Viral haemorrhagic fevers imported into non-endemic countries: risk assessment and management.
BACKGROUND
Viral haemorrhagic fevers (VHFs) are severe infections capable of causing haemorrhagic disease and fatal multi-organ failure. Crimean-Congo, Marburg, Ebola and Lassa viruses cause both sporadic cases and large epidemics over wide endemic areas.


METHODS
Original articles and reviews identified by PubMed search and personal reading; European and United States national guidance and legislation. World Health Organization information, documents and reports. VHFs cause significant morbidity and mortality in their endemic areas; they can cause healthcare-related infections, and their broad diversity and range are increasingly recognized.


RESULTS
There is uncertainty about the risks presented by VHFs in non-endemic countries, particularly in healthcare environments. Consensus on the best modes of care and infection control are only slowly emerging.


CONCLUSIONS
With increasing commerce in rural and low-income areas, VHF outbreaks increasingly expand, causing social and economic damage.


CONCLUSIONS
New ecologies, viral strains and clinical syndromes are being discovered. There is a great need for rapid diagnostic tests and effective antiviral treatments. Vaccine development programmes are challenged by multiple viral strains and the need for trials in rural communities.
Bannister
Barbara
B
Department of Infectious Diseases, Royal Free Hospital, Hampstead, London NW3 2QG, UK. barbara.bannister@royalfree.nhs.uk
D000818:Animals; D004196:Disease Outbreaks / Q000517:prevention & control*; D004197:Disease Reservoirs / Q000821:virology*; D004199:Disease Vectors; D014943:Global Health; D006482:Hemorrhagic Fevers, Viral / Q000453:epidemiology* / Q000517:prevention & control / Q000635:transmission; D006801:Humans; D017053:Infection Control / Q000379:methods*; D018570:Risk Assessment