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See viral haemorrhagic fever risk assessment algorithm above.
Inclusion criteria for high possibility of VHF:
Presence of fever >37.5 or positive history of fever in the last 24 hrs AND of travel to VHF endemic area in the last 21 days (see maps in appendix 1 below) AND:
Living in basic rural conditions where Lassa fever endemic (see maps in appendix 1 below)
Visiting caves/mines, or having contact with/eating primates, antelopes or bats in a Marburg/Ebola endemic area (see maps in appendix 1 below)
Travelling in an area where Crimean-Congo fever is endemic (see maps in appendix 1 below) AND sustaining a tick bite or crushing a tick with their bare hands OR had close involvement with animal slaughter
The patient has active bleeding or extensive bruising
Returning traveller from an area with current outbreak
If there is a high possibility of VHF, appropriate PPE should be donned (see PPE section below) and the patient moved safely to room 18 (negative pressure) in CDU
Investigation for malaria should proceed concurrently with VHF investigations
If a patient has previously had Ebola virus diagnosed (“Ebola survivor”) please discuss with the ID consultant on‐call. This document does not apply to them necessarily.
If these criteria are not met then there is a low possibility of VHF, malaria investigation should be prioritised and the patient managed in a single room with ensuite/commode.
If presenting with a child with a fever, ED reception staff should ask if they have visited one of the countries highlighted on the VHF and CCHF maps (see appendix 1 below) within the last 21 days.
Areas with endemic haemorrhagic fever include-
|Out with Africa-||Afghanistan
Serbia and Montenegro
United Arab Emirates
Stored in ED major incident cupboard
Removal (doffing) of PPE
Breech of PPE
ED Majors Consultant
Pamela Joannidis (Nurse Consultant and lead)
Angela Johnson( Senior IPCN)
Sharon Carlton ( Administrator)
ID Consultant On Call:
Virology lab (West of Scotland Virology Centre)
Geographic distribution of Crimean-Congo Haemorrhagic Fever
Grab Bags with the required blood bottles are in the trolley in the ED major incident cupboard.
Take only labelled blood bottles, parafilm and cannulation equipment into the room.
After filling the bottles, the doctor should wipe their hands with an alcohol soaked wipe, then wipe each bottle individually. Seal the blood bottles with PARAFILM laboratory tape by wrapping the tape around the lid of each bottle like “cling‐film”
An assistant, wearing gloves, should come to the door of the room, but not enter the room. The assistant should hold open specimen bags each containing absorbent tissue. The doctor from the patient’s room should drop a single blood bottle into each bag using a no touch technique.
Away from the patient room, the assistant should seal each bag, then wrap each specimen + bag in bubble wrap before sealing it in the waterproof hard plastic container. The request form and sealed container is then put back in the cardboard box and sealed with the sticker provided prior to delivery to the lab.
Last reviewed: 11 June 2021
Next review: 30 June 2024
Author(s): Ciara Carrick
Approved By: Emergency Department