1206. Survival of pediatric Ebola hemorrhagic fever patients is associated with altered endothelial function
Session: Oral Abstract Session: Biomarkers of Infectious Diseases
Saturday, October 5, 2013: 9:42 AM
Room: The Moscone Center: 300

Ebola virus has been responsible for over 20 outbreaks of hemorrhagic fever (HF) over the past 40 years. The largest Ebola HF outbreak to date, caused by Sudan virus, occurred in the Gulu district of Uganda in 2000–2001, resulting in 425 cases with an overall CFR of 53%.  This outbreak was unique because approximately one third of the cases were 21 years of age or less.  While infants less than 5 years of age were severely affected with 77% mortality, children and adolescents had lower mortality rates (43%) when compared to adults (56%).  This relative protection in the pediatric population, and the known role of the endothelium in maintaining hemostasis, led us ask if pediatric patients had markers of improved endothelial function as an explanation for their improved outcomes. 


Laboratory confirmed cases were identified in both the pediatric and adult populations. They were matched for sex, outcome and presence or absence of hemorrhagic manifestations.  Available serum samples were then anonymized and analyzed by multiplex assay for quantities of various markers of endothelial function: E-selectin, soluble vascular adhesion molecule (sVCAM), soluble intracellular adhesion molecule (sICAM), and soluble CD40 ligand (sCD40L).

Results: Serum from 45 laboratory confirmed pediatric patients was available for testing. Using this subgroup, relative protection was demonstrated in the pediatric patients.  Pediatric patients had higher levels of sVCAM and sICAM than their adult counterparts regardless of outcome. However, survival did correlate with lower ICAM and VCAM levels in pediatric patients.  Lower levels of E-selectin were noted in pediatric patients and this correlated with survival. In contrast, there was no difference in E-selectin levels in fatal or non-fatal adult patients.  Finally, sCD40L, a known activator of endothelial cells, and a promoter of coagulation was elevated in all non-fatal cases regardless of age. 


Survival from Sudan virus infection in pediatric patients correlated with lower E-selectin, sICAM and sVCAM levels and higher sCD40L levels. This suggests that the endothelium may play a critical role in the survival of pediatric patients during infection with Sudan virus.

Anita Mcelroy, MD, PhD1,2, Bobbie Erickson1, Jonathan Towner, PhD1, Stuart Nichol, PhD1, Pierre Rollin, MD1 and Christina Spiropoulou, PhD1, (1)Centers for Disease Control and Prevention, Atlanta, GA, (2)Pediatrics/Division of Infectious Disease, Emory University School of Medicine, Atlanta, GA


A. Mcelroy, None

B. Erickson, None

J. Towner, None

S. Nichol, None

P. Rollin, None

C. Spiropoulou, None

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