2014 年塞拉利昂两家埃博拉管理中心收治的 5 岁及以下儿童住院症状和体征以及与死亡相关的因素：一项回顾性队列研究。
Inpatient signs and symptoms and factors associated with death in children aged 5 years and younger admitted to two Ebola management centres in Sierra Leone, 2014: a retrospective cohort study.
机构信息
Manson Unit, Médecins Sans Frontières, London, UK; Department of Paediatrics, St Mary's Hospital, Imperial College NHS Healthcare Trust, London, UK.
Manson Unit, Médecins Sans Frontières, London, UK.
出版信息
Lancet Glob Health. 2016 Jul;4(7):e495-501. doi: 10.1016/S2214-109X(16)30097-3.
BACKGROUND
Médecins Sans Frontières (MSF) opened Ebola management centres (EMCs) in Sierra Leone in Kailahun in June, 2014, and Bo in September, 2014. Case fatality in the west African Ebola virus disease epidemic has been highest in children younger than 5 years. Clinical data on outcomes can provide important evidence to guide future management. However, such data on children are scarce and disaggregated clinical data across all ages in this epidemic have focussed on symptoms reported on arrival at treatment facilities, rather than symptoms and signs observed during admission. We aimed to describe the clinical characteristics of children aged 5 years and younger admitted to the MSF EMCs in Bo and Kailahun, and any associations between these characteristics and mortality.
METHODS
In a retrospective cohort study, we included data from children aged 5 years and younger with laboratory-confirmed Ebola virus disease admitted to EMCs between June and December, 2014. We described epidemiological, demographic, and clinical characteristics and viral load (measured using Ebola virus cycle thresholds [Ct]), and assessed their association with death using Cox regression modelling.
FINDINGS
We included 91 children in analysis; 52 died (57·1%). Case fatality was higher in children aged less than 2 years (76·5% [26/34]) than those aged 2-5 years (45·6% [26/57]; adjusted HR 3·5 [95% CI 1·5-8·5]) and in those with high (Ct<25) versus low (Ct≥25) viral load (81·8% [18/22] vs 45·9% [28/61], respectively; adjusted HR 9·2 [95% CI 3·8-22·5]). Symptoms observed during admission included: weakness 74·7% (68); fever 70·8% (63/89); distress 63·7% (58); loss of appetite 60·4% (55); diarrhoea 59·3% (54); and cough 52·7% (48). At admission, 25% (19/76) of children were afebrile. Signs significantly associated with death were fever, vomiting, and diarrhoea. Hiccups, bleeding, and confusion were observed only in children who died.
INTERPRETATION
This description of the clinical features of Ebola virus disease over the duration of illness in children aged 5 years and younger shows symptoms associated with death and a high prevalence of distress, with implications for clinical management. Collection and analysis of age-specific data on Ebola is very important to ensure that the specific vulnerabilities of children are addressed.
FUNDING
No specific funding was received for this study. EB is supported by the National Health and Medical Research Council of Australia.
背景
无国界医生组织（MSF）分别于 2014 年 6 月和 9 月在塞拉利昂的凯拉洪和博城开设了埃博拉管理中心（EMC）。在西非埃博拉病毒病疫情中，5 岁以下儿童的病死率最高。临床结局数据可提供重要证据，以指导未来的管理。然而，针对儿童的此类数据十分匮乏，而此次疫情中所有年龄段的离散临床数据都集中在抵达治疗设施时报告的症状上，而不是在入院期间观察到的症状和体征。我们旨在描述在博城和凯拉洪的 MSF EMC 中收治的 5 岁及以下儿童的临床特征，以及这些特征与死亡率之间的任何关联。
方法
在一项回顾性队列研究中，我们纳入了 2014 年 6 月至 12 月期间在 EMC 中收治的实验室确诊埃博拉病毒病且年龄在 5 岁及以下的儿童的数据。我们描述了流行病学、人口统计学和临床特征以及病毒载量（使用埃博拉病毒循环阈值 [Ct] 测量），并使用 Cox 回归模型评估了它们与死亡的相关性。
结果
我们共纳入了 91 名儿童进行分析；其中 52 人死亡（57.1%）。年龄小于 2 岁的儿童（病死率 76.5% [26/34]）高于 2-5 岁的儿童（病死率 45.6% [26/57]；校正 HR 3.5 [95%CI 1.5-8.5]），病毒载量高（Ct<25）的儿童（病死率 81.8% [18/22]）高于病毒载量低（Ct≥25）的儿童（病死率 45.9% [28/61]；校正 HR 9.2 [95%CI 3.8-22.5]）。入院时观察到的症状包括：乏力 74.7%（68 例）；发热 70.8%（63/89 例）；呼吸困难 63.7%（58 例）；食欲不振 60.4%（55 例）；腹泻 59.3%（54 例）；咳嗽 52.7%（48 例）。入院时，25%（19/76）的儿童无发热。与死亡显著相关的体征包括发热、呕吐和腹泻。仅在死亡的儿童中观察到呃逆、出血和意识混乱。
结论
本研究描述了 5 岁及以下儿童埃博拉病毒病在整个病程中的临床特征，显示出与死亡相关的症状和较高的呼吸困难发生率，这对临床管理具有重要意义。收集和分析特定年龄的埃博拉病毒数据非常重要，以确保解决儿童的具体脆弱性问题。
资金
本研究无特定资金支持。EB 得到了澳大利亚国家卫生与医学研究委员会的支持。
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