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; Ct 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.