Early risk assessment for viral haemorrhagic fever: experience at the Hospital for Tropical Diseases, London, UK.
OBJECTIVE
To implement a policy of systematic screening for viral haemorrhagic fever (VHF) among travellers returning from African countries with fever, commencing at initial clinical contact.


METHODS
A protocol based on UK Advisory Committee on Dangerous Pathogens guidance was developed collaboratively by medical, nursing and laboratory staff. Audit was carried out to quantify resource demands and effects on time to diagnose malaria, the main differential diagnosis.


RESULTS
A protocol is now implemented for all patients presenting to HTD with fever, with clear guidelines for interaction with clinical and laboratory staff at each stage. The protocol required moderate amounts of clinical and laboratory staff time and resulted in some additional hospital admissions. The time to a diagnosis of malaria increased from a median of 90 (range 50-125) min in patients without VHF risk to a median of 140 (range 101-225) min (p=0.0025) in those assessed as at risk.


CONCLUSIONS
Although all acute medical services need to have robust procedures for early detection of patients with serious transmissible conditions, few implement such a policy. Our protocol requires increased human and other resources but has no important impact on the rapidity of diagnosis of malaria, and is now embedded in local practice.
The Hospital for Tropical Diseases, Directorate of Infection, University College London Hospitals, Mortimer Market, Capper Street off Tottenham Court Road, London WC1E 6AU, UK.
Charles J
CJ
Woodrow
Alice C
AC
Eziefula
Dan
D
Agranoff
Geoffrey M
GM
Scott
Julie
J
Watson
Peter L
PL
Chiodini
Diana N J
DN
Lockwood
Alison D
AD
Grant
D000349:Africa; D002985:Clinical Protocols; D003937:Diagnosis, Differential; D003955:Diagnostic Tests, Routine; D042241:Early Diagnosis; D005334:Fever / Q000209:etiology*; D006482:Hemorrhagic Fevers, Viral / Q000175:diagnosis*; D006782:Hospitals, Special / Q000592:standards*; D006801:Humans; D008131:London; D008403:Mass Screening / Q000592:standards*; D008485:Medical Audit; D018570:Risk Assessment; D014195:Travel; D014330:Tropical Medicine / Q000379:methods / Q000592:standards*; D006113:United Kingdom