Treatment algorithm

Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups: see disclaimer

INITIAL

unidentified viral haemorrhagic fever

1st line – ribavirin

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INITIAL
|
unidentified viral haemorrhagic fever
1st line – 

ribavirin

Ribavirin may be given if a viral haemorrhagic fever is suspected until yellow fever is confirmed, either clinically or by a laboratory, as it has some efficacy in other viral haemorrhagic fevers.[13]

However, as ribavirin has been found to be ineffective for yellow fever in monkey studies, it is discontinued once yellow fever has been confirmed.[41]

Primary options

ribavirin: 33 mg/kg intravenously as a loading dose, followed by 16 mg/kg every 6 hours for 4 days, then 8 mg/kg every 8 hours for 6 days

Plus – supportive therapy

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INITIAL
|
unidentified viral haemorrhagic fever
Plus – 

supportive therapy

Treatment recommended for ALL patients in selected patient group

Patients should be hospitalised for supportive care and observation when possible.

This involves rest, maintaining nutrition and preventing hypoglycaemia, nasogastric suction to prevent gastric distension and aspiration, H2 antagonists (to prevent gastric bleeding), treating hypotension with fluid replacement and vasoactive drugs, giving oxygen, correcting acidosis, treating bleeding complications with fresh frozen plasma, haemodialysis for renal failure, and treating secondary infection with antibiotics.[2] Analgesics/antipyretics are recommended for pain and fever; however, non-steroidal anti-inflammatory drugs (NSAIDs), including aspirin, should be avoided due to the increased risk of bleeding in these patients.

Critically ill patients (i.e., those with multi-organ failure, severe haemorrhagic complications, and/or refractory hypotension) require intensive care monitoring.

The above recommendations are based on clinical experience, but have not been evaluated in clinical studies.[2]

Patients should be isolated/protected from further mosquito exposure (e.g., staying indoors) for up to 5 days following onset of fever to break the transmission cycle.

ACUTE

confirmed yellow fever

1st line – supportive therapy

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ACUTE
|
confirmed yellow fever
1st line – 

supportive therapy

Patients should be hospitalised for supportive care and observation when possible.

This involves rest, maintaining nutrition and preventing hypoglycaemia, nasogastric suction to prevent gastric distension and aspiration, H2 antagonists (to prevent gastric bleeding), treating hypotension with fluid replacement and vasoactive drugs, giving oxygen, correcting acidosis, treating bleeding complications with fresh frozen plasma, haemodialysis for renal failure, and treating secondary infection with antibiotics.[2] Analgesics/antipyretics are recommended for pain and fever; however, non-steroidal anti-inflammatory drugs (NSAIDs), including aspirin, should be avoided due to the increased risk of bleeding in these patients.

Critically ill patients (i.e., those with multi-organ failure, severe haemorrhagic complications, and/or refractory hypotension) require intensive care monitoring.

The above recommendations are based on clinical experience, but have not been evaluated in clinical studies.[2]

Patients should be isolated/protected from further mosquito exposure (e.g., staying indoors) for up to 5 days following onset of fever to break the transmission cycle.

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Choose a patient group to see our recommendations

Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups. See disclaimer

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