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Hemorrhagic Fevers


What are hemorrhagic fevers?

Hemorrhagic fevers (HFs) are illnesses that are caused by several groups of viruses. HFs are also called viral hemorrhagic fevers. HFs include the Ebola and Marburg viruses, yellow fever, dengue hemorrhagic fever, and Crimean-Congo hemorrhagic fever. The viruses are commonly found in rats, mice, and other field rodents. The viruses can also be found in carriers such as mosquitoes and ticks. The viruses leading to HFs can be found anywhere in the world where these animals and carriers live. HFs may cause mild illness, but they may also cause life-threatening illness.

How are HFs spread?

  • Infected animals may spread the virus if you touch the animal or its urine, feces (bowel movements), or other body fluids. You can also get an HF if you eat the meat of an infected animal An HF from handling an infected animal is more common in hunters and animal workers.
  • Carriers such as mosquitos or ticks can spread an HF virus by biting you. You can also get the virus by smashing a carrier against your skin.
  • Bio-terrorism is when an HF virus is used as a biologic weapon against people. The viruses are usually inhaled when they are used as a weapon of terrorism.
  • Lab accidents can cause the virus to spread. People who work in a lab handle blood and other body fluids often. If a lab accident occurs with an infected person's body fluids, the lab worker may become infected.
  • Person to person contact occurs if you get an HF from another person who is infected with the virus. This can occur if you have close contact with an infected person's body fluids. You can also be infected if you touch an object with an infected person's body fluids on it.

What increases my risk for an HF?

Unless you live or travel where HF viruses live, your risk for an HF is low. The animals that carry the virus do not usually travel outside of their natural living area. Your risk for an HF increases if you travel to an area where the virus lives. Tropical, wet areas and areas where there is a lot of standing water may have more mosquitoes. Your risk for an HF is higher if the virus is brought into the area where you live. This may happen when a person travels from one country to another and becomes infected. It also may happen if an infected animal is brought to the area where you live.

What are the signs and symptoms of HFs?

Depending on the kind of HF you have, you may have very few or no symptoms. Your symptoms may begin a couple days to a week or more after you have been infected.

  • Common signs and symptoms:
    • Fever or shaking chills
    • Diarrhea, nausea, vomiting, stomach pain, or loss of appetite
    • Headache or dizziness
    • Muscle and joint aches
    • Pain behind your eyes, or swollen, red eyes
    • Sore throat with or without white or yellow spots on your tonsils
    • Fatigue and weakness
  • More serious signs and symptoms:
    • Bleeding from a body opening, such as your eyes, ears, nose, mouth, or rectum
    • Bleeding gums or signs of bleeding under your skin, such as bruises or red or purple dots
    • Chest pain or trouble breathing
    • Confusion, shaking, or seizures
    • Jaundice (yellowing of the skin or whites of the eyes)
    • Urinating very little or not at all

How are HFs diagnosed?

Your healthcare provider will ask if you have traveled to another country recently. Tell your healthcare provider if you were bitten by any insects or were in contact with any rodents or rodent nests. Tell your healthcare provider if you have been in contact with someone who has an HF. Your healthcare provider will do a complete physical exam and check for signs of bleeding. You may also need any of the following:

  • Blood and urine tests may show signs of infection or the cause of infection. They may also be done to get information about your overall health.
  • A throat culture is a test that may help healthcare providers learn which type of virus is causing your illness. A throat culture is done by rubbing a cotton swab against the back of your throat.
  • An ultrasound uses sound waves to show pictures of your organs and tissues on a monitor. Your healthcare provider may use an ultrasound to look at the organs in your abdomen or chest. He will look for signs of organ damage and areas of fluid collection caused by an HF.

How are HFs treated?

There are no treatments that cure HFs. Treatment will depend on your symptoms, such as fever, diarrhea, and bleeding, and if your symptoms are severe. The goal of treatment is to control your symptoms and help your body fight the HF. You may need any of the following:

  • Antiviral medicine may be given to fight the virus causing your HF. This medicine may decrease your signs and symptoms, and help you feel better faster.
  • IV fluid replacement may be needed if you lose too much body fluid. You will receive liquids through a tube that is placed in your vein.
  • Hemodialysis cleans your blood when your kidneys cannot. Extra water, chemicals, and waste products are removed from your blood by a dialyzer or dialysis machine. The dialysis machine does this by passing your blood through a filter, then returning it back to you. You may need dialysis if your HF caused your kidneys to stop working.
  • Isolation may be needed because you have an infection that can spread to others. You may need reverse isolation if your body is having trouble with fighting the infection. This is a private hospital room to protect you from other people's germs. Healthcare providers and visitors may need to wear gloves, a face mask, or a gown. Everyone must wash their hands when they enter and leave your room.
  • Plasma transfusion may be needed if your HF causes you to bleed. Plasma is the liquid part of your blood. You will get the transfusion through an IV. The risk for AIDS, hepatitis, or West Nile virus from a blood transfusion is rare. Ask your healthcare provider for information if you have any concerns.

How can I decrease my risk for an HF?

  • Avoid contact with infected animals and insects. Examples are mosquitoes, ticks, and rodents. Protect yourself from insect bites by wearing protective clothing, insect repellant, and using bed nets. Make sure your windows have screens to keep insects out. Wear protective gloves if you are in contact with rodent droppings (urine or feces) or rodent nests.
  • Avoid contact with an infected person. Also avoid close contact with the person's body fluids. If you are caring for someone with an HF, wear protective clothing. You will need to clean all objects used to care for the infected person as directed by a healthcare provider.
  • Get vaccinated. Get vaccinated against yellow fever if you will be traveling to areas where mosquitoes carry yellow fever. The yellow fever vaccine does not protect you for your entire life. Ask your healthcare provider for more information about vaccines against HFs.
  • Use caution when you travel. Avoid traveling to areas where there is a high number of HF infections.

What should I do if I have an HF?

If you are diagnosed with an HF, give your healthcare provider a list of all your close contacts. This includes family, friends, and coworkers. Any person you have had contact with will need to be seen by a healthcare provider. Each person should be checked for signs and symptoms of an HF. If you are a woman, tell your healthcare provider if you are currently breastfeeding your child. You may need to stop breastfeeding while you have an HF. You may pass the HF infection to your child through your breast milk.

When should I contact my healthcare provider?

  • You feel dizzy and weak, or you have fainted.
  • You have a fever that is not getting better or gets higher, and shaking chills.
  • You have a severe headache.
  • You have blisters or yellow or white spots in your throat.
  • You have new or increased abdominal pain, vomiting, or diarrhea.
  • You have questions or concerns about your condition or care.

When should I seek immediate care or call 911?

  • You are unable to urinate, or you urinate more or less than usual for you.
  • You feel very confused, shaky, and tired, or you have a seizure.
  • You have chest pain or trouble breathing.
  • You have new or increased bleeding from your ears, nose, mouth, eyes, or rectum.
  • You have new or increased blood in your vomit, urine, or bowel movements. You are female and have much heavier bleeding than normal during your monthly period.
  • You have new or increased bruising or red or purple dots on your skin.
  • Your heart is beating faster than is normal for you.
  • Your skin is cold and you feel very restless.
  • Your skin or the whites of your eyes turn yellow, or your abdomen is swollen and hard.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your healthcare providers to decide what care you want to receive. You always have the right to refuse treatment. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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