"Infection Control for Viral Haemorrhagic Fevers
In the African Health Care Setting"

About the Manual

In 1995, an outbreak of Ebola hemorrhagic fever (Ebola HF) affected more than 300 people in and around the city of Kikwit, Democratic Republic of the Congo (formerly, Zaire); approximately 80% of the patients died. More than one-fourth of all the patients were health care workers. After the outbreak, the DRC Ministry of Health, the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) developed practical recommendations for carrying out viral hemorrhagic fever (VHF) isolation precautions in rural health facilities in Africa. These recommendations have been consolidated in a manual for the local health community.

Although there is still a great deal to learn about Ebola HF, two observations from the Kikwit outbreak strongly indicate that future outbreaks of this magnitude could be prevented:

• The first case occurred in January 1995, but went unrecognized as Ebola HF by health-care workers. This one case started a chain of transmission of the virus that finally was recognized in April of that year, when many more cases appeared. The outbreak peaked in May. Thus, between January and April, there was a window of opportunity that could have allowed early detection and proper management of patients; the early response might have prevented widespread transmission of the virus.
  
• After an international investigation team arrived in May 1995 and worked with Kikwit medical community to introduce VHF isolation precautions as well as standard precautions, no further nosocomial transmission of the virus was documented, indicating that although Ebola HF is highly infectious, the use of these measures is effective in preventing the spread of disease.

The observations sent a strong message to the public health and medical communities in Africa and internationally: combining early suspicion of VHF and isolation precautions can help to prevent another serious outbreak of Ebola HF or other VHF in the future. The only question remaining was how these goals could be achieved in a region where resources are scarce and the health care infrastructure is either underdeveloped or deteriorating. This manual, prepared collaboratively by CDC and WHO, attempts to address the issues of early provisional diagnosis and response within a limited infrastructure. It is designed for the following uses:

• for prevention through preparedness--to help African health facilities make advance preparations for responding with appropriate precautions when a VHF case is suspected.
  
• for planning and conducting in-service training to strengthen standard precautions and VHF isolation precautions.
  
• as a rapid reference when a VHF case appears at a health facility where no previous VHF preparations have been made.

The recommendations in the manual make use of common, low-cost supplies, such as household bleach, water, cotton cloth, and plastic sheeting. Step-by-step instructions for implementing the recommendations are presented along with instructional aids for easy reference in health centers.

The manual is available in both English and French versions.

Viewing and printing the Manual

The English Manual is available in html and Adobe Acrobat Reader format (PDF). 

The French Manual is available only in the Adobe Acrobat reader format (PDF).

To view or print the .pdf files you must have Adobe Acrobat Reader (version 3.0 or higher) installed on your computer. If you have the reader, click on PDF link of each section of the manual to open it.

If you do not have the reader, you may obtain it -- free -- from Adobe Corporation. Download the program from the Adobe Acrobat Reader website.

The manual is viewable in portions or as a whole. Viewing by section is advisable if your connection to the Internet is slow or costly.

The PDF version of the manual has been formatted for paper size A4 (210 x 297 mm), not 8.5 x 11 inches. If printing the PDF manual, you may need to adjust the print size in Acrobat Reader, at Print>Print Setup.

Table of Contents for Manual

Section Title	Web html version	Adobe Acrobat PDF version
Introduction Provides an overview on viral haemorrhagic fevers; lists the contents, target audience, objectives, and suggested use of the manual.	html	PDF
Section 1:  Use Standard Precautions with All Patients Describes how to establish routine precautions for infection control. The section emphasizes the importance of using Standard Precautions consistently, especially handwashing before and after examining patients with fever.	html	PDF
Section 2:  Identify Suspected Cases of VHF Lists common signs and symptoms of VHF and the immediate precautions to take when a VHF is suspected.	html	PDF
Section 3:  Isolate the Patient Lists recommended supplies and describes how to set up an isolation area. It includes checklists that can be used in an emergency situation and practical suggestions for alternate equipment when recommended items are not available.	html	PDF
Section 4:  Wear Protective Clothing Describes the protective clothing that should be worn when VHF is present in the health facility. It also provides information about selecting appropriate items when recommended clothing is not available.	html	PDF
Section 5:  Disinfect Reusable Supplies and Equipment Describes the use of VHF Isolation Precautions during patient care and when disinfecting and cleaning contaminated surfaces, supplies and equipment. This section also presents recommended first aid for accidental exposures.	html	PDF
Section 6:  Dispose of Waste Safely Describes step-by-step procedures for disposing of VHF-contaminated waste. It also lists detailed instructions for building an incinerator from available material.	html	PDF
Section 7:  Use Safe Burial Practices Describes how to prepare bodies of deceased VHF patients safely for burial and how to prevent disease transmission through contact with the deceased patient.	html	PDF
Section 8: Mobilize Community Resources and Conduct Community Education Provides guidance for involving the community in disease prevention and control activities when VHF is suspected. It also describes how to choose a VHF Coordinator.	html	PDF
Section 9:  Make Advance Preparations to Use VHF Isolation Precautions Lists steps for preparing in advance to use VHF Isolation Precautions. If advance preparations have been carried out, and a VHF is suspected, the supplies are ready and health facility staff are trained in recommended practices. When advance preparations are not possible, VHF Isolation Precautions must be implemented in an emergency situation.	html	PDF
Annex 1:  Standard Precautions for Hospital Infection Control	html	PDF
Annex 2:  Specific Features of VHFs	html	PDF
Annex 3:  Planning and Setting up the Isolation Area	html	PDF
Annex 4:  Adapting VHF Isolation Precautions for a Large Number of Patients	html	PDF
Annex 5:  Making Protective Clothing	html	PDF
Annex 6:  Requirements for Purchasing Protective Clothing	html	PDF
Annex 7:  Disinfecting Water for Drinking, Cooking and Cleaning	html	PDF
Annex 8:  Preparing Disinfectant Solutions by Using Other Chlorine Products	html	PDF
Annex 9:  Making Supplies: Sharps Container, Incinerator, and Boot Remover	html	PDF
Annex 10:  Sample Job-aids and Posters for Use in the Health Facility	html	PDF
Annex 11:  Laboratory Testing for VHFs	html	PDF
Annex 12:  Skin Biopsy on Fatal Cases for Diagnosis of Ebola	html	PDF
Annex 13:  Community Education Materials	html	PDF
Annex 14:  Conducting In-service Training for VHF isolation Precautions	html	PDF
Annex 15:  Local resources for community mobilization and education	html	PDF
Annex 16:  International and Regional Contacts	html	PDF
References	html	PDF

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English Manual

French Manual

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This page last reviewed November 26, 2003

National Center for Infectious Diseases
Centers for Disease Control and Prevention