Ebola Virus Disease In Children Research Articles

Ebola virus disease in children: epidemiology, pathogenesis, management, and prevention.

Ebola disease is a severe disease with extremely high case-fatality rates ranging from 28-100%. Observations made during the 2013-2016 West African epidemic improved our understanding of the clinical course of Ebola disease and accelerated the study of therapeutic and preventative strategies. The epidemic also highlighted the unique challenges associated with providing optimal care for children during Ebola disease outbreaks. In this review, we outline current understanding of Ebola disease epidemiology, pathogenesis, management, and prevention, highlighting data pertinent to the care of children. IMPACT: In this review, we summarize recent advancements in our understanding of Ebola disease epidemiology, clinical presentation, and therapeutic and preventative strategies. We highlight recent data pertinent to the care of children and pregnant women and identify research gaps for this important emerging viral infection in children.

Ebola virus disease in children in Conakry and Coyah Ebola treatment centers and risk factors associated with death

ObjectiveTo study Ebola virus disease (EVD) in children aged 15 years and below, and to identify risk factors associated with death. Patients and methodsRetrospective, multicenter, descriptive, and analytical study of files of children aged 15 years and below in Ebola treatment centers (ETC) of Donka from March 2014 to May 2015. We included all files of children aged 15 years and below hospitalized for EVD in the two ETCs. ResultsA total of 739 patients hospitalized in both ETCs, 146 children aged 15 years and below (20%) were registered during the study period. The mean age of children was 6.73±4.26 years. Most children were aged above five years (65.8%) and the mean time to consultation was 4.34±3.21 days. The main clinical signs were asthenia (78.8%), fever (75.3%), anorexia (53.4%), headache (45.9%), vomiting (41.8%), abdominal pain (29.5%), and diarrhea (28.8%). The case fatality was 48%, including 54.3% in Coyah and 45% in Conakry. Older age (aOR=0.83, 95% CI [0.76–0.95]), fever (aOR=3.28, 95% CI [1.22–8.87]), diarrhea (aOR=2.98, 95% CI [1.19–4.48]), and hemorrhage (aOR=3.13, 95% CI [1.00–10.38]) were independently associated with death due to EVD. ConclusionEVD remains serious especially in children, with high case fatality. Risk factors independently associated with death were young age, diarrhea, hemorrhage, and fever. Particular attention to these risk factors and vaccination will contribute to improving the prognosis of EVD in children.

Ebola virus disease in children during the 2014–2015 epidemic in Guinea: a nationwide cohort study

EVD is a major threat to child health, especially among children under 5years of age. To date, none of demographic and clinical features, except younger age, have been consistently shown to affect mortality outcome in children infected with Ebola virus. What is Known: • The 2014-2015 West Africa Ebola epidemic is the largest and most widespread outbreak of Ebola virus disease (EVD) in history, with more than 11,000 deaths in Guinea, Liberia, and Sierra Leone. • During ongoing outbreak investigations, it is suggested that young children aged less than 5years are particularly vulnerable and highly susceptible to death. What is New: • Demographic and clinical characteristics of the nationwide cohort of pediatric patients with laboratory-confirmed EVD in Guinea are reported. • The results confirm the high rate of death among EVD children under 5years of age, while none of demographic and clinical features, except younger age, could serve as a predictor of mortality outcome in pediatric patients with EVD.

Ebola virus disease in children presents special challenges

Ebola virus disease in children presents special challenges

Ebola Virus Disease in Children, Sierra Leone, 2014–2015

Little is known about potentially modifiable factors in Ebola virus disease in children. We undertook a retrospective cohort study of children <13 years old admitted to 11 Ebola holding units in the Western Area, Sierra Leone, during 2014-2015 to identify factors affecting outcome. Primary outcome was death or discharge after transfer to Ebola treatment centers. All 309 Ebola virus-positive children 2 days-12 years old were included; outcomes were available for 282 (91%). Case-fatality was 57%, and 55% of deaths occurred in Ebola holding units. Blood test results showed hypoglycemia and hepatic/renal dysfunction. Death occurred swiftly (median 3 days after admission) and was associated with younger age and diarrhea. Despite triangulation of information from multiple sources, data availability was limited, and we identified no modifiable factors substantially affecting death. In future Ebola virus disease epidemics, robust, rapid data collection is vital to determine effectiveness of interventions for children.

Ebola Virus Disease in Children, Sierra Leone, 2014–2015

Abstract Little is known about potentially modifiable factors in Ebola virus disease in children. We undertook a retrospective cohort study of children <13 years old admitted to 11 Ebola holding units in the Western Area, Sierra Leone, during 2014–2015 to identify factors affecting outcome. Primary outcome was death or discharge after transfer to Ebola treatment centers. All 309 Ebola virus–positive children 2 days–12 years old were included; outcomes were available for 282 (91%). Case-fatality was 57%, and 55% of deaths occurred in Ebola holding units. Blood test results showed hypoglycemia and hepatic/renal dysfunction. Death occurred swiftly (median 3 days after admission) and was associated with younger age and diarrhea. Despite triangulation of information from multiple sources, data availability was limited, and we identified no modifiable factors substantially affecting death. In future Ebola virus disease epidemics, robust, rapid data collection is vital to determine effectiveness of interventions for children.

Ebola virus disease in children: towards a better clinical picture and improved management.

The west African Ebola virus disease (EVD) outbreak is the largest ever seen in history, with more than 28 000 cases and 11 300 deaths since early 2014. Prior to this outbreak, knowledge about diagnosis and clinical management of EVD was very limited. But gaps in knowledge on EVD were even more marked in the paediatric population. One of the main challenges faced was the difference in clinical presentation of the disease in children compared with adults. In their observational study in The Lancet Global Health, Tejshri Shah and colleagues1Shah T Greig J van der Plas LM et al.Inpatient signs and symptoms and factors associated with death in children aged 5 years and younger admitted to two Ebola management centres in Sierra Leone, 2014: a retrospective cohort study.Lancet Glob Health. 2016; 4: e495-e501Summary Full Text Full Text PDF PubMed Scopus (20) Google Scholar add important information to the picture of EVD in children younger than 5 years and the follow-up of their symptoms during the acute phase while admitted to Ebola treatment centres (ETCs). The study provides clinical markers for severity—fever, diarrhoea, and vomiting—that are helpful in future triage, in addition to markers that help identify those likely to have poor outcomes such as hiccuping, bleeding, and confusion. It would have been interesting to understand whether the severity of the clinical presentation or PCR cycle threshold values changed over the course of the outbreak. This study builds on important evidence about the absence of fever in many EVD cases (25% of children1Shah T Greig J van der Plas LM et al.Inpatient signs and symptoms and factors associated with death in children aged 5 years and younger admitted to two Ebola management centres in Sierra Leone, 2014: a retrospective cohort study.Lancet Glob Health. 2016; 4: e495-e501Summary Full Text Full Text PDF PubMed Scopus (20) Google Scholar vs 15% of adults2Lado M Walker NF Baker P et al.Clinical features of patients isolated for suspected Ebola virus disease at Connaught Hospital, Freetown, Sierra Leone: a retrospective cohort study.Lancet Infect Dis. 2015; 15: 1024-1033Summary Full Text Full Text PDF PubMed Scopus (88) Google Scholar) noted in previous reviews of clinical features of Ebola. Those without fever did not meet the WHO case definition for a suspected case, highlighting the need to reassess this definition so as not to miss significant numbers of paediatric cases during a future outbreak. Shah and colleagues' study shows that the majority of children with confusion died. Although the confusional state may represent the encephalitic stage of EVD, the contribution of metabolic causes is not known. Some papers on the clinical features of EVD in children described several cases of hypoglycaemia.3Fitzgerald F Naveed A Wing K et al.Ebola virus disease in children in Sierra Leone: a retrospective study.Lancet. 2016; 387: S44Summary Full Text Full Text PDF Google Scholar, 4Fitzgerald F Awonuga W Shah T Youkee D Ebola response in Sierra Leone: the impact on children.J Infect. 2016; (published online May 11.)http://dx.doi.org/10.1016/j.jinf.2016.04.016PubMed Google Scholar It would have been useful to measure the blood glucose concentrations in children in this study to understand the importance of hypoglycaemia in children with confusion and thus to improve the management of patients in ETCs. Apart from the clinical presentation, there are other factors that make children a special and vulnerable population. One of the most relevant is the source of EVD infection in children, particularly when the parents were not affected. We know that the disease is transmitted through contact with body fluids (blood, vomit, faeces, urine, etc) of EVD patients in the gastrointestinal symptomatic phase and dead affected bodies. The assumption that the transmission of the disease in this population can only come from the parents and household contacts led to many delays in the detection of cases. Many children are looked after by neighbours and relatives and share spaces with other children who may be infected. But the description of those contacts was difficult for children, particularly for those younger than 5 years in whom language is not yet fully developed. Additionally, traditional burials during which children may have been baptised with the water used to wash the dead bodies (many of whom probably died from EVD) were potential sources of infection for children during the beginning of the outbreak when the Safe Medical Burials policy5National Ebola Response CentreSierra Leone Emergency Management Program standard operating procedure for safe, dignified medical burials.http://www.nerc.sl/sites/default/files/docs/SOP%20for%20Burial%20SL%20Version2_26Feb2015app.pdfGoogle Scholar was not yet established. All these factors made it very difficult to establish an accurate case definition of EVD in children in the west African outbreak—screening staff were not able to rely on epidemiological links or contact histories as we did with adults. That meant isolating and testing most children who presented to health-care facilities with common symptoms such as fever, diarrhoea, vomiting, distress, or unexplained crying. That may have overstretched health-care facilities attending to children at that time, and exposed many to potential nosocomial transmission of EVD. In the case of Freetown and the western Area of Sierra Leone, the tertiary referral hospital for children had to close for some months while it was refurbished and adapted to meet the preadmission requirement for isolation and testing for EVD. A rapid diagnostic test with high sensitivity and specificity would allow a quick rule-out for polysymptomatic children presenting to such facilities, reducing the need for dedicated EVD bed capacity.6Walker NF Brown CS Youkee D et al.Evaluation of a point-of-care blood test for identification of Ebola virus disease at Ebola holding units, Western Area, Sierra Leone, January to February 2015.Euro Surveill. 2015; 20 (pii=21073.)Crossref Scopus (64) Google Scholar In keeping with our experience, Shah and colleagues' study demonstrates a higher mortality in children presenting earlier to the ETC, which the authors attribute to survivor bias. We observed that those who presented earlier tended to be more likely to have a known high-risk contact than those who presented later. It may therefore be that children with high risk, and therefore high viral load exposure—eg, sibling illness—were brought to health-care facilities earlier. Another crucial challenge was the management of fluids in children with EVD due to the absence of clinical guidelines for this population. The insertion of cannulas in sick children, mainly those with distress, constituted a high risk procedure in the “red” zone when staffing was very limited (at least in the beginning of the outbreak). It would be helpful to know whether the mortality in children in Shah and colleagues' study changed over time with the introduction of intravenous fluids and the increase in the number of health-care workers, mainly with the availability of EVD survivors to help and support children at ETCs. Their contribution probably made an impact on the outcome of children admitted in those facilities. In conclusion, this paper presents important evidence about clinical presentations of children with EVD before and during admission that will bring more accuracy to the case definition and follow-up of this special population in a future outbreak. Although more information about management is required, clinical guidelines should be developed to reduce mortality in children due to treatable conditions while affected by EVD. We declare no competing interests. Inpatient signs and symptoms and factors associated with death in children aged 5 years and younger admitted to two Ebola management centres in Sierra Leone, 2014: a retrospective cohort studyThis description of the clinical features of Ebola virus disease over the duration of illness in children aged 5 years and younger shows symptoms associated with death and a high prevalence of distress, with implications for clinical management. Collection and analysis of age-specific data on Ebola is very important to ensure that the specific vulnerabilities of children are addressed. Full-Text PDF Open Access

Ebola virus disease in children in Sierra Leone: a retrospective cohort study

BackgroundThe outbreak of Ebola virus disease in West Africa has claimed more than 11 200 lives with more than 28 000 cases. Infected children under the age of 5 years have a high mortality rate but little is known about disease progression and possible predictors of outcome. Circumstantial factors such as transfer distances from Ebola holding units to Ebola treatment centres and admission with a caregiver might affect outcome. We aimed to identify clinical, epidemiological, and management risk factors for mortality in children with Ebola virus disease. MethodsChildren under the age of 12 years admitted to 11 Ebola holding units in the Western Area of Sierra Leone from Aug 1, 2014, to April 1, 2015, were eligible for inclusion. Retrospective data were collected from site admission books, case investigation forms, and clinical records, and cross-referenced with district-wide laboratory results, burial records, child protection records, staff interviews, and telephone calls to guardians. Univariate and multivariate analyses were used to identify features independently associated with mortality. Findings309 children with Ebola virus disease (aged 2 days to 12 years) were admitted (median age 6 years, IQR 3–10). Outcomes were available for 282 children (91%). 161 children (57%) died with 89 deaths (55%) occurring at Ebola holding units and 72 (45%) at Ebola treatment centres. Marked derangement of white cell count, C-reactive protein, and renal and liver function were seen with extensive hypoglycaemia. Up to 60% of children were admitted without a caregiver. Factors that potentially affected mortality such as age, clinical features, delayed attendance, transfer distance, caregiver accompaniment, and medications received are being examined. Multiple imputation is being performed to account for missing data. InterpretationThis is the most comprehensive paediatric cohort of Ebola virus disease to date, and the only cohort to incorporate data from both Ebola holding units and Ebola treatment centres. Data sharing between sites is crucial to identify potentially modifiable risk factors and guide future operational responses. FundingThis study was funded by Save the Children and supported by the Medical Research Council and the National Institute for Health Research Biomedical Research Centre at Great Ormond Street Hospital for Children NHS Foundation Trust and University College London.

Clinical Inquiries Received by CDC Regarding Suspected Ebola Virus Disease in Children—United States, July 9, 2014, to January 4, 2015

Clinical Inquiries Received by CDC Regarding Suspected Ebola Virus Disease in Children—United States, July 9, 2014, to January 4, 2015

Clinical Inquiries Received by CDC Regarding Suspected Ebola Virus Disease in Children--United States, July 9, 2014-January 4, 2015.

The 2014–2015 Ebola virus disease (Ebola) epidemic is the largest in history and represents the first time Ebola has been diagnosed in the United States. On July 9, 2014, CDC activated its Emergency Operations Center and established an Ebola clinical consultation service to assist U.S. state and local public health officials and health care providers with the evaluation of suspected cases. CDC reviewed all 89 inquiries received by the consultation service during July 9, 2014– January 4, 2015, about children (persons aged ≤18 years). Most (56 [63%]) children had no identifiable epidemiologic risk factors for Ebola; among the 33 (37%) who did have an epidemiologic risk factor, in every case this was travel from an Ebola-affected country. Thirty-two of these children met criteria for a person under investigation (PUI) because of clinical signs or symptoms. Fifteen PUIs had blood samples tested for Ebola virus RNA by reverse transcription–polymerase chain reaction; all tested negative. Febrile children who have recently traveled from an Ebola-affected country can be expected to have other common diagnoses, such as malaria and influenza, and in the absence of epidemiologic risk factors for Ebola, the likelihood of Ebola is extremely low. Delaying evaluation and treatment for these other more common illnesses might lead to poorer clinical outcomes. Additionally, many health care providers expressed concerns about whether and how parents should be allowed in the isolation room. While maintaining an appropriate level of vigilance for Ebola, public health officials and health care providers should ensure that pediatric PUIs receive timely triage, diagnosis, and treatment of other more common illnesses, and care reflecting best practices in supporting children’s psychosocial needs.

UK preparedness for children with Ebola infection

Ebola virus disease (EVD) is a viral haemorrhagic fever, with a case fatality rate of 50% (25–90%). The current outbreak in West Africa (Guinea, Sierra Leone and Liberia) is the...

Care of the child with Ebola virus disease.

To provide clinicians with practical considerations for care of children with Ebola virus disease in resource-rich settings. Review of the published medical literature, World Health Organization and government documents, and expert opinion. There are limited data regarding Ebola virus disease in children; however, reported case-fatality proportions in children are high. Ebola virus may affect immune regulation and endothelial function differently in children than adults. Considerations for care of children with Ebola virus disease are presented. Ebola virus disease is a severe multisystem disease with high mortality in children and adults. Hospitals and clinicians must prepare to provide care for patients with Ebola virus disease before such patients present for care, with particular attention to rigorous infection control to limit secondary cases. Although there is no proven specific treatment for Ebola virus disease, meticulous supportive care offers patients the best chance of survival.