Public Release: 

Ebola more deadly for young children

Imperial College London

Ebola progresses more quickly and is more likely to be fatal for children under five, according to new research.

An international group of scientists led by Imperial College London and the World Health Organization analysed data on Ebola cases in children under 16 during the current outbreak in Guinea, Liberia and Sierra Leone, comparing them to cases in adults.

The results show that although the rate of infection is lower in children than adults, young children who get the disease have a lower chance of surviving it.

The findings are published in the New England Journal of Medicine.

As of March 2015, nearly 4,000 children under 16 have been affected by Ebola in the current epidemic, around a fifth of all confirmed and probable cases. The proportion of cases made up by children has been gradually increasing over the course of the epidemic, but the explanation for this is unclear.

Ebola has affected young children most severely, killing around 90 per cent of children aged under a year and around 80 per cent of children aged one to four years who are infected. Older children are much more likely to survive the disease - it has killed 52 per cent of children infected aged 10 to 15. For adults aged 16 to 44, the case fatality rate is 65 per cent.

The incubation period - the time between becoming infected and showing symptoms - was 6.9 days in children under a year, compared with 9.8 days in children aged 10 to 15. Younger children also had shorter times from the onset of symptoms to hospitalisation and death.

There were also differences in the symptoms experienced by children. Children were more likely to have a fever when they first see a doctor, and less likely to have pain in the abdomen, chest, joints, or muscles; difficulty breathing or swallowing; or hiccups.

Professor Christl Donnelly, from the Medical Research Council Centre for Outbreak Analysis and Modelling at Imperial College London and a co-author of the study, said: "These findings show that Ebola affects young children quite differently to adults, and it's especially important that we get them into treatment quickly. We also need to look at whether young children are getting treatment that's appropriate for their age."

Dr Chris Dye, head of WHO's Ebola epidemiology team in Geneva and a co-author of the study, added: "The findings of this study emphasise that children suffering from Ebola need the highest quality medical care, but they leave open the question of why older children, aged 10-15 years, appear to be less vulnerable to Ebola than either infants or adults. This is a topic for future research."

Dr Robert Fowler from the University of Toronto, who also co-authored the study, said: "The very youngest of children - neonates - appear to have the worst outcomes from Ebola. "We suspect that numerous factors are at play. First, the youngest of children are so dependent upon others for their care and wellbeing, and their caregivers may have also been unwell due to Ebola.

"Additionally, Ebola frequently causes a vomiting and diarrhoeal illness that leads to dehydration and electrolyte and metabolic abnormalities. This is not different from adults, but children seem to have less reserve, and get sick more quickly. In order to prevent children from getting dehydrated and developing 'shock', it is critical that they receive sufficient fluids - usually intravenously when they can no longer keep fluids down due to vomiting - and placing intravenous catheters in young children can be challenging.

"All of these challenges demand that we appreciate the high mortality in young children and evolve more dedicated and specialised means of caring for them in an Ebola outbreak - from nurses and doctors with expertise in paediatric care, with the support system in place in a treatment facility to provide medical and emotional care in a specialised manner."

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The research was supported by the Medical Research Council, the Bill and Melinda Gates Foundation, the Models of Infectious Disease Agent Study of the National Institute of General Medical Sciences (National Institutes of Health), the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Modelling Methodology at Imperial College London, the EU PREDEMICS consortium, the Wellcome Trust, and Fogarty International Center.

For more information please contact:

Sam Wong
Research Media Officer
Imperial College London
Email: sam.wong@imperial.ac.uk
Tel: +44(0)20 7594 2198
Out of hours duty press officer: +44(0)7803 886 248

Margaret Harris
Media, Ebola
World Health Organization
Email: harrism@who.int
Tel: +41 227 911 646
+41 796 036 224

Notes to editors:

1. WHO Ebola Response Team, 'Ebola Virus Disease among Children in West Africa' New England Journal of Medicine 372;13 DOI: 10.1056/NEJMc1415318

2. About Imperial College London

Imperial College London is one of the world's leading universities. The College's 14,000 students and 7,500 staff are expanding the frontiers of knowledge in science, medicine, engineering and business, and translating their discoveries into benefits for society.

Founded in 1907, Imperial builds on a distinguished past - having pioneered penicillin, holography and fibre optics - to shape the future. Imperial researchers work across disciplines to improve global health, tackle climate change, develop sustainable energy technology and address security challenges. This blend of academic excellence and its real-world application feeds into Imperial's exceptional learning environment, where students participate in research to push the limits of their degrees.

Imperial nurtures a dynamic enterprise culture, where collaborations with industrial, healthcare and international partners are the norm. In 2007, Imperial College London and Imperial College Healthcare NHS Trust formed the UK's first Academic Health Science Centre. This unique partnership aims to improve the quality of life of patients and populations by taking new discoveries and translating them into new therapies as quickly as possible.

Imperial has nine London campuses, including Imperial West: a new 25 acre research and innovation centre in White City, west London. At Imperial West, researchers, businesses and higher education partners will co-locate to create value from ideas on a global scale. http://www.imperial.ac.uk

3. About the Medical Research Council

The Medical Research Council has been at the forefront of scientific discovery to improve human health. Founded in 1913 to tackle tuberculosis, the MRC now invests taxpayers' money in some of the best medical research in the world across every area of health. Thirty MRC-funded researchers have won Nobel prizes in a wide range of disciplines, and MRC scientists have been behind such diverse discoveries as vitamins, the structure of DNA and the link between smoking and cancer, as well as achievements such as pioneering the use of randomised controlled trials, the invention of MRI scanning, and the development of a group of antibodies used in the making of some of the most successful drugs ever developed. Today, MRC-funded scientists tackle some of the greatest health problems facing humanity in the 21st century, from the rising tide of chronic diseases associated with ageing to the threats posed by rapidly mutating micro-organisms. http://www.mrc.ac.uk

4. About the Wellcome Trust

The Wellcome Trust is a global charitable foundation dedicated to improving health. We provide more than £700 million a year to support bright minds in science, the humanities and the social sciences, as well as education, public engagement and the application of research to medicine. Our £18 billion investment portfolio gives us the independence to support such transformative work as the sequencing and understanding of the human genome, research that established front-line drugs for malaria, and Wellcome Collection, our free venue for the incurably curious that explores medicine, life and art. http://www.wellcome.ac.uk

5. About the National Institute for Health Research

The National Institute for Health Research (NIHR) is funded by the Department of Health to improve the health and wealth of the nation through research. Since its establishment in April 2006, the NIHR has transformed research in the NHS. It has increased the volume of applied health research for the benefit of patients and the public, driven faster translation of basic science discoveries into tangible benefits for patients and the economy, and developed and supported the people who conduct and contribute to applied health research. The NIHR plays a key role in the Government's strategy for economic growth, attracting investment by the life-sciences industries through its world-class infrastructure for health research. Together, the NIHR people, programmes, centres of excellence and systems represent the most integrated health research system in the world. For further information, visit the NIHR website (http://www.nihr.ac.uk).

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