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- Title
H5N1 Avian Influenza in Children.
- Authors
Oner, Ahmet Faik; Dogan, Nazim; Gasimov, Viktor; Adisasmito, Wiku; Coker, Richard; Chan, Paul K. S.; Lee, Nelson; Tsang, Owen; Hanshaoworakul, Wanna; Zaman, Mukhtiar; Bamgboye, Ebun; Swenson, Anna; Toovey, Stephen; Dreyer, Nancy A.
- Abstract
A patient registry, representing the largest global knowledge base on clinical presentation and case fatality for confirmed cases of avian influenza, shows that most pediatric patients who present with rhinorrhea survive this infection, regardless of country and antiviral treatment.Background. Avian influenza continues to pose a threat to humans and maintains the potential for greater transmissibility. Understanding the clinical presentation and prognosis in children will help guide effective diagnosis and treatment.Methods. A global patient registry was created to enable systematic collection of clinical, exposure, treatment, and outcomes data on confirmed cases of H5N1. Bivariate and multivariate statistical tools were used to describe clinical presentation and evaluate factors prognostic of survival.Results. Data were available from 13 countries on 193 children <18 years who were confirmed as having been infected with H5N1; 35.2% of cases were from Egypt. The case fatality rate (CFR) for children was 48.7%, with Egypt having a very low pediatric CFR. Overall, children aged ≤5 years had the lowest CFR and were brought to hospitals more quickly and treated sooner than older children. Children who presented for medical care with a complaint of rhinorrhea had a 76% reduction in the likelihood of death compared with those who presented without rhinorrhea, even after statistical adjustment for age, having been infected in Egypt, and oseltamivir treatment (P = .02). Delayed initiation of treatment with oseltamivir increases the likelihood of death, with an overall 75% increase in the adjusted odds ratio for death for each day of delay.Conclusions. The presence of rhinorrhea appears to indicate a better prognosis for children with H5N1, with most patients surviving regardless of age, country, or treatment. For individuals treated with oseltamivir, early initiation of treatment substantially enhances the chance of survival.
- Subjects
AVIAN influenza treatment; H5N1 Influenza; PEDIATRIC therapy; MEDICAL care; MEDICAL statistics; OSELTAMIVIR; SURVIVAL analysis (Biometry)
- Publication
Clinical Infectious Diseases, 2012, Vol 55, Issue 1, p26
- ISSN
1058-4838
- Publication type
Article
- DOI
10.1093/cid/cis295