Considerations for Discharging People under Evaluation for Selected Viral Hemorrhagic Fevers (VHF)

This guidance refers only to the following viral hemorrhagic fevers: Ebola, Marburg, Lassa, Crimean Congo Hemorrhagic Fever (CCHF) and the South American Hemorrhagic Fevers (i.e., those caused by Junin, Machupo, Chapare, Guanarito and Sabia viruses). Refer to the pathogen-specific pages for further information about the individual pathogens (e.g., signs and symptoms, incubation periods, routes of transmission, diagnosis, treatments).

Healthcare providers evaluating a patient for viral hemorrhagic fever (VHF) should consider these criteria when deciding to discharge:

  1. In the clinical judgment of the medical team, the patient’s illness no longer appears consistent with VHF.
  2. The patient is afebrile off antipyretics (no fever and hasn’t taken fever reducing medications) for 24 hours, or there is an alternative explanation for fever.
  3. All symptoms compatible with VHF (for example, diarrhea or vomiting) have either resolved or can be accounted for by an alternative diagnosis.
  4. The patient has no clinical laboratory results consistent with VHF, or those that could be consistent with VHF have been otherwise explained.
  5. The patient is able to self-monitor (or to monitor a child, if the patient is a child).
  6. There is a plan for the patient to return for medical care if symptoms recur, which has been explained to the patient, and the patient understands what to do if symptoms recur.
  7. Local and state health departments have been engaged and concur.

Important information about RT-PCR testing for VHF:

  • A negative RT-PCR test result for VHF from a blood specimen collected less than 72 hours after the onset of symptoms does not necessarily rule out VHF.
    • The test should be repeated if the patient is still symptomatic after 72 hours.
    • A repeat test is not required if the patient has recovered from the illness that brought them to medical attention.
  • A negative RT-PCR test result for VHF from a blood specimen collected more than 72 hours after symptom onset rules out VHF.
  • Positive VHF RT-PCR results are considered presumptive until confirmed by CDC.