Abstract
BackgroundYoung children who contract Ebola Virus Disease (EVD) have a high case fatality rate, but their sources of infection and the role of breastfeeding are unclear.Methods/Principal FindingsHousehold members of EVD survivors from the Kerry Town Ebola Treatment Centre in Sierra Leone were interviewed four to 10 months after discharge to establish exposure levels for all members of the household, whether or not they became ill, and including those who died. We analysed a cohort of children under three years to examine associations between maternal illness, survival and breastfeeding, and the child’s outcome. Of 77 children aged zero to two years in the households we surveyed, 43% contracted EVD. 64 children and mothers could be linked: 25/40 (63%) of those whose mother had EVD developed EVD, compared to 2/24 (8%) whose mother did not have EVD, relative risk adjusted for age, sex and other exposures (aRR) 7·6, 95%CI 2·0–29·1. Among those with mothers with EVD, the risk of EVD in the child was higher if the mother died (aRR 1·5, 0·99–2·4), but there was no increased risk associated with breast-feeding (aRR 0·75, 0·46–1·2). Excluding those breastfed by infected mothers, half (11/22) of the children with direct contact with EVD cases with wet symptoms (diarrhoea, vomiting or haemorrhage) remained well.Conclusion/SignificanceThis is the largest study of mother-child pairs with EVD to date, and the first attempt at assessing excess risk from breastfeeding. For young children the key exposure associated with contracting EVD was mother’s illness with EVD, with a higher risk if the mother died. Breast feeding did not confer any additional risk in this study but high risk from proximity to a sick mother supports WHO recommendations for separation. This study also found that many children did not become ill despite high exposures.
Highlights
Young children experience a high case fatality rate from Ebola, but the incidence of Ebola Virus Disease (EVD) in children appears to be lower than in adults.[1,2,3,4] Young children may have limited exposure outside the home, but within the household maintaining hygiene in young children is difficult, efforts may be made to keep children away from those who are sick
We found that the risk of a child under three developing Ebola disease was low unless their mother had EVD, and that the risk was high if their mother died of EVD
We found young children in Ebola-affected households whose mothers were not ill had a surprisingly low risk of developing EVD which was not all explained by low exposure to the virus
Summary
Young children experience a high case fatality rate from Ebola, but the incidence of Ebola Virus Disease (EVD) in children appears to be lower than in adults.[1,2,3,4] Young children may have limited exposure outside the home, but within the household maintaining hygiene in young children is difficult, efforts may be made to keep children away from those who are sick. Breastfeeding is a possible additional source of infection for young children: Ebola has been found in breast milk, but the risk to breastfed babies and the contribution of breastfeeding to transmission is poorly understood.[5,6] An investigation of household contacts following the Ebola outbreak in Gulu, Uganda in 2000 included five infants whose mother had EVD: three of four infants who were breastfed developed EVD.[7] The other infant was reported to have been separated from his mother early in the course of her illness and remained well; it is not clear if he was breastfed. Young children who contract Ebola Virus Disease (EVD) have a high case fatality rate, but their sources of infection and the role of breastfeeding are unclear
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