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Viral hemorrhagic fevers or VHF, are a diverse group of animal and human illnesses in which fever and hemorrhage are caused by a viral infection.[1]

Signs and symptoms

Signs and symptoms of VHF include, by definition fever and bleeding,[2][3] as well as, small red or purple spots called petechiae, bleeding, circulatory shock, malaise, muscle pain, headache, vomiting, and diarrhea.[2]

Cause 1

Four families of the RNA viruses have been recognized as being able to cause hemorrhagic fevers, they are, Flaviviridae family which includes Dengue fever and Arenaviridae family which includes the Yellow fever virus, which gives rise to the Yellow fever disease.[2]

Cause 2

As well as, Bunyaviridae family which includes the Rift Valley fever virus, which gives rise to Rift Valley fever and the Filoviridae family which includes Ebola and Marburg viruses, where both have high mortality rates and have caused several outbreaks, particularly the former.[2]


Different hemorrhagic fever viruses act on the body in different ways, resulting in different symptoms. In most VHF, it is likely that several mechanisms contribute to symptoms, including liver damage, disseminated intravascular coagulation, and bone marrow dysfunction. In DIC, small blood clots form in blood vessels throughout the body, removing platelets necessary for clotting from the bloodstream and thus reducing clotting ability. [4]


Definitive diagnosis is usually made at a reference laboratory with advanced biocontainment capabilities. The findings of laboratory investigation vary somewhat between the viruses but in general, there is a decrease in the total white cell count, a decrease in the platelet count, an increase in the blood serum liver enzymes.[2][5][6]


With the exception of yellow fever vaccine and Ebola vaccines, vaccines for VHF-associated viruses are generally not available. Post-exposure prophylactic ribavirin may be effective for some bunyavirus and arenavirus infections.[7][8]


In 2020, the FDA approved Inmazeb a combination of three monoclonal antibodies and Ebanga a single monoclonal antibody for treating Ebola virus disease, specifically Zaire ebolavirus one of the species within the genus Ebolavirus.[9] Medical management of individuals infected with VHF may require intensive supportive care. Antiviral therapy with intravenous ribavirin may be useful in Bunyaviridae and Arenaviridae infections.[10]


The epidemiology of viral hemorrhagic fevers have been shown to be, in part, as follows, Uíge Province in Angola was the site of a outbreak of Marburg virus disease in 2005, the largest one to date of this disease.[11] A VHF outbreak in the village of Mweka, Democratic Republic of the Congo that started in August 2007, and that killed 103 people, has been shown to be caused, partially, by Ebola virus; the same virus that caused thousands of deaths and cases in west Africa years later.[12][13]


  1. "What are VHFs? | Viral Hemorrhagic Fevers (VHFs) | CDC". 3 September 2021. Retrieved 26 February 2022.
  2. 2.0 2.1 2.2 2.3 2.4 Mangat, Rupinder; Louie, Ted (2022). "Viral Hemorrhagic Fevers". StatPearls. StatPearls Publishing. Retrieved 27 February 2022.
  3. "Hemorrhagic Fevers". Retrieved 27 February 2022.
  4. Paessler, Slobodan; Walker, David H. (24 January 2013). "Pathogenesis of the viral hemorrhagic fevers". Annual Review of Pathology. 8: 411–440. doi:10.1146/annurev-pathol-020712-164041. ISSN 1553-4014. Retrieved 4 March 2022.
  5. "Viral Hemorrhagic Fevers - Chapter 4 - 2020 Yellow Book | Travelers' Health | CDC". Retrieved 5 March 2022.
  6. Singh, Sunit K.; Ruzek, Daniel (19 April 2016). Viral Hemorrhagic Fevers. CRC Press. p. 407. ISBN 978-1-4398-8431-7. Retrieved 5 March 2022.
  7. Ergönül Ö, Keske Ş, Çeldir MG, Kara İA, Pshenichnaya N, Abuova G; et al. (2018). "Systematic Review and Meta-analysis of Postexposure Prophylaxis for Crimean-Congo Hemorrhagic Fever Virus among Healthcare Workers". Emerg Infect Dis. 24 (9): 1642–1648. doi:10.3201/eid2409.171709. PMC 6106438. PMID 30124196.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  8. Hadi CM, Goba A, Khan SH, Bangura J, Sankoh M, Koroma S; et al. (2010). "Ribavirin for Lassa fever postexposure prophylaxis". Emerg Infect Dis. 16 (12): 2009–11. doi:10.3201/eid1612.100994. PMC 3294560. PMID 21122249.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  9. "Treatment | Ebola (Ebola Virus Disease) | CDC". 26 February 2021. Retrieved 27 February 2022.
  10. "Viral hemorrhagic fevers". Retrieved 6 March 2022.
  11. Towner, J. S.; Khristova, M. L.; Sealy, T. K.; Vincent, M. J.; Erickson, B. R.; Bawiec, D. A.; Hartman, A. L.; Comer, J. A.; Zaki, S. R.; Ströher, U.; Gomes Da Silva, F.; Del Castillo, F.; Rollin, P. E.; Ksiazek, T. G.; Nichol, S. T. (2006). "Marburgvirus Genomics and Association with a Large Hemorrhagic Fever Outbreak in Angola". Journal of Virology. 80 (13): 6497–516. doi:10.1128/JVI.00069-06. PMC 1488971. PMID 16775337.
  12. Leroy, Eric M.; Epelboin, Alain; Mondonge, Vital; Pourrut, Xavier; Gonzalez, Jean-Paul; Muyembe-Tamfum, Jean-Jacques; Formenty, Pierre (December 2009). "Human Ebola outbreak resulting from direct exposure to fruit bats in Luebo, Democratic Republic of Congo, 2007". Vector Borne and Zoonotic Diseases (Larchmont, N.Y.). 9 (6): 723–728. doi:10.1089/vbz.2008.0167. ISSN 1557-7759. Retrieved 2 March 2022.
  13. "Ebola virus disease". Retrieved 6 March 2022.