Neurologic Sequelae After Ebola Virus Disease in Children in Liberia: An Observational Study

The West Africa Ebola virus disease (EVD) outbreak resulted in over 28,000 individuals infected, primarily in Liberia, Guinea, and Sierra Leone. Data from previous outbreaks indicate lasting health problems in survivors. The long-term neurologic impact of EVD remains largely unknown. The aim of this study was to characterize the neurologic and neurocognitive sequelae of EVD in pediatric survivors of the 2015 outbreak in Liberia.

In this cross-sectional observational study conducted in Monrovia, Liberia, pediatric survivors of acute EVD aged younger than 18 years at the time of infection and older than 2 years at the time of the visit, along with their asymptomatic close contacts as controls, were seen at a median of 18 months after EVD. The single clinic visit included a neurologic history and symptom questionnaire, neurologic examination, and neurocognitive testing. Seropositive survivors and seronegative controls were included in analyses, with the t test used for continuous variables and the χ² or Fisher exact test used for categorical variables.

The cohort included 31 EVD cases and 41 controls, with a median age of 11 years (44% female). Neurologic symptoms that were reported significantly more frequently in cases than in controls included arm/leg weakness (67.7% vs 4.9%, p < 0.0001); problems with sitting, standing, or walking (22.6% vs 4.9%, p = 0.031); difficulty seeing (38.7% vs 9.8%, p = 0.003); difficulty understanding speech (32.3% vs 0%, p < 0.0001); fecal incontinence (19.4% vs 0%, p = 0.0051); and lack of motivation (22.2% vs 0%, p = 0.0052). EVD cases more often demonstrated disability than controls on the modified Rankin Scale. EVD cases "either sometimes or often" faced consequences for poor behavior, became upset for unknown reasons, and had difficulty completing tasks independently more often than controls on executive function assessment. There was no significant difference between groups in individual neurologic examination components, frequency of uveitis, or cognitive test scores.

Numerous neurologic symptoms were reported more commonly in EVD cases than in controls, suggesting that EVD may have a lasting effect on the nervous system. Limitations included small sample size and reliance on participant self-report. Our findings highlight the importance of long-term clinical monitoring of pediatric EVD survivors, given the potential impact on childhood development.