title: Characteristics and Outcomes of Pediatric Patients With Ebola Virus Disease Admitted to Treatment Units in Liberia and Sierra Leone: A Retrospective Cohort Study.
abstract: 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.
authors.affiliation: Warren Alpert Medical School, and.|Department of Pediatrics, Division of Infectious Diseases, Brown University, Providence, Rhode Island; and.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Smit
authors.affiliation: Warren Alpert Medical School, and.|Department of Pediatrics, Division of Infectious Diseases, Brown University, Providence, Rhode Island; and.
authors.forename: Ian C
authors.initials: IC
authors.lastname: Michelow
authors.affiliation: Warren Alpert Medical School, and.
authors.forename: Justin
authors.initials: J
authors.lastname: Glavis-Bloom
authors.affiliation: International Medical Corps, Los Angeles, California.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Wolfman
authors.affiliation: Warren Alpert Medical School, and adam_levine@brown.edu.|International Medical Corps, Los Angeles, California.
authors.forename: Adam C
authors.initials: AC
authors.lastname: Levine
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003681:Dehydration; D003967:Diarrhea; D005260:Female; D006470:Hemorrhage; D019142:Hemorrhagic Fever, Ebola / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy* / Q000821:virology; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D007988:Liberia / Q000453:epidemiology; D008288:Malaria / Q000453:epidemiology; D008297:Male; D044342:Malnutrition; D018512:Parasitemia / Q000453:epidemiology; D010961:Plasmodium; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012807:Sierra Leone / Q000453:epidemiology; D016896:Treatment Outcome; D019562:Viral Load
keywords: Ebola; PCR.; child; malaria; mortality