Viral haemorrhagic fevers (VHF) are zoonoses caused by several different viruses. They are geographically restricted and occur in rural settings or in health-care facilities. All of these viral illnesses, except Ebola and Marburg, have mild self-limiting forms.
Serological surveys have shown that Lassa fever is widespread in West Africa and may lead to up to 500000 infections annually. Mortality overall may be low, as 80% of cases are asymptomatic, but in hospitalised cases mortality averages 15%. Ebola outbreaks have occurred at a rate of approximately one per year, involving up to a few hundred cases. The largest outbreaks have been in the Democratic Republic of Congo, Uganda and Sudan.
Marburg has been documented less frequently, with outbreaks in the Democratic Republic of Congo and Uganda, but the largest outbreak to date involved 163 cases in Angola in 2005. Mortality rates of Ebola and Marburg are high.
VHF have extended into Europe, with an outbreak of Congo–Crimean haemorrhagic fever in Turkey in 2006, and cases of haemorrhagic fever with renal syndrome in the Balkans and Russia. These conditions remain very rare in the UK, with about one case of Lassa fever arriving in the country every 2 years.
Kyasanur forest disease is a tick-borne VHF currently confined to a small focus in Karnataka, India; there are about 500 cases annually. Monkeys are the principal hosts, but with forest felling, there are fears that this disease will increase. New outbreaks and new agents are identified sporadically.
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