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Epidemiologists working on the most recent Ebola outbreak in the world are mobilizing to try to solve a mystery. Why are so many children – some still young – infected with the virus?
The disproportionate number of recent infections among children in the Democratic Republic of the Congo – especially in Beni, the hot spot of the epidemic – was a surprise. generally, young children do not represent a large proportion of cases during an Ebola outbreak.
But during the first two weeks of October, nearly 60% of new cases reported in and around Beni were children under 16, said Dr. Peter Salama, of the World Organization. of Health, at STAT.
"It's unusual for this epidemic and it was unusual in previous epidemics … to see this proportion of children," said Salama, who termed it "very large".
The latest status report from the World Health Agency indicated that out 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 5 years old.
In total, there were 223 confirmed and probable cases in this outbreak, which began in July. Of these, 144 were fatal.
Salama, WHO's Deputy Director General for Emergency Preparedness and Response, said Beni's epidemiologists are trying to understand what is behind the confusing phenomenon affecting children.
At this point, they have a theory – although Salama pointed out that this is just this at this stage.
It is currently the peak season of malaria in Beni. Children in particular can become seriously ill when they contract malaria. And it seems that many of the children who contracted the Ebola virus in Beni had recently seen doctors or traditional healers.
If a clinic or traditional healer treats an undiagnosed Ebola patient, other people also present could be infected. It is thought that this happened recently to a plumber who worked on the US Blue Helmets complex in Beni.
It is also possible that children brought for malaria care received a therapy – something injectable – that could explain the exposures, Salama said.
"This is a theory that is working now and we are trying to shed light over the next few days," he said of the malaria hypothesis.
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Some of the children died at home, which puts the family members who care for them at serious risk. But others have been brought to Ebola treatment centers, Salama said.
The emergency medical intervention group Alima runs the Ebola treatment center in Beni and, for the first time during an Ebola outbreak, began using a new innovative approach to build community trust and encourage people to care for their sick relatives, Salama. I said.
This approach is built around a cube – a closed and clear enclosure in which a patient receives care. The medical staff stays outside the cube, but can reach inside by gloved ports to provide care. (They do not need multiple layers of protective gear that make them look stranger than human.)
Biosafety Emergency Epidemic Care Units (CUBEs), in which the new treatments are being administered, at the ALIMA Ebola treatment center at the Beni General Hospital, Congo, on August 16, 2018. Photo taken on August 16, 2018. Photo of Nyka Alexander / WHO via Reuters
"From the point of view of the family's commitment and understanding of what's going on, I think this is an extremely important step forward," said Salama. "I have no scientific evidence on this, but anecdotally, I think it helps a lot of family members who feel more confident about what's going on and staying in touch with their loved ones."
There is still resistance from the community. And this, added to the security problems, has caused a disturbing turn: it is becoming more and more difficult for stakeholders to follow the chain of transmission of the Ebola virus. Knowing where the virus is spreading is essential for controlling an epidemic.
In the past three or four weeks, an increasing proportion of cases were people who had not been identified as previous case contacts. And more and more, even retrospective attempts to understand how these people were infected fail to trace the links. "This is extremely disturbing," Salama said.
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The response coordinators are studying the possibility of using rapid virus sequencing to strengthen their surveillance efforts, he said. Comparison of the genetic pattern of a virus with others during the outbreak may indicate whether a new infection is part of an established chain of transmission or is perhaps a sign that other transmission chains have spread the disease without being detected.
"Given that we are now fighting for safety reasons to be able to follow the chain or chains of transmission, having this additional assurance of genetics would be another data point," Salama said.
WHO is discussing the matter with the Ministry of Health and is seeking an agreement. According to Salama, the country's national laboratory, the National Institute for Biomedical Research, believes it has the capacity to do the job.
If that does not work, there are other options, Salama said. "There are a lot of bands who want to support us on this, and we think it's another good innovation."
This article is reproduced with the permission of STAT. It was first published on October 19, 2018. Find the original story here.
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