Long-term Neurologic, Cognitive and Psychiatric Sequelae of Ebola in Liberian Pediatric Survivors
Hanalise Huff1, Princess Lobbo3, Victor Taryor3, Joseph Dorbor3, Rebecca Slewion3, Gina Norato2, Richa Dugirrala1, Leroy Yankae4, Avindra Nath5, Dehkontee Dennis3, Kumblytee Johnson3, Bridgette Billioux6
1National Institute of Health, 2Clinical Trials Unit, National Institute of Health, 3PREVAIL, 4Neurology, JFK Medical Center, 5National Institutes of Health, 6National Institute of Neurological Disorder and Stroke, National Institutes of Health
Objective:
To characterize the neurologic, cognitive and psychiatric sequelae following Ebola Virus Disease (EVD) in children at ten years or greater following infection.
Background:
The 2014 West Africa EVD epidemic infected over 28,000 people, mostly in the countries of Liberia, Guinea, and Sierra Leone. Pediatric Liberian survivors seen at about 18 months after EVD had significantly more physical disability and executive function issues and reported neurologic symptoms including limb weakness, fecal incontinence, and motivation issues significantly more than controls. The long-term impact of EVD on the developing brain, however, was largely unknown.
Design/Methods:
This cross-sectional observational study enrolled EVD survivors (cases) and their close contacts (controls) in Monrovia, Liberia between February and September 2025. A single visit included neurologic history and symptom questionnaire, depression screening (PHQ-9), neurologic exam, and cognitive testing via NIH Toolbox Cognition Battery (NIHTB-CB) and International Cognitive Assessment-Pediatrics (ICA-P). Symptom prevalence was compared using Fisher’s exact test. Comparisons adjusting for age, sex and education for test scores used multiple linear regression and for PHQ-9 used Poisson regression (statistical significance= p<0.05).
Results:
One-hundred fifty-three cases and 175 controls were seen with median age 20 years (range 9-27) and 55% female. Sixty-two percent reported difficulty finding food and 91% reported less than 3 meals daily. The prevalence of memory problems (p<0.001), confusion (p=0.0012), and vision problems (p=0.0288) were significantly higher in cases than controls. On NIHTB-CB, attention was found to be significantly worse for cases than controls (p=0.01) with no significant difference in other cognitive domains but the overall fluid composite score bordering on significance (p=0.051). Scores did not differ significantly between groups on PHQ-9 (β=0.08, p=0.65) nor ICA-P (p=0.468).
Conclusions:
At 10 years following infection, pediatric EVD survivors have significantly higher prevalence of memory problems, confusion and visual problems and were found to have significantly worse attention when compared with controls.
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