On March 23, 2014, the World Health Organization (WHO) announced that an Ebola virus outbreak that started in the Republic of Guinea in December 2013 had spread to numerous West African countries.1,2 The Ebola epidemic of 2014 was the longest, largest, and most pervasive outbreak to date.3 In previous Ebola virus disease (EVD) outbreaks, children represented a small proportion of infected cases and were underrepresented in EVD studies.4,5 However, the index case for this epidemic was traced back to an 18-month-old child in Guinea.6 Early data from the 2014 EVD epidemic indicate that approximately 20% of all cases were in children aged < 16 years, with case fatality rates as high as 90% in children < 1 year old.7
EVD is an acute disease that results in high morbidity and mortality. The Ebola virus, along with the Marburg virus, belongs to the Filoviridae family.8 There are 5 distinct species of Ebola virus, each of which is named for the region where it was originally identified.9 The species are Sudan ebolavirus, Zaire ebolavirus, Taï Forest ebolavirus, Bundibugyo ebolavirus, and Reston ebolavirus.8 The filoviruses are enveloped, negative-sense single-stranded RNA viruses with a filamentous structure. The virus particles typically have a diameter of 80 nm and can be as long as 14,000 nm.10
The Ebola outbreak of 2014 had significant impact on African countries and led to a global public health emergency. The likelihood of contracting EVD in the United States is extremely low unless a person has direct contact with the blood or body fluids (eg, urine, saliva, vomit, sweat, semen, or diarrhea) of a symptomatic person with EVD.3 Case definitions for EVD have been established by the WHO. (See Table 1.) Clinicians are uniquely tasked to distinguish between EVD and common pediatric illnesses, as children with EVD may present with nonspecific signs and symptoms.
Abbreviation: EVD, Ebola virus disease.
Adapted from: World Health Organization. Case definition recommendations for Ebola or Marburg virus diseases. Available at: http://apps.who.int/iris/bitstream/10665/146397/1/WHO_EVD_CaseDef_14.1_eng.pdf?ua=1&ua=1.
This issue of Pediatric Emergency Medicine Practice focuses on the recognition, evaluation, and management of children with EVD by offering a review of the recent advances in these areas. It provides updated information and guidelines on management for clinicians who may be the first point of contact for patients. This information will allow clinicians to maintain a high index of suspicion while differentiating between common ailments and EVD. Adequate prehospital care will serve to reduce transmission to others, decrease unnecessary healthcare worker exposure, and reduce morbidity and mortality with early recognition and management.
Marlie Dulaurier, MD;Katherine Moyer, DO;Rebecca Wallihan, MD
July 2, 2016
August 2, 2019
4 AMA PRA Category 1 Credits™, 4 ACEP Category I Credits, 4 AAFP Prescribed Credits, 4 AOA Category 2-A or 2-B Credits. Specialty CME Credits: Included as part of the 4 credits, this CME activity is eligible for 0.5 Pharmacology CME credits