Hemorrhagic Fever

Hemorrhagic Fever with Renal Syndrome is a viral infectious disease caused by hantaviruses and related pathogens. The term encompasses a diverse group of illnesses caused by RNA viruses from five families: Arenaviridae, Filoviridae, Flaviviridae, Hantaviridae, and Rhabdoviridae. The disease is classified under ICD-10 code A98.5 and ICD-11 code 1D67.0. The etiologic agent varies by geographic region and specific syndrome, with hantaviruses being the primary cause of HFRS presentations involving renal dysfunction.

The clinical syndrome is characterized by fever and bleeding manifestations, which are typically the most prevalent and severe symptoms. The pathophysiology involves bleeding diathesis, capillary leak, and circulatory shock, with severity varying according to the specific viral agent. Laboratory findings commonly include decreased white blood cell count, reduced platelet count, elevated liver enzymes, and impaired clotting function evidenced by prolonged prothrombin and activated partial thromboplastin times. Some presentations, such as nephropathia epidemica caused by hantaviruses, are considered mild, while others like Ebola or Marburg virus infections tend to be debilitating or lethal. All viral hemorrhagic fevers carry the potential to cause hypotension, high fever, and death.

Hemorrhagic fevers occur across multiple geographic regions with varying endemicity patterns depending on the specific viral agent. The diseases are zoonotic in nature, meaning they can be transmitted from wild animal reservoirs to human populations. For example, Lassa fever is spread by rodents, specifically mice. Both humans and non-human animals can serve as hosts. Surveillance burden is significant due to the potential for severe outcomes, the zoonotic transmission cycle, and the risk of nosocomial spread in healthcare settings. Historical epidemics, such as the cocoliztli outbreaks in Mexico during the 16th century, demonstrate the longstanding presence of hemorrhagic fever syndromes.

Transmission occurs through exposure to infected animal reservoirs, particularly rodents and other wild animals. The zoonotic nature of these diseases means human infection typically results from contact with contaminated excreta, saliva, or other materials from infected animals. Healthcare-associated transmission is a particular concern, with Lassa, Crimean-Congo hemorrhagic fever, Ebola, and Marburg viruses showing propensity for nosocomial spread. Human-to-human transmission varies by virus but is documented for several agents within the hemorrhagic fever group.

Source-backed detail on specific high-risk groups is not yet available. However, based on transmission patterns, individuals with occupational or residential exposure to rodent reservoirs and healthcare workers providing care to infected patients are at elevated risk. The severity of outcomes varies by viral agent and individual factors, but the potential for severe disease exists across all infected populations.

Prevention strategies focus on avoiding exposure to infected animals and implementing strict infection control measures in healthcare settings. With the exception of yellow fever and Ebola vaccines, vaccines for viral hemorrhagic fevers are generally not available. Post-exposure prophylaxis with ribavirin is available for Crimean-Congo hemorrhagic fever exposure and may be beneficial for Lassa fever exposure. Healthcare workers caring for patients with viral hemorrhagic fevers should employ multiple precautions including hand hygiene, double gloving, protective gowns, shoe coverings, face shields or goggles, and airborne precautions including fit-tested respirators. These measures are essential to prevent nosocomial transmission.

Surveillance for hemorrhagic fever requires awareness of both endemic and emerging patterns, given the zoonotic transmission cycle and potential for outbreak amplification. Monitoring should include tracking of febrile illness with hemorrhagic manifestations, coordination with veterinary and wildlife health authorities for reservoir monitoring, and maintenance of laboratory capacity for definitive diagnosis at reference facilities with appropriate biocontainment. The diversity of causative agents and varying clinical severity necessitate a broad surveillance case definition while ensuring rapid detection of high-consequence pathogens like Ebola or Crimean-Congo hemorrhagic fever.

1. 1 Wikidata. RNA virus infectious disease.
2. 2 Wikipedia. Viral hemorrhagic fever - Wikipedia.

ICD-10

A98.5

ICD-11

1D67.0

Total cases

154K

Total deaths

1K

Peak month

2012-11

Coverage

2 reporting countries · 2010-01-01 → 2026-05-02