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.

Keywords: Ebola; Ebola virus disease; Sierra Leone; children; viruses.

Figure 1

Patient care pathway of EHUs, Western Area (including Freetown), Sierra Leone, August 2014–March 2015. The OICC was set up to care for children with substantial Ebola virus exposure (usually a first-degree relative with confirmed EVD) and without relatives to care for them during the 21-day incubation period. Figure reproduced from (8) (Creative Commons License). EHU, Ebola holding unit; EVD, Ebola virus disease; OICC, observational interim care center.

Figure 2

Location of Ebola holding units (blue star) and Ebola treatment centers (red circle), Western Area, Sierra Leone, January 2015. Population density map source: MapAction (cited 2015 Nov 8); reproduced with permission. Population figures are projected for 2014 from the 2004 census (http://www.mapaction.org/?option=com_mapcat&view=mapdetail&id=3589)..

Figure 3

Outcome characteristics of children <13 years of age with Ebola virus disease, Western Area, Sierra Leone, August 2014–March 2015. A) Patient outcome flowchart; B) patient count and case-fatality rate (CFR) by month; C) Patient count and CFR by age. Error bars indicate 95% CIs.