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

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.

Automated summary

The Sudan virus disease outbreak in Uganda in 2022 highlighted the lack of effective clinical management guidelines for viral haemorrhagic fevers (VHFs). A systematic review identified 32 guidelines, with the majority being of low quality and lacking supporting evidence. The inconsistent and incomplete guidance on supportive care and therapeutics poses risks to patients and challenges for clinicians. It is recommended to establish a standard living guideline framework and invest in trials to improve the quality and applicability of guidelines, as well as identify optimal treatment strategies and affordable interventions for VHFs.