Management of Hazard Group 4 viral haemorrhagic fevers and similar human infectious diseases of high consequence: November 2015

This document provides guidance on the risk assessment and management of patients in the United Kingdom in whom infection with a viral haemorrhagic fever (VHF) should be considered or is confirmed. This guidance aims to eliminate or minimise the risk of transmission to healthcare workers and others coming into contact with an infected patient or their samples. This guidance replaces the previous Advisory Committee on Dangerous Pathogens’ (ACDP) publication ‘Management and Control of Viral Haemorrhagic Fevers,’ published in 2012. VHFs are severe and life-threatening viral diseases that have been reported in parts of Africa, South America, the Middle East and Eastern Europe. VHFs are of particular public health importance because they can spread within a hospital setting; they have a high case-fatality rate; they are difficult to recognise and detect rapidly; and there is no effective treatment. Environmental conditions in the UK do not support the natural reservoirs or vectors of any of the haemorrhagic fever viruses, and all recorded cases of VHF in the UK have been acquired abroad, with the exception of one laboratory worker who sustained a needle-stick injury. In preparing this guidance, ACDP undertook a new assessment of the risks of transmission of VHF infection. Evidence from outbreaks strongly indicates that the main routes of transmission of VHF infection are direct contact (through broken skin or mucous membrane) with blood or body fluids, and indirect contact with environments contaminated with splashes or droplets of blood or body fluids. Experts agree that there is no circumstantial or epidemiological evidence of airborne transmission risk from VHF patients. Following the revised risk assessment, this guidance recommends control options for the isolation of VHF patients in the UK. These options include flexibility in the isolation of a patient with a VHF infection within a specialist High Level Isolation Unit (HLIU)