Evaluation of the efficacy of ribavirin therapy on survival of Crimean-Congo hemorrhagic fever patients: a case-control study.
The mortality rate resulting from Crimean-Congo hemorrhagic fever (CCHF) has been reported in different epidemics to range from 5% to more than 70%. While ribavirin has been recommended as the drug of choice in the treatment of CCHF, no consistent study has unequivocally demonstrated its effectiveness. Using the case-control method, we attempted to evaluate the efficacy of ribavirin in reducing mortality among CCHF cases admitted to Boo-Ali Educational Hospital in Zahedan, Iran, during the years 2000 to 2006. Sixteen deaths among CCHF cases were compared with 47 cases of survival. All patients had a definitive diagnosis based on the results of IgG and IgM capture ELISA tests recorded in their files. Ribavirin therapy for patients who survived had begun on average approximately 24 h earlier than the initiation of ribavirin therapy in the cases of death (P=0.033), and about 2 days earlier in non-bleeding survivors than in bleeding survivors (P=0.013). Based on the results of a multivariable analysis, the most important variables found to enhance survival were the time interval between the disease onset and ribavirin prescription (P=0.004), the time interval between bleeding onset and ribavirin prescription (P=0.037), and the time interval between disease onset and bleeding onset (P=0.014). Based on our findings, ribavirin appears to exert a marked effect on disease outcome, especially when it is prescribed within the first 4 days of the disease.
Izadi
Shahrokh
S
Department of Epidemiology and Biostatistics, Zahedan University of Medical Sciences, Chabahar, Iran. izadish@yahoo.com
Salehi
Masoud
M
D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000494:pharmacology / Q000627:therapeutic use*; D016022:Case-Control Studies; D002648:Child; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D003225:Hemorrhagic Fever Virus, Crimean-Congo / Q000187:drug effects* / Q000302:isolation & purification; D006479:Hemorrhagic Fever, Crimean / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D007074:Immunoglobulin G / Q000032:analysis; D007075:Immunoglobulin M / Q000032:analysis; D007492:Iran / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D012254:Ribavirin / Q000494:pharmacology / Q000627:therapeutic use*; D017741:Survivors; D016896:Treatment Outcome
D000998:Antiviral Agents; D007074:Immunoglobulin G; D007075:Immunoglobulin M; D012254:Ribavirin