Transmission of Viral Hemorrhagic Fevers in High-Income Hospitals
Transmission of viral hemorrhagic fevers to health care personnel in high-income settings is rare, according to a systematic review and meta-analysis. Researchers evaluated cases of viral hemorrhagic fever diagnosed after patient admission that triggered formal hospital investigations, analyzing data from 35 eligible studies across 5,890 screened records.
Global Distribution of Cases and Reporting Locations
Source origins and reporting locations varied widely across the analyzed literature. Africa accounted for source origins in 15 reports, while Asia contributed 10. Europe accounted for 5 source origins, South America for 4, and North America for 1. When looking at reporting locations specifically, Europe led with 17 reports, followed by North America with 9, Asia with 8, and South America with 1.
Lassa virus emerged as the most frequently reported pathogen, appearing in 8 studies. Crimean-Congo hemorrhagic fever virus followed in 7 studies. Severe fever with thrombocytopenia syndrome virus and Ebola virus each appeared in 6 cases, and Andes virus was documented in 4 cases. Marburg virus appeared in 2 studies, while Hantaan virus and Sabiá virus each appeared in a single study.
Direct contact with body fluids drove most exposures
Direct contact with body fluids represented the most frequently documented exposure category, appearing in 80% of the evaluated studies. Physical contact without body fluids occurred in 69% of studies. These figures reflect the proportion of studies reporting each circumstance rather than the exact count of individual personnel exposed.
Personal protective equipment use patterns showed distinct gaps during initial assessments. Staff used some, but not all, required protective gear in 49% of studies, while 37% of reports noted no PPE use. Other reported activities included handling laboratory specimens in 43% of studies, indirect contact with body fluids in 31%, intubation in 23%, and handling contaminated waste in 23%.
Contact tracing and monitoring lead infection control interventions
Contact tracing served as the most frequently documented intervention, appearing in 89% of the studies. Monitoring of exposed contacts occurred in 83% of reports, and testing of contacts was documented in 80%. Facilities utilized isolation wards in 57% of studies, and personal protective equipment implementation after case identification was recorded in 46% of reports.
Specialized sample management was noted in 34% of studies, while specialized waste management appeared in 23%. Quarantine of exposed contacts occurred in 20% of studies, and staff cohorting was reported in 6%. For medical management following exposure, ribavirin prophylaxis appeared in 20% of studies, and ribavirin treatment was documented in 6%.
What was the median exposure time and most frequent virus?
What was the median exposure time before disease recognition?
The median exposure time before disease recognition and the implementation of viral hemorrhagic fever precautions was 3 days across the evaluated studies.
Which viral hemorrhagic fever was reported most frequently?
Lassa virus was the most frequently reported virus, appearing across 8 of the analyzed studies.
What was the most commonly reported intervention after an exposure?
Contact tracing was the most frequently documented intervention, appearing in 89% of the studies.
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