Abstract
The 2013–2015 West African Ebola outbreak was by far the largest outbreak the world has ever faced. Ebola Treatment Units were set up throughout the three affected countries to care for suspected and confirmed cases of Ebola; among the most challenging patients cared for were children, who despite the best care available often had mortality rates far higher than healthy young adults. In addition to Liberia and Guinea, Sierra Leone also suffered immensely during the outbreak. Here we present the key elements for the care of children, grounded in the principles of pediatric critical care, balanced by our own experiences in Sierra Leone in 2014–2015, and informed by the peer-reviewed medical literature. These guidelines will need to be updated as further evidence and technologies become available should they be needed to care for children again in a future ETU, but they demonstrate the complexities and difficulties in providing theoretically simple yet practically complex care under austere conditions.
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Notes
- 1.
Port Loko is the capital city and the second largest town in the Port Loko District of the Northern Province of Sierra Leone. It has a population of approximately 24,000 inhabitants, the majority of whom are from the Temne ethnic group, speaking the Temne and Krio languages. Lying 45 miles east of Freetown, Port Loko is an importance bauxite mining and trade center for the country.
References
Ansumana, R., Jacobsen, K. H., Sahr, F., Idris, M., Bangura, H., Boie-Jalloh, M., et al. (2015). Ebola in Freetown area, Sierra Leone--A case study of 581 patients. New England Journal of Medicine, 372(6), 587–588. https://doi.org/10.1056/NEJMc1413685.
Baez, F., Perez, J., & Reed, G. (2015). Meet Cuban Ebola fighters: Interview with Felix Baez and Jorge Perez. MEDICC Review, 17(1), 6–10.
Bower, H., Johnson, S., Bangura, M. S., Kamara, A. J., Kamara, O., Mansaray, S. H., et al. (2016). Exposure-specific and age-specific attack rates for Ebola virus disease in Ebola-affected households, Sierra Leone. Emerging Infectious Diseases, 22(8), 1403–1411. https://doi.org/10.3201/eid2208.160163.
Broadhurst, M. J., Brooks, T. J., & Pollock, N. R. (2016). Diagnosis of Ebola virus disease: Past, present, and future. Clinical Microbiology Reviews, 29(4), 773–793. https://doi.org/10.1128/CMR.00003-16.
Chertow, D. S., Kleine, C., Edwards, J. K., Scaini, R., Giuliani, R., & Sprecher, A. (2014). Ebola virus disease in West Africa--Clinical manifestations and management. New England Journal of Medicine, 371(22), 2054–2057. https://doi.org/10.1056/NEJMp1413084.
Chertow, D. S., Uyeki, T. M., & DuPont, H. L. (2015). Loperamide therapy for voluminous diarrhea in Ebola virus disease. Journal of Infectious Diseases, 211(7), 1036–1037. https://doi.org/10.1093/infdis/jiv001.
Cournac, J. M., Karkowski, L., Bordes, J., Aletti, M., Duron, S., Janvier, F., et al. (2016). Rhabdomyolysis in Ebola virus disease. Results of an observational study in a treatment center in Guinea. Clinical Infectious Diseases, 62(1), 19–23. https://doi.org/10.1093/cid/civ779.
Damkjaer, M., Rudolf, F., Mishra, S., Young, A., & Storgaard, M. (2017). Clinical features and outcome of Ebola Virus disease in pediatric patients: A retrospective case series. Journal of Pediatrics, 182(3), 378–381.e371. https://doi.org/10.1016/j.jpeds.2016.11.034.
DeBiasi, R. L., Song, X., Cato, K., Floyd, T., Talley, L., Gorman, K., et al. (2016). Preparedness, evaluation, and care of pediatric patients under investigation for Ebola virus disease: Experience from a pediatric designated care facility. Journal of the Pediatric Infectious Diseases Society, 5(1), 68–75. https://doi.org/10.1093/jpids/piv069.
Delamou, A., Ayadi, A. M., Sidibe, S., Delvaux, T., Camara, B. S., Sandouno, S. D., et al. (2017). Effect of Ebola virus disease on maternal and child health services in Guinea: A retrospective observational cohort study. Lancet Global Health, 5(4), e448–e457. https://doi.org/10.1016/S2214-109X(17)30078-5.
Dhillon, R. S., Srikrishna, D., Garry, R. F., & Chowell, G. (2015). Ebola control: Rapid diagnostic testing. Lancet Infectious Diseases, 15(2), 147–148. https://doi.org/10.1016/S1473-3099(14)71035-7.
Dornemann, J., Burzio, C., Ronsse, A., Sprecher, A., De Clerck, H., Van Herp, M., et al. (2017). First newborn baby to receive experimental therapies survives Ebola virus disease. Journal of Infectious Diseases. https://doi.org/10.1093/infdis/jiw493.
Eriksson, C. O., Uyeki, T. M., Christian, M. D., King, M. A., Braner, D. A., Kanter, R. K., et al. (2015). Care of the child with Ebola virus disease. Pediatric Critical Care Medicine, 16(2), 97–103. https://doi.org/10.1097/PCC.0000000000000358.
Farmer, P. (2015). The secret to curing West Africa from Ebola is no secret at all. Retrieved November 5, 2017, from http://wapo.st/14IXlAZ.
Fitzgerald, F., Awonuga, W., Shah, T., & Youkee, D. (2016a). Ebola response in Sierra Leone: The impact on children. Journal of Infection, 72(Suppl), S6–S12. https://doi.org/10.1016/j.jinf.2016.04.016.
Fitzgerald, F., Naveed, A., Wing, K., Gbessay, M., Ross, J. C., Checchi, F., et al. (2016b). Ebola virus disease in children, Sierra Leone, 2014-2015. Emerging Infectious Diseases, 22(10), 1769–1777. https://doi.org/10.3201/eid2210.160579.
Fitzgerald, F., Wing, K., Naveed, A., Gbessay, M., Ross, J. C., Checchi, F., et al. (2017a). Risk in the “Red Zone”: Outcomes for children admitted to Ebola holding units in Sierra Leone without Ebola virus disease. Clinical Infectious Diseases. https://doi.org/10.1093/cid/cix182.
Fitzgerald, F., Wing, K., Naveed, A., Gbessay, M., Ross, J. C. G., Checchi, F., et al. (2017b). Refining the paediatric Ebola case definition: A study of children in Sierra Leone with suspected Ebola virus disease. Lancet, 389, S19. https://doi.org/10.1016/s0140-6736(17)30415-4.
Fowler, R. A., Fletcher, T., Fischer II, W. A., Lamontagne, F., Jacob, S., Brett-Major, D., et al. (2014). Caring for critically ill patients with ebola virus disease. Perspectives from West Africa. American Journal of Respiratory and Critical Care Medicine, 190(7), 733–737. https://doi.org/10.1164/rccm.201408-1514CP.
Frieden, T. (2015). Eight ways Ebola threatens the children of West Africa. Retrieved October 23, 2017, from http://fxn.ws/1G6fSnZ.
Gignoux, E., Azman, A. S., de Smet, M., Azuma, P., Massaquoi, M., Job, D., et al. (2016). Effect of artesunate-amodiaquine on mortality related to Ebola virus disease. New England Journal of Medicine, 374(1), 23–32. https://doi.org/10.1056/NEJMoa1504605.
Glynn, J. R. (2015). Age-specific incidence of Ebola virus disease. Lancet, 386(9992), 432. https://doi.org/10.1016/S0140-6736(15)61446-5.
Guerrant, R. L., Oria, R. B., Moore, S. R., Oria, M. O., & Lima, A. A. (2008). Malnutrition as an enteric infectious disease with long-term effects on child development. Nutrition Reviews, 66(9), 487–505. https://doi.org/10.1111/j.1753-4887.2008.00082.x.
Hartley, M. A., Young, A., Tran, A. M., Okoni-Williams, H. H., Suma, M., Mancuso, B., et al. (2017). Predicting Ebola severity: A clinical prioritization score for Ebola virus disease. PLoS Neglected Tropical Diseases, 11(2), e0005265. https://doi.org/10.1371/journal.pntd.0005265.
Hermans, V., Zachariah, R., Woldeyohannes, D., Saffa, G., Kamara, D., Ortuno-Gutierrez, N., et al. (2017). Offering general pediatric care during the hard times of the 2014 Ebola outbreak: Looking back at how many came and how well they fared at a Medecins Sans Frontieres referral hospital in rural Sierra Leone. BMC Pediatrics, 17(1), 34. https://doi.org/10.1186/s12887-017-0786-z.
Iannotti, L. L., Trehan, I., Clitheroe, K. L., & Manary, M. J. (2015). Diagnosis and treatment of severely malnourished children with diarrhoea. Journal of Paediatrics and Child Health, 51(4), 387–395. https://doi.org/10.1111/jpc.12711.
Katona, P., & Katona-Apte, J. (2008). The interaction between nutrition and infection. Clinical Infectious Diseases, 46(10), 1582–1588. https://doi.org/10.1086/587658.
Kreuels, B., Wichmann, D., Emmerich, P., Schmidt-Chanasit, J., de Heer, G., Kluge, S., et al. (2014). A case of severe Ebola virus infection complicated by Gram-negative septicemia. New England Journal of Medicine, 371(25), 2394–2401. https://doi.org/10.1056/NEJMoa1411677.
Lado, M., Walker, N. F., Baker, P., Haroon, S., Brown, C. S., Youkee, D., et al. (2015). Clinical features of patients isolated for suspected Ebola virus disease at Connaught Hospital, Freetown, Sierra Leone: A retrospective cohort study. Lancet Infectious Diseases, 15(9), 1024–1033. https://doi.org/10.1016/S1473-3099(15)00137-1.
Lamontagne, F., Clement, C., Fletcher, T., Jacob, S. T., Fischer II, W. A., & Fowler, R. A. (2014). Doing today’s work superbly well--Treating Ebola with current tools. New England Journal of Medicine, 371(17), 1565–1566. https://doi.org/10.1056/NEJMp1411310.
Lazzerini, M., & Wanzira, H. (2016). Oral zinc for treating diarrhoea in children. Cochrane Database of Systematic Reviews, (12), CD005436. https://doi.org/10.1002/14651858.CD005436.pub5.
Liddell, A. M., Davey Jr., R. T., Mehta, A. K., Varkey, J. B., Kraft, C. S., Tseggay, G. K., et al. (2015). Characteristics and clinical management of a cluster of 3 patients eith Ebola virus disease, including the first domestically acquired cases in the United States. Annals of Internal Medicine, 163(2), 81–90. https://doi.org/10.7326/M15-0530.
Lyon, G. M., Mehta, A. K., Varkey, J. B., Brantly, K., Plyler, L., McElroy, A. K., et al. (2014). Clinical care of two patients with Ebola virus disease in the United States. New England Journal of Medicine, 371(25), 2402–2409. https://doi.org/10.1056/NEJMoa1409838.
MacDermott, N. E., De, S., & Herberg, J. A. (2016). Viral haemorrhagic fever in children. Archives of Disease in Childhood, 101(5), 461–468. https://doi.org/10.1136/archdischild-2014-307861.
Maitland, K., Kiguli, S., Opoka, R. O., Engoru, C., Olupot-Olupot, P., Akech, S. O., et al. (2011). Mortality after fluid bolus in African children with severe infection. New England Journal of Medicine, 364(26), 2483–2495. https://doi.org/10.1056/NEJMoa1101549.
McElroy, A. K., Erickson, B. R., Flietstra, T. D., Rollin, P. E., Nichol, S. T., Towner, J. S., et al. (2014). Biomarker correlates of survival in pediatric patients with Ebola virus disease. Emerging Infectious Diseases, 20(10), 1683–1690. https://doi.org/10.3201/eid2010.140430.
Mendoza, E. J., Qiu, X., & Kobinger, G. P. (2016). Progression of Ebola therapeutics during the 2014-2015 Outbreak. Trends in Molecular Medicine, 22(2), 164–173. https://doi.org/10.1016/j.molmed.2015.12.005.
Mobula, L. M. (2014). Courage is not the absence of fear: Responding to the Ebola outbreak in Liberia. Global Health: Science and Practice, 2(4), 487–489. https://doi.org/10.9745/GHSP-D-14-00157.
Nebehay, S. (2015). High rates of child deaths from Ebola, special care needed: WHO. Retrieved March 25, 2017, from http://reut.rs/1D5rmbR.
Nelson, J. M., Griese, S. E., Goodman, A. B., & Peacock, G. (2016). Live neonates born to mothers with Ebola virus disease: A review of the literature. Journal of Perinatology, 36(6), 411–414. https://doi.org/10.1038/jp.2015.189.
Nosten, F., & White, N. J. (2007). Artemisinin-based combination treatment of falciparum malaria. American Journal of Tropical Medicine and Hygiene, 77(6 Suppl), 181–192.
Palich, R., Gala, J. L., Petitjean, F., Shepherd, S., Peyrouset, O., Abdoul, B. M., et al. (2016). A 6-Year-old child with severe Ebola virus disease: Laboratory-guided clinical care in an Ebola treatment center in Guinea. PLoS Neglected Tropical Diseases, 10(3), e0004393. https://doi.org/10.1371/journal.pntd.0004393.
Paterson, M. L., & Callahan, C. W. (2015). The use of intraosseous fluid resuscitation in a pediatric patient with Ebola virus disease. Journal of Emergency Medicine, 49(6), 962–964. https://doi.org/10.1016/j.jemermed.2015.06.010.
Peacock, G., Uyeki, T. M., & Rasmussen, S. A. (2014). Ebola virus disease and children: What pediatric health care professionals need to know. JAMA Pediatrics, 168(12), 1087–1088. https://doi.org/10.1001/jamapediatrics.2014.2835.
Prevail II Writing Group. (2016). A randomized, controlled trial of ZMapp for Ebola virus infection. New England Journal of Medicine, 375(15), 1448–1456. https://doi.org/10.1056/NEJMoa1604330.
Rosenke, K., Adjemian, J., Munster, V. J., Marzi, A., Falzarano, D., Onyango, C. O., et al. (2016). Plasmodium parasitemia associated with increased survival in Ebola virus-infected patients. Clinical Infectious Diseases, 63(8), 1026–1033. https://doi.org/10.1093/cid/ciw452.
Rouhani, S., Meloney, L., Ahn, R., Nelson, B. D., & Burke, T. F. (2011). Alternative rehydration methods: A systematic review and lessons for resource-limited care. Pediatrics, 127(3), e748–e757. https://doi.org/10.1542/peds.2010-0952.
Schibler, M., Vetter, P., Cherpillod, P., Petty, T. J., Cordey, S., Vieille, G., et al. (2015). Clinical features and viral kinetics in a rapidly cured patient with Ebola virus disease: A case report. Lancet Infectious Diseases, 15(9), 1034–1040. https://doi.org/10.1016/S1473-3099(15)00229-7.
Schieffelin, J. S., Shaffer, J. G., Goba, A., Gbakie, M., Gire, S. K., Colubri, A., et al. (2014). Clinical illness and outcomes in patients with Ebola in Sierra Leone. New England Journal of Medicine, 371(22), 2092–2100. https://doi.org/10.1056/NEJMoa1411680.
Scrimshaw, N. S. (2003). Historical concepts of interactions, synergism and antagonism between nutrition and infection. Journal of Nutrition, 133(1), 316S–321S.
Scrimshaw, N. S., Taylor, C. E., & Gordon, J. E. (1968). Interactions of nutrition and infection. Monograph Series of the World Health Organization, 57, 3–329.
Shah, S., Price, D., Bukham, G., Shah, S., & Wroe, E. (2011). The partners in health manual of ultrasound for resource-limited settings. Boston: Partners In Health.
Shah, T., Greig, J., van der Plas, L. M., Achar, J., Caleo, G., Squire, J. S., et al. (2016). 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 Global Health, 4(7), e495–e501. https://doi.org/10.1016/S2214-109X(16)30097-3.
Sissoko, D., Keita, M., Diallo, B., Aliabadi, N., Fitter, D. L., Dahl, B. A., et al. (2017). Ebola virus persistence in breast milk after no reported illness: A Likely source of virus transmission from mother to child. Clinical Infectious Diseases. https://doi.org/10.1093/cid/ciw793.
Smit, M. A., Michelow, I. C., Glavis-Bloom, J., Wolfman, V., & Levine, A. C. (2017). Characteristics and outcomes of pediatric patients with Ebola virus disease admitted to treatment units in Liberia and Sierra Leone: A retrospective cohort study. Clinical Infectious Diseases, 64(3), 243–249. https://doi.org/10.1093/cid/ciw725.
Spandorfer, P. R. (2011). Subcutaneous rehydration: Updating a traditional technique. Pediatric Emergency Care, 27(3), 230–236. https://doi.org/10.1097/PEC.0b013e31820e1405.
Sprecher, A. G., Caluwaerts, A., Draper, M., Feldmann, H., Frey, C. P., Funk, R. H., et al. (2015). Personal protective equipment for filovirus epidemics: A call for better evidence. Journal of Infectious Diseases, 212(Suppl 2), S98–S100. https://doi.org/10.1093/infdis/jiv153.
Takahashi, S., Metcalf, C. J., Ferrari, M. J., Moss, W. J., Truelove, S. A., Tatem, A. J., et al. (2015). Reduced vaccination and the risk of measles and other childhood infections post-Ebola. Science, 347(6227), 1240–1242. https://doi.org/10.1126/science.aaa3438.
Tang, A. M., Dong, K., Deitchler, M., Chung, M., Maalouf-Manasseh, Z., Tumilowicz, A., et al. (2013). Use of cutoffs for mid-upper arm circumference (muac) as an indicator or predictor of nutritional and health-related outcomes in adolescents and adults: A systematic review. Washington, DC: FHI 360/FANTA.
Tomasik, E., Ziolkowska, E., Kolodziej, M., & Szajewska, H. (2016). Systematic review with meta-analysis: Ondansetron for vomiting in children with acute gastroenteritis. Alimentary Pharmacology and Therapeutics, 44(5), 438–446. https://doi.org/10.1111/apt.13728.
Trehan, I., & Manary, M. J. (2015). Management of severe acute malnutrition in low-income and middle-income countries. Archives of Disease in Childhood, 100(3), 283–287. https://doi.org/10.1136/archdischild-2014-306026.
Trehan, I., Goldbach, H. S., LaGrone, L. N., Meuli, G. J., Wang, R. J., Maleta, K. M., et al. (2013). Antibiotics as part of the management of severe acute malnutrition. New England Journal of Medicine, 368(5), 425–435. https://doi.org/10.1056/NEJMoa1202851.
Trehan, I., Kelly, T., Marsh, R. H., George, P. M., & Callahan, C. W. (2016). Moving towards a more aggressive and comprehensive model of care for children with Ebola. Journal of Pediatrics, 170(28–33), e21–e27. https://doi.org/10.1016/j.jpeds.2015.11.054.
UNICEF. (2014). Guidelines for a revised implementation of integrated community case management of childhood illnesses (ICCM) during the Ebola outbreak. New York: UNICEF.
Uyeki, T. M., Mehta, A. K., Davey Jr., R. T., Liddell, A. M., Wolf, T., Vetter, P., et al. (2016). Clinical management of Ebola virus disease in the United States and Europe. New England Journal of Medicine, 374(7), 636–646. https://doi.org/10.1056/NEJMoa1504874.
Walker, P. G., White, M. T., Griffin, J. T., Reynolds, A., Ferguson, N. M., & Ghani, A. C. (2015). Malaria morbidity and mortality in Ebola-affected countries caused by decreased health-care capacity, and the potential effect of mitigation strategies: A modelling analysis. Lancet Infectious Diseases, 15(7), 825–832. https://doi.org/10.1016/S1473-3099(15)70124-6.
WHO Ebola Response Team. (2015). Ebola virus disease among children in West Africa. New England Journal of Medicine, 372(13), 1274–1277. https://doi.org/10.1056/NEJMc1415318.
WHO/UNICEF/WFP. (2014). Interim guideline: Nutritional care of children and adults with Ebola virus disease in treatment centres. Geneva: World Health Organization.
Wolf, T., Kann, G., Becker, S., Stephan, C., Brodt, H. R., de Leuw, P., et al. (2015). Severe Ebola virus disease with vascular leakage and multiorgan failure: Treatment of a patient in intensive care. Lancet, 385(9976), 1428–1435. https://doi.org/10.1016/S0140-6736(14)62384-9.
World Health Organization. (1999). Management of severe malnutrition: A manual for physicians and other senior health workers. Geneva: World Health Organization.
World Health Organization. (2014a). Interim infection prevention and control guidance for care of patients with suspected or confirmed filovirus haemorrhagic fever in health-care settings, with focus on Ebola. Geneva: World Health Organization.
World Health Organization. (2014b). Interim list of WHO essential medicines necessary to treat Ebola cases based on existing guidelines. Geneva: World Health Organization.
World Health Organization. (2015). Manual for the care and management of patients in Ebola Care Units/Community Care Centres: Interim emergency guidance. Geneva: World Health Organization.
World Health Organization. (2016a). Clinical management of patients with viral haemorrhagic fever: A pocket guide for front line health workers. Geneva: World Health Organization.
World Health Organization. (2016b). Interim guidance: Clinical care for survivors of Ebola virus disease. Geneva: World Health Organization.
World Health Organization. (2016c). Personal protective equipment for use in a filovirus disease outbreak: Rapid advice guideline. Geneva: World Health Organization.
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Trehan, I., George, P.M., Callahan, C.W. (2019). Comprehensive Clinical Care for Infants and Children with Ebola Virus Disease. In: Schwartz, D., Anoko, J., Abramowitz, S. (eds) Pregnant in the Time of Ebola. Global Maternal and Child Health. Springer, Cham. https://doi.org/10.1007/978-3-319-97637-2_5
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