Infectious Diseases in Critical Care Medicine

prophylaxis based on the infectious agent such as ribavirin in imported Lassa fever cases (161). In
the event this situation was to arise, the medical personnel must obtain the CDC references in the
Morbidity and Mortality Weekly Reportin order to have all specific guidelines.

REFERENCES

1. UN World Tourism Organization. Historical perspective of world tourism. Available at: http://
   unwto.org/facts/eng/historical.htm. Accessed on July 14 2008.


2. Hill DR, Ericsson CD, Pearson RD, et al. The practice of travel medicine: guidelines by the Infectious
   Disease Society of America. Clin Infect Dis 2006; 43:1499–1539.


3. International Society of Travel Medicine. The body of knowledge for the practice of travel medicine.
   Available at http://www.istm.org/educational_resources/body-ed-aspx. Accessed 15 July 2008.


4. Freedman DO, Weld LH, Kozarsky PE, et al. Spectrum of disease and relation to place of exposure
   among ill returned travelers. N Engl J Med 2006; 354(2):119–130.


5. Geosentinel. The global surveillance network of the ITSM and CDC. Available at: http://www.istm.
   org/geosentinel/main.html. Accessed 2 July 2008.


6. Wilson ME, Weld LH, Boggild A, et al. Fever in returned travelers: results from the GeoSentinel
   Surveillance Network. Clin Infect Dis 2007; 44:1560–1568.


7. Ryan ET, Wilson ME, Kain KC. Illness after international travel. N Engl J Med 2002; 347(7):505–516.


8. Warrell DA. Management of severe malaria. Parassitologia 1999; 41(1–3):287–294.


9. Leder K, Black J, O’Brien D, et al. Malaria in travelers: a review of the GeoSentinel Surveillance
   Network. Clin Infect Dis 2004; 39(8):1104–1112.


10. Greenberg AE, Lobel HO. Mortality fromPlasmodium falciparummalaria in travelers from the United
    States, 1959 to 1987. Ann Intern Med 1990; 113(4):326–327.

Table 5 General Considerations in the Management of Suspected VHF

Steps Action

1 Rapid assessment to determine if VHF suspect (fever within 3 wks of exposure plus travel to endemic

region or direct contact with potentially infected blood or body fluids)

2 Isolate immediately (main focus is avoidance of blood/body fluid exposure—refer to CDC guidelines for

specific details)

3 Rule out more common illness such as malaria and typhoid fever (refer to guidelines for proper specimen

handling)

4 Contact local/state health department and the CDC [tel: (404) 639-1510 during normal working hours;

after hours (404) 639-2888]

5 If clinical syndrome/exposure history supportive of Lassa fever or CCHF, consider ribavirin therapy (also

consider prophylaxis for high-risk contacts)

All suspected cases of VHF should be reported immediately to local and state health departments and to CDC

(Special Pathogens Branch, 404 639-2888). Consult the Special Pathogens Branch before obtaining or sending

specimens to CDC for confirmatory testing. State health departments should also be notified before sending

specimens to CDC. For links to state health departments visit the “Information Networks and Other Information

Sources” page on the CDC Web site http://www.cdc.gov/other.htm

Abbreviations: CCHG, Crimean-Congo hemorrhagic fever; CDC, Centers for Disease Control; VHF, viral

hemorrhagic fever.

Table 4 VHF Etiologies Associated with Nosocomial Spread

Virus Geographic Region Case Fatality Rate Therapeutic Options

Lassa West Africa 1%–2% Ribavirin (efficacy in clinical trial)a
Ebola Zaire, Sudan 65%–88% Supportive care
Marburg East and Central Africa 23% Supportive care
CCHF Eastern Europe, eastern
Mediterranean, Asia, and Africa

15%–70% Ribavirin (in vitro evidence/no

controlled trial)

aRibavirin dosing regimen—30 mg/kg loading dose IV (max. 2 g) then 16 mg/kg (max. 1 g/dose) q6h4 days,

then 8 mg/kg (max. 500 mg) q8h6 days; ribavirin prophylaxis in close contacts—(unproven regimen) 5 mg/kg
t.i.d.2–3 weeks.
Abbreviations: CCHF, Crimean-Congo hemorrhagic fever; VHF, viral hemorrhagic fever.

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