Approach

The mainstay of treatment is early recognition of infection coupled with effective isolation and best available supportive care in a hospital setting. Ribavirin may be considered in some patients.

Isolation and infection control

Most human-to-human transmission of CCHF virus is via direct contact with infected blood and body fluids. Therefore, it is recommended that in caring for any patient with suspected or documented CCHF virus infection, specific barrier precautions (including use of gloves, gowns, face shields, and masks) should be implemented immediately. For procedures that may generate an aerosol, healthcare workers should consider wearing an N95 or FFP2 respirator (European Norm [EN] 61010-1).[40][61]

To minimise risk of needlestick injuries, sharps containers should be available at all times and the use of safety-engineered devices should also be considered.[40][61]

Supportive therapies

Supportive therapy could be lifesaving, especially for severe patients and those who are admitted to hospital at the late stage of disease.

Supportive therapies include fluid and electrolyte management, and use of analgesics and/or antipyretics (e.g., paracetamol). Aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) should be avoided due to the risk of haemorrhage.[80][81]

People with severe CCHF will need escalation to intensive care with renal replacement therapy and ventilation support provided as required, and necessary infection-control precautions.[82]

Major bleeding occurs infrequently, but is a manifestation of advanced infection that is usually fatal. When available, platelet and plasma transfusions should be given according to local protocols.[80]

Antiviral therapy

Ribavirin is the only antiviral drug that has been used to treat viral haemorrhagic fever syndromes, including CCHF and Lassa fever.[83][84][85] Ribavirin has been shown to be effective against CCHF virus in vitro.[86][87][88]

In clinical practice, observational studies have found ribavirin to be effective, especially if given during the early phase of the infection.[40][79][80]​[89][90][91]​​​[92]​ However, there are conflicting studies, including a meta-analysis, which have not shown a clinically significant difference in survival with ribavirin, leading to some debate about its use in CCHF.[93][94][95]​ A Cochrane review of five studies with 748 patients (including one randomised controlled trial) was inconclusive, with the authors stating that they didn't know whether the use of ribavirin in patients with CCHF reduced mortality, length of hospital stay, or the risk of patients needing platelet transfusions.[96]

Despite the lack of evidence, ribavirin is on the World Health Organization (WHO) essential medicines list for the treatment of viral haemorrhagic fevers. WHO recommends that ribavirin can be used to treat patients with CCHF. It may also be considered for high-risk patient contacts. Its efficacy has not been proven by randomised controlled trials, and there are differences in opinion on its clinical effectiveness in the published literature. Nevertheless, observational data from Lassa fever, for which there has been more experience, suggest that ribavirin is most effective if given in the first 6 days of illness.[81]

Post-exposure prophylaxis

Oral ribavirin has been used for post-exposure prophylaxis in CCHF.[80][97] In one meta-analysis, post-exposure prophylaxis with ribavirin reduced the odds of infection and the odds of death when used <48 hours after symptom onset.[98] Ribavirin post-exposure prophylaxis is generally well tolerated, and should be considered for healthcare workers who have had high-risk exposures such as needlestick injuries.[61][99][100] The WHO supports this recommendation.[81]

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