Procédure de gestion du risque de fièvre hémorragique virale pour les professionnels de la santé et les autres parties prenantes concernées

Objectives

The procedure establishes a national and regional public-health framework for early recognition, classification, containment and safe management of suspected, probable and confirmed viral haemorrhagic fever, including Ebola, Marburg, Lassa, Crimean-Congo haemorrhagic fever and Rift Valley fever. It combines clinical, laboratory and epidemiological assessment to guide public-health action, while distinguishing case classification from clinical diagnosis.[1][2][3]

• Identify potential cases through compatible symptoms, recent travel or residence in epidemic or endemic areas, contact with cases or their body fluids, occupational exposure, healthcare exposure, wildlife exposure and other zoonotic risks.[4][5][6]
• Classify people as non-cases, exposed or possible cases, probable cases, or confirmed cases according to exposure history, clinical presentation, epidemiological links and validated laboratory findings.[7][8][9]
• Prevent onward transmission through early notification, infection prevention and control, protected referral, laboratory biosafety, contact tracing, risk-based monitoring, safe waste management and safe handling of deaths.[10][11][12][13]
• Protect healthcare workers, laboratory personnel, families, contacts and the public from exposure to infectious biological fluids and contaminated materials.[2][14][15]
• Provide safe clinical care, supportive treatment and pathogen-specific treatment options where indicated, including expert consideration of targeted treatments and clinical trials.[16][17][18]

Implementation

Implementation follows a stepped pathway from assessment by primary-care or hospital clinicians, through regional public-health validation and reference-hospital management, to coordinated laboratory confirmation, contact management and communication. Regional health authorities coordinate case assessment and follow-up, while designated high-level isolation reference hospitals manage probable cases and the Institute of Tropical Medicine serves as National Reference Centre and laboratory partner.[1][19][20][11][21]

• Assess suspected cases using a flowchart centred on recent travel or contact during the preceding 21 days, exposure risk, fever or compatible symptoms, multiorgan failure and unexplained sudden death; consult current international outbreak information because geographical risk lists change over time.[4][19]
• Apply immediate precautions for suspected cases by limiting contact, maintaining distance where appropriate, isolating the patient where possible, avoiding non-essential diagnostic sampling before referral, and notifying the competent regional health authority for further risk assessment.[19][22]
• Monitor asymptomatic exposed people for 21 days after their last exposure through twice-daily temperature measurement, symptom vigilance and reporting arrangements proportionate to low, moderate or high exposure risk; activate probable-case measures if fever above 38°C or compatible symptoms develop.[23]
• Refer probable cases to UZ Antwerpen or CHU Saint-Pierre in Brussels, with the regional authority and infectious-diseases physician coordinating safe transfer; minimise care and avoid blood sampling, intravenous access and aerosol-generating procedures before arrival at a reference hospital.[20][24]
• Use enhanced personal protective equipment for staff near probable cases, and apply reference-hospital high-level isolation procedures that include double gloves, impermeable protective clothing, protective footwear and respiratory protection.[24]
• Collect and transport samples under biosafety requirements to the Institute of Tropical Medicine or, where required, the Bernhard Nocht Institute; use molecular detection of viral ribonucleic acid or virus isolation for confirmation, and repeat early negative tests where symptoms persist.[2][25][26]
• Restrict high-risk laboratory work to essential testing, use containment level 3 for non-replicating differential and biochemical analyses, and require containment level 4, authorisation and legal compliance for virus multiplication or amplification.[14][15]
• Activate hospital crisis procedures and a central Emergency Operations Centre involving regional authorities, the Federal Public Service Health, Food Chain Safety and Environment, the reference hospital, and the Institute of Tropical Medicine; coordinate information-sharing, laboratory-result communication and press communication through the interfederal plan.[21][17]
• Identify and categorise healthcare, household, social, laboratory and travel contacts by the date, nature, duration and frequency of exposure, and apply precautions and monitoring according to accidental, low- or high-risk classification.[11][12][27]
• Monitor filovirus and arenavirus contacts for 21 days and bunyavirus contacts for 14 days; require daily active reporting for high-risk contacts, while allowing asymptomatic low-risk contacts to continue normal activities without quarantine.[27]
• Manage symptomatic contacts through consultation with a reference-hospital infectious-diseases physician and coordinate transport through the regional health authority; determine post-exposure prophylaxis case by case according to the pathogen and exposure.[28][29]
• Classify waste from probable cases as high-risk infectious waste, use layered leak-proof packaging and disinfection procedures, and arrange compliant storage, transport and disposal.[30][31][32]
• Limit handling of deceased patients, avoid autopsy and ritual care, use double leak-proof body bags and sealed coffins, label remains as high-risk infectious material, and arrange burial or cremation promptly, preferably within 48 hours.[13][33][34]
• Maintain operational records through questionnaires, contact registers, staff-contact logs and burial registers; the supplied material does not specify programme-wide performance indicators, routine evaluation schedules, budgets or financing arrangements.[22][21][35]

Monitoring & Evaluation

Monitoring and accountability rely primarily on notification, structured risk assessment, laboratory confirmation, contact tracing, exposure-based follow-up and multi-level coordination rather than a formal performance-management framework.[1][22][11][17]

• Use standardised clinical, epidemiological and laboratory criteria to distinguish non-cases, possible or exposed cases, probable cases and confirmed cases for public-health action; these classifications support risk management and do not replace clinical diagnosis.[2][7][8][9]
• Notify the competent regional health authority promptly when viral haemorrhagic fever is suspected or a probable case is identified, enabling a brief risk assessment with the treating clinician and a decision on case status.[19][22]
• Complete a detailed questionnaire for probable cases covering clinical presentation, hospitalisation, travel during the 21 days before symptom onset, exposure history, vaccination, malaria prophylaxis and available laboratory results.[22][36][37][38]
• Maintain current epidemiological awareness by consulting outbreak communications and information from endemic areas when assessing a notified case, because country risk lists are changeable snapshots.[4][39]
• Monitor asymptomatic exposed persons for 21 days after their last exposure through twice-daily temperature checks, symptom vigilance and daily transmission of readings and complaints to the regional authority physician or occupational health service, with arrangements determined by exposure risk.[23]
• Escalate to probable-case measures when an exposed person develops fever above 38°C or compatible symptoms, and reassess people initially classified as non-cases if their condition deteriorates or remains clinically unclear.[40][23]
• Classify exposure as low, moderate or high risk and use the categorisation to determine follow-up, precautions and work-related restrictions.[23][11][12]
• Monitor confirmed-case contacts for 21 days for filoviruses and arenaviruses and 14 days for bunyaviruses, including twice-daily temperature measurement and daily symptom checks.[27]
• Require high-risk contacts to report actively to the regional health authority each day, while enabling low-risk contacts to continue normal activities while asymptomatic and requiring them to seek assessment if fever or compatible symptoms arise.[27]
• Compile contact records for healthcare workers, laboratory personnel, household members, friends, travel contacts and other potentially exposed people, recording the date, duration, frequency and nature of contact and its risk category.[11][30][12]
• Maintain a register of hospital staff who contacted the patient, including the date, type, duration and frequency of contact, and coordinate subsequent contact follow-up according to laboratory results.[21]
• Confirm infection through molecular detection of viral ribonucleic acid in a clinical sample or virus isolation.[2][9]
• Repeat testing case by case if an initial result is negative within 72 hours of fever or symptom onset and symptoms persist; regard a negative result as fully exclusionary after 72 hours of illness unless an alternative diagnosis is established earlier.[26]
• Classify a probable case as a non-case after a negative test more than 72 hours after symptom onset, or after an early negative result followed by 48 hours without fever or compatible symptoms; classify laboratory-validated infection as confirmed.[26]
• Report laboratory results from the Institute of Tropical Medicine to the responsible infectious-diseases specialist at the reference hospital, who communicates them through the central team to regional and federal health authorities for contact measures.[26]
• Coordinate probable-case management through the regional authority, reference hospital, Institute of Tropical Medicine as National Reference Centre, and an Emergency Operations Centre under the Federal Public Service Health, Food Chain Safety and Environment.[11][21]
• Use secure information-sharing platforms and coordinate public communication through the central team, the Emergency Operations Centre and the interfederal communications arrangements.[17]
• Assign the Risk Management Group responsibility for overseeing correct procedure application and making decisions required to manage a confirmed situation.[17]
• Record all burials of patients with viral haemorrhagic fever in a register maintained by the competent authority.[35][13]
• Apply laboratory biosafety controls, including notification for specified containment level 3 activities and formal authorisation for non-patient-care research involving viral haemorrhagic fever viruses.[15]

No formal programme-level indicator set, performance targets, routine evaluation cycle, independent accountability mechanism or comprehensive reporting timetable is specified beyond the notification, monitoring, registers, laboratory reporting, coordination and procedural-control arrangements described.[11][17][27][14][31]

Costing & Financing

Costing and financing are largely unspecified: the material does not provide an overall budget, financing model, resource-mobilisation plan, funding-gap assessment or economic assumptions for implementation.[1][24][14][31]

• Identify substantial operational resource requirements, including high-level isolation capacity, personal protective equipment, reference-hospital transport, diagnostic testing, specimen packaging, safety cabinets, spill kits, validated disinfectants, waste containers and authorised waste transport.[24][25][15][41][31][32]
• Require healthcare institutions to establish internal risk-management and decontamination procedures, but do not allocate a budget or identify a funding source for these functions.[21][24]
• Provide a historical price of 39.80 euros, excluding value-added tax and shipping, for one box of Septodry absorbent sachets in 2013.[42]
• Describe zinc film as less expensive than zinc coffins, without a monetary value, currency, date or quantified saving.[43]
• Indicate that a regional health-authority physician may assist in arranging material for funeral procedures, without specifying financing responsibility or cost.[34]

No further explicit cost items, allocations, funding gaps or quantified economic comparisons are specified in the supplied material.[43][44]