Recognising Ebola virus disease in young children

By Adenike Grange

EBOLA Viral Disease, EVD, is now universally known to be a deadly disease that affects young and old, men and women, rich and poor, military and civilian without any discrimination whatsoever.

The signs and symptoms of EVD include persistent fever, general malaise, severe diarrhoea, vomiting, peculiar body rash, spontaneous bleeding into any part of the body and finally exhaustion.

It is important to note that fever, cough and diarrhoea are the three commonest symptoms of illnesses in young children under two years of age.

These children, because of their immaturity and low immunity are prone to infections of all types including bacterial, viral, parasitic and fungal infections. About eighty percent of children seen in the children’s emergency ward are suffering from infections of various types and their complications.

This is why we must be cautiously vigilant when managing sick children. On the one hand most of the childhood illnesses that are encountered on daily basis will be those that have been routinely managed with variable success rates.
This well-known pattern of presentation is likely to mask the odd child that may present with Ebola. It is noteworthy that the first case of this disease in West Africa  was traced back to a  two-year-old who died in December, 2013 in Guinea.

The report was published in The New England Journal of Medicine by a research team studying the outbreak. It would appear that no one could explain how such a small child could have become the first person infected.

It is, therefore, imperative that the child health worker takes a good history paying particular attention to the possibility of exposure of the child to infected persons or infected animals.

It will also be of help historically to eliminate the presence of common childhood vaccine-preventable diseases if the child has not been fully immunised against those diseases.
Thus, the importance of getting children to be immunised cannot be over-emphasised under the circumstances. The regular use of insecticide-treated bed-nets and appropriate management of the environment will also reduce the possibility of malaria as a differential diagnosis, even though common problems must always be considered first.

It must be emphasised that most cases of acute illnesses that present as emergencies are not caused by Ebola so there is no need to panic or neglect the children especially if they are unable to express themselves.

In such cases, the key to diagnosis lies in the history given by the primary child carers who are usually the parents,  but then the carers must be encouraged to be truthful. There is no gainsaying that many patients do not respond truthfully to questions that are designed to assist the health care providers to make the correct diagnosis.

Correct diagnosis
They sometimes falsify the addresses of their residences, their ages,  movements and social practices.

In this predicament that we find ourselves, we are pleading with parents and other primary child carers to speak the truth always because it may save their lives, the lives of members of their families, friends and others who may be their casual contacts.

Accurate and relevant history taking for all is one of the tools for saving lives and containing this contagious and life-threatening disease.
Finally in a broader context, Government and all stakeholders must be commended for the prompt and vibrant response  that has been demonstrated since the unfortunate emergence of Ebola in Nigeria.

Professor Adenike Grange is Consultant Paediatrician and former Minister of Health of the Federal Republic of Nigeria

Culled from : http://www.vanguardngr.com