Ebola virus disease (EVD), formerly known as Ebola haemorrhagic fever, is an acute infection caused by the Ebola virus. EVD starts with a flu-like syndrome, fever and profound weakness which may initially appear 2 to 21 days after exposure to the virus.
Symptoms of EVD, including a lack of appetite, sore throat, and difficulty in swallowing and breathing, have a direct or indirect impact on nutrition. Vomiting, along with diarrhoea, causes additional nutritional stress through rapid loss of electrolytes, protein, other essential nutrients and fluid.
EVD patients may have varied nutritional priorities, depending on the stage of the illness and the individual patient’s underlying nutritional status. It is unclear whether preceding nutritional status contributes directly to the outcome of the disease. Currently, it is unknown whether nutritional support contributes to patients’ survival.
The Ebola virus is present in breast milk and cases of infants of breastfeeding mothers contracting EVD have been noted. However, the transmission mechanism (whether via pregnancy and delivery, breast milk or the close contact with the mother with Ebola, which might include contact with other body fluids) is not clear.
The 2014 WHO interim guideline lays out some basic principles of optimal nutritional care for adults and paediatric patients during treatment and convalescence in Ebola treatment units, community care centres or other centres where Ebola patients are receiving care and support. Further guidance on breastfeeding can be found in the 2016 pocket guide.
WHO Recommendations
Breastfeeding
Breastfeeding should be stopped if acute EVD is suspected or confirmed in lactating women or in a breastfeeding child. The child should be separated from the breastfeeding woman and provided a breastmilk substitute as needed.
Children without confirmed Ebola virus (EBOV) infection who are exposed to breastmilk of women with confirmed EVD should be considered contacts. The child should stop breastfeeding, be given a breastmilk substitute as needed, and undergo close monitoring for signs and symptoms of EVD for 21 days. Post-exposure prophylaxis for EVD can be considered for children exposed to breastmilk of women infected with EBOV on a case-by-case basis and in accordance with existing research protocols.
If a breastfeeding woman and her child are both diagnosed with EVD, breastfeeding should be discontinued, the pair should be separated, and appropriate breastmilk substitutes provided. However, if the child is under six months of age and no safe and appropriate breastmilk substitutes are available, or the child cannot be adequately cared for, then the option to not separate and continue breastfeeding may be considered.
A woman who has recovered from EVD, cleared viremia and wants to continue breastfeeding should wait until after two consecutive negative EBOV breastmilk tests by RT-PCR, separated by 24 hours. During this time, the child should be given a breastmilk substitute.
Provision of food
Until further evidence is available, patients should be provided with a minimum of the recommended daily allowance for each nutrient.
During convalescence, patients should be encouraged to eat as much as they can.
General management, diet and feeding of children and adults with Ebola virus disease
Patients should be provided with food if they are conscious and can swallow.
The nutritional needs and approach to nutritional care in any individual will be determined by the patient’s preceding nutritional status, severity of illness and age.
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