November 17. 2014
What is known about Ebola virus disease and children?
- Information is limited on the impact of the current outbreak on children.
- Outbreaks have previously occurred in settings with limited resources.
- Information about pediatric cases has not been routinely collected.
For more information: "Ebola Virus and Children: What Pediatric Health Care Professionals Need to Know" (JAMA Pediatrics)
What are the signs and symptoms of Ebola in children?
- Signs and symptoms of Ebola include fever and severe headache, muscle pain, vomiting, diarrhea, stomach pain, or unexplained bleeding or bruising. Signs and symptoms may appear from 2 to 21 days after exposure, although 8 to 10 days is most common.
- In children, fever, nausea, vomiting and diarrhea are common symptoms of many illnesses year-round. This means pediatric health care providers must be vigilant in asking about travel to an Ebola-impacted country or any contact with individuals with Ebola.
- Because the symptoms are similar to several much more common illnesses, prompt laboratory testing is important in a person who has been exposed to someone with confirmed Ebola, or who has traveled to a country where the disease is widespread. Additional tests that may be performed include malaria, typhoid, a viral panel and measles.
- A person with the Ebola virus can only infect others after they begin to have symptoms.
Does the course of the disease progress differently in children?
- Most of what we know about Ebola comes from adults who have been diagnosed with the disease. Limited data on previous outbreaks suggest that children are more prone to fever and respiratory or gastrointestinal symptoms and less likely, in general, to experience hemorrhage or central nervous system signs. Children younger than 5 years may be at increased risk for illness and death.
- In adults, most Ebola infections result in severe disease. On average, about half of the people with Ebola die from the disease, but some fatality rates have approached 71% in West African countries. However, this fatality rate relates to settings with limited resources, i.e., those without the healthcare delivery system and resources available in the U.S.
- According to the Centers for Disease Control and Prevention (CDC), in the current outbreak patients usually begin showing symptoms about 9 to 11 days after exposure. The disease typically begins with a fever, chills, headache and malaise. Within five days after the onset of symptoms, patients may develop gastrointestinal symptoms including abdominal pain, nausea, vomiting and diarrhea. Some individuals develop a rash on the torso or face by day 5 to 7. Eye infection may be present. Contrary to popular belief, only a minority of patients have bleeding.
- In fatal cases, death usually occurs around 10 to 12 days after the onset of symptoms and is due to septic shock and multi-organ system failure.
For more information: Ebola Virus Disease Information for Clinicians in U.S. Healthcare Settings (CDC)
Are children more vulnerable to the effects of Ebola?
- Information from previous Ebola outbreaks shows that fewer children were identified with Ebola. That may be because parents/guardians shield children from infected victims and make sure that children do not care for sick adults or visit hospital areas where Ebola patients are being cared for.
- However, in one outbreak in which large numbers of children were affected, school-age children and adolescents had increased survival compared with children less than 5 years of age and with adults.
- Children are more likely to become dehydrated from vomiting or diarrhea because they have less body fluid reserve than adults do, and this increases their risk for rapid dehydration. Children also have smaller circulating blood volumes than adults, so without rapid intervention, relatively small amounts of blood loss can become dangerous more quickly.
For more information: The Youngest Victims: Disaster Preparedness to Meet Children's Needs (AAP)
How is Ebola transmitted?
- The risk of transmission is low, with attack rates of only 15-20% in a community. The risk is much lower if proper universal and contact precautions are maintained.
- Becoming infected requires direct, physical contact with the bodily fluids (saliva, vomit, feces, urine, blood, semen, etc.) of people who have been infected with or died from Ebola virus disease.
- People are much more infectious in the later stages of the disease. It is believed that people are not infectious in the incubation phase before symptoms develop.
- In the U.S., only healthcare workers who have cared for patients with Ebola have been infected.
- There are very few areas of the country where a patient diagnosed with Ebola has come into direct contact with others. If you live in an area where people have come into contact with a patient, it is important to follow instructions from public health authorities.
How is Ebola treated in children? Are children candidates for any of the experimental treatments that have been offered to adults?
- Supportive care is recommended for all patients with Ebola, including children. Supportive care includes oral or intravenous fluids, blood products, and treatment of co-infections with antibiotics.
- Several experimental therapies and vaccines are in development and may be available in the future.
- It's important to understand that while the mortality rate is high for Ebola, these numbers reflect the situation in West Africa and the limited resources so far available there. Within the U.S. healthcare system, it's likely to be a much different situation.
- Limited data are available for treating Ebola in infants, including how to evaluate or treat infants exposed to Ebola in utero or at delivery, and whether breastfeeding is safe for infants born to mothers who have recovered from Ebola. The Ebola virus has been found in breast milk of women recovering from Ebola, but it is unknown whether mother-to-infant transmission has occurred.
How do isolation and quarantine protocols impact children? What is the guidance for parents caring for a child who is diagnosed with Ebola?
- Children, who depend on their parents or other adults for their physical and psychological needs, pose a unique situation in terms of isolation and quarantine protocols. With most infectious illnesses, children often are isolated with a family member so that the child can continue to be nurtured while ill. With Ebola, the decision will depend in part on hospital protocols, public health advisories, and what opportunities for transmission may have occurred before seeking medical care for the child and on the health of the parent or caregiver.
- For the general population, the CDC advises that those who have had direct contact with a person sick with Ebola should be monitored for 21 days after the last contact, ideally with daily temperature checks. Despite a lack of evidence that Ebola can be transmitted before symptoms develop, it's usually recommended that people who have been exposed avoid close contact or activities with household members that might result in exposure to bodily fluids, such as sharing of utensils or kissing. People who develop fever or other Ebola symptoms should be isolated immediately until the diagnosis can be ruled out.
How should parents talk with children about Ebola?
Children and teens may be worried about what they are hearing about Ebola. Adults can help by providing correct information and reassuring children that there are ways to contain and treat this illness. Good hygiene is always important.
Exposure to media (viewing the news on a computer or on television) can traumatize children. Limit media coverage—if children are going to watch media coverage, consider taping it (to allow adults to preview) and watch along with them to answer questions and help them process the information.
David J. Schonfeld, MD, FAAP, pediatrician-in-chief and director of the National Center for School Crisis and Bereavement at St. Christopher's Hospital for Children in Philadelphia, suggests the following when discussing Ebola with your child:
- Consider your child's maturity level and coping style. Generally, older children are more ready for information than younger ones.
- Ask your children what they have already heard and understand about Ebola. Ask them what other information they would like.
- Be factual and honest. Help children understand the differences between the common illnesses they have encountered and rare, localized diseases like Ebola. It isn't helpful or effective to provide graphic details.
- If you are unsure of an answer, explain to your child that you don't know.
- Remain calm and confident. Don't tell children they "shouldn't worry." Rather, support them as they learn to overcome their fears.
What can individual members of the public do to protect themselves?
- The Ebola virus can be killed with soap and water, heat, or a disinfectant or sanitizing agent such as bleach. According to the CDC, washing hands frequently or using an alcohol-based hand sanitizer is a good precaution.
- While only a few people in the U.S. have been infected with Ebola, it's anticipated many thousands will become ill with influenza this year, and many will die due to the flu. Flu symptoms can be similar to those of Ebola, including fever and muscle pain. It's important for all individuals to be immunized against influenza to protect them from flu, and also to reduce the likelihood of needing to visit a hospital or doctor's office. See the CDC infographic.
How long does Ebola live outside the body?
- Ebola can be killed with chlorine bleach.
- The Environmental Protection Agency has a list of disinfectants (including bleach) that can be used in healthcare settings, institutional settings and residential settings to kill the Ebola virus.
- Ebola on dry surfaces, such as doorknobs and countertops, can survive for several hours. Ebola virus in body fluids, such as blood, can survive up to several days at room temperature.
- There is no evidence that special cleaning is required in any setting other than where a patient with active infection is being cared for.
How prepared is the U.S. medical community to handle Ebola?
- Several adults have been successfully treated at hospitals in the U.S.
- In the U.S., transmission to household contacts of known Ebola patients has not occurred.
- Pediatricians and hospitals are being provided with the latest information as quickly as it becomes available so they can obtain the necessary equipment and practice how they will screen, diagnose and treat Ebola patients in advance.
- Ebola poses extremely low risk to the U.S. general population. Ebola patients can be transported and managed safely when appropriate precautions are used.
- The AAP is working collaboratively with the CDC Children's Preparedness Team (focuses on all emergencies) and the Children's Task Force (specific to Ebola).