Children infected with Ebola may require different treatment regimens

Children with Ebola virus disease (EVD) may benefit from different treatment regimens than adults, according to a study recently published in Emerging Infectious Diseases.

Researchers from the Centers for Disease Control and Prevention used a series of multiplex assays to measure the concentrations of serum analytes from patients in a 2000-2001 outbreak to identify biomarkers specific to pediatric disease. The authors said pediatric patients tend to be underrepresented in EVD studies because of outbreak dynamics and societal structure.

Historically, children have been less affected by EVD than adults. During the 2000-2001 Sudan virus-associated EVD outbreak in Uganda's Gulu district, the case-fatality rates (CFR) were lower in children than adults, but the reasons for increased survival rates were not known. The researchers used assays from the 2000-2001 outbreak to investigate factors associated with increased survival of pediatric patients with EVD.

"In this study, we used a series of multiplex assays to measure the concentrations of 55 serum analytes in specimens from patients from the Gulu outbreak to identify biomarkers that had age-specific associations with survival, hemorrhagic manifestations, or both," the researchers said.

The authors found that pediatric patients who survived had higher levels of the chemokine regulated on activation, secreted marker and normal-T cell expressed than pediatric patients who died. The patients also had lower levels of soluble intracellular adhesion molecule, plasmoinogen activator inhibitor 1 and soluble vascular cell adhesion molecule than the patients who died. Adult patients were found to have similar levels of the analytes regardless of outcome.

"In summary, our data suggest that different pathophysiologic mechanisms of disease may be at work in pediatric patients, and children may benefit from different treatment than their adult counterparts," the authors said. "Therapeutic interventions targeted at decreasing endothelial activation in pediatric patients early during the course of infection might include drugs that affect endothelial activation, such as statins."

The researchers suggested a better understanding of the chemokine regulated on activation could help in future therapeutic design.