Should we be aware of dangerous viral hemorrhagic fevers?

Have you ever heard of 'hemorrhagic fever'? You may have heard it in the news when talking about dangerous diseases like Ebola. Even hearing this name makes you a little scared, doesn't it? This is a topic that we all need to be aware of. Simply put, Viral Hemorrhagic Fevers (VHF) are a common name given to a group of viral infections. What these viruses do is damage the blood vessels in our body, disrupt the natural process of blood clotting, and cause the body to bleed uncontrollably.

What are these types of hemorrhagic fevers (VHFs)?

Many diseases fall into this category called VHF. Some are very mild, but some can be life-threatening. Dengue fever, which is very well-known among us, also belongs to this category.

These are some of the main types of VHF that are seen:

• Ebola Virus Disease (EVD)
• Marburg Virus Disease (MVD)
• Conditions caused by Hantavirus
• Dengue Fever - This is very familiar to us in Sri Lanka, isn't it?
• Lassa Fever
• Yellow Fever
• Crimean-Congo Hemorrhagic Fever (CCHF)

Where are these diseases most common?

Each of these VHF types is seen in different parts of the world. These are often reported:

• From African countries: especially from West and Central Africa.
• From Central and South America.
• From Asian countries: In Asia, where we live, VHFs like dengue are also common.
• From the Pacific Islands.

Generally, these diseases are rarely seen in countries like America, Canada, and Europe. In those countries, only Hantavirus infections are mainly reported.

What are the possible symptoms of these flu diseases?

This is a very important part. Because in the early stages, the symptoms of this disease can be a little difficult to distinguish from a normal viral fever. But we need to be especially attentive to the symptoms that appear when the condition is serious.

Why do these viruses cause bleeding?

This is a bit of a complicated story. Simply put, when these VHF viruses enter our bodies, they do two main things.

1. Damages blood vessels: This virus damages the walls of the delicate blood vessels throughout our bodies. Then, blood starts leaking from those vessels.

2. Disrupts blood clotting: Normally, when we get a cut on our body, the blood stops bleeding because of the blood clotting process. This virus interferes with the cells (platelets) and proteins involved in that process. Then, even a small amount of bleeding cannot be stopped.

It is when these two reasons come together that bleeding begins to flow uncontrollably inside and outside the body.

What virus families cause this?

The viruses that cause VHF can be divided into four main families:

• Arenaviruses
• Filoviruses (Ebola and Marburg belong to this family)
• Bunyaviruses
• Flaviviruses (dengue and yellow fever belong to this family)

How are these diseases transmitted?

The ways these diseases are transmitted vary. Not all VHFs are transmitted in the same way. In general, there are several main ways these diseases can be transmitted.

• Mosquito bites: This is how diseases like dengue and yellow fever are spread.
• Through tick bites: Diseases like Crimean-Congo fever are transmitted by ticks.
• By contact with bodily fluids of an infected person: When a patient's blood, urine, feces, saliva, breast milk, semen, or vaginal secretions enter the body through a cut, wound, or mucous membrane of a healthy person (diseases like Ebola can be transmitted this way).
• Contact with body fluids of infected animals: Some types of VHF can be transmitted through contact with the urine and feces of small animals such as rats, monkeys, and bats.

How are these diseases treated?

Unfortunately, there is no definitive "cure" for most VHF diseases. Only a few diseases, such as Ebola, have newly introduced antiviral treatments.

Therefore, supportive care is often provided, which means helping to maintain the patient's body functions.

• Providing the body with the necessary amount of fluids: Saline (IV fluids) are given through a vein to prevent dehydration due to vomiting and diarrhea.
• Oxygen: If there is difficulty breathing, oxygen is given. It may also be necessary to connect to mechanical ventilation.
• Symptom control: Medications are given to control things like fever, pain, and vomiting.
• Blood transfusion: If you are bleeding excessively or have low platelet counts, you may need to receive blood or platelet transfusions.

In a hospital, these patients are often treated separately from others and with special safety measures in place. This is essential to prevent the spread of the disease to others.

How to protect yourself from these diseases? (Prevention)

The best thing to do is to protect yourself from these dangerous diseases. There are several things we can do to do that.

• Getting vaccinated: There are vaccines for several diseases, such as yellow fever, dengue, and Ebola. However, these vaccines are not available in all countries. If you are traveling to a country where these diseases are common, it is important to ask your doctor about this before you leave.
• Insect protection: Do everything you can to protect yourself from mosquitoes and ticks.
• Wear clothes that cover the body completely.
• Use mosquito nets.
• Use mosquito repellents.
• If there are dengue mosquito breeding sites around, destroy them.
• Avoid contact with animals: Avoid direct contact with animals that can carry these diseases, especially rats and bats.
• Follow safety procedures: If you are caring for a patient like this (e.g., healthcare worker), be sure to wear Personal Protective Equipment (PPE) such as gloves, goggles, and masks. Avoid any direct contact with the patient's body fluids.

When should you see a doctor?

If you live in an area where this disease is common, have recently traveled to one, or have other risk factors, and develop the early symptoms mentioned above along with a fever, see a doctor immediately.

When should you go to the hospital's Emergency Department (ETU) immediately?

If you experience any of the following serious symptoms , go to the nearest hospital Emergency Department (ETU) without delay. It is also important to inform the staff that you suspect you may have VHF when you go to the hospital.

• Severe pain in the chest, neck, or stomach
• Difficulty breathing
• Vomiting or diarrhea that cannot be stopped
• Having a seizure
• Confusion or loss of consciousness
• Uncontrolled bleeding from anywhere in the body