tetano
Editor, Senior Moderator
Infect Dis. (2012) doi: 10.1093/infdis/jis509 First published online: August 20, 2012
Paul K. S. Chan1,
Nelson Lee1,
Mukhtiar Zaman2,
Wiku Adisasmito3,
Richard Coker4,
Wanna Hanshaoworakul6,
Viktor Gasimov7,
Ahmet Faik Oner8,
Nazim Dogan9,
Owen Tsang10,
Bounlay Phommasack11,
Sok Touch12,
Anna Swenson13,
Stephen Toovey5 and
Nancy A. Dreyer13
+ Author Affiliations
1Faculty of Medicine, The Chinese University of Hong Kong
2Khyber Teaching Hospital, Peshawar, Pakistan
3Department of Health Policy and Administration, University of Indonesia, Depok, Indonesia
4London School of Hygiene and Tropical Medicine, Academic Centre for Travel Medicine and Vaccines, London, United Kingdom
5Royal Free and University College Medical School, Department of Infection and Immunity, Academic Centre for Travel Medicine and Vaccines, London, United Kingdom
6Ministry of Public Health, Nonthaburi, Thailand
7Azerbaijan Ministry of Health, Baku, Azerbaijan
8Yuzuncu Yil University, Van, Erzurum, Turkey
9Ataturk University Medical School, Erzurum, Turkey
10Hospital Authority Infectious Disease Centre at the Princess Margaret Hospital, Kowloon, Hong Kong SAR
11Ministry of Health, Lao PDR
12 Ministry of Health, Cambodia
13Quintiles Outcome, Cambridge, Massachusetts, USA
Corresponding Author: Nancy A. Dreyer, Quintiles Outcome, 201 Broadway, Cambridge, MA, 02139, USA (ndreyer@outcome.com, +1 617-715-6810)
Abstract
Background. Oseltamivir is widely used as treatment for H5N1 infection, but like any intervention, is not always effective.
Methods. Using Avian Influenza Registry data from ten countries (www.avianfluregistry.org), the risk of death in 215 patients with confirmed H5N1 infections and treated with oseltamivir is examined according to viral clade, age, respiratory failure, and adjunctive treatment with corticosteroids or antibiotics.
Results. The median age of cases was 18 years, and 50% were male. The highest fatality rate occurred in a country with clade 2.1 virus circulation, and the lowest, in countries with clade 2.2 (p<0.001). In univariate analyses, youth (≤5 years) and treatment within 2 days of symptom onset were protective against fatality. When accounting for all risk factors, early oseltamivir is particularly effective when initiated in the absence of respiratory failure (OR 0.17, p=0.04) . Patients already suffering from advanced respiratory failure requiring ventilatory support at the time of oseltamivir initiation were more likely to die than patients who did not (p<0.001 ). Adjunctive therapy did not improve survival.
Conclusions. Oseltamivir is especially effective for treating human H5N1 infection when given early and before onset of respiratory failure. Effect of viral clade on fatality and treatment response deserves further investigation.
http://jid.oxfordjournals.org/content/early/2012/08/20/infdis.jis509.short?rss=1
Paul K. S. Chan1,
Nelson Lee1,
Mukhtiar Zaman2,
Wiku Adisasmito3,
Richard Coker4,
Wanna Hanshaoworakul6,
Viktor Gasimov7,
Ahmet Faik Oner8,
Nazim Dogan9,
Owen Tsang10,
Bounlay Phommasack11,
Sok Touch12,
Anna Swenson13,
Stephen Toovey5 and
Nancy A. Dreyer13
+ Author Affiliations
1Faculty of Medicine, The Chinese University of Hong Kong
2Khyber Teaching Hospital, Peshawar, Pakistan
3Department of Health Policy and Administration, University of Indonesia, Depok, Indonesia
4London School of Hygiene and Tropical Medicine, Academic Centre for Travel Medicine and Vaccines, London, United Kingdom
5Royal Free and University College Medical School, Department of Infection and Immunity, Academic Centre for Travel Medicine and Vaccines, London, United Kingdom
6Ministry of Public Health, Nonthaburi, Thailand
7Azerbaijan Ministry of Health, Baku, Azerbaijan
8Yuzuncu Yil University, Van, Erzurum, Turkey
9Ataturk University Medical School, Erzurum, Turkey
10Hospital Authority Infectious Disease Centre at the Princess Margaret Hospital, Kowloon, Hong Kong SAR
11Ministry of Health, Lao PDR
12 Ministry of Health, Cambodia
13Quintiles Outcome, Cambridge, Massachusetts, USA
Corresponding Author: Nancy A. Dreyer, Quintiles Outcome, 201 Broadway, Cambridge, MA, 02139, USA (ndreyer@outcome.com, +1 617-715-6810)
Abstract
Background. Oseltamivir is widely used as treatment for H5N1 infection, but like any intervention, is not always effective.
Methods. Using Avian Influenza Registry data from ten countries (www.avianfluregistry.org), the risk of death in 215 patients with confirmed H5N1 infections and treated with oseltamivir is examined according to viral clade, age, respiratory failure, and adjunctive treatment with corticosteroids or antibiotics.
Results. The median age of cases was 18 years, and 50% were male. The highest fatality rate occurred in a country with clade 2.1 virus circulation, and the lowest, in countries with clade 2.2 (p<0.001). In univariate analyses, youth (≤5 years) and treatment within 2 days of symptom onset were protective against fatality. When accounting for all risk factors, early oseltamivir is particularly effective when initiated in the absence of respiratory failure (OR 0.17, p=0.04) . Patients already suffering from advanced respiratory failure requiring ventilatory support at the time of oseltamivir initiation were more likely to die than patients who did not (p<0.001 ). Adjunctive therapy did not improve survival.
Conclusions. Oseltamivir is especially effective for treating human H5N1 infection when given early and before onset of respiratory failure. Effect of viral clade on fatality and treatment response deserves further investigation.
http://jid.oxfordjournals.org/content/early/2012/08/20/infdis.jis509.short?rss=1