are symptomatic within 3 weeks

Mortality

  • Somewhere between 50 and 80%

Management

  • Supportive
  • Transfuse from a survivor
  • ZMapp currently the most highly regarded specific therapy (cocktail of 3 monoclonal antibodies)

Public health tenets

Enable early diagnosis, isolation/quarantine/social distancing, trace contacts asap, immaculate infection control (hygiene, disposal), ensure appropriate burial facilities. Social mobilization measures and community education also crucial. Vaccination not yet available.

Rate of spread

Doubling rates differ between countries (15 to 30 days). Under-reporting is certain. A total of 20,000 reported cases by early November is predicted.

Ethics

New treatments are likely to be scarce and expensive – who gets them? How much can you hurry the drug development process?

 

Read:

Gostin in JAMA

Briand in NEJM

Now a great CDC site on Ebola

WHO Ebola site

Public health England map

UK advisory on dangerous pathogens

1 comment

1 ping

  1. Gaya Rupasinghe

    Well done,
    This will be very helpful in clinical practice.

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