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Characteristics and Outcomes of Pediatric Patients With Ebola Virus Disease Admitted to Treatment Units in Liberia and Sierra Leone: A Retrospective Cohort Study
BACKGROUND. The clinical and virologic characteristics of Ebola virus disease (EVD) in children have not been thoroughly documented. METHODS. Consecutive children aged <18 years with real-time polymerase chain reaction (RT-PCR)–confirmed EVD were enrolled retrospectively in 5 Ebola treatment unit...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2017
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5241778/ https://www.ncbi.nlm.nih.gov/pubmed/28011610 http://dx.doi.org/10.1093/cid/ciw725 |
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author | Smit, Michael A. Michelow, Ian C. Glavis-Bloom, Justin Wolfman, Vanessa Levine, Adam C. |
author_facet | Smit, Michael A. Michelow, Ian C. Glavis-Bloom, Justin Wolfman, Vanessa Levine, Adam C. |
author_sort | Smit, Michael A. |
collection | PubMed |
description | BACKGROUND. The clinical and virologic characteristics of Ebola virus disease (EVD) in children have not been thoroughly documented. METHODS. Consecutive children aged <18 years with real-time polymerase chain reaction (RT-PCR)–confirmed EVD were enrolled retrospectively in 5 Ebola treatment units in Liberia and Sierra Leone in 2014/2015. Data collection and medical management were based on standardized International Medical Corps protocols. We performed descriptive statistics, multivariate logistic regression, and Kaplan-Meier survival analyses. RESULTS. Of 122 children enrolled, the median age was 7 years and one-third were aged <5 years. The female-to-male ratio was 1.3. The most common clinical features at triage and during hospitalization were fever, weakness, anorexia, and diarrhea, although 21% of patients were initially afebrile and 6 patients remained afebrile. Bleeding was rare at presentation (5%) and manifested subsequently in fewer than 50%. The overall case fatality rate was 57%. Factors associated with death in bivariate analyses were age <5 years, bleeding at any time during hospitalization, and high viral load. After adjustment with logistic regression modeling, the odds of death were 14.8-fold higher if patients were aged <5 years, 5-fold higher if the patient had any evidence of bleeding, and 5.2-fold higher if EVD RT-PCR cycle threshold value was ≤20. Plasmodium parasitemia had no impact on EVD outcomes. CONCLUSIONS. Age <5 years, bleeding, and high viral loads were poor prognostic indicators of children with EVD. Research to understand mechanisms of these risk factors and the impact of dehydration and electrolyte imbalance will improve health outcomes. |
format | Online Article Text |
id | pubmed-5241778 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-52417782017-01-23 Characteristics and Outcomes of Pediatric Patients With Ebola Virus Disease Admitted to Treatment Units in Liberia and Sierra Leone: A Retrospective Cohort Study Smit, Michael A. Michelow, Ian C. Glavis-Bloom, Justin Wolfman, Vanessa Levine, Adam C. Clin Infect Dis Major Article BACKGROUND. The clinical and virologic characteristics of Ebola virus disease (EVD) in children have not been thoroughly documented. METHODS. Consecutive children aged <18 years with real-time polymerase chain reaction (RT-PCR)–confirmed EVD were enrolled retrospectively in 5 Ebola treatment units in Liberia and Sierra Leone in 2014/2015. Data collection and medical management were based on standardized International Medical Corps protocols. We performed descriptive statistics, multivariate logistic regression, and Kaplan-Meier survival analyses. RESULTS. Of 122 children enrolled, the median age was 7 years and one-third were aged <5 years. The female-to-male ratio was 1.3. The most common clinical features at triage and during hospitalization were fever, weakness, anorexia, and diarrhea, although 21% of patients were initially afebrile and 6 patients remained afebrile. Bleeding was rare at presentation (5%) and manifested subsequently in fewer than 50%. The overall case fatality rate was 57%. Factors associated with death in bivariate analyses were age <5 years, bleeding at any time during hospitalization, and high viral load. After adjustment with logistic regression modeling, the odds of death were 14.8-fold higher if patients were aged <5 years, 5-fold higher if the patient had any evidence of bleeding, and 5.2-fold higher if EVD RT-PCR cycle threshold value was ≤20. Plasmodium parasitemia had no impact on EVD outcomes. CONCLUSIONS. Age <5 years, bleeding, and high viral loads were poor prognostic indicators of children with EVD. Research to understand mechanisms of these risk factors and the impact of dehydration and electrolyte imbalance will improve health outcomes. Oxford University Press 2017-02-01 2016-10-25 /pmc/articles/PMC5241778/ /pubmed/28011610 http://dx.doi.org/10.1093/cid/ciw725 Text en © The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America. http://creativecommons.org/licenses/by-nc-nd/4.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, contact journals.permissions@oup.com. |
spellingShingle | Major Article Smit, Michael A. Michelow, Ian C. Glavis-Bloom, Justin Wolfman, Vanessa Levine, Adam C. Characteristics and Outcomes of Pediatric Patients With Ebola Virus Disease Admitted to Treatment Units in Liberia and Sierra Leone: A Retrospective Cohort Study |
title | Characteristics and Outcomes of Pediatric Patients With Ebola Virus Disease Admitted to Treatment Units in Liberia and Sierra Leone: A Retrospective Cohort Study |
title_full | Characteristics and Outcomes of Pediatric Patients With Ebola Virus Disease Admitted to Treatment Units in Liberia and Sierra Leone: A Retrospective Cohort Study |
title_fullStr | Characteristics and Outcomes of Pediatric Patients With Ebola Virus Disease Admitted to Treatment Units in Liberia and Sierra Leone: A Retrospective Cohort Study |
title_full_unstemmed | Characteristics and Outcomes of Pediatric Patients With Ebola Virus Disease Admitted to Treatment Units in Liberia and Sierra Leone: A Retrospective Cohort Study |
title_short | Characteristics and Outcomes of Pediatric Patients With Ebola Virus Disease Admitted to Treatment Units in Liberia and Sierra Leone: A Retrospective Cohort Study |
title_sort | characteristics and outcomes of pediatric patients with ebola virus disease admitted to treatment units in liberia and sierra leone: a retrospective cohort study |
topic | Major Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5241778/ https://www.ncbi.nlm.nih.gov/pubmed/28011610 http://dx.doi.org/10.1093/cid/ciw725 |
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