Plans for future influenza pandemics must raise awareness of Reye's syndrome

BMJ 1998; 317 doi: https://doi.org/10.1136/bmj.317.7153.284 (Published 25 July 1998) Cite this as: BMJ 1998;317:284
  1. Susan Hall, Consultant epidemiologist,
  2. Richard Lynn, Scientific coordinator
  1. Department of Paediatrics, Sheffield Children's Hospital, Sheffield S10 2TH
  2. British Paediatric Surveillance Unit of the Royal College of Paediatrics and Child Health, London W1N 6DE

    EDITOR—Walker and Christie report that the index patient in the outbreak of avian influenza in Hong Kong died of Reye's syndrome.1 Reye's syndrome was an important cause of death and severe neurological morbidity in the United States in the 1970s and early 1980s, particularly during influenza epidemics. Its incidence fell sharply after recognition of its association with aspirin and the introduction of public education and warning labelling on aspirin products.2

    In the United Kingdom, surveillance of Reye's syndrome in children under 16 has been carried out by the British Paediatric Surveillance Unit of the Royal College of Paediatrics and Child Health since August 1981. A dramatic decline in reported cases and deaths has been observed since warning labelling was introduced for aspirin in 1986.3 In the most recent complete surveillance year, to July 1997, the provisional total (seven) was the lowest ever recorded.

    Although Reye's syndrome is still being reported, the clinical and epidemiological pattern has changed since 1986; most patients, especially those under 3, probably have unrecognised “Reye-like” inherited metabolic disorders.2 Thus in the United Kingdom, as in the United States, the warnings against giving aspirin to children unless clinically indicated have had an important public health benefit. These warnings should be reinforced in any plans for future influenza pandemics.

    Walker and Christie do not state whether the index patient in the outbreak in Hong Kong had taken aspirin. The United Kingdom health departments' plan for pandemic influenza includes reminding parents not to give aspirin to children under 12 who have symptoms of influenza.4

    Does this go far enough? It is consistent with widely held perceptions about the age distribution of Reye's syndrome and with the wording of the current warning. Of 48 cases of the syndrome associated with aspirin reported to the Reye's syndrome surveillance scheme between 1984 and 1996, however, 14 were in patients aged over 12. Furthermore, adult Reye's syndrome is well documented and is probably underrecognised.5 Plans for future influenza pandemics should include measures to raise diagnostic awareness of the syndrome at all ages, the enhancement of surveillance, and the provision of specialist management in intensive care units.


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