Standard of care for viral haemorrhagic fevers (VHFs): a systematic review of clinical management guidelines for high-priority VHFs

Ishmeala Rigby, Melina Michelen, Andrew Dagens, Vincent Cheng, Dania Dahmash, Eli Harriss, Eika Webb, Erhui Cai, Samuel Lipworth, Alexandra Oti, Valeria Balan, Helen Piotrowski, Robert Nartowski, Amanda Rojek, Helen Groves, Peter Hart, Muge Cevik, Henry Kyobe Bosa, Lucille Blumberg, Tom E FletcherPeter W Horby, Shevin T Jacob, Louise Sigfrid

Research output: Contribution to journalArticle (Academic Journal)peer-review

2 Citations (Scopus)

Abstract

The Sudan virus disease outbreak in Uganda in 2022 showed our vulnerability to viral haemorrhagic fevers (VHFs). Although there are regular outbreaks of VHFs with high morbidity and mortality, which disproportionally affect low-income settings, our understanding of how to treat them remains inadequate. In this systematic review, we aim to explore the availability, scope, standardisation, and quality of clinical management guidelines for VHFs. We identified 32 guidelines, 25 (78%) of which were low quality and did not have supporting evidence and eight (25%) of which had been produced or updated in the past 3 years. Guidance on supportive care and therapeutics had little detail and was sometimes contradictory. Guidelines based on uncertain evidence are a risk to patients, an ethical challenge for clinicians, and a challenge to implementing trials due to heterogeneous standards of care. We recommend a standard living guideline framework to improve the quality, scope, and applicability of guidelines. Furthermore, investments into trials should aim to identify optimal treatment strategies for VHFs and prioritise affordable and scalable interventions to improve outcomes globally.
Original languageEnglish
Pages (from-to)e240-e252
JournalThe Lancet Infectious Diseases
Volume23
Issue number7
DOIs
Publication statusPublished - 6 Feb 2023

Bibliographical note

Funding Information:
We thank the International Severe Acute Respiratory and Emerging Infection Consortium Global Support Centre for logistical and administrative support, all the members of the International Severe Acute Respiratory and Emerging Infection Consortium Global Clinical Research Network, and the external experts who completed the survey and submitted guidelines.

Publisher Copyright:
© 2023 Elsevier Ltd

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