viral haemorrhagic fevers
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Viral hemorrhagic fevers (VHFs) are a diverse group of animal and human
illness A disease is a particular abnormal condition that negatively affects the structure or function of all or part of an organism, and that is not immediately due to any external injury. Diseases are often known to be medical conditions that a ...
es in which
fever Fever, also referred to as pyrexia, is defined as having a temperature above the normal range due to an increase in the body's temperature set point. There is not a single agreed-upon upper limit for normal temperature with sources using val ...
and
hemorrhage Bleeding, hemorrhage, haemorrhage or blood loss, is blood escaping from the circulatory system from damaged blood vessels. Bleeding can occur internally, or externally either through a natural opening such as the mouth, nose, ear, urethra, v ...
are caused by a
viral infection A viral disease (or viral infection) occurs when an organism's body is invaded by pathogenic viruses, and infectious virus particles (virions) attach to and enter susceptible cells. Structural Characteristics Basic structural characteristics, ...
. VHFs may be caused by five distinct families of
RNA virus An RNA virus is a virusother than a retrovirusthat has ribonucleic acid ( RNA) as its genetic material. The nucleic acid is usually single-stranded RNA (ssRNA) but it may be double-stranded (dsRNA). Notable human diseases caused by RNA virus ...
es: the families '' Filoviridae'', ''
Flaviviridae ''Flaviviridae'' is a family of enveloped positive-strand RNA viruses which mainly infect mammals and birds. They are primarily spread through arthropod vectors (mainly ticks and mosquitoes). The family gets its name from the yellow fever viru ...
'', ''
Rhabdoviridae ''Rhabdoviridae'' is a family of negative-strand RNA viruses in the order '' Mononegavirales''. Vertebrates (including mammals and humans), invertebrates, plants, fungi and protozoans serve as natural hosts. Diseases associated with member ...
'', and several member families of the ''
Bunyavirales ''Bunyavirales'' is an order of segmented negative-strand RNA viruses with mainly tripartite genomes. Member viruses infect arthropods, plants, protozoans, and vertebrates. It is the only order in the class ''Ellioviricetes''. The name ''Bunyav ...
'' order such as '' Arenaviridae'', and ''
Hantaviridae ''Hantaviridae'' is a family of viruses in the order ''Bunyavirales''. It is named for the Hantan River area in South Korea where an early outbreak of one of its species was observed. Taxonomy * '' Actantavirinae'' ** '' Actinovirus'' * '' Aga ...
''. All types of VHF are characterized by fever and bleeding disorders and all can progress to high fever, shock and death in many cases. Some of the VHF agents cause relatively mild illnesses, such as the Scandinavian '' nephropathia epidemica'' (a
hantavirus ''Orthohantavirus'' is a genus of single-stranded, enveloped, negative-sense RNA viruses in the family '' Hantaviridae'' within the order ''Bunyavirales''. Members of this genus may be called orthohantaviruses or simply hantaviruses. Orthohantav ...
), while others, such as
Ebola virus ''Zaire ebolavirus'', more commonly known as Ebola virus (; EBOV), is one of six known species within the genus '' Ebolavirus''. Four of the six known ebolaviruses, including EBOV, cause a severe and often fatal hemorrhagic fever in humans and o ...
, can cause severe, life-threatening disease.


Signs and symptoms

Signs and symptoms of VHFs include (by definition) fever and bleeding: * Flushing of the face and chest, small red or purple spots (
petechiae A petechia () is a small red or purple spot (≤4 mm in diameter) that can appear on the skin, conjunctiva, retina, and mucous membranes which is caused by haemorrhage of capillaries. The word is derived from Italian , 'freckle,' of obscure origi ...
), bleeding, swelling caused by
edema Edema, also spelled oedema, and also known as fluid retention, dropsy, hydropsy and swelling, is the build-up of fluid in the body's tissue. Most commonly, the legs or arms are affected. Symptoms may include skin which feels tight, the area ma ...
, low blood pressure (
hypotension Hypotension is low blood pressure. Blood pressure is the force of blood pushing against the walls of the arteries as the heart pumps out blood. Blood pressure is indicated by two numbers, the systolic blood pressure (the top number) and the di ...
), and circulatory shock. *
Malaise As a medical term, malaise is a feeling of general discomfort, uneasiness or lack of wellbeing and often the first sign of an infection or other disease. The word has existed in French since at least the 12th century. The term is often used ...
,
muscle pain Myalgia (also called muscle pain and muscle ache in layman's terms) is the medical term for muscle pain. Myalgia is a symptom of many diseases. The most common cause of acute myalgia is the overuse of a muscle or group of muscles; another like ...
, headache, vomiting, and diarrhea occur frequently. The severity of symptoms varies with the type of virus. The "VHF syndrome" (capillary leak, bleeding diathesis, and circulatory compromise leading to shock) appears in a majority of people with filoviral hemorrhagic fevers (e.g., Ebola and
Marburg virus Marburg virus (MARV) is a hemorrhagic fever virus of the '' Filoviridae'' family of viruses and a member of the species '' Marburg marburgvirus'', genus '' Marburgvirus''. It causes Marburg virus disease in primates, a form of viral hemorrhagi ...
),
Crimean–Congo hemorrhagic fever Crimean–Congo hemorrhagic fever (CCHF) is a viral disease. Symptoms of CCHF may include fever, muscle pains, headache, vomiting, diarrhea, and bleeding into the skin. Onset of symptoms is less than two weeks following exposure. Complicatio ...
(CCHF), and the
South American hemorrhagic fever South is one of the cardinal directions or Points of the compass, compass points. The direction is the opposite of north and is perpendicular to both east and west. Etymology The word ''south'' comes from Old English ''sūþ'', from earlier Pro ...
s caused by
arenavirus An arenavirus is a bisegmented ambisense RNA virus that is a member of the family ''Arenaviridae''. These viruses infect rodents and occasionally humans. A class of novel, highly divergent arenaviruses, properly known as reptarenaviruses, have ...
es, but only in a small minority of patients with
dengue Dengue fever is a mosquito-borne tropical disease caused by the dengue virus. Symptoms typically begin three to fourteen days after infection. These may include a high fever, headache, vomiting, muscle and joint pains, and a characteristic ...
or Rift Valley fever.


Causes

Five families of RNA viruses have been recognised as being able to cause hemorrhagic fevers. * The order ''
Bunyavirales ''Bunyavirales'' is an order of segmented negative-strand RNA viruses with mainly tripartite genomes. Member viruses infect arthropods, plants, protozoans, and vertebrates. It is the only order in the class ''Ellioviricetes''. The name ''Bunyav ...
'' includes the families '' Arenaviridae'', ''
Fimoviridae ''Emaravirus'' is a genus of negative-strand RNA viruses which infect plants. The plant virus group is the sole genus in the family ''Fimoviridae''. The genus has 21 species. Structure Virions of this genus are between 80 and 100 nm and co ...
'', and all members of the former family ''Bunyaviridae'', especially ''
Peribunyaviridae ''Peribunyaviridae'' is a family of viruses in the order ''Bunyavirales''. Its name partially derives from Bunyamwera, Uganda }), is a landlocked country in East Africa. The country is bordered to the east by Kenya, to the north by So ...
''. :* The family '' Arenaviridae'' include the viruses responsible for
Lassa fever Lassa fever, also known as Lassa hemorrhagic fever (LHF), is a type of viral hemorrhagic fever caused by the Lassa virus. Many of those infected by the virus do not develop symptoms. When symptoms occur they typically include fever, weakness, ...
(
Lassa virus ''Lassa mammarenavirus'' (LASV) is an arenavirus that causes Lassa hemorrhagic fever, a type of viral hemorrhagic fever (VHF), in humans and other primates. ''Lassa mammarenavirus'' is an emerging virus and a select agent, requiring Biosafet ...
),
Lujo virus Lujo is a bisegmented RNA virus—a member of the family '' Arenaviridae''—and a known cause of viral hemorrhagic fever (VHF) in humans. Its name was suggested by the Special Pathogens Unit of the National Institute for Communicable Diseases of ...
,
Argentine Argentines (mistakenly translated Argentineans in the past; in Spanish (masculine) or (feminine)) are people identified with the country of Argentina. This connection may be residential, legal, historical or cultural. For most Argentines, ...
( Junin virus),
Bolivian Bolivian may refer to: * Something of, or related to Bolivia ** Bolivian people ** Demographics of Bolivia ** Culture of Bolivia * SS ''Bolivian'', a British-built standard cargo ship A cargo ship or freighter is a merchant ship that carries ...
( Machupo virus), Brazilian ( Sabiá virus), Chapare hemorrhagic fever ( Chapare virus),
Venezuelan Venezuela (; ), officially the Bolivarian Republic of Venezuela ( es, link=no, República Bolivariana de Venezuela), is a country on the northern coast of South America, consisting of a continental landmass and many islands and islets in th ...
( Guanarito virus) and Whitewater Arroyo virus hemorrhagic fevers. :* The former family ''Bunyaviridae'' includes ::* the causative agents of
Hantavirus hemorrhagic fever with renal syndrome Hantavirus hemorrhagic fever with renal syndrome (HFRS) is a group of clinically similar illnesses caused by species of hantaviruses. It is also known as Korean hemorrhagic fever and epidemic hemorrhagic fever. It is found in Europe, Asia, and A ...
(HV-HFRS) (''
Hantaviridae ''Hantaviridae'' is a family of viruses in the order ''Bunyavirales''. It is named for the Hantan River area in South Korea where an early outbreak of one of its species was observed. Taxonomy * '' Actantavirinae'' ** '' Actinovirus'' * '' Aga ...
''), ::* the Crimean-Congo hemorrhagic fever (CCHF) virus from the genus ''
Orthonairovirus ''Orthonairovirus'' is a genus of viruses in the family ''Nairoviridae'' of the order Bunyavirales that include viruses with circular, negative-sense single stranded RNA. It got its name from the Nairobi sheep disease that affects the gastroin ...
'' (''
Nairoviridae ''Nairoviridae'' is a family of viruses in the order ''Bunyavirales ''Bunyavirales'' is an order of segmented negative-strand RNA viruses with mainly tripartite genomes. Member viruses infect arthropods, plants, protozoans, and vertebrates. I ...
''), ::* Garissa virus and Ilesha virus from the genus ''
Orthobunyavirus ''Orthobunyavirus'' is a genus of the '' Peribunyaviridae'' family in the order ''Bunyavirales''. There are currently ~170 viruses recognised in this genus. These have been assembled into 103 species and 20 serogroups. The name ''Orthobunyavirus ...
'' (''
Peribunyaviridae ''Peribunyaviridae'' is a family of viruses in the order ''Bunyavirales''. Its name partially derives from Bunyamwera, Uganda }), is a landlocked country in East Africa. The country is bordered to the east by Kenya, to the north by So ...
''), and ::* the Rift Valley fever (RVF) virus from the genus ''
Phlebovirus ''Phlebovirus'' is one of twenty genera of the family ''Phenuiviridae'' in the order ''Bunyavirales''. The genus contains 66 species. It derives its name from Phlebotominae, the vectors of member species '' Naples phlebovirus'', which is said to ...
'' (''
Phenuiviridae ''Phenuiviridae'' is a family of negative-strand RNA viruses in the order '' Bunyavirales''. Ruminants, camels, humans, and mosquitoes serve as natural hosts. Member genus ''Phlebovirus'' is the only genus of the family that has viruses that caus ...
''). * The family '' Filoviridae'' (order ''
Mononegavirales ''Mononegavirales'' is an order of negative-strand RNA viruses which have nonsegmented genomes. Some common members of the order are Ebola virus, human respiratory syncytial virus, measles virus, mumps virus, Nipah virus, and rabies virus. A ...
'') includes
Ebola virus ''Zaire ebolavirus'', more commonly known as Ebola virus (; EBOV), is one of six known species within the genus '' Ebolavirus''. Four of the six known ebolaviruses, including EBOV, cause a severe and often fatal hemorrhagic fever in humans and o ...
and
Marburg virus Marburg virus (MARV) is a hemorrhagic fever virus of the '' Filoviridae'' family of viruses and a member of the species '' Marburg marburgvirus'', genus '' Marburgvirus''. It causes Marburg virus disease in primates, a form of viral hemorrhagi ...
. * The family ''
Flaviviridae ''Flaviviridae'' is a family of enveloped positive-strand RNA viruses which mainly infect mammals and birds. They are primarily spread through arthropod vectors (mainly ticks and mosquitoes). The family gets its name from the yellow fever viru ...
'' (order '' Amarillovirales'') includes
dengue Dengue fever is a mosquito-borne tropical disease caused by the dengue virus. Symptoms typically begin three to fourteen days after infection. These may include a high fever, headache, vomiting, muscle and joint pains, and a characteristic ...
,
yellow fever Yellow fever is a viral disease of typically short duration. In most cases, symptoms include fever, chills, loss of appetite, nausea, muscle pains – particularly in the back – and headaches. Symptoms typically improve within five days. ...
, and two viruses in the
tick-borne encephalitis Tick-borne encephalitis (TBE) is a viral infectious disease involving the central nervous system. The disease most often manifests as meningitis, encephalitis or meningoencephalitis. Myelitis and spinal paralysis also occurs. In about one third ...
group that cause VHF:
Omsk hemorrhagic fever Omsk hemorrhagic fever is a viral hemorrhagic fever caused by a Flavivirus. It was found in Siberia and was named for an outbreak in the city of Omsk. First records of the new virus appeared around 1940–1943. Signs and symptoms There are a num ...
virus and Kyasanur Forest disease virus. * The family ''
Togaviridae This category is for articles about virus families (or redirects to such articles). There should be no subcategories. families Families (biology) ...
'' (order ''
Martellivirales ''Martellivirales'' is an order of viruses. Taxonomy The following families are recognized: *''Bromoviridae'' *''Closteroviridae'' *''Endornaviridae'' *'' Kitaviridae'' *'' Mayoviridae'' *''Togaviridae'' *''Virgaviridae ''Virgaviridae'' is a ...
'') includes '' Chikungunya virus'' which causes Chikungunya fever. * Family ''
Rhabdoviridae ''Rhabdoviridae'' is a family of negative-strand RNA viruses in the order '' Mononegavirales''. Vertebrates (including mammals and humans), invertebrates, plants, fungi and protozoans serve as natural hosts. Diseases associated with member ...
'' (order ''
Mononegavirales ''Mononegavirales'' is an order of negative-strand RNA viruses which have nonsegmented genomes. Some common members of the order are Ebola virus, human respiratory syncytial virus, measles virus, mumps virus, Nipah virus, and rabies virus. A ...
''): In September 2012 scientists writing in the journal
PLOS Pathogens ''PLOS Pathogens'' is a peer-reviewed open-access medical journal. All content in ''PLOS Pathogens'' is published under the Creative Commons "by-attribution" license. ''PLOS Pathogens'' began operation in September 2005. It was the fifth journa ...
reported the isolation of a member of the ''
Rhabdoviridae ''Rhabdoviridae'' is a family of negative-strand RNA viruses in the order '' Mononegavirales''. Vertebrates (including mammals and humans), invertebrates, plants, fungi and protozoans serve as natural hosts. Diseases associated with member ...
'' responsible for 2 fatal and 2 non-fatal cases of hemorrhagic fever in the Bas-Congo district of the Democratic Republic of Congo. The virus was named Bas-Congo virus. The non-fatal cases occurred in healthcare workers involved in the treatment of the other two, suggesting the possibility of person-to-person transmission. This virus is related to the
Ephemerovirus ''Ephemerovirus'' is a genus of viruses in the family ''Rhabdoviridae'', order ''Mononegavirales ''Mononegavirales'' is an order of negative-strand RNA viruses which have nonsegmented genomes. Some common members of the order are Ebola viru ...
and Tibrovirus genera. The pathogen that caused the
cocoliztli The Cocoliztli Epidemic or the Great Pestilence was an outbreak of a mysterious illness characterized by high fevers and bleeding which caused millions of deaths in New Spain during the 16th-century. The Aztec people called it ''cocoliztli'', Na ...
epidemics in Mexico of 1545 and
1576 Year 1576 ( MDLXXVI) was a leap year starting on Sunday (link will display the full calendar) of the Julian calendar. Events January–June * January 20 – Viceroy Martín Enríquez de Almanza founds the settlement of León ...
is still unknown, and the 1545 epidemic may have been bacterial rather than viral.


Pathophysiology

Different hemorrhagic fever viruses act on the body in different ways, resulting in different symptoms. In most VHFs, it is likely that several mechanisms contribute to symptoms, including liver damage,
disseminated intravascular coagulation Disseminated intravascular coagulation (DIC) is a condition in which blood clots form throughout the body, blocking small blood vessels. Symptoms may include chest pain, shortness of breath, leg pain, problems speaking, or problems moving parts ...
(DIC), and bone marrow dysfunction. In DIC, small blood clots form in blood vessels throughout the body, removing platelets necessary for clotting from the bloodstream and reducing clotting ability. DIC is thought to cause bleeding in Rift Valley, Marburg, and Ebola fevers. For filoviral hemorrhagic fevers, there are four general mechanisms of pathogenesis. The first mechanism is dissemination of virus due to suppressed responses by
macrophages Macrophages (abbreviated as M φ, MΦ or MP) ( el, large eaters, from Greek ''μακρός'' (') = large, ''φαγεῖν'' (') = to eat) are a type of white blood cell of the immune system that engulfs and digests pathogens, such as cancer ce ...
and
dendritic cell Dendritic cells (DCs) are antigen-presenting cells (also known as ''accessory cells'') of the mammalian immune system. Their main function is to process antigen material and present it on the cell surface to the T cells of the immune system. Th ...
(antigen presenting cells). The second mechanism is prevention of
antigen In immunology, an antigen (Ag) is a molecule or molecular structure or any foreign particulate matter or a pollen grain that can bind to a specific antibody or T-cell receptor. The presence of antigens in the body may trigger an immune respon ...
specific immune response. The third mechanism is
apoptosis Apoptosis (from grc, ἀπόπτωσις, apóptōsis, 'falling off') is a form of programmed cell death that occurs in multicellular organisms. Biochemical events lead to characteristic cell changes ( morphology) and death. These changes in ...
of lymphocytes. The fourth mechanism is when infected macrophages interact with toxic
cytokines Cytokines are a broad and loose category of small proteins (~5–25 kDa) important in cell signaling. Cytokines are peptides and cannot cross the lipid bilayer of cells to enter the cytoplasm. Cytokines have been shown to be involved in autocrin ...
, leading to
diapedesis Leukocyte extravasation (also commonly known as leukocyte adhesion cascade or diapedesis – the passage of cells through the intact vessel wall) is the movement of leukocytes out of the circulatory system and towards the site of tissue damage ...
and coagulation deficiency. From the vascular perspective, the virus will infect vascular endothelial cells, leading to the reorganization of the
VE-cadherin Cadherin 5, type 2 or VE-cadherin (vascular endothelial cadherin) also known as CD144 ( Cluster of Differentiation 144), is a type of cadherin. It is encoded by the human gene ''CDH5''. Function VE-cadherin is a classical cadherin from the cad ...
catenin complex (a protein important in cell adhesion). This reorganization creates intercellular gaps in endothelial cells. The gaps lead to increased endothelial permeability and allow blood to escape from the vascular circulatory system. The reasons for variation among patients infected with the same virus are unknown but stem from a complex system of virus-host interactions. Dengue fever becomes more virulent during a second infection by means of
antibody-dependent enhancement Antibody-dependent enhancement (ADE), sometimes less precisely called immune enhancement or disease enhancement, is a phenomenon in which binding of a virus to suboptimal antibodies enhances its entry into host cells, followed by its repl ...
. After the first infection,
macrophage Macrophages (abbreviated as M φ, MΦ or MP) ( el, large eaters, from Greek ''μακρός'' (') = large, ''φαγεῖν'' (') = to eat) are a type of white blood cell of the immune system that engulfs and digests pathogens, such as cancer ce ...
s display antibodies on their cell membranes specific to the dengue virus. By attaching to these antibodies, dengue viruses from a second infection are better able to infect the macrophages, thus reducing the immune system's ability to fight off infection.


Diagnosis

Definitive diagnosis is usually made at a reference laboratory with advanced
biocontainment One use of the concept of biocontainment is related to laboratory biosafety and pertains to microbiology laboratories in which the physical containment of pathogenic organisms or agents ( bacteria, viruses, and toxins) is required, usually ...
capabilities. The findings of laboratory investigation vary somewhat between the viruses but in general, there is a decrease in the total white cell count (particularly the
lymphocyte A lymphocyte is a type of white blood cell (leukocyte) in the immune system of most vertebrates. Lymphocytes include natural killer cells (which function in cell-mediated, cytotoxic innate immunity), T cells (for cell-mediated, cytotoxic a ...
s), a decrease in the
platelet Platelets, also called thrombocytes (from Greek θρόμβος, "clot" and κύτος, "cell"), are a component of blood whose function (along with the coagulation factors) is to react to bleeding from blood vessel injury by clumping, thereby i ...
count, an increase in the blood serum
liver enzyme Liver function tests (LFTs or LFs), also referred to as a hepatic panel, are groups of blood tests that provide information about the state of a patient's liver. These tests include prothrombin time (PT/INR), activated partial thromboplastin tim ...
s, and reduced blood clotting ability measured as an increase in both the
prothrombin Thrombin (, ''fibrinogenase'', ''thrombase'', ''thrombofort'', ''topical'', ''thrombin-C'', ''tropostasin'', ''activated blood-coagulation factor II'', ''blood-coagulation factor IIa'', ''factor IIa'', ''E thrombin'', ''beta-thrombin'', ''gamma- ...
(PT) and activated
partial thromboplastin time The partial thromboplastin time (PTT), also known as the activated partial thromboplastin time (aPTT or APTT), is a blood test that characterizes coagulation of the blood. A historical name for this measure is the kaolin-cephalin clotting time ( ...
s (PTT). The
hematocrit The hematocrit () (Ht or HCT), also known by several other names, is the volume percentage (vol%) of red blood cells (RBCs) in blood, measured as part of a blood test. The measurement depends on the number and size of red blood cells. It is norm ...
may be elevated. The serum urea and creatine may be raised but this is dependent on the hydration status of the patient. The bleeding time tends to be prolonged.


Prevention

With the exception of
yellow fever vaccine Yellow fever vaccine is a vaccine that protects against yellow fever. Yellow fever is a viral infection that occurs in Africa and South America. Most people begin to develop immunity within ten days of vaccination and 99 percent are protected ...
and
Ebola vaccine Ebola vaccines are vaccines either approved or in development to prevent Ebola. As of 2022, there are only vaccines against the Zaire ebolavirus. The first vaccine to be approved in the United States was rVSV-ZEBOV in December 2019. It had be ...
s, vaccines for VHF-associated viruses are generally not available. Post-exposure prophylactic (preventive)
ribavirin Ribavirin, also known as tribavirin, is an antiviral medication used to treat RSV infection, hepatitis C and some viral hemorrhagic fevers. For hepatitis C, it is used in combination with other medications such as simeprevir, sofosbuvir, pe ...
may be effective for some bunyavirus and arenavirus infections. VHF isolation guidelines dictate that all VHF patients (with the exception of dengue patients) should be cared for using strict contact precautions, including hand hygiene, double gloves, gowns, shoe and leg coverings, and face shield or goggles. Lassa, CCHF, Ebola, and Marburg viruses may be particularly prone to
nosocomial A hospital-acquired infection, also known as a nosocomial infection (from the Greek , meaning "hospital"), is an infection that is acquired in a hospital or other health care facility. To emphasize both hospital and nonhospital settings, it is so ...
(hospital-based) spread. Airborne precautions should be utilized including, at a minimum, a fit-tested, HEPA filter-equipped respirator (such as an N-95 mask), a battery-powered, air-purifying respirator, or a positive pressure supplied air respirator to be worn by personnel coming within 1,8 meter (six feet) of a VHF patient. Groups of patients should be cohorted (sequestered) to a separate building or a ward with an isolated air-handling system. Environmental decontamination is typically accomplished with hypochlorite (e.g. bleach) or phenolic disinfectants.


Management

Medical management of VHF patients may require intensive supportive care. Antiviral therapy with intravenous
ribavirin Ribavirin, also known as tribavirin, is an antiviral medication used to treat RSV infection, hepatitis C and some viral hemorrhagic fevers. For hepatitis C, it is used in combination with other medications such as simeprevir, sofosbuvir, pe ...
may be useful in Bunyaviridae and Arenaviridae infections (specifically Lassa fever, RVF, CCHF, and HFRS due to Old World Hantavirus infection) and can be used only under an experimental protocol as IND approved by the U.S. Food and Drug Administration (FDA). Interferon may be effective in Argentine or Bolivian hemorrhagic fevers (also available only as IND).


Epidemiology

* Cocoliztli in Mexico 1545 and
1576 Year 1576 ( MDLXXVI) was a leap year starting on Sunday (link will display the full calendar) of the Julian calendar. Events January–June * January 20 – Viceroy Martín Enríquez de Almanza founds the settlement of León ...
. * The Great
Yellow Fever Epidemic of 1793 During the 1793 yellow fever epidemic in Philadelphia, 5,000 or more people were listed in the official register of deaths between August 1 and November 9. The vast majority of them died of yellow fever, making the epidemic in the city of 50,0 ...
in Philadelphia, PA, US. Nearly 10% of the population of 50,000 died from the disease. *
Mékambo Mékambo is a small town in north-eastern Gabon on the banks of the Zadié river. It is located in the Ogooué-Ivindo province of Gabon and is the seat of the Zadié Department. It has received international press for recent outbreaks of Ebola ...
in
Gabon Gabon (; ; snq, Ngabu), officially the Gabonese Republic (french: République gabonaise), is a country on the west coast of Central Africa. Located on the equator, it is bordered by Equatorial Guinea to the northwest, Cameroon to the nort ...
is the site of several outbreaks of
Ebola virus ''Zaire ebolavirus'', more commonly known as Ebola virus (; EBOV), is one of six known species within the genus '' Ebolavirus''. Four of the six known ebolaviruses, including EBOV, cause a severe and often fatal hemorrhagic fever in humans and o ...
disease. *
Orientale Province Orientale Province ( French: ''Province orientale'', "Eastern province") is one of the former provinces of the Democratic Republic of the Congo and its predecessors the Congo Free State and the Belgian Congo. It went through a series of boundary ...
,
Democratic Republic of the Congo The Democratic Republic of the Congo (french: République démocratique du Congo (RDC), colloquially "La RDC" ), informally Congo-Kinshasa, DR Congo, the DRC, the DROC, or the Congo, and formerly and also colloquially Zaire, is a country in ...
villages of Durba and
Watsa Watsa is a community in the Haut-Uele Province of the Democratic Republic of the Congo, administrative center of the Watsa Territory. It is served by Watsa Airport, a grass airstrip south of the town. Watsa was the location of the VI battalion ...
were the epicenter of the 1998–2000 outbreak of
Marburg virus Marburg virus (MARV) is a hemorrhagic fever virus of the '' Filoviridae'' family of viruses and a member of the species '' Marburg marburgvirus'', genus '' Marburgvirus''. It causes Marburg virus disease in primates, a form of viral hemorrhagi ...
disease. *
Uíge Province Uíge (pronunciation: ; kg, Wizidi) is one of the eighteen Provinces of Angola, located in the northwestern part of the country. Its capital city is of the same name. History During the Middle Ages, the Uíge Province was the heartland of the ...
in
Angola , national_anthem = "Angola Avante"() , image_map = , map_caption = , capital = Luanda , religion = , religion_year = 2020 , religion_ref = , coordinat ...
was the site of another outbreak of Marburg virus disease in 2005, the largest one to date of this disease. * A VHF outbreak in the village of
Mweka, Democratic Republic of the Congo Mweka is a town in southern-central Democratic Republic of the Congo, situated on the Kasai railway line between Kananga (250 km away) and the Kasai River port of Ilebo (172 km away). Mweka is also the headquarters of the Territoire ...
(DRC) that started in August 2007, and that has killed 103 people (100 adults and three children), has been shown to be caused (at least partially) by
Ebola virus ''Zaire ebolavirus'', more commonly known as Ebola virus (; EBOV), is one of six known species within the genus '' Ebolavirus''. Four of the six known ebolaviruses, including EBOV, cause a severe and often fatal hemorrhagic fever in humans and o ...
. * A viral hemorrhagic fever is a possible cause of the
Plague of Athens The Plague of Athens ( grc, Λοιμὸς τῶν Ἀθηνῶν}, ) was an epidemic that devastated the city-state of Athens in ancient Greece during the second year (430 BC) of the Peloponnesian War when an Athenian victory still seemed within r ...
during the
Peloponnesian War The Peloponnesian War (431–404 BC) was an ancient Greek war fought between Athens and Sparta and their respective allies for the hegemony of the Greek world. The war remained undecided for a long time until the decisive intervention of ...
. * A viral hemorrhagic fever is an alternate
theory A theory is a rational type of abstract thinking about a phenomenon, or the results of such thinking. The process of contemplative and rational thinking is often associated with such processes as observational study or research. Theories may ...
of the cause of the
Black Death The Black Death (also known as the Pestilence, the Great Mortality or the Plague) was a bubonic plague pandemic occurring in Western Eurasia and North Africa from 1346 to 1353. It is the most fatal pandemic recorded in human history, causi ...
and the
Plague of Justinian The plague of Justinian or Justinianic plague (541–549 AD) was the first recorded major outbreak of the first plague pandemic, the first Old World pandemic of plague, the contagious disease caused by the bacterium ''Yersinia pestis''. The dis ...
* The initial, and currently only, outbreak of
Lujo virus Lujo is a bisegmented RNA virus—a member of the family '' Arenaviridae''—and a known cause of viral hemorrhagic fever (VHF) in humans. Its name was suggested by the Special Pathogens Unit of the National Institute for Communicable Diseases of ...
in September–October 2008 left 4/5 patients dead. * The
2014 West Africa Ebola outbreak The 2013–2016 epidemic of Ebola virus disease, centered in Western Africa, was the most widespread outbreak of the disease in history. It caused major loss of life and socioeconomic disruption in the region, mainly in Guinea, Liberia and S ...
, which was the biggest outbreak in history.


Biowarfare potential

The VHF viruses are spread in a variety of ways. Some may be transmitted to humans through a respiratory route. According to Soviet defector
Ken Alibek Kanatzhan "Kanat" Alibekov ( kk, Қанатжан Байзақұлы Әлібеков, Qanatjan Baizaqūly Älıbekov; russian: Канатжан Алибеков, Kanatzhan Alibekov; born 1950), known as Kenneth "Ken" Alibek since 1992, is a Kazak ...
, Soviet scientists concluded China may have tried to weaponize a VHF virus during the late 1980s but discontinued to do so after an outbreak. The virus is considered by military medical planners to have a potential for aerosol dissemination, weaponization, or likelihood for confusion with similar agents that might be weaponized.


See also

* Dr.
Matthew Lukwiya Matthew Lukwiya (24 November 1957 – 5 December 2000) was a Ugandan physician and the supervisor of St. Mary's Hospital Lacor, outside of Gulu. He was at the forefront of the 2000 Ebola virus disease outbreak in Uganda until he died from the ...
(1957–2000) * C. J. Peters *
Biosafety Biosafety is the prevention of large-scale loss of biological integrity, focusing both on ecology and human health. These prevention mechanisms include conduction of regular reviews of the biosafety in laboratory settings, as well as strict guide ...
* Jordi Casals-Ariet


References


External links

* * * {{Authority control Animal viral diseases Tropical diseases