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Viral Hemorrhagic Fever

What is suspected or confirmed viral hemorrhagic fever?
Viral hemorrhagic fever (VHF) refers to a group of illnesses caused by several families of viruses. In general, the term describes a severe condition in which multiple organ systems in the body are affected. Typically, the vascular (blood vessel) system is damaged, and the body loses its ability to control bleeding. Some types of hemorrhagic fever viruses cause relatively mild illnesses; others cause severe, life-threatening disease.

What are the symptoms of viral hemorrhagic fever?
Specific signs and symptoms vary by the type of VHF, but they often begin with high fever, fatigue, dizziness, muscle aches, loss of strength and exhaustion. People with severe cases of VHF show signs of bleeding under the skin, in internal organs or from the mouth, eyes or ears. Although they may bleed from many sites around the body, people rarely die from of blood loss. Severely-ill people may also experience shock, coma, delirium, or seizures. Some types of VHF are associated with kidney failure.

How common is viral hemorrhagic fever and how is it usually caused?
Human cases or outbreaks of hemorrhagic fevers rarely occur. But an outbreak cannot be easily predicted.

What is bioterrorism?
Bioterrorism is the intentional use of biological agents, or germs, to cause illness. Bioterrorism has occurred in NYC only in 2001, when several media outlets received letters that were intentionally contaminated with anthrax bacteria.

How soon after viral hemorrhagic fever infection do symptoms appear?
Depending on the virus, symptoms can appear between two and 30 days following exposure.

What should I do if I have or someone I know has viral hemorrhagic fever symptoms?
Anyone with the symptoms of viral hemorrhagic fever should contact their medical provider immediately. If there is severe bleeding, chest pain, breathing difficulty, severe headache, confusion or other serious illness, call 911.

Who usually gets viral hemorrhagic fever when the disease occurs naturally?
Hantavirus is the only VHF that naturally occurs in the eastern United States. It is a rare disease that occurs in people exposed to mouse urine and droppings contaminated with the virus. Most cases of Hantavirus have occurred among people who have cleaned hunting cabins and other dwellings without wearing appropriate masks.

How is viral hemorrhagic fever spread?
The viruses carried in rodents are transmitted to humans through contact with urine, feces, saliva or other excretions from the infected rodents. The viruses transmitted by insects are usually spread when an infected mosquito or tick bites a human or when a human crushes a tick. However, some infected insects may first spread the virus to animals (livestock, for example). Humans then become infected when they care for or slaughter the infected animals.

Is viral hemorrhagic fever contagious?
Some viruses that cause VHF can spread from one person to another, once the first person has become infected. Ebola, Marburg, Lassa and Crimean-Congo hemorrhagic fever viruses are examples. This type of transmission can occur directly, through close contact with infected people or their body fluids. It can also occur indirectly, through contact with objects contaminated with infected body fluids. For example, contaminated syringes and needles have played an important role in spreading infection in outbreaks of Ebola hemorrhagic fever and Lassa fever.

How is viral hemorrhagic fever diagnosed?
Viral hemorrhagic fever can be diagnosed only at a small number of government laboratories. Blood tests usually will determine whether any of the suspected viral hemorrhagic fevers have caused a patient’s illness.

What is the treatment for viral hemorrhagic fever?
Patients receive supportive medical therapy, but generally speaking, there is no other treatment or cure for VHF. Ribavirin, an anti-viral drug, has been effective in treating some people with Lassa fever or hemorrhagic fever with renal syndrome.

Is there a vaccine for viral hemorrhagic fever, and how can I get it?
With the exception of yellow fever and Argentine hemorrhagic fever, for which vaccines have been developed, no vaccines exist that can protect against these diseases. In places where VHFs occur naturally, prevention efforts focus on avoiding contact with animal and insect hosts.

What has New York City done to address the threat of viral hemorrhagic fever?
Many federal, state, and city agencies, including the New York City Department of Health and Mental Hygiene (DOHMH), have been working together for several years to prepare for the detection and response to a bioterrorism incident in New York City. In cooperation with other emergency response agencies, the Health Department has established systems to improve detection and response to public health emergencies caused by the intentional release of a biological agent.

How Will I Cope?
A viral hemorrhagic fever outbreak in NYC can be very stressful, especially if it is large scale event. It can disrupt your everyday life and make you and those around you feel less safe. You may experience fear and uncertainty. Learning about stress and strategies to manage it can help you cope.

Prepare Today, Cope Better Tomorrow - Stress during Disasters provides basic information and practical advice on dealing with the stress and anxiety caused by disasters. It is available in seven languages.

If there is a viral hemorrhagic fever outbreak in the city and you feel overwhelmed and unable to cope, or if you are concerned about someone else, you can find help by calling 1-800 LIFENET. LIFENET is a free, confidential helpline for New York City residents, available 24/7, with trained staff ready to take your calls and offer advice: 1-800-LifeNet 1-800-543-3638 (English), 1-877-Ayudese 1-877-298-3373 (Spanish), 1-877-990-8585 (Chinese), 1-212-982-5284 (TTY).

Where can I get more information?
For more information about viral hemorrhagic fever, visit:

Centers for Disease Control and Prevention (CDC)