Viral Haemorrhagic Fevers

– Are grouped under this term a dozen disease etiologies and different transmission mode with common clinical signs.

– Dengue haemorrhagic fever is a viral haemorrhagic fever which is the subject of a specific chapter.

Clinical signs:

– Joint Syndrome:

• fever higher than 38.5 ° C

• short remission J3-J4

• hemorrhagic signs (purpura, epistaxis, melena, hematemesis)

– Clinical signs are often non-specific, their severity varies by etiology.

Viral Haemorrhagic FeversLaboratory:

– Send a sample of whole blood for serological diagnostic reference laboratory (eg Institut Pasteur). Attach a clinical description.

– Protection during removal (gloves, glasses, etc.).

– Use a triple transport packaging: wrap a tube paper towel with the blood sample and place it in a primary container, rigid and sealed (package 1). The absorbent paper should be sufficient to absorb all the blood collected if a tube should break. then place the container in a rigid primary and secondary sealed container suitable for transporting infectious substances (package 2). then place the secondary container in a rigid cardboard packaging bearing the biohazard label (package 3).

– The filter paper may be used. It is easier to carry but the small volume of blood is used to test a limited number of causes.

To behave:

Suspected haemorrhagic fever (isolated cases of fever with haemorrhagic signs in endemic areas):

– Isolation: isolated room (or failing screens / partitions); restrict visits (ensure their protection: overalls, gloves, mask).

– Standard hygiene precautions:

The basic rules of hospital hygiene must in all cases be respected. Most cases of intra-hospital infections have occurred due to the non

Following these simple rules.

• gloves for blood samples

• coats during consultations and care

• household gloves for handling soiled laundry

• hand washing

• Safety procedures injections

– Completing these non-specific measures by wearing masks and gloves when examining the patient, and goggles if splashing.

Confirmed cases of Ebola, Marburg, Lassa, Crimean-Congo or epidemic of unknown etiology:

– Specific measures:

• strict confinement in a reserved area, with input / output sas,

• disinfection of excreta (2% available chlorine) and safe disposal,

• disinfection of soiled linen by chlorination (0.1% chlorine)

• protective clothing for staff: double gloves, mask, cap, goggles, double gown, apron, rubber boots,

• input / output circuit: clean laundry for the staff at the entrance; disinfection area exit: overalls, boots and rubber gloves are soaked in chlorine solution (0.1% chlorine) 2 hours before washing. Container for disposable material.Handwashing with soap.

– The accompanying (1 maximum), assisted and supervised by staff, following the same steps.

– In case of death, do not wash the body. If cultural imperative: protective clothing, chlorinated water wash (2% available chlorine), small number of people.

Burial as soon as possible, in a body bag if possible.

– Port of protective gear when handling soiled equipment. No contaminated material may leave the isolation area which includes an incinerator pit at sharp / sharp objects and organic waste pit.

Confirmed cases of yellow fever or fever, Rift Valley:

– Universal hygiene measures.

– Place the patient under mosquito net to prevent transmission.

In all cases: declare the country’s health authorities.

Treatment:

– Etiological treatment: only for Lassa and Crimean-Congo (ribavirin).

– Symptomatic treatment :

• Fever: paracetamol. Acetylsalicylic acid (aspirin) is cons-indicated.

• pains: lightweight (paracetamol), moderate (tramadol), severe (sublingual morphine): see pain.

• Dehydration: follow plans for the prevention or treatment of dehydration, WHO.

• hemorrhagic shock.

• convulsions.

• Vomiting: promethazine PO

Children 2 to 10 years: 10 to 25 mg to be repeated every 6 hours if necessary

Children over 10 years and adults: 25 mg to be repeated every 6 hours if necessary

– For Ebola and Marburg injections of information must be strictly limited.

The establishment and maintenance of venous catheters pose a risk of contamination to personnel. Any intravenously must be completely secured to the patient, often confused, can not pull it out.

Prevention:

– Vaccination

• Yellow fever: mass vaccination for epidemic

Children from the age of 6 months and adults: a single dose of 0.5 ml IM or deep SC preferably in the deltoid muscle.In pregnant women, do not give in case of epidemic. Routine Immunization (EPI)

• Fever, Rift Valley (only in epidemics)

– Fight against vectors when they are known.

– Hospital hygiene essential in all cases.

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Editor-in-chief of the Medical Actu website; general practitioner graduated from the Faculty of Medicine of Algiers in 2005 currently practicing as a liberal.

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