An Ebola outbreak presents a new mystery involving children

Friday, October 19, 2018
By Paul Martin

OCTOBER 19, 2018

Epidemiologists working on the world’s latest Ebola outbreak are racing to try to solve a mystery. Why have so many children — some still infants — been infected with the virus?

The disproportionate number of recent infections among children in the Democratic Republic of Congo — specifically in Beni, the outbreak’s current hot spot — has come as a surprise; typically young children don’t make up a big proportion of cases during an Ebola outbreak.

But in the first two weeks of October, nearly 60 percent of the newly reported cases in and around Beni were children under the age of 16, Dr. Peter Salama, of the World Health Organization, told STAT.

“It is unusual for this outbreak and it is unusual in previous outbreaks … to see this proportion of kids,” said Salama, who called it “a very high number.”

The latest situation report from the global health agency noted that of 43 cases reported in early October — there have been more since the report was written — 20 were children. Nine of the children were under the age of 5.

Overall there have been 223 confirmed and probable cases in this outbreak, which is believed to have begun in July. Of those infections, 144 have been fatal.

Salama, who is WHO’s deputy director-general of emergency preparedness and response, said epidemiologists in Beni are trying to figure out what’s behind the puzzling phenomenon involving children.

At this point, they have a theory — though Salama stressed that it is only that at this stage.

It is currently peak malaria season in Beni. Children in particular can become severely ill when they contract malaria. And it appears that a lot of the children who contracted Ebola in Beni had recently seen medical practitioners or traditional healers.

If a clinic or traditional healer is treating an undiagnosed Ebola patient, other people also present could become infected. That is believed to have happened recently to a plumber who worked on the U.N. peacekeepers’ compound at Beni.

It’s also possible that children who were brought for care for malaria might have received a therapy — something injectable — that could explain the exposures, Salama said.

“It’s a working theory at the moment and we’re trying to get to the bottom of it over the next couple of days,” he said of the malaria hypothesis.

Some of the children have died at home, which puts the family members who looked after them at grave risk. But others have been brought to Ebola treatment centers, Salama said.

The emergency medical response group Alima is operating the Ebola treatment center at Beni and, for the first time in an Ebola outbreak, has started to use an innovative new approach to build community trust and encourage people to bring sick loved ones in for care, Salama said.

That approach is built around a cube — a contained, clear enclosure in which a patient receives care. Medical personnel remain outside the cube, but can reach inside through gloved ports to deliver care. (They don’t need the multiple layers of protective equipment that make them look more alien than human.)

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