Table 1

Features of the viral haemorrhagic fevers3–24

Virus	Disease	Geography	Human infection source	Incubation (days)	Treatment	Clinical precautions	Common clinical features and case fatality rate
Family: Filoviridae; Genera: Ebolavirus¹, Marburgvirus²
Zaire ebolavirus, Sudan ebolavirus, Bundibugyo ebolavirus, Tai Forest ebolavirus¹	Ebola virus disease	Africa (central, western and eastern)	Fruit bats, infected non-human primates, human-to-human, nosocomial, sexual transmission	2–21	Supportive and antibody based therapies	Isolation of patient Full PPE for healthcare workers	Fever, weakness, headache, profuse diarrhoea, vomiting, conjunctival injection, hiccoughs, haemorrhage CFR=25–90%
Marburg marburgvirus²	Marburg HF	Africa (central, eastern and southern)	Fruit bats, infected non-human primates and forest antelope, human-to-human, nosocomial	2–21	Supportive	Isolation of patient Full PPE for healthcare workers	Fever, weakness, headache, myalgia, vomiting, diarrhoea, conjunctival injection, haemorrhage CFR=24–88%
Family: Arenaviridae; Genus: Mammarenavirus
Lassa mammarenavirus	Lassa fever	West and central Africa	Rodents, human-to-human, nosocomial, sexual transmission	6–21	Supportive and ribavirin	Isolation of patient Full PPE for healthcare workers	Fever, sore throat, retrosternal pain, myalgia, severe cases—gross oedema, haemorrhage, deafness CFR=Approximately 15% (hospitalised patients)
Junin mammarenavirus	Argentine HF	Argentina	Rodents, human-to-human, nosocomial	5–19	Supportive and convalescent plasma	Isolation of patient Full PPE for healthcare workers	Fever, headache, myalgia, vomiting, retro-orbital pain, haemorrhage, irritability, ataxia CFR=up to 30%
Machupo mammarenavirus	Bolivian HF	Bolivia	Rodents, human-to-human (rare), nosocomial (rare)	5–19	Supportive and ?ribavirin	Isolation of patient Full PPE for healthcare workers	Fever, headache, myalgia, vomiting, retro-orbital pain, haemorrhage, irritability, ataxia CFR=up to 30%
Guanarito mammarenavirus	Venezuelan HF	Venezuela	Rodents, human-to-human, nosocomial	?7–14	Supportive and ?ribavirin	Isolation of patient Full PPE for healthcare workers	Fever, headache, sore throat, arthralgia/myalgia, diarrhoea, conjunctivitis, haemorrhage CFR=up to 30%
Sabia mammarenavirus	Brazilian HF	Brazil	Rodents, human-to-human, nosocomial	?7–14	Supportive and ribavirin	Isolation of patient Full PPE for healthcare workers	Fever, headache, myalgia, vomiting, retro-orbital pain, haemorrhage, jaundice, hepatic necrosis CFR=up to 30%
Chapare mammarenavirus	Chapare HF	Bolivia	Rodents, human-to-human, nosocomial	?7–14	Supportive and ribavirin	Isolation of patient Full PPE for healthcare workers	Unclear, little known, similar clinical presentation to Bolivian HF
Lujo mammarenavirus	Lujo	Zambia	Rodents, human-to-human, nosocomial	9–13	Supportive and ribavirin	Isolation of patient Full PPE for healthcare workers	Fever, myalgia, sore throat, headache, diarrhoea, vomiting, rash, facial oedema, conjunctival injection, haemorrhage CFR=approx. 80%
Family: Bunyaviridae; Genera: Nairovirus¹, Phlebovirus², Hantavirus³
Crimean-Congo hemorrhagic fever virus¹	Crimean-Congo HF	Africa, Balkans, Russia, Middle East, central Asia, western China	Ticks, livestock animals (cattle, sheep, goats), ostriches, human-to-human, nosocomial	1–13	Supportive and ribavirin	Isolation of patient Full PPE for healthcare workers	Fever, myalgia, headache, vomiting, diarrhoea, bleeding (nose, gums) CFR=30% (15–70%), approximately 5% in children <18 years
Severe fever with thrombocytopenia syndrome virus²	Severe fever with thrombocytopenia syndrome	China, Japan, South Korea and North Korea	Ticks, human-to-human, nosocomial	5–15	Supportive	Isolation of patient Full PPE for healthcare workers	Fever, thrombocytopenia, leucopenia, myalgia, vomiting, diarrhoea, headache with evolving disseminated intravascular coagulation, haemorrhage and multiorgan failure. CFR=8%
Rift Valley fever virus²	Rift Valley fever	Sub-Saharan and northern Africa, Saudi Arabia, Yemen	Livestock animals, unpasteurised milk, Aedes mosquitoes, haematophagous flies	2–6	Supportive and ribavirin and antibody therapies	No interhuman transmission—Standard IP&C measures	Fever, myalgia/arthralgia, headache, photophobia CFR≤1% (approximately 50% in haemorrhagic form)
Hantaan virus, Seoul virus, Puumala virus³	Haemorrhagic fever with renal syndrome	worldwide	Rodents	9–35	Supportive and ribavirin	No documented interhuman transmission—standard IP&C measures	Fever, headache, blurred vision, myalgia, vomiting, proteinuria, renal impairment, mild haemorrhage. Hantaan CFR=5–15% Puumala CFR≤1%
Sin Nombre virus, Black Creek Canal virus, Bayou virus, Andes virus³	Hantavirus pulmonary syndrome	Americas	Rodents	7–28	Supportive	Occasional interhuman spread for Andesvirus—isolation of patient and full PPE. Standard IP&C measures for other Hantaviruses	Fever, myalgia, headache, vomiting, diarrhoea, shortness of breath, cough, pulmonary oedema, pleural effusion CFR=40–50%
Family: Flaviviridae Genus: Flavivirus
Dengue virus (types 1–4)	Dengue HF, Dengue shock syndrome	Africa, South-East Asia, West Pacific Americas, East Mediterranean region	Aedes mosquitoes	4–10	Supportive	No interhuman transmission—occasional nosocomial transmission from needlestick injuries—Standard IP&C measures	Fever, myalgia, headache, rash, haemorrhage CFR≤1% (up to 10% for severe (haemorrhagic) Dengue)
Yellow fever virus	Yellow fever	Africa, South America	Aedes mosquitoes	3–6	Supportive	No known interhuman transmission—Standard IP&C measures. Aerosol infection in laboratory setting—full PPE	Jaundice, renal impairment, encephalopathy, haemorrhage CFR=20%
Omsk hemorrhagic fever virus	Omsk HF	Russian federation	Ticks, infected muskrats	3–14	Supportive	No known interhuman spread—Standard IP&C measures. Aerosol infection in laboratory setting—full PPE	Biphasic—first phase: fever, myalgia, headache, diarrhoea, vomiting, haemorrhage second phase: fever, encephalitic symptoms CFR=0.4–2.5%
Kyasanur forest disease virus	Kyasanur Forest disease	India, Western China	Ticks, infected monkeys	3–8	Supportive	Suggestion of nosocomial spread. Consider isolation and full PPE. High risk of infection in laboratory setting—full PPE	Biphasic—first phase: fever, myalgia, headache, haemorrhage, conjunctivitis second phase—neurological manifestations CFR=2–30% (recent studies indicate <4%)
Alkhurma hemorrhagic fever virus (variant of Kyasanur)	Alkhurma HF	Saudi Arabia, Egypt	Ticks, mosquitoes, infected animals (sheep, camels), unpasteurised milk	3–8	Supportive	No known interhuman transmission—Standard IP&C measures.	Fever, headache, myalgia/arthralgia, vomiting, haemorrhage, encephalitis CFR=Up to 25%

CFR, case fatality rate; IP&C, infection prevention & control; PPE, personal protective equipment.