Health Advisory: Viral Hemorrhagic Fever

The Situation Report | March 10, 2025

The New York State Department of Health and the New York City Department of Health and Mental Hygiene (NYCDOHMH), Bureau of Immunization issued a health advisory to revise previously published guidance regarding New York State (NYS) healthcare facility and clinical provider readiness for a person with suspected or confirmed viral hemorrhagic fever (VHF). This advisory also broadens the scope of recommendations to include all contagious VHFs, including but not limited to Ebola, Marburg, Lassa, and Crimean-Congo hemorrhagic fever.

In nearly all cases, individuals with fever presenting to NYS healthcare facilities have other illnesses and not VHF. However, outbreaks of VHF recur outside the United States; therefore, NYS healthcare facilities could encounter a patient with compatible symptoms, travel, or other exposures that would result in suspicion for VHF.

This Health Advisory is specific to general hospitals with emergency departments, off campus emergency departments, and rural emergency hospitals, hereafter referred to as healthcare facilities. However, all clinical settings, particularly diagnostic and treatment centers, urgent care centers, and other entities that care for patients with acute illnesses, should review this guidance to determine how best to apply it to their settings.

This document supersedes the NYS Department of Health’s October 27, 2022, HEALTH ADVISORY: Ebola Virus Disease (EVD) in Uganda

Clinician Actions

Evaluating a Person for Possible VHF

• Healthcare providers should not refer a person with possible VHF to a healthcare facility without first consulting with the local health department (LHD) – see contact information below.
  • This includes situations in which you speak to a patient on the phone but do not see them in person.
  • If a patient must immediately be referred to an emergency department, you must alert the receiving emergency department and the LHD.
• While remaining vigilant for a VHF diagnosis, conduct clinically appropriate laboratory testing to determine an alternate diagnosis that may account for the patient’s illness, such as common respiratory illnesses (e.g., COVID-19, influenza), malaria, measles, gastroenteritis, and other diseases that affect both travelers and non-travelers.
  • See NYS/NYC Guidance for Laboratory Testing and Management of Persons Under Investigation for Viral Hemorrhagic Fevers (VHF) in Non-Designated Hospitals.
• Whenever there is concern about VHF, providers must perform a thorough symptom and exposure history based on recommendations for the current outbreak (if any) or endemic area and, if VHF remains a concern, discuss the patient’s case with the LHD where the patient
  • An appropriate history includes both epidemiologic and clinical factors. Some epidemiologic factors may be outbreak-dependent, but they typically involve more details than simply travel to an involved country, for example:
    • Which specific areas of the country did they travel to and what were their activities?
    • Did they have contact with a person with suspect or confirmed VHF in the past 21 days?

• Were they in an area with an active VHF outbreak or where VHF is endemic in the past 21 days?
• Review the latest guidance, typically from the Centers for Disease Control and Prevention (CDC), for the outbreak in question to determine outbreak-specific exposure criteria and questions, such as exact geographic areas of concern.
• Review the following:
  • CDC Guide for Clinicians Evaluating an Ill Person for VHF or Other High- consequence Disease
  • CDC Clinical Screening and Diagnosis for VHFs
  • Viral Hemorrhagic Fever (VHF) 2025 Case Definition

• If clinical and epidemiologic risk factors support a suspicion of VHF:
  • Ensure the patient has been isolated as described below (Patient Placement).
  • Restrict access to the room in which the patient is Minimize the number of staff who interact with the patient and keep a list of staff who do.
  • Follow all CDC recommended infection control practices and correct PPE use as described below (Infection Prevention and Control).
  • Ensure that the patient continues to receive standard medical care, including blood draws for alternate diagnoses (e.g., malaria) and necessary emergency procedural interventions (e.g., dialysis).
  • More detailed information on emergency services is available at CDC Interim Guidance for Emergency Services.
• Contact the LHD where the patient resides for consultation as soon as VHF is
  • LHD contact information is as follows:
    • Outside New York City (NYC): LHD contact information is at https://www.nysacho.org/directory. If unable to reach the LHD, contact the NYS Department of Health’s Bureau of Communicable Disease Control at 518-473-4439 during business hours or 1-866-881-2809 evenings, weekends, and holidays.
    • In NYC: Use the NYC Provider Access Line (866-692-3641) to contact the NYC Health Department.

• Additionally, healthcare facilities should notify the LHD where the hospital is located and the NYS Department of Health, either directly or through the LHD where the patient
• When contacting the LHD, be prepared to:
  • Describe the patient’s travel history, including dates and detailed locations of travel (including areas within a country of concern, if applicable) and epidemiologic risk factors;
  • Describe the patient’s presenting signs, symptoms, and duration of illness;
  • Determine, in consultation with the LHD and the NYS Department of Health, whether VHF testing will be conducted;
  • Determine, in consultation with the LHD and the NYS Department of Health, whether referral to a Special Pathogen Treatment Center for further workup and testing is indicated;
  • Receive assistance to arrange patient transport, if needed.