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Viral Hemorrhagic Fever Preparedness and Response

This guide shares clinical and operational recommendations for managing a California frontline healthcare facility's response to viral hemorrhagic fevers like Ebola, yellow fever, hantavirus, Marburg, and dengue fever.

Recommendations for frontline facilities

The U.S. Centers for Disease Control and Prevention (CDC) recommends all frontline healthcare facilities prepare for patients with Ebola or other viral hemorrhagic fevers (VHFs) by:

  1. Training staff to quickly identify, isolate, and manage potentially infected patients
  2. Developing systems to safely manage waste disposal, cleaning, and disinfection
  3. Notifying state and local public health officials according to protocols

Frontline facilities include acute care hospitals, urgent care clinics, critical access hospitals, and other emergency care settings, but not primary care offices or other non-emergent ambulatory care settings.

Preparing facilities for Ebola and other VHF Outbreaks

Personal protective equipment

The viral hemorrhagic fevers spread through contact with bodily fluids — so proper use of personal protective equipment (PPE) is especially important. In the case of Ebola, the CDC recommends frontline care facilities have enough PPE on hand for at least 12-24 hours of continuous care

    Facility preparedness

    In addition to sufficient PPE practices, an effective VHF response also includes:

    • High-level containment care (HLCC) units – physically isolated areas that use enhanced engineering controls to contain the viruses while staff provide all aspects of clinical care to potentially infected patients
    • Zones for donning, doffing, and storage of PPE – including appropriate showering facilities for staff members exiting sensitive care units
    • Designated areas of risk to reduce potential contamination and guide healthcare worker flow:
      • Red/Hot Zone for patient rooms, laboratory
      • Yellow/Warm Zone for anteroom, decontamination area, waste processing, doffing
      • Green/Cold Zone for nurse station, clean supply room, staff egress changing area
    • Telehealth strategies – allow healthcare workers to communicate with and assess patients remotely to limit direct contact

      Responding to a Potential VHF Infection

      The California state and LA County health authorities follow the "identify, isolate, and inform" model of care recommended by the CDC for patients suspected of infection with viral hemorrhagic fever. 


      Because early symptoms of viral hemorrhagic fevers often mirror those of other infectious diseases, getting a detailed travel and exposure history from a patient is critical. The California Department of Public Health (CDPH) offers a screening form to help assess a patient's risk of infection.


      If a patient's screening indicates they might be infected with Ebola or another viral hemorrhagic fever, healthcare providers should isolate the patient and notify their local healthcare department immediately. In LA County, healthcare providers should contact the Department of Public Health Acute Communicable Disease Control Program

      8 a.m.–5 p.m. Monday–Friday at 213-240-7941 or
      after hours at 213-974-1234.

      When receiving these calls, local heath departments will provide immediate infection control guidance for the suspected case being reported, and then immediately notify the California Department of Public Health.

      Patient Transport

      The CDPH will provide consultation to help determine if a patient needs further evaluation or transport to a designated assessment and treatment facility. In cases of low risk of VHF infection, they may recommend the patient remain at the frontline facility while testing is conducted, to help minimize exposure.

      Waste Management

      Because of the nature of VHF symptoms, an HLCC setting can reportedly generate over 1,000 pounds of waste per patient. This includes solid and liquid patient waste, patient linens, healthcare worker PPE and linens, contaminated medical devices, and other general medical waste associated with VHF contamination, which are designated as Category A Infectious Substances. A comprehensive waste management plan and staff training are an important part of VHF infection control and prevention. 

      Related Resources

      Disinfectants for Use against Ebola

      The EPA’s list of registered disinfectants that meet CDC criteria for use against the Ebola virus on hard, non-porous surfaces.
      Region: United States
      Source: US EPA
      Updated: Apr. 04, 2022

      Guidance for collection, transport and submission of specimens for Ebola Virus Disease testing

      Information, protocols, and standards from the CDC for the collection, transport, and submission of specimens for Ebola virus testing.
      Region: United States
      Source: CDC
      Updated: Apr. 01, 2022

      Management of Wastewater Generated by Patient Infected with Ebola

      Memo with revised consensus recommendations for dialogue between the wastewater sector and hospitals on the management of wastewater generated by patients infected with the Ebola virus.
      Region: California
      Source: CASA
      Updated: Jun. 02, 2016

      Ebola Exposure Daily Symptom Monitoring Log

      Printable PDF form to log contacts under Ebola Virus Disease surveillance.
      Region: Los Angeles County
      Source: LACDPH ACDC
      Updated: Nov. 05, 2014

      Ebola 2013 Outbreak TImeline

      Interactive map and timeline of the history of Ebola and other Special Pathogens.
      Region: United States
      Source: NETEC