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Nosocomial Ebola transmission rate among children ‘lower than feared’
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During the Ebola outbreak in Sierra Leone, nosocomial transmission of Ebola virus disease among pediatric patients was only 0.5%, considerably less than originally expected given the varying adherence to quarantine measures among different health facilities.
“In the western area of Sierra Leone, patients with suspected [Ebola virus disease (EVD)] were isolated in ‘Red Zones’ in Ebola holding units (EHUs) whilst awaiting results of EVD tests,” Felicity Fitzgerald, MRCPCH, from the UCL Great Ormond Street Institute of Child Health, and colleagues wrote. “Turnaround times for results averaged 48 hours but were frequently longer due to overwhelming demand and system bottlenecks. Concerns were raised that EHUs could act as amplification sites for EVD owing to close proximity between patients and duration of exposure.”
According to researchers, if a child was EVD–negative but required additional clinical care, they were required to remain at an EHU, further increasing their risk of exposure to nosocomial infection. To determine whether uninfected children were at heightened risk of acquiring EVD while in EHUs, Fitzgerald and colleagues described prognoses of EVD–negative children and nosocomial infection risk by estimating the rate of readmission with EVD.
Children younger than 13 years who were in 11 EHUs in the western area between Aug. 14, 2014, and March 31, 2015, were included in this cohort study. The researchers compiled data from paper clinical records, as well as case investigation forms, site admission books and staff interviews, directly at the participating EHUs. Data regarding children transferred to Ola During Children’s Hospital following an EHU stay were cross-referenced with demographic data for bed management from the Western Area Ebola Response Center, burial records, child protection records and lab results.
Between August 2014 and March 2015, 1,054 children were placed into the 11 EHUs in western Sierra Leone. Weekly admissions within this time frame increased from a median of 8 in August to October, 2014, to 50 from February to March, 2015. Among children in participating EHUs, 69% were EVD–negative; outcomes of 99.9% of these children, who had a median age of 3 years and were 50% female, were known. Additionally, between October 2014 to February 2015, the number of children without EVD rose from 23% to 94%. When data were available regarding accompaniment, 17% of children admitted to EHUs were alone and 20% had EVD contact.
In the time for symptom onset to turn to presentation (median = 2 days), several medications were administered, including antibiotics (82%), antimalarials (84%) and intravenous fluids (38%). Out of all cases presented, 9% were fatal. Of children who survived to discharge (92%), 19% were admitted to the local children’s hospital for further treatment. Here, an additional eight children died. The remaining children were released to go home (73%), an observational interim care center (2%) or an orphanage (1%). Six percent of children have unknown discharge locations.
“Previous evidence suggests that it is the direct exposure to bodily fluids and the sharing of latrine facilities which increased infection risk, rather than sharing a ward per se, so infants in nappies may have experienced less risk,” Fitzgerald and colleagues wrote. “Furthermore, it appears that children may be less susceptible than adults to EVD infection, although the mechanism underlying this is undetermined. Children might be more exposed owing to the challenges of maintaining patient separation, but data from mixed-age populations showed a slightly higher rate of positive readmissions.” — by Katherine Bortz
Disclosure: The researchers report no relevant financial disclosures.
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