Fock R, Koch U, Wirtz A, Peters M, Ruf B, Grünwald T (2001): Erste medizinische und antiepidemische Maßnahmen bei Verdacht auf virales hämorrhagisches Fieber. [Initial medical and antiepidemic measures applied to cases with suspected viral haemorrhagic fever]
Med. Welt 52: 126-132.

The prevention of transmission of serious imported infectious diseases like a viral haemorrhagic fever (VHF) assigns a considerably important role to the primary care physician in practice resp. clinic. If the suspected case is not detected, a potential index patient poses the risk to spread the dangerous pathogens. Necessary safety measures have to be initiated already before results from the virological examinations are available. A careful travel history is unrenounceable. If a viral haemorrhagic fever is clinically suspected, one has to critically investigate if the respective pathogen is endemic in the country of origin resp. the tourist country or if any outbreaks have been recently identified there. The clinical agnosis of VHF in its initial stage is difficult due to the nonspecific symptoms. Other infections, especially malaria infection as the most important differential diagnosis, have to be excluded. Pathognomonic haemorrhagic manifestations and multiple organ failure occur only in advanced stages of the disease. In case of a justified suspicion the patient should be immediately sent resp. transferred to one of the five German special isolation units. However, if the patient's condition requires immediate hospitalization, transfer into the next available hospital should not be delayed. Every hospital should be able to perform emergency treatment under "barrier nursing" conditions. Preparedness relies on implementing such a case in its hygiene plan and staff instructions.