Characteristics and Outcomes of Pediatric Patients With Ebola Virus Disease Admitted to Treatment Units in Liberia and Sierra Leone: A Retrospective Cohort Study

Smit, Michael; Michelow, Ian C.; Glavis-Bloom, Justin; Wolfman, Vanessa; Levine, Adam C.

doi:10.1093/cid/ciw725

Cited by 35 publications

(45 citation statements)

References 30 publications

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“…Children accounted for >18% of confirmed Ebola cases in Liberia [15] and for 13% of patients included in this analysis. Children <5 years of age have higher case fatality ratios than older children, which may result from a variety of factors, including nutritional status and immunologic response [21]. In this study, children and adults experienced different symptoms, with more adults reporting headache, post-EVD musculoskeletal syndrome, fatigue, insomnia, palpitations, visual problems, and joint problems.…”

Section: Discussionmentioning

confidence: 85%

Care of Ebola Survivors and Factors Associated With Clinical Sequelae—Monrovia, Liberia

Maurice

Ervin

Orone³

et al. 2018

Open Forum Infectious Diseases

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BackgroundThe Eternal Love Winning Africa (ELWA) Clinic was the first clinic to provide free, comprehensive care to Ebola virus disease (EVD) survivors in Liberia. The objectives of this analysis were to describe the demographics and symptoms of EVD survivors at ELWA from January 2015 through March 2017 and to identify risk factors for development of sequelae.MethodsPatients’ demographic and clinical information was collected by chart review in June 2016 and March 2017. Associations with clinical sequelae were analyzed using the chi-square test, t test, and multivariate logistic regression.ResultsFrom January 2015 to March 2017, 329 EVD survivors were evaluated at ELWA. Most survivors experienced myalgia/arthralgia (73%; n = 239) and headache (53%; n = 173). The length of time from Ebola Treatment Unit (ETU) discharge to first clinic visit ranged from 0 to 30 months. Many visits (30%) occurred 24 or more months after ETU discharge. The proportion of visits for headache, weight loss, joint pain, visual problems, insomnia, fatigue, memory loss, decreased libido, depression, and uveitis decreased over time. More men than women had visits for depression; however, these differences were not significant. Symptom prevalence differed in adults and children; significantly more adults experienced myalgia/arthralgia (77% vs 44%), visual problems (41% vs 12%), post-EVD-related musculoskeletal pain (42% vs 15%), and insomnia (17% vs 2%).ConclusionsEVD survivors frequented ELWA for EVD-related symptoms many months after ETU discharge, indicating a long-term need for care. Reported symptoms changed over time, which may reflect eventual resolution of some sequelae.

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Section: Discussionmentioning

confidence: 85%

Care of Ebola Survivors and Factors Associated With Clinical Sequelae—Monrovia, Liberia

Maurice

Ervin

Orone³

et al. 2018

Open Forum Infectious Diseases

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“…Although children typically constitute a disproportionately small number of EVD cases, they have shorter incubation periods, and a more rapid disease course. Children have a higher risk of death than older populations, with children of <5 years of age at the highest risk [44][45][46][47][48][49] . Possible explanations for the low incidence of EVD in children include behavioural factors, such as deliberate prevention of exposure to infected individ uals 46 , and differences in susceptibility have) yet to be identified.…”

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confidence: 99%

Ebola virus disease

Jacob

Crozier

Fischer

et al. 2020

Nat Rev Dis Primers

422

345

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To date, 12 distinct filoviruses have been described 1. The seven filoviruses that have been found in humans belong either to the genus Ebolavirus (Bundibugyo virus (BDBV), Ebola virus (EBOV), Reston virus (RESTV), Sudan virus (SUDV) and Taï Forest virus (TAFV); Fig. 1) or to the genus Marburgvirus (Marburg virus (MARV) and Ravn virus (RAVV)) 2. The WHO International Classification of Diseases Revision 11 (ICD-11) of 2018 recognizes two major subcategories of filovirus disease (FVD): Ebola disease caused by BDBV, EBOV, SUDV or TAFV, and Marburg disease caused by MARV or RAVV. Ebola virus disease (EVD) is defined as a disease only caused by EBOV. This subcategorization of FVD is largely based on the increasing evidence of molecular differences between ebolaviruses and marburgviruses, differences that may influence virus-host reservoir tropism, pathogenesis and disease phenotype in accidental primate hosts 2. Since the discovery of filoviruses in 1967 (reF. 3), 43 FVD outbreaks (excluding at least five laboratoryacquired infections) have been recorded in or exported from Africa 4. The epidemiological definition of outbreak is one or more cases above the known endemic prevalence. For example, the single case of TAFV infection recorded in a setting in which FVD had never been reported before (Côte d'Ivoire) 5 is still considered an outbreak. All FVD outbreaks, with the exception of that caused by TAFV, were characterized by extremely high case-fatality rates (CFRs, also known as lethality). Until 2013, the most extensive outbreak, caused by SUDV, involved 425 cases and 224 deaths (CFR 52.7%) 6. The overall limited numbers of FVD cases (1967-2013: 2,886 cases including 1,982 deaths 4), the typical remote and rural locations of outbreaks and the often delayed announcement of new outbreaks to the international community 7 have prevented the systematic study of clinical FVD in humans. Thus, the commonly used description of FVD was derived either from observation of small groups of patients in care settings that were not well-equipped for diagnosis, treatment and disease characterization, or from observations of even smaller samples, such as individuals who were transferred from Equatorial Africa to Europe and the USA or who fell sick in Europe or the USA after contracting the virus elsewhere. Pathological characterization of FVD via autopsies has been rare 7,8. In the absence of extensive human clinical data, FVD could only be defined further via the use of experimental animal infections 9,10 .

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“…The WHO indicators, including fever, breathing difficulties, and gastrointestinal symptoms, are common features in many pediatric pathologies. In this outbreak, gastrointestinal symptoms dominated, whereas bleeding, characteristic of previous outbreaks, was rare ( 3 , 15 – 19 ). This difference meant clinical diagnosis of EVD in the West African outbreak was difficult, which motivated this study.…”

Section: Discussionmentioning

confidence: 66%

Development of a Pediatric Ebola Predictive Score, Sierra Leone1

Fitzgerald¹,

Wing²,

Naveed³

et al. 2018

Emerg. Infect. Dis.

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We compared children who were positive for Ebola virus disease (EVD) with those who were negative to derive a pediatric EVD predictor (PEP) score. We collected data on all children <13 years of age admitted to 11 Ebola holding units in Sierra Leone during August 2014–March 2015 and performed multivariable logistic regression. Among 1,054 children, 309 (29%) were EVD positive and 697 (66%) EVD negative, with 48 (5%) missing. Contact history, conjunctivitis, and age were the strongest positive predictors for EVD. The PEP score had an area under receiver operating characteristics curve of 0.80. A PEP score of 7/10 was 92% specific and 44% sensitive; 3/10 was 30% specific, 94% sensitive. The PEP score could correctly classify 79%–90% of children and could be used to facilitate triage into risk categories, depending on the sensitivity or specificity required.

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Characteristics and Outcomes of Pediatric Patients With Ebola Virus Disease Admitted to Treatment Units in Liberia and Sierra Leone: A Retrospective Cohort Study

Abstract: Summary.In a large, retrospective cohort of Ebola virus–infected children aged <18 years, the odds of death were ≥5-fold higher if patients were aged <5 years, had evidence of bleeding, or real-time polymerase chain reaction cycle threshold value ≤20.

Cited by 35 publications

References 30 publications

Care of Ebola Survivors and Factors Associated With Clinical Sequelae—Monrovia, Liberia

Care of Ebola Survivors and Factors Associated With Clinical Sequelae—Monrovia, Liberia

Ebola virus disease

Development of a Pediatric Ebola Predictive Score, Sierra Leone1

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