Moving Towards a More Aggressive and Comprehensive Model of Care for Children with Ebola

Abstract

bola is a devastating illness for children, particularly those under 5 years of age. Although children are proportionally less affected than adults during outbreaks of Ebola, including in the current West Africa outbreak, it remains a major threat to child health in the affected nations and a neglected area of investigation and discussion. The threat is not only for those infected with Ebola, but for all children in the affected region because of the tremendous impact of this outbreak on national health care systems. In addition to what appears to be a different immunologic response to Ebola in children, the uniquely challenging bedside care of suspect and infected children plays a significant role in the increased morbidity and mortality in this age group. Little information has been published on efforts to care for children in Ebola treatment units (ETUs). We present a report of our experience caring for children at what was the largest ETU in Port Loko, Sierra Leone, and a discussion of our protocols for caring for children with Ebola, with the hope of stimulating an international dialogue regarding the care of children with this disease. These protocols represent the culmination of the accumulated experience and knowledge of our ETU health care staff. Although, admittedly, they reflect some shared insights from staff at other ETUs, themajority stem from the published literature with adaptations of standard pediatric therapy. The protocols represent the care we aspired to provide to each child at the time our ETU closed inMarch 2015 and serve as a starting point for future ETU providers and policymakers for the next Ebola epidemic. Because of resource limitations, a rigorous evidence-based demonstration of efficacy for all of these recommended interventions remains to be done. Thus, the protocols are well rooted in solid, biological rationale and clinical experience but as yet lack ideal empirical support.