Review of Ebola virus disease in children – how far have we come?

ABSTRACT

Ebola virus (EBOV) causes an extremely contagious viral haemorrhagic fever associated with high mortality. While, historically, children have represented a small number of total cases of Ebolavirus disease (EVD), in recent outbreaks up to a quarter of cases have been in children. They pose unique challenges in clinical management and infection prevention and control. In this review of paediatric EVD, the epidemiology of past EVD outbreaks with specific focus on children is discussed, the clinical manifestations and laboratory findings are described and key developments in clinical management including specific topics such as viral persistence and breastfeeding while considering unique psychosocial and anthropological considerations for paediatric care including of survivors and orphans and the stigma they face are discussed. In addition to summarising the literature, perspectives based on the authors’ experience of EVD outbreaks in the Democratic Republic of the Congo (DRC) are described.

Abbreviations: ARDS: acute respiratory distress syndrome; aOR: adjusted odds ratio; ALT: alanine transferase; ALIMA: Alliance for International Medical Action; AST: aspartate transaminase; BUN: blood urea nitrogen; CNS: central nervous system; CUBE: chambre d’urgence biosécurisée pour épidémie; COVID-19: coronavirus disease 2019; C_t: cycle threshold; DRC: Democratic Republic of Congo; ETC: ebola treatment centre; ETU: ebola treatment unit; EBOV: ebola virus; EVD: ebolavirus disease; FEAST: fluid expansion as supportive therapy; GP: glycoprotein; IV: intravenous; MEURI: monitored emergency use of unregistered interventions; NETEC: National Ebola Training and Education Centre; NP: nucleoprotein; ORS: oral rehydration solution; PALM: Pamoja Tulinde Maisha; PREVAIL: Partnership for Research on Ebola Virus in Liberia; PPE: personal protective equipment; PCR: polymerase chain reaction; PEP: post-exposure prophylaxis; RDTs: rapid diagnostic tests; RT: reverse transcriptase; RNA: ribonucleic acid; UNICEF: United Nations International Children’s Emergency Fund; USA: United States of America; WHO: World Health Organization

KEYWORDS:

• Ebola virus disease
• children
• EVD
• paediatrics
• infection prevention and control
• clinical management

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Notes on contributors

Devika Dixit

Devika Dixit (B.Sc (Honours), McMaster University; M.Sc, McMaster University; MD, University of Alberta; DTM&H, Peru; FRCPC, Paediatrics and Infectious Diseases) is a paediatric infectious diseases and tropical medicine specialist with expertise in global pandemic and epidemic disease outbreak control and clinical management as well as occupational health and safety. She is an Assistant Professor at the University of Saskatchewan and former Clinical Assistant Professor at the University of Alberta. She is a former staff member of the Health Emergencies programme at the World Health Organization.

Kasereka Masumbuko Claude

Kasereka Masumbuko Claudeis a surgeon working in Eastern Democratic Republic of Congo (DRC). Currently he is completing a PhD in Epidemiology, at the School of Public Health at the University of Alberta, Canada. He is also the medical director of the Association for Health Innovation in Africa (AFHIA), a non-profit organization specialized in research in Eastern DRC.

Lindsey Kjaldgaard

Lindsey Kjaldgaardis a second year Paediatric Resident at the University of Alberta. She received her undergraduate (Bachelor of Science) and MD from the University of Manitoba.

Michael T. Hawkes

Michael Hawkes (B.Eng, McGill University; MD, University of Alberta; PhD, University of Toronto; DTM&H, Peru; FRCPC, Paediatrics and Infectious Diseases) is a clinician-scientist at the University of Alberta. In addition to a clinical practice in consultant Paediatric Infectious Diseases at the Stollery Children’s Hospital, he leads a translational research program in global paediatric infections. Diseases of focus include some of the leading infectious disease killers of children in the world today: malaria, pneumonia, HIV, and Ebolavirus disease.