This is the second, updated version of the WHO's Clinical Management of
Patients with Viral Haemorrhagic Fever: A Pocket Guide for Front-line
Health Workers. Interim Emergency Guidance for Country Adaption, first
published in March 2014.
This pocket guide provides clear guidance on current best practices for
viral haemorrhagic fever (VHF), including both clinical management and
infection prevention and control. Throughout, guidance is provided for
the front-line health worker, focusing on triage and case definition,
early and ongoing case management, infection control and subsequent
hospital discharge. Recommendations come predominantly from published
VHF guidelines (primarily consensus-based), and also are draw from
algorithms for diarrhoreal diseases, sepsis and vaginal bleeding
management from the WHO Integrated Management of Adolescent and Adult
Illness (IMAI) and Childhood Illness (IMCI) guidelines and other current
WHO normative guidelines. The rationale for including the management of
GI loss from diarrhoreal disease and vomiting and the sepsis algorithms
is that many patients in the West African Ebola epidemic have had severe
diarrhorea and vomiting with dehydration and shock; others have this
combined with severe sepsis or clinical pictures consistent with
suspected pathophysiology and final common pathway of severe sepsis,
with manifestations of increased vascular permeability, vasodilatation,
multiple organ failure and shock. In addition, this book provides
guidance on infection prevention and control to minimize nosocomial
transmission and on the common clinical manifestations of VHF to help
the front-line health worker increase his or her level of suspicion for
VHF, particularly before an epidemic is recognized in the community.
Separate notes have been added on the care of children and pregnant
women.
Importantly, this document does not cover how to create a VHF treatment
unit (that is, an isolation ward), and it also does not address
community interventions to control transmission or respond to disease
outbreaks. It is hoped that this manual will be complement such guidance
and will strengthen the overall response to VHF outbreaks in Africa,
contributing to the Integrated Disease Surveillance and Response
activities necessary for compliance with international health
regulations.
Although these guidelines concentrate on Ebola Virus Disease (EVD),
referred to throughout this guide as Ebola, they also address Lassa
fever, which is an endemic problem in Sierra Leone and also occurs in
Liberia, Guinea and Nigeria, as well as two other viral haemorrhagic
fevers that are transmitted person-to-person, Marburg and Crimean-Congo
haemorrhagic fever. Country adaptation should address which VHFs are
included in this pocket guide.
