TY - JOUR
T1 - H5N1 avian influenza in children
AU - Oner, Ahmet Faik
AU - Dogan, Nazim
AU - Gasimov, Viktor
AU - Adisasmito, Wiku
AU - Coker, Richard
AU - Chan, Paul K.S.
AU - Lee, Nelson
AU - Tsang, Owen
AU - Hanshaoworakul, Wanna
AU - Zaman, Mukhtiar
AU - Bamgboye, Ebun
AU - Swenson, Anna
AU - Toovey, Stephen
AU - Dreyer, Nancy A.
N1 - Funding Information:
Financial support. This work was supported by a contract to Outcome Sciences, Inc, from F. Hoffmann-La Roche. The sponsor provided scientific collaboration and had rights to nonbinding review of manuscripts but did not have the right to decide whether papers should be submitted for publication, to choose authors, or to approve the wording of any manuscripts.
PY - 2012/7
Y1 - 2012/7
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=84862181908&partnerID=8YFLogxK
U2 - 10.1093/cid/cis295
DO - 10.1093/cid/cis295
M3 - Article
C2 - 22423125
AN - SCOPUS:84862181908
SN - 1058-4838
VL - 55
SP - 26
EP - 32
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
IS - 1
ER -