Comparison of oral ribavirin treatment in CrimeanCongo haemorrhagic fever: a historical cohort study in Turkey
Abstract number: 1732_149
Elaldi N., Bodur H., Celikbas A., Ozkurt Z., Leblebicioglu H., Bakir M., Aydin K., Yilmaz N., Dokmetas I., Cevik M.A., Dokuzoguz B., Tasyaran M.A., Ozturk R., Vahaboglu H., Engin A.
Objectives: To analyse the efficacy of oral ribavirin treatment in CrimeanCongo haemorrhagic fever (CCHF) patients and to compare with a historical cohort.
Methods: In Turkey, patients admitted to four tertiary care hospitals with a disease resembling CCHF were treated with oral ribavirin as recommended by the World Health Organisation (WHO) between April and September, 2004. Treated patients were compared with an untreated historical cohort who admitted to the same hospitals in 2003. Sera from suspected CCHF patients were obtained immediately following hospitalisation. Whenever possible, a second sample was obtained at least one week later. Serologic and virologic analyses were performed in the CCHF reference laboratory of the RSH Institute of the Turkish Ministry of Health. Only the patients that obtained a definitive diagnosis of CCHF by means of clinical presentation and the presence of specific IgM antibody against CCHF virus and/or viral RNA were included in the study. Demographics of all patients, clinical and laboratory findings, given blood and blood products, length of hospitalisation stay and outcome were recorded.
Results: The treatment group and the historical cohort consisted of 126 and 92 confirmed CCHF cases respectively. The mean age of the treatment group was 44 and 41 years in the historical cohort (p > 0.05). Among the given mean units of blood products, only the amount of consumed fresh frozen plasma was significantly lower than the treatment group (median 4 vs 6.5 units; p < 0.05). Median length of hospitalisation days was 8 in the treatment group and 9 days in the historical cohort (p > 0.05). The case fatality rate in the treatment group was not significantly different than in the historical cohort (7.1% vs 11.9%; p > 0.05). A logistic regression analyse showed altered sensorium and/or prolonged international normalised ratio (>1.4) were independent predictors of mortality. These predictors discriminated fatal cases with a sensitivity of 0.73 (14 of 19 fatal patients) and a specificity of 0.83 (156 of 186 non-fatal patients).
Conclusions: The results of this study showed that oral ribavirin treatment failed to improve the survival rate in our confirmed CCHF cases. However, more controlled studies with oral ribavirin are needed before more definite conclusion. We suggest the use of only the parenteral form of ribavirin according to a risk assessment by the predictors of mortality.
|Session name:||European Society of Clinical Microbiology and Infectious Diseases|
|Location:||ICC, Munich, Germany|
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