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H5N1 Avian Influenza in Children

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  • H5N1 Avian Influenza in Children

    Clin Infect Dis. 2012 Mar 15. [Epub ahead of print]
    H5N1 Avian Influenza in Children.
    Oner AF, Dogan N, Gasimov V, Adisasmito W, Coker R, Chan PK, Lee N, Tsang O, Hanshaoworakul W, Zaman M, Bamgboye E, Swenson A, Toovey S, Dreyer NA.

    Yuzuncu Yil University, Van, and.

    BackgroundAvian 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.MethodsA 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.ResultsData were available from 13 countries on 193 cases <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 very low pediatric CFR. Overall, children aged ≤5 years had the lowest CFR and were brought to hospital more quickly and treated sooner than older children. Pediatric cases 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=0.02). 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.ConclusionsThe presence of rhinorrhea appears to indicate a better prognosis for children with H5N1, with most cases surviving regardless of age, country, or treatment. For cases treated with oseltamivir, early initiation of treatment substantially enhances the chance of survival.

    [PubMed - as supplied by publisher]