Infection Control for Viral Haemorrhagic Fevers in the African Health Care Setting

About The Manual

In 1995, an outbreak of Ebola hemorrhagic fever (Ebola HF) affected more than 300 people in and around the city of Kikwit, Democratic Republic of the Congo (formerly, Zaire); approximately 80% of the patients died. More than one-fourth of all the patients were health care workers. After the outbreak, the DRC Ministry of Health, the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) developed practical recommendations for carrying out viral hemorrhagic fever (VHF) isolation precautions in rural health facilities in Africa. These recommendations have been consolidated in a manual for the local health community.

Although there is still a great deal to learn about Ebola HF, two observations from the Kikwit outbreak strongly indicate that future outbreaks of this magnitude could be prevented:

  • The first case occurred in January 1995, but went unrecognized as Ebola HF by health-care workers. This one case started a chain of transmission of the virus that finally was recognized in April of that year, when many more cases appeared. The outbreak peaked in May. Thus, between January and April, there was a window of opportunity that could have allowed early detection and proper management of patients; the early response might have prevented widespread transmission of the virus.
  • After an international investigation team arrived in May 1995 and worked with Kikwit medical community to introduce VHF isolation precautions as well as standard precautions, no further nosocomial transmission of the virus was documented, indicating that although Ebola HF is highly infectious, the use of these measures is effective in preventing the spread of disease.

The observations sent a strong message to the public health and medical communities in Africa and internationally: combining early suspicion of VHF and isolation precautions can help to prevent another serious outbreak of Ebola HF or other VHF in the future. The only question remaining was how these goals could be achieved in a region where resources are scarce and the health care infrastructure is either underdeveloped or deteriorating. This manual, prepared collaboratively by CDC and WHO, attempts to address the issues of early provisional diagnosis and response within a limited infrastructure. It is designed for the following uses:

  • for prevention through preparedness–to help African health facilities make advance preparations for responding with appropriate precautions when a VHF case is suspected.
  • for planning and conducting in-service training to strengthen standard precautions and VHF isolation precautions.
  • as a rapid reference when a VHF case appears at a health facility where no previous VHF preparations have been made.

The recommendations in the manual make use of common, low-cost supplies, such as household bleach, water, cotton cloth, and plastic sheeting. Step-by-step instructions for implementing the recommendations are presented along with instructional aids for easy reference in health centers.

The manual is available in English, French, and Portuguese.

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