Group 5. Haemorrhagic (bleeding) fevers

Disease tools: 17. Ebola virus disease 18. Lassa fever 19. Marburg haemorrhagic fever

So far in this manual you have read about a range of infections that cause epidemics. Some can be treated by improving living conditions, social distancing and handwashing, reducing overcrowding, or ensuring that the water supply is clean. Others require vaccination or, in severe cases, referral to a health facility.

This group of diseases includes three infections that are very similar. They are in the same group because: they are caused by similar germs; they spread in the same way; and they all cause very severe symptoms. Although these diseases are not very common, they are very dangerous and can cause death to many people. Their names are: Ebola virus disease, Marburg fever and Lassa fever.

Sometimes the cause of an epidemic is not known because it is a new disease or because the diagnostic procedure is not available. We should treat such epidemics with particular care until the germ that causes them is confirmed because they can be highly contagious.

How are these diseases transmitted?

Ebola, Marburg fever and Lassa fever are transmitted by contact with the body fluids of an infected person or animal, including blood, vomit, saliva, urine, stools, etc. They can also be transmitted through contact with the bodies of people who have died from the disease, or contact with any object that an infected person has touched, such as bed sheets, surfaces, tools, etc.

The main concerns with these diseases is that they have the potential to pass from one person to another and can cause the death of a high proportion of the people they infect.

What symptoms do they cause?

Ebola, Marburg fever and Lassa fever cause very severe symptoms, including bleeding, fever, headache, pain of different kinds, diarrhoea, vomiting and failure of organs. They can cause the death of many of the people they infect.

How do we prevent these diseases?

Ebola, Marburg fever and Lassa fever occur in only a few countries. It is hard to prevent them, but if people know about them and are able to detect them early, an epidemic that starts can be brought under control more easily. Ebola and Marburg fever can also affect animals such as bats and monkeys. Transmission from animals to humans can be stopped by not eating bush meat (or cooking it very well), and by not eating or touching sick or dead animals. In most cases Lassa fever is spread by contact with rat urine, though human-to-human transmission can also occur. It is important to reduce contact with rats and observe recommended hygiene practices, especially when handling food and cooking utensils.

How to deal with cases of these diseases

The best way to deal with cases of these diseases is to isolate sick individuals and keep them at a safe distance from other people, because other people are likely to be infected if they come too close. Above all, refer those who are sick to specialized health facilities as soon as possible. It is very important to always use personal protection equipment (PPE) when dealing directly with people who are sick from Ebola, Marburg fever and Lassa fever.

Epidemics of Ebola, Marburg fever and Lassa fever can generate fear and panic in the community. It is extremely important to communicate effectively in such situations. Explain the disease to members of the community and tell them how to prevent it. Communities may have to change or adapt their normal practices, especially practices related to caring for the sick and the dead.

How to detect an epidemic?

An epidemic is suspected when many people (especially if they live in areas where one of the diseases is known to have been present in the recent past) have symptoms of a severe disease or a number of people who have been in close contact die suddenly in a short period of time.

How to deal with an epidemic?

If an epidemic of Ebola, Marburg fever or Lassa fever occurs, you should take several actions.

• Familiarize yourself with the culture of the community, and in particular with how the community cares for the sick and the dead.
• Build trust with members of the community.
• Involve the community in efforts to control the epidemic.
• Take steps to protect yourself from getting the disease. Use PPE if you are involved in high risk activities. •
• Take steps to detect people who are sick and refer them to specialized health facilities. 
• Clean items and surfaces that have been touched by sick people or by dead bodies. Use very strong cleaning products, such as bleach and other products that kill germs effectively. (This is a special activity and requires special training.)
• Bury people who have died of Ebola, Marburg fever and Lassa fever safely. (This is a special activity and requires special training.)
• Teach community members how to protect themselves from the infection. 
• Manage rumours and misinformation.
• Give psychosocial support to communities and families and also to health workers and volunteers.

What can volunteers do?

When dealing with Ebola, Marburg fever and Lassa fever epidemics, the most important action that volunteers can take is to protect themselves. You should not take risks and should do everything possible to avoid falling sick, because, if you do not, you will add to the epidemic and will not be able to help others. It is essential to use PPE whenever you are in close contact with sick people. We explain below how to do this.

Volunteers do not normally care for patients who have Ebola, Marburg fever or Lassa fever because people who are infected need highly specialized treatment given by health professionals. However, volunteers can make effective contributions in other ways. 

• Risk communication. Take steps to mobilize members of the community to protect themselves against infection and modify their behaviour in accordance with medical recommendations (using BCC). This is your main role. Talk to the community about the epidemic, and teach people how to protect themselves, how to care for relatives who are sick, and how to deal with dead bodies. 
• Encourage leaders and members of the community to help detect new cases and refer them to health facilities.
• Respond to rumours in the community and report rumours to health authorities. 
• Teach members of the community how to make strong disinfectants and cleaning products and how to apply them. Distribute cleaning tools. 
• Give psychosocial support to sick people and their families. 
• It is unusual for volunteers to help care for patients or deal with the burial of dead bodies, but you may be asked to do this if no one else can. It should be done after appropriate specialized training, under the strict supervision and instruction of specialists. Full PPE should be used at all times. 
• On rare occasions, after receiving training, you may be asked to monitor or trace the contacts of patients. This too should be done under specialist supervision; appropriate PPE should be worn.

What to do when a cluster of unexplained illnesses or deaths occurs?

As mentioned earlier in the chapter, diseases can sometimes be caused by a completely new organism. Recent examples include SARS (severe acute respiratory syndrome) and MERS (Middle East respiratory syndrome). Health authorities may also need time to confirm what is causing people to become sick or die. If you are not sure what is causing an epidemic, act as you would act if you were dealing with Ebola, Marburg fever or Lassa fever. Take every precaution until you are sure how the disease is spread and how best to protect yourself and others.

Participate

Discuss together the possibility of a haemorrhagic fever epidemic in your community. Look at the disease tools for haemorrhagic fevers and select the action and message tools for each. Discuss with your facilitator the similarities and differences between the tools for each disease in this category.

Discuss the best way to detect the presence of haemorrhagic fever in a community.

Discuss what precautions volunteers should take if they work in highly infectious disease epidemics.