Table 1

Features of the viral haemorrhagic fevers3–24

VirusDiseaseGeographyHuman infection sourceIncubation (days)TreatmentClinical precautionsCommon clinical features and case fatality rate
Family: Filoviridae; Genera: Ebolavirus1, Marburgvirus2
Zaire ebolavirus, Sudan ebolavirus, Bundibugyo ebolavirus, Tai Forest ebolavirus1Ebola virus diseaseAfrica (central, western and eastern)Fruit bats, infected non-human primates, human-to-human, nosocomial, sexual transmission2–21Supportive and antibody based therapiesIsolation of patient
Full PPE for healthcare workers
Fever, weakness, headache, profuse diarrhoea, vomiting, conjunctival injection, hiccoughs, haemorrhage
CFR=25–90%
Marburg marburgvirus2Marburg HFAfrica (central, eastern and southern)Fruit bats, infected non-human primates and forest antelope, human-to-human, nosocomial2–21SupportiveIsolation of patient
Full PPE for healthcare workers
Fever, weakness, headache, myalgia, vomiting, diarrhoea, conjunctival injection, haemorrhage
CFR=24–88%
Family: Arenaviridae; Genus: Mammarenavirus
Lassa mammarenavirusLassa feverWest and central AfricaRodents, human-to-human, nosocomial, sexual transmission6–21Supportive and ribavirinIsolation 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 mammarenavirusArgentine HFArgentinaRodents, human-to-human, nosocomial5–19Supportive and convalescent plasmaIsolation of patient
Full PPE for healthcare workers
Fever, headache, myalgia, vomiting, retro-orbital pain, haemorrhage, irritability, ataxia
CFR=up to 30%
Machupo mammarenavirusBolivian HFBoliviaRodents, human-to-human (rare), nosocomial (rare)5–19Supportive and ?ribavirinIsolation of patient
Full PPE for healthcare workers
Fever, headache, myalgia, vomiting, retro-orbital pain, haemorrhage, irritability, ataxia
CFR=up to 30%
Guanarito mammarenavirusVenezuelan HFVenezuelaRodents, human-to-human, nosocomial?7–14Supportive and ?ribavirinIsolation of patient
Full PPE for healthcare workers
Fever, headache, sore throat, arthralgia/myalgia, diarrhoea, conjunctivitis, haemorrhage
CFR=up to 30%
Sabia mammarenavirusBrazilian HFBrazilRodents, human-to-human, nosocomial?7–14Supportive and ribavirinIsolation of patient
Full PPE for healthcare workers
Fever, headache, myalgia, vomiting, retro-orbital pain, haemorrhage, jaundice, hepatic necrosis CFR=up to 30%
Chapare mammarenavirusChapare HFBoliviaRodents, human-to-human, nosocomial?7–14Supportive and ribavirinIsolation of patient
Full PPE for healthcare workers
Unclear, little known, similar clinical presentation to Bolivian HF
Lujo mammarenavirusLujoZambiaRodents, human-to-human, nosocomial9–13Supportive and ribavirinIsolation 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 virus1Crimean-Congo HFAfrica, Balkans, Russia, Middle East, central Asia, western ChinaTicks, livestock animals (cattle, sheep, goats), ostriches, human-to-human, nosocomial1–13Supportive and ribavirinIsolation 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 virus2Severe fever with thrombocytopenia syndromeChina, Japan, South Korea and North KoreaTicks, human-to-human, nosocomial5–15SupportiveIsolation 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 virus2Rift Valley feverSub-Saharan and northern Africa, Saudi Arabia, YemenLivestock animals, unpasteurised milk, Aedes mosquitoes, haematophagous flies2–6Supportive and ribavirin and antibody therapiesNo interhuman transmission—Standard IP&C measuresFever, myalgia/arthralgia, headache, photophobia
CFR≤1% (approximately 50% in haemorrhagic form)
Hantaan virus, Seoul virus, Puumala virus3Haemorrhagic fever with renal syndromeworldwideRodents9–35Supportive and ribavirinNo documented interhuman transmission—standard IP&C measuresFever, 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 virus3Hantavirus pulmonary syndromeAmericasRodents7–28SupportiveOccasional interhuman spread for Andesvirus—isolation of patient and full PPE. Standard IP&C measures for other HantavirusesFever, 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 syndromeAfrica, South-East Asia, West Pacific Americas, East Mediterranean regionAedes mosquitoes4–10SupportiveNo interhuman transmission—occasional nosocomial transmission from needlestick injuries—Standard IP&C measuresFever, myalgia, headache, rash, haemorrhage
CFR≤1% (up to 10% for severe (haemorrhagic) Dengue)
Yellow fever virusYellow feverAfrica, South AmericaAedes mosquitoes3–6SupportiveNo known interhuman transmission—Standard IP&C measures. Aerosol infection in laboratory setting—full PPEJaundice, renal impairment, encephalopathy, haemorrhage
CFR=20%
Omsk hemorrhagic fever virusOmsk HFRussian federationTicks, infected muskrats3–14SupportiveNo known interhuman spread—Standard IP&C measures. Aerosol infection in laboratory setting—full PPEBiphasic—first phase: fever, myalgia, headache, diarrhoea, vomiting, haemorrhage
second phase: fever, encephalitic symptoms
CFR=0.4–2.5%
Kyasanur forest disease virusKyasanur Forest diseaseIndia, Western ChinaTicks, infected monkeys3–8SupportiveSuggestion of nosocomial spread. Consider isolation and full PPE. High risk of infection in laboratory setting—full PPEBiphasic—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 HFSaudi Arabia, EgyptTicks, mosquitoes, infected animals (sheep, camels), unpasteurised milk3–8SupportiveNo 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.