Public health priority: Urgent.
PHU response time: Respond immediately to probable and confirmed cases. Enter probable and confirmed cases on NDD within 1 working day.
Case management: Notify the Communicable Diseases Branch. Refer to the NSW Health Guideline (GL2016_002) NSW Contingency Plan for Viral Haemorrhagic Fevers. Hospitalise at the Viral Haemorrhagic Fever Treatment Facility, Westmead Hospital. Determine source of infection.
Contact management: Place contacts under active surveillance. Viral haemorrhagic fevers are subject to the Commonwealth Biosecurity Act 2015 in addition to the NSW Public Health Act 2010.
To identify cases, their source of infection and to prevent further transmission.
A probable case requires:
A compatible clinical illness as determined by an infectious disease physician. Common presenting complaints are fever, myalgia, and prostration, with headache, pharyngitis, conjunctival injection, flushing, and gastrointestinal symptoms. This may be complicated by spontaneous bleeding, petechiae, hypotension, and perhaps shock, oedema and neurologic involvement.
A confirmed case requires laboratory definitive evidence.
Laboratory definitive evidence requires confirmation by the Special Pathogens Laboratory, CDC, Atlanta, or the Special Pathogens Laboratory, National Institute of Virology (NIV), Johannesburg.
Testing is available through the Institute of Clinical Pathology and Medical Research, Westmead Hospital.
Viral haemorrhagic fevers are to be notified by:
Probable and confirmed cases should be entered onto NDD.
Note that viral haemorrhagic fevers are subject to the Commonwealth Quarantine Act 1908.
Important agents are Lassa fever virus (Arenavirus), Ebola virus, Marburg virus (Filoviradae) and Crimean-Congo haemorrhagic fever virus.
Mode of transmission depends on the particular virus, but in Australia (in the absence of enzootic cycles) is likely to be through exposure to blood and body fluids of infected persons.
See Section 2. Case definition.
Immediately on notification, begin the follow-up investigation and notify the Communicable Diseases Branch. Refer to the NSW Health Guideline (GL2016_02) NSW Contingency Plan for Viral Haemorrhagic Fevers.
Within 1 working day of notification enter on NDD probable and confirmed cases only.
The response to a notification will normally be carried out in collaboration with the case's health carers. But regardless of who does the follow-up, PHU staff should ensure that action has been taken to:
Identify the source of the infection, including details of travel and exposures to potentially infectious sources.
The case or relevant care-giver should be informed about the nature of the infection and the mode of transmission, including the likelihood of sexual transmission (for Marburg and Ebola fevers).
Institute isolation procedures in accordance with the NSW Health Guideline (GL2016_02) NSW Contingency Plan for Viral Haemorrhagic Fevers. Investigate transfer of the patient to the VHF Treatment Facility, Westmead.
None usually required. In the case of Rift Valley fever, notify NSW Agriculture immediately.
Contacts are defined as persons living with, caring for, testing laboratory specimens from, or having close contact with the case during the incubation period.
High risk contacts have experienced definite percutaneous or permucosal exposure (for example needle stick injury, body fluid contact with mucosal surfaces or broken skin).
Medium risk contacts have a high possibility of percutaneous or permucosal exposure (for example body fluids contact on intact skin, close face-to-face exposure without a mask, exposure to large volume of body fluids on protective clothing).
Low risk contacts have a low possibility of percutaneous or permucosal exposure (for example exposure to small volumes of body fluids on protective clothing, touched patient without gloves, handled specimen/cleaning without gloves).
Examples of aerosol exposure risk include handling unsealed specimens, cleaning room without a mask and being in the same room without a mask, but not having physical contact with the case.
Contacts should be placed under surveillance for the duration of the incubation period since last exposure.
Advise susceptible contacts (or parents/guardians) of the risk of infection and the reason for and duration of quarantine. Blood must not be donated.
Contacts may be quarantined. They may be released under quarantine surveillance for up to 3 weeks during which they are required to notify a Human Biosecurity Officer if suffering from a febrile illness. Public health units should initiate active daily surveillance at least for high and medium risk contacts.