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

Abstract

Children died rapidly, more than half in Ebola holding units before transfer to treatment units.

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

“…The odds of death were 20-fold higher in EVD patients aged <5 years compared with older children. This finding is consistent with other data reported from the West African EVD epidemic [4, 21, 27, 28]. Days of hospitalization before death for half of those aged <2 years ranged from 6 to 12 days.…”

Development of a Pediatric Ebola Predictive Score, Sierra Leone1

“…The age cutoff matched the WHO case definition distinguishing between children and adolescents, anticipating that adolescents would have an adult disease phenotype. Settings and data collection methods have been described previously ( 4 , 10 ). We visited each EHU to extract data from paper clinical records, case investigation forms, and site admission books and to interview staff.…”

“…Variables were sex, age, contact history (yes/no), presence of 16 symptoms at EHU admission (yes/no), and days from symptom onset to EHU visit ( 4 ). We included age as a binary variable (<2 years and > 2 years), given the higher burden of febrile illnesses that appear similar to EVD (e.g., malaria) in younger children.…”

“…During admission, however, EVD-negative patients risked exposure to EVD, raising concerns that EHUs could act as amplification sites for infection ( 3 – 7 ). Children, many of whom were unaccompanied, were particularly vulnerable, and, because EHUs were overstretched, supervision to minimize the risk of cross-infection was challenging ( 4 , 8 ). …”

“…Beginning in December 2014, the WHO case definition was modified to be age dependent (late-2014 case definition) (Figure 1; Technical Appendix Table 1). Under this definition, children only required fever and either 1 symptom (in children <5 years of age), 2 symptoms (in children 5–12 years of age), or > 3 symptoms (in children >12 years of age) ( 4 ). This definition increased the likelihood of admitting EVD-negative children.…”