IN 1988, CDC published guidelines for managing patients with suspected viral hemorrhagic fever (VHF).1 Pending a comprehensive review of the 1988 guidelines, this notice provides interim recommendations that update the 1988 guidelines for health-care settings in the United States. This update applies to four viruses that cause syndromes of VHF: Lassa, Marburg, Ebola, and Congo-Crimean hemorrhagic fever viruses; although the risk and/or mode of nosocomial transmission differs for each of these viruses, the limited data do not permit clear distinctions.
In Africa, transmission of VHF has been associated with reuse of unsterile needles and syringes and with provision of patient care without appropriate barrier precautions to prevent exposure to virus-containing blood and other body fluids (including vomitus, urine, and stool). The risks associated with various body fluids have not been well defined as most caregivers who acquired infection had multiple contacts with multiple fluids. Epidemiologic studies