â€¢ Mainstay is supportive e.g. antipyretics for fever, replace fluids due to capillary hyper-permeability states, treat dehydration and fever, avoid shock and metabolic acidosis

â€¢ Ribavirin: it is indicated for post-exposure prophylaxis and treatment of Lassa fever. Its efficacy is demonstrated if given during the first 6 days of illness. However, it is used with caution in pregnant women.

â€¢ Vaccination for yellow fever: Health facilities should be supported during routine childhood immunization schedule and immunization supplies should be made available for routine yellow fever activities. Mass vaccination campaigns should be conducted during epidemics.

â€¢ Case-based surveillance and management: Analyze data for trends; investigate mild febrile illnesses and unexplained deaths that suggest VHF outbreaks.Ensure that personnel at health facilities in the district know how to identify suspected cases of VHF and that health facilities use a standard case definition for reporting.Report to the nearest local health authority immediately. All cases should be reported as universally required by IHR (2005). Place all suspected cases in isolation (dedicated wards) and health workers should take Infection Prevention and Control measures (use of PPEs, handwashingetc). Cases should be ccounselled not to engage in sexual intercourse for 2 months following treatment for Lassa fever and Ebola. Safe burial practices should be ensured.

â€¢ Vector control: Living quarters should be sprayed with residual insecticide and insecticide-treated bednetsâ€™ use intensified. Stagnant waters around the house should be emptied and potential mosquito breeding sites eliminated by applying larvicides.Entomological surveillance is important in tracking vectors of arboviral VHFs. Rodent populations should be controlled. Homes should have screen guards and food supplies stored in rodent-proof containers.

â€¢ Points of entry: Standard Operating Procedures for VHF screening at points of entry should be available. Persons arriving from countries with confirmed VHF outbreaks should be screened for symptoms consistent with VHF case definition. Safe and secure holding areas with capacity for temporarily quarantine must be available. Aerosol spraying of prescribed insecticides of aircrafts and ships arriving from arboviral VHF endemic areas should be intensified and kept free from breeding of insect vectors (at least 400 meters around their perimeters).

References

1. Center for Disease Control and Prevention. Viral Hemorrhagic Fevers Fact Sheet [Internet]. Available from: http://www.cdc.gov/ncidod/dvrd/spb/mnpages/dispages/Fact_Sheets/Viral_Hemorrhagic_Fevers_Fact_Sheet.pdf

2. GOV.UK. VHFs in Africa: areas of known risk [Internet]. 2014. Available from: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/365845/VHF_Africa_960_640.png

3. Chakrabarti D, Banik S. Viral hemorrhagic fever. Med Updat. 2012;22:54â€“8.

4. GOV.UK. Lassa fever: origins, reservoirs, transmission and guidelines [Internet]. Guidance. 2014 [cited 2015 Aug 11]. p. 8â€“12. Available from: https://www.gov.uk/lassa-fever-origins-reservoirs-transmission-and-guidelines

5. World Health Organization. Dengue and severe dengue [Internet]. Media Center. 2014. p. 4â€“7. Available from: http://www.who.int/mediacentre/factsheets/fs117/en/

6. Adekolu-John E, Fagbami A. Arthropod-borne virus antibodies in sera of residents of Kainji Lake Basin, Nigeria 1980. Trans R Soc Trop Med Hyg. 1983;77(2):149â€“51.

7. Fagbami AH, Monath TP, Fabiyi A. Dengue virus infections in Nigeria: a survey for antibodies in monkeys and humans. Trans R Soc Trop Med Hyg. 1977;71(1):60â€“5.

8. Idris AN, Baba MM, Thairu Y, Bamidele O. Sero-prevalence of dengue type-3 Virus among patients with febrile illnesses attending a tertiary hospital in Maiduguri, Nigeria. Int J Med. 2013;5(December):560â€“3.

9. Heilman JM, De Wolff J, Beards GM, Basden BJ. Dengue fever: A Wikipedia clinical review. Open Med. 2014;8(4):e105â€“15.

10. Robertson SE, Hull BP, Tomori O, Bele O, LeDuc JW, Esteves K. Yellow fever: a decade of reemergence. JAMA [Internet]. 1996;276(14):1157â€“62. Available from: http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=8827969 http://digitaal.uba.uva.nl:9003/uva-linker?sid=OVID:medline&id=pmid:8827969&id=doi:&issn=0098-7484&isbn=&volume=276&issue=14&spage=1157&pages=1157-62&date=1996&title=JAMA

11. World Health Organization. Increased risk of urban yellow fever outbreaks in Africa [Internet]. Emergencies preparedness, response. 2016 [cited 2016 Sep 14]. p. 1â€“4. Available from: http://www.who.int/csr/disease/yellowfev/urbanoutbreaks/en/

12. Tomori O, Fabiyi A, Sorungbe A, Smith A, McCormick J. Viral Hemorrhagic Fever Antibodies in Nigerian Populations. Am J Trop Med Hyg. 1988;38(2):407â€“10.

13. World Health Organization. Ebola Situation Report [Internet]. Ebola - Current Situation. 2016. p. 2. Available from: http://apps.who.int/ebola/current-situation/ebola-situation-report-30-march-2016

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