title: Effects of Mother's Illness and Breastfeeding on Risk of Ebola Virus Disease in a Cohort of Very Young Children.
abstract: BACKGROUND
  Young children who contract Ebola Virus Disease (EVD) have a high case fatality rate, but their sources of infection and the role of breastfeeding are unclear.
  
  
  RESULTS
  Household members of EVD survivors from the Kerry Town Ebola Treatment Centre in Sierra Leone were interviewed four to 10 months after discharge to establish exposure levels for all members of the household, whether or not they became ill, and including those who died. We analysed a cohort of children under three years to examine associations between maternal illness, survival and breastfeeding, and the child's outcome. Of 77 children aged zero to two years in the households we surveyed, 43% contracted EVD. 64 children and mothers could be linked: 25/40 (63%) of those whose mother had EVD developed EVD, compared to 2/24 (8%) whose mother did not have EVD, relative risk adjusted for age, sex and other exposures (aRR) 7·6, 95%CI 2·0-29·1. Among those with mothers with EVD, the risk of EVD in the child was higher if the mother died (aRR 1·5, 0·99-2·4), but there was no increased risk associated with breast-feeding (aRR 0·75, 0·46-1·2). Excluding those breastfed by infected mothers, half (11/22) of the children with direct contact with EVD cases with wet symptoms (diarrhoea, vomiting or haemorrhage) remained well.
  
  
  CONCLUSIONS
  This is the largest study of mother-child pairs with EVD to date, and the first attempt at assessing excess risk from breastfeeding. For young children the key exposure associated with contracting EVD was mother's illness with EVD, with a higher risk if the mother died. Breast feeding did not confer any additional risk in this study but high risk from proximity to a sick mother supports WHO recommendations for separation. This study also found that many children did not become ill despite high exposures.
authors.affiliation: Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom.
authors.forename: Hilary
authors.initials: H
authors.lastname: Bower
authors.affiliation: Save the Children, Freetown, Sierra Leone.
authors.forename: Sembia
authors.initials: S
authors.lastname: Johnson
authors.affiliation: Save the Children, Freetown, Sierra Leone.
authors.forename: Mohamed S
authors.initials: MS
authors.lastname: Bangura
authors.affiliation: Save the Children, Freetown, Sierra Leone.
authors.forename: Alie Joshua
authors.initials: AJ
authors.lastname: Kamara
authors.affiliation: Save the Children, Freetown, Sierra Leone.
authors.forename: Osman
authors.initials: O
authors.lastname: Kamara
authors.affiliation: Save the Children, Freetown, Sierra Leone.
authors.forename: Saidu H
authors.initials: SH
authors.lastname: Mansaray
authors.affiliation: Save the Children, Freetown, Sierra Leone.
authors.forename: Daniel
authors.initials: D
authors.lastname: Sesay
authors.affiliation: Save the Children, Freetown, Sierra Leone.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Turay
authors.affiliation: Save the Children, London, United Kingdom.
authors.forename: Francesco
authors.initials: F
authors.lastname: Checchi
authors.affiliation: Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom.
authors.forename: Judith R
authors.initials: JR
authors.lastname: Glynn
mesh_terms: D001942:Breast Feeding; D002648:Child; D019142:Hemorrhagic Fever, Ebola / Q000635:transmission*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical; D007407:Interviews as Topic; D018570:Risk Assessment; D012807:Sierra Leone