Viral Hemorrhagic Fever: Causes, Symptoms And Treatment Of Viral Hemorrhagic Fever
Viral hemorrhagic fevers are caused by some groups of viruses that can create mild to severe symptoms. Know the symptoms and possible treatment options for the VHFs.
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Last updated on 3rd Jul, 2025
Viral hemorrhagic fevers, or VHFs, refer to a family of illnesses caused by different viruses. VHFs have two facets; while some conditions are mild and easily manageable, others are extremely severe and pose a threat to the individual’s life. Owing to globalisation and migration, today, viruses are no longer limited to their place of origin; they are travelling and affecting people worldwide. For better context, the Ebola virus was originally found in areas of Congo and Sudan, but it later caused devastation across Africa. The significance of VHFs is not limited to their impact on human health; they also have wider economic impacts.
Causes and Transmission
Several families of viruses that cause the VHFs are:
Arenaviridae family: This virus family is responsible for Lassa fever, Argentine hemorrhagic fever, Bolivian hemorrhagic fever, and more.
Bunyaviridae family: It causes Rift Valley fever, Hantavirus pulmonary syndrome, and hemorrhagic fever with renal syndrome.
Filoviridae family: This virus family causes Ebola virus disease and Marburg hemorrhagic fever.
Flaviviridae family: It is responsible for Dengue, Yellow fever, and more.
The viruses can be transmitted through different ways, such as:
Tick bites
Contact with bodily fluids of an infected person, including blood, saliva, poop, pee, etc.
Contact with the bodily fluids of infected animals, such as rodents, livestock or fruit bats, and non-human primates (monkeys or apes).
Mosquito bites
Pathophysiology
Generally, there are three phases of VHF: the generalisation phase, the early organ phase, and the late organ/convalescent phase. In the first phase, the patient experiences non-specific symptoms such as fever, headache, and gastrointestinal symptoms. During the second phase, the individuals experience petechiae, oedema, mucosal haemorrhage, bloody diarrhoea, etc. In the last phase or late organ stage, the disease will progress to intravascular coagulation, liver dysfunction, shock, and seizures. It can gradually lead to coma and death.
Geographic Distribution and Epidemiology
VHF viruses are found across Africa, Asia, America, and Europe. Lassa virus has outbreaks in West Africa, with a danger level of 50%. This disease can be rapidly spread through direct contact with multimammate rats. Crimean-Congo hemorrhagic fever is an endemic in Africa and Asia, and it can occur due to exposure to the blood or other bodily fluids from an infected creature.
Dengue fever has become endemic in 100+ countries, including Africa, the Pacific Islands, Europe, Asia, Australia, and the Americas. It has 0.8% to 2.5% severe mortality and morbidity rates due to dengue hemorrhagic fever and dengue shock syndrome.
However, the Ebola virus disease is the most fatal VHF in the world. There have been several outbreaks in the Democratic Republic of the Congo. The mortality rate is 80% to 90% in this place.
Symptoms and Clinical Manifestations
The symptoms of VHF vary based on the specific disease and the affected individual. But some of the common signs are:
Fever
Dizziness
Loss of strength
Fatigue
Headache
Muscle aches
Exhaustion
In severe cases, the VHF symptoms include:
Vomiting blood
Bleeding from eyes, nose, vagina or gums
Difficulty of breathing
Extreme low blood pressure
Severe diarrhoea or vomiting
Chest, stomach or neck pain
Seizures
Diagnosis and Differential Diagnoses
The diagnosis of VHF during the first few days is challenging. First, the patients must tell their healthcare providers about their medical and travel history. They should also know whether they were exposed to mosquitoes, rodents, ticks, bats, or non-human primates. They have to mention the names of the countries they visited and the timing. Based on this information, the doctors prescribe a few lab tests to confirm the diagnosis and separate the cases of VHFs from others. Typically, blood tests, urinalysis, throat swabs, and lumbar punctures (spinal taps) are used for this purpose.
Treatment and Management Strategies
For most VHFs, supportive care is essential as no specific treatments are available at this moment. The doctors may recommend these types of treatments:
A therapy to retain body fluid is called IV, which helps to balance the minerals for muscles and nerves.
Monoclonal antibody therapies like Ebanga and Inmazeb to treat Ebola.
Antiviral medicine such as ribavirin (Virazole) to reduce the infections for Lassa fever.
For some patients, kidney dialysis becomes helpful as it clears the wastes from blood during kidney failure.
Prevention and Control Measures
Vaccination is the most effective strategy to prevent VHF. Several vaccines are available based on the type of VHF. The vaccinations for yellow fever and Argentine hemorrhagic fever provide the most positive results. However, not every vaccine is efficient in preventing disease. So, currently, the search will develop more feasible vaccines for VHFs.
Yellow Fever Vaccine: It is the most successful vaccine against VHF, with over 35 years of immunity in a single dose.
Argentine Hemorrhagic Fever: This is another important vaccine for VHFs. It has successfully reduced the illness in high-risk areas.
Zaire Ebola Virus Vaccine: This vaccine was effective during the Ebola virus disease outbreak in 2014-2016.
Hantavirus Vaccines: This DNA-based Hantavirus vaccine has shown promising results in controlling Hantavirus strains.
Lassa Fever Vaccine: This vaccine, made with advanced genetic engineering, virology, and immune profiling technologies, provides broad protection against LASV strains.
Crimean–Congo Hemorrhagic Fever (CCHF) Vaccine: In this vaccine, a modified Ankara (MVA) vector was used to deliver the key elements of the CCHF virus glycoprotein. It showed a positive response for building protection against the virus.
Apart from vaccination, there are some other preventive measures such as:
Controlling ticks and mosquitoes to enter the home and associated environment.
Use insect barriers such as insect repellent, bed nets, and window screens to prevent insect bites.
Wearing long sleeves and long pants with permethrin.
Prevent exposure to rodents or livestock in the areas of outbreaks.
Prognosis and Long-term Impact
The mortality rate for VHFs depends on the type of virus causing it. For instance, the most dangerous hemorrhagic fevers, Ebola and Marburg, have a high mortality rate of more than 40%. However, the Mortality rate for Dengue and Lassa fever is only around 1%.
The doctor will treat the patient in the hospital to effectively manage the symptoms and any other further complications. They might also suggest isolation for the patient to stop the spread of the virus.
As VHF affects multiple organs at the same time, it causes severe weakness, fatigue, and other issues. The doctor recommends immediate isolation and hospitalisation based on the severity of the symptoms.
Research and Future Directions
Research regarding VHFs is a challenging task and creates several barriers for workers. The research on vaccination and treatment is still ongoing. Currently, the treatment procedure only depends upon supportive care. However, the application of new technologies, such as remote sensing and genomic sequencing, is helping in the advanced research of VHF. These tools offer real-time insights into the spread of viruses. As a result, this approach has become beneficial in understanding VHF outbreaks. Also, field validation technologies and portable diagnostics are helping in resource-limited or remote research work.
Conclusion
VHFs indicate numerous diseases caused by certain groups of viruses. Some VHFs have lower mortality rates and can be cured by supportive care, while others have high mortality rates and don't have any specific treatment. With the ongoing research, one can only hope that scientists will find a cure for these diseases soon enough to stop the next outbreak without losing lives. However, individuals should be aware of this and exercise all preventive measures while travelling or living in the outbreak areas to ensure they remain protected and safe.
Consult Top Infectious Disease Specialist
Consult Top Infectious Disease Specialist
Dr. Naseeha Mohammed S V
Pulmonology Respiratory Medicine Specialist
6 Years • MBBS, MD ,DNB Respiratory Medicine
Bengaluru
Apollo Clinic, Sarjapur Road, Bengaluru
Dr. Amrutha G
General Physician/ Internal Medicine Specialist
10 Years • MBBS,DNB(family medicine), Diabetologist-CCEBDM,CCGDM
Bengaluru
Apollo Clinic, Sarjapur Road, Bengaluru
Dr. Aijaz Muzamil
Ent Specialist
46 Years • MBBS, Ms ENT
Bengaluru
Apollo Clinic, Sarjapur Road, Bengaluru
Dr Varun Panicker
General Physician/ Internal Medicine Specialist
6 Years • MBBS
Bengaluru
Apollo Clinic, JP nagar, Bengaluru
Dr Sumanth R
General Physician
2 Years • MBBS
Bengaluru
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