Clinical Management of Patients with Viral Haemorrhagic Fever

This is the second updated version of the WHO s Clinical management of patients with viral haemorrhagic fever: A pocket guide for front-line health workers. Interim emergency guidance for West Africa - for country adaptation first published in March 2014. This pocket guide seeks to provide clear guidance on current best practices for viral haemorrhagic fever (VHF) including both clinical management and infection prevention and control. Throughout guidance is provided for the front-line health worker focusing on triage and case definition early and ongoing case management infection control and subsequent hospital discharge. Recommendations come predominantly from published VHF guidelines (primarily consensus-based) and also are draw from algorithms for diarrhoeal diseases sepsis and vaginal bleeding management from the WHO Integrated Management of Adolescent and Adult Illness (IMAI) and Childhood Illness (IMCI) guidelines and other current WHO normative guidelines. The rationale for including the management of GI loss from diarrhoeal disease and vomiting and the sepsis algorithms is that many patients in the West African Ebola epidemic have had severe diarrhoea and vomiting with dehydration and shock; others have this combined with severe sepsis or a clinical pictures consistent with suspected pathophysiology and final common pathway of severe sepsis with manifestations of increased vascular permeability vasodilatation multiple organ failure and shock. In addition this book provides guidance on infection prevention and control to minimize nosocomial transmission and on the common clinical manifestations of VHF to help the front-line health worker increase his or her level of suspicion for VHF particularly before an epidemic is recognized in the community. Separate notes have been added on the care of children and pregnant women. Importantly this document does not cover how to create a VHF treatment unit (that is an isolation ward) and it also does not address community interventions to control transmission or respond to disease outbreaks. It is hoped that this manual will be complement such guidance and will strengthen the overall response to VHF outbreaks in Africa contributing to the Integrated Disease Surveillance and Response activities necessary for compliance with international health regulations. Although these guidelines concentrate on Ebola Virus Disease (EVD) referred to throughout this guide as Ebola they also address Lassa fever which is an endemic problem in Sierra Leone and also occurs in Liberia Guinea and Nigeria as well as two other viral haemorrhagic fevers that are transmitted person-to-person Marburg and Crimean-Congo haemorrhagic fever. Country adaptation should address which VHFs are included in this pocket guide.