Background Reye's syndrome is characterized by encephalopathyand fatty degeneration of the liver, usually after influenzaor varicella. Beginning in 1980, warnings were issued aboutthe use of salicylates in children with those viral infectionsbecause of the risk of Reye's syndrome.
Methods To describe the pattern of Reye's syndrome in the UnitedStates, characteristics of the patients, and risk factors forpoor outcomes, we analyzed national surveillance data collectedfrom December 1980 through November 1997. The surveillance systemis based on voluntary reporting with the use of a standard case-reportform.
Results From December 1980 through November 1997 (surveillanceyears 1981 through 1997), 1207 cases of Reye's syndrome werereported in patients less than 18 years of age. Among thosefor whom data on race and sex were available, 93 percent werewhite and 52 percent were girls. The number of reported casesof Reye's syndrome declined sharply after the association ofReye's syndrome with aspirin was reported. After a peak of 555cases in children reported in 1980, there have been no morethan 36 cases per year since 1987. Antecedent illnesses werereported in 93 percent of the children, and detectable bloodsalicylate levels in 82 percent. The overall case fatality ratewas 31 percent. The case fatality rate was highest in childrenunder five years of age (relative risk, 1.8; 95 percent confidenceinterval, 1.5 to 2.1) and in those with a serum ammonia levelabove 45 µg per deciliter (26 µmol per liter) (relativerisk, 3.4; 95 percent confidence interval, 1.9 to 6.2).
Conclusions Since 1980, when the association between Reye'ssyndrome and the use of aspirin during varicella or influenza-likeillness was first reported, there has been a sharp decline inthe number of infants and children reported to have Reye's syndrome.Because Reye's syndrome is now very rare, any infant or childsuspected of having this disorder should undergo extensive investigationto rule out the treatable inborn metabolic disorders that canmimic Reye's syndrome.
Source Information
From the Division of Viral and Rickettsial Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta.
Address reprint requests to Dr. Belay at Mailstop A-39, Centers for Disease Control and Prevention, 1600 Clifton Rd., N.E., Atlanta, GA 30333, or at ebb8{at}cdc.gov.
Reye's Syndrome
Hall S. M., Lynn R., Johnson G. M., Belay E. D., Schonberger L. B., Monto A. S.
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N Engl J Med 1999;
341:845-847, Sep 9, 1999.
Correspondence
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