Ophthalmic sequelae and psychosocial impact in pediatric ebola survivors

Jessica G Shantha; Dominick Canady; Caleb Hartley; Amy Cassedy; Chris Miller; Sheila T Angeles-Han; Lloyd C M Harrison-Williams; Matthew J Vandy; Natalie Weil; Gilberte Bastien; Steven Yeh

doi:10.1016/j.eclinm.2022.101483

Ophthalmic sequelae and psychosocial impact in pediatric ebola survivors

EClinicalMedicine. 2022 Jun 3:49:101483. doi: 10.1016/j.eclinm.2022.101483. eCollection 2022 Jul.

Authors

Affiliations

¹ University of California San Francisco, F.I. Proctor Foundation, San Francisco, CA, United States.
² Morehouse School of Medicine, Atlanta, GA, United States.
³ Rollins School of Public Health, Emory University, Atlanta, GA, United States.
⁴ Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, OH, United States.
⁵ Northwestern University Feinberg School of Medicine, Chicago, IL, United States.
⁶ Ministry of Health and Sanitation Sierra Leone, Freetown, Sierra Leone.
⁷ Children's Hospital New Orleans, New Orleans, LA, United States.
⁸ Truhlsen Eye Institute, Department of Ophthalmology, University of Nebraska Medical Center, Omaha, NE, United States.
⁹ Child Health Research Institute, University of Nebraska Medical Center, Omaha, NE, United States.
¹⁰ Global Center for Health Security, University of Nebraska Medical Center, Omaha, NE, United States.
¹¹ Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, United States.

Abstract

Background: Ebola virus disease (EVD) outbreaks in West Africa (2013-2016) and the Democratic Republic of Congo (2018-2020) have resulted in thousands of EVD survivors who remain at-risk for survivor sequelae. While EVD survivorship has been broadly reported in adult populations, pediatric EVD survivors are under-represented. In this cross-sectional study, we investigated the prevalence of eye disease, health-related quality-of-life, vision-related quality-of-life, and the burden of mental illness among pediatric EVD survivors in Sierra Leone.

Methods: Twenty-three pediatric EVD survivors and 58 EVD close contacts were enrolled. Participants underwent a comprehensive ophthalmic examination and completed the following surveys: Pediatric Quality of Life Inventory Version 4.0, Effect of Youngsters Eyesight on Quality-of-Life, and the Revised Child Anxiety and Depression Scale.

Findings: A higher prevalence of uveitis was observed in EVD survivor eyes (10·8%) cohort compared to close contacts eyes (1·7%, p=0·03). Overall, 47·8% of EVD survivor eyes and 31·9% of close contact eyes presented with an eye disease at the time of our study (p=0·25). Individuals diagnosed with an ocular complication had poorer vision-related quality-of-life (p=0·02).

Interpretation: Both health related quality-of-life and vision-related quality-of-life were poor among EVD survivors and close contacts. The high prevalence of eye disease associated with reduced vision health, suggests that cross-disciplinary approaches are needed to address the unmet needs of EVD survivors.

Funding: National Institutes of Health R01 EY029594, K23 EY030158; National Eye Institute; Research to Prevent Blindness (Emory Eye Center); Marcus Foundation Combating Childhood Illness; Emory Global Health Institute; Stanley M. Truhlsen Family Foundation.

Keywords: Ebola; Ebola virus disease; Emerging infectious diseases; Mental health; Post-Ebola virus disease syndrome; Psychosocial stressors; Uveitis.