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:
- In the clinical judgment of the medical team, the patient’s illness no longer appears consistent with VHF.
- 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.
- All symptoms compatible with VHF (for example, diarrhea or vomiting) have either resolved or can be accounted for by an alternative diagnosis.
- The patient has no clinical laboratory results consistent with VHF, or those that could be consistent with VHF have been otherwise explained.
- The patient is able to self-monitor (or to monitor a child, if the patient is a child).
- 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.
- 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.