title: H5N1 avian influenza in children.
abstract: 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.
authors.affiliation: Yuzuncu Yil University, Van, Turkey.
authors.forename: Ahmet Faik
authors.initials: AF
authors.lastname: Oner
authors.forename: Nazim
authors.initials: N
authors.lastname: Dogan
authors.forename: Viktor
authors.initials: V
authors.lastname: Gasimov
authors.forename: Wiku
authors.initials: W
authors.lastname: Adisasmito
authors.forename: Richard
authors.initials: R
authors.lastname: Coker
authors.forename: Paul K S
authors.initials: PK
authors.lastname: Chan
authors.forename: Nelson
authors.initials: N
authors.lastname: Lee
authors.forename: Owen
authors.initials: O
authors.lastname: Tsang
authors.forename: Wanna
authors.initials: W
authors.lastname: Hanshaoworakul
authors.forename: Mukhtiar
authors.initials: M
authors.lastname: Zaman
authors.forename: Ebun
authors.initials: E
authors.lastname: Bamgboye
authors.forename: Anna
authors.initials: A
authors.lastname: Swenson
authors.forename: Stephen
authors.initials: S
authors.lastname: Toovey
authors.forename: Nancy A
authors.initials: NA
authors.lastname: Dreyer
mesh_terms: D000293:Adolescent; D000998:Antiviral Agents / Q000627:therapeutic use; D001208:Asia / Q000453:epidemiology; D001382:Azerbaijan / Q000453:epidemiology; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D004534:Egypt / Q000453:epidemiology; D006801:Humans; D007223:Infant; D053124:Influenza A Virus, H5N1 Subtype; D007251:Influenza, Human / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality / Q000821:virology; D016015:Logistic Models; D009549:Nigeria / Q000453:epidemiology; D016017:Odds Ratio; D053139:Oseltamivir / Q000627:therapeutic use; D012307:Risk Factors; D016019:Survival Analysis
chemical_list: D000998:Antiviral Agents; D053139:Oseltamivir