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 hemorrhagic fever

1st line – ribavirin

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INITIAL
|
unidentified viral hemorrhagic fever
1st line – 

ribavirin

Ribavirin may be given if a viral hemorrhagic fever is suspected until yellow fever is confirmed, either clinically or by a laboratory, as it has some efficacy in other viral hemorrhagic 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.[43]

In the US, intravenous ribavirin is available from the Centers for Disease Control and Prevention (CDC) only for compassionate use in this indication.

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 hemorrhagic fever
Plus – 

supportive therapy

Treatment recommended for ALL patients in selected patient group

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

This involves rest, maintaining nutrition and preventing hypoglycemia, 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, hemodialysis for renal failure, and treating secondary infection with antibiotics.[2] Analgesics/antipyretics are recommended for pain and fever; however, nonsteroidal 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 multiorgan failure, severe hemorrhagic 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 hospitalized for supportive care and observation when possible.

This involves rest, maintaining nutrition and preventing hypoglycemia, 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, hemodialysis for renal failure, and treating secondary infection with antibiotics.[2] Analgesics/antipyretics are recommended for pain and fever; however, nonsteroidal 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 multiorgan failure, severe hemorrhagic 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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