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Younger children have highest mortality rate for Ebola
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Children aged younger than 5 years are more likely to die from Ebola and experience faster progressing illness vs. adults, according to study findings discussed in a letter to the editor published in the New England Journal of Medicine.
“The epidemic of Ebola virus disease (EVD) in West Africa has caused clinical illness and death among persons with reported ages ranging from less than 1 year to more than 100 years,” researchers from the WHO Ebola Response Team wrote. “Most published estimates of key epidemiologic parameters have been based on patients of all ages, and have thus been dominated by cases in which patients are 16 years of age or older, and as of Jan. 5, 2015, these cases accounted for 79% of the confirmed and probable cases for which age has been reported.”
To determine disease progression and outcomes among the pediatric population, researchers assessed children with probable or confirmed Ebola virus reported in Guinea, Liberia and Sierra Leone and stratified cases according to age.
Mean incubation period among 14 children aged 1 year was shortest at 6.9 days (95% CI, 5.1-9.5), compared with 9.8 days (95% CI, 8.7-11.1) among 184 children aged 10 to 15 years.
Christl A. Donnelly
Time from symptom onset to death was shorter among younger children, according to the researchers.
Ninety-two percent of children aged younger than 1 year with Ebola had fever before clinical presentation. Children aged younger than 16 years were significantly more likely to present with fever vs. adults (P < .001).
Patients aged younger than 16 years were less likely to report pain in the abdomen, chest, joints or muscles, difficulty breathing or swallowing and hiccups between symptom onset and clinical presentation vs. older patients (P < .001). This finding may be due to younger children having difficulty reporting specific symptoms, according to researchers.
Patients aged 10 to 15 years had the lowest case fatality rate, while patients aged younger than 4 years had the highest. Further, patients aged younger than 45 years had a lower case fatality rate vs. patients aged 45 years and older.
“These findings show that Ebola affects younger children quite differently than adults, and it is especially important that we get them into treatment quickly,” researcher Christl A. Donnelly, ScD, of Imperial College London, said in a press release. “We also need to look at whether young children are getting treatment that is appropriate for their age.”
Not only do the study findings indicate differences in disease presentation, progression and mortality between children and adults, they suggest that adolescents have the highest survival rate.
“The findings of this study emphasize that children suffering from Ebola need the highest quality medical care,” study researcher Christopher Dye, DPhil, of WHO’s Ebola epidemiology team in Geneva, said in the release. “But they leave open the question of why older children, aged 10 to 15 years, appear to be less vulnerable to Ebola than either infants or adults. This is the topic for future research.” – by Amanda Oldt
Disclosure: Agua-Agum reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.
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