The Management of Viral Haemorrhagic Fevers in Ireland - Health ...

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Alkhurma HF Saudi Arabia (Makkah & Najran provinces) 1957 N Ticks Probably sheep, camels, goats Probably 3-8 days 25-30%Omsk HF Siberia 1946 N Ticks Rodents, muskrat 3 - 8 days 0.4 – 2.5%Kyasanur Forest Fever India 1957 N Ticks Goats, cows, sheep 3 - 8 days 2-10%Yellow Fever West Africa & South America 1927 N Mosquitoes Humans (monkeys) 3 - 6 daysFlavivirdiaeMarburg Eastern & Southern Africa, incl. Angola,DR Congo, Kenya, Zimbabwe & Uganda1967 Y - African fruit bat 3 - 10 days up to 90%Ebola Central & Eastern Africa, incl. DR Congo,Gabon, Sudan, Ivory Coast, Uganda, Rep.of the Congo1976 Y - African fruit bat 2 - 21 days 50-90%Filoviridaemonths)(few days - fewRift Valley Fever Africa N Mosquitoes Sheep and cattle 3 - 12 days1%Crimean-Congo HF Africa, Eastern Europe, Middle East, Asia 1944 Y Ixodid ticks(Hyalommagenus)Small mammals, livestock,wide range of domestic & wildanimals(1 - 13 days)1 -3 days10-50%Bunyaviridaecases)Lujo Southern Africa 2008 Y Possibly rodents 9-18 days (280% (4/5 cases)(Guanarito)Venezuelan HFVenezuela 1989 N Rodents 7 -16 daysBrazilian HF (Sabia) Brazil 1990 N Rodents 7 -16 daysBolivian HF (Chapre) Cochabamba province, Bolivia 2003 N Unknown Unknown UnknownBolivian HF (Machupo) Benin province Bolivia 1963 N Rodents 7 -16 days 5-30%Argentine HF (Junin) Argentina 1958 N Rodents 7 -16 days 5-30%Lassa fever West Africa, incl. Liberia, Guinea, SierraLeone, Nigeriashed virus in urine & faecesof hospitalised cases1969 Y Rodents of genus Mastomys6 - 21 days 1% overall, up to 20%ArenaviridaeFamilyDisease (Virus)Distribution FirstDescribedPersonto-personTransmissionVectors Reservoir Hosts Incubation PeriodUsual (range)Case Fatality RateTable 2. Key Characteristics of Viral Haemorrhagic Fevers1. Introduction The Management of Viral Haemorrhagic Fevers in Ireland/HPSC 2012- 19 -
1.10 Requirement to notify VHF to the World Health Organization under theInternational Health Regulations, 2005The aim of the International Health Regulations (IHR) is to help the international community prevent andrespond to acute public health risks that pose a serious risk to health worldwide and have the potential to crossborders. The IHR require countries to notify WHO of events that may constitute a Public Health Emergency ofInternational Concern (PHEIC). This is done by the WHO IHR National Focal Point at HPSC. An event of VHF(Ebola, Lassa, or Marburg) “shall always lead to utilisation of the algorithm in Annex 2 (a decision instrument forthe assessment and notification of events that may constitute a PHEIC), because this disease has demonstratedthe ability to cause serious public health impact and to spread rapidly internationally” and would be notified toWHO (Appendix D).The IHR 2005 came into force in 2007. There is a nationally agreed mechanism for responding to Public HealthEmergencies of International Concern (PHEIC) and this is the National Public Health Outbreak Response Planand Team (NPHORT). This would be activated in the event of a case of VHF arising in Ireland.1.11 Establishment and role of National Isolation CentresThe National Isolation Unit (NIU) for adult patients, located at the Mater Misericordiae University Hospital,Dublin (St. Bernard’s Ward), is the national referral centre for High Risk suspected and Confirmed cases ofVHF.Officially opened in December 2008, the self-contained unit has 12 beds including six lobbied, en-suite singlerooms with negative pressure ventilation. Two of the isolation rooms are of high specification and are separatefrom the rest of the unit with different air-handling systems. It is designed to admit, isolate and treat patientssuspected or diagnosed with highly infectious diseases who are referred from all over Ireland who have bothhazardous and highly infectious diseases. The Unit will also provide essential care of infectious diseasesstemming from any bioterrorism.There is currently no designated national paediatric referral centre for VHF. Contingency arrangements in theevent of a paediatric case arising are currently in development.This updated document provides guidance on the role of the National Isolation Unit in the assessment andclinical management of patients with VHF. It also provides information on ambulance transfer protocols fromhospitals to the NIU.1.12 Web resourcesThe VHF section of the Health Protection Surveillance Centre website (http://www.hpsc.ie/hpsc/A-Z/Vectorborne/ViralHaemorrhagicFever/) has been updated to reflect these guidelines. Available resourcesinclude up-to-date information on endemic countries and outbreaks of VHF, fact sheets and useful links as wellas the forms and algorithms contained in this document, which are available for download.1. Introduction The Management of Viral Haemorrhagic Fevers in Ireland/HPSC 2012- 20 -
Page 1 and 2: The Management ofViral Haemorrhagic
Page 3 and 4: 3.5 Infection prevention and contro
Page 5: The Viral Haemorrhagic Fever Sub-Co
Page 9 and 10: • As soon as VHF is being conside
Page 11 and 12: BackgroundIntroductionViral haemorr
Page 13 and 14: The search strategy for these guide
Page 15 and 16: 1.3 Overview of VHFsVHFs share a nu
Page 17 and 18: 1.6 Marburg haemorrhagic feverMarbu
Page 19: 1.9 FlavivirusesThe flaviviruses ca
Page 23 and 24: Table 3. Clinical presentation of C
Page 25 and 26: Patient Risk Assessment Key Points
Page 27 and 28: 2.4 Initial management of patient c
Page 29 and 30: If the malaria test is positive:•
Page 31 and 32: 3. Infection Prevention and Control
Page 37 and 38: - All acute hospitals should have a
Page 41 and 42: - For larger spills, cover the area
Page 43 and 44: 3.8 Handling human remainsThe gener
Page 45 and 46: 4.3 Packaging and transport of biol
Page 47 and 48: 4.5 Laboratory testing for High Ris
Page 49 and 50: 5. Public Health Management of Impo
Page 51 and 52: In the case of suspected Lassa feve
Page 53 and 54: Box 1Risk CategorisationCasual/no-r
Page 55 and 56: 5.4.4 Management of contactsThis is
Page 57 and 58: 5. Public Health Management of Impo
Page 59 and 60: Figure 3 Summary of notification pr
Page 61 and 62: should be identified in a bid to av
Page 63 and 64: The procedure for cleaning and disi
Page 65 and 66: 1. covert release of a biological a
Page 67 and 68: References1. Scientific Advisory Co
Page 69 and 70: 55. Department of Health and Childr
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Appendix A: Search Strategies for V
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Appendix C: Published Reports on Re
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available 24 hours a day to answer
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coughing. They advise that the stag
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This was the first highly pathogeni
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Appendix D: Annex 2: Decision Instr
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Has the patient...Clinical Risk Ass
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Appendix G: Summary of VHF Risk Cat
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longer thus increasing the risk of
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In April 1990, CDC reported on filo
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24. CDC Special Pathogens Branch. K
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Appendix J: VHF Risk Assessment for
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Malaria Test Results:Malaria test 1
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Port of Arrival:Name:Via:Arrived by
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VHF Case Exposure Assessment & Cont
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Healthcare workers:1234567891011121
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Total number of contactsVHF Case Ex
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Category of worker:CleanerDoctorIf
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Relationship to case:PassengerIf ot
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Are you currently well?Have you fev
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VHF High Risk Contact Surveillance
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VHF High Risk Contact Surveillance
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Appendix O:VHF Checklists of action
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Appendix P:Campus Map, Mater Miseri
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