The Ebola outbreak in Congo – the second-largest on record – has inflicted an unusually heavy toll on children. More than a quarter of the confirmed and probable cases identified as of early April were children under 15, compared to 18% in the last major outbreak in West Africa in 2013-2016, according to figures compiled by the World Health Organization (WHO).
The disease can progress rapidly, crippling the immune system and shutting down vital organs.
Young children and babies are especially vulnerable. Their small bodies are less equipped to cope with extreme fluid loss brought on by common symptoms such as diarrhea, vomiting, fever and bleeding, said Daniel Bausch, an infectious disease specialist at the London School of Hygiene and Tropical Medicine.
More than two out of every three children infected in this outbreak have died compared with just over half the adults, the WHO said. As of May 26, the death toll stood at 1,281 people, including at least 541 who were under 18.
At the Ebola treatment centre in Beni, a city of several hundred thousand with close ties to neighboring Uganda, five members of the same family of farmers were being treated for Ebola in late March. Three were children.
Marcela Kaswera, 45, said she had sent her children to their older brother in the village of Biakatu after their hometown of Oicha was attacked by members of an Islamist militia.
When they returned, her 7-year-old son was feverish. He died in her arms at a hospital, where he posthumously tested positive for Ebola.
In quick succession, Kaswera’s 13-year-old son, 2-year-old daughter, grown-up son, daughter-in-law and grandson all developed symptoms of the virus and were transferred to the treatment centre run by the Alliance for International Medical Action.
Ebola cases would typically be divided more or less equally between male and female patients. But in this outbreak, women and girls account for 58% of cases, down from a peak of 62% in December, the WHO said.
The reason more women and children have fallen sick remains a bit of a mystery. But experts suspect it may be because the Beni area, where the outbreak began in August, was also battling malaria at the time.
Malaria can cause severe complications in pregnant women and children, requiring treatment at medical facilities where they risk exposure to undiagnosed Ebola patients, said Mike Ryan, who heads the WHO’s health emergencies program.
Healthcare standards in Congo vary widely due to lack of oversight of a system that includes many unregistered private clinics and traditional healers operating out of their homes.
The virus is transmitted through contact with infected bodily fluids. But health workers operating outside of government hospitals do not always follow guidelines to prevent cross-contamination, according to Congo’s health ministry.
This is Congo’s tenth Ebola outbreak, but it is the first in the densely populated provinces of North Kivu and Ituri, where militias carry out sporadic raids from hidden strongholds in the tropical forest. Women and children are often the first to be displaced by the bloodshed.