Zespół reye’a – Epidemiologia

Zespół reye’a
Epidemiologia

Zespół Reye’a to rzadka, potencjalnie śmiertelna choroba występująca niemal wyłącznie u dzieci, charakteryzująca się ostrą, niezapalną encefalopatią z obrzękiem mózgu oraz stłuszczeniem wątroby, najczęściej po infekcjach wirusowych, zwłaszcza grypy lub ospy wietrznej. Epidemiologia wskazuje na szczyt zachorowań w wieku 5-14 lat (mediana 6 lat), z częstością występowania w USA od 0,15 do 0,88 przypadków na 100 000 dzieci rocznie, osiągając nawet 6/100 000 podczas epidemii grypy. Po wprowadzeniu ostrzeżeń dotyczących stosowania aspiryny u dzieci w latach 80. XX wieku, liczba przypadków drastycznie spadła – w USA do mniej niż 2 przypadków rocznie od 1994 roku, a w Wielkiej Brytanii z 0,63 do 0,11/100 000 dzieci poniżej 12 lat. Diagnostyka opiera się na klinicznej definicji CDC: ostra encefalopatia z obrzękiem mózgu bez zapalenia (płyn mózgowo-rdzeniowy <8 leukocytów/μl), hepatopatia z trzykrotnym lub większym wzrostem AST, ALT lub amoniaku oraz wykluczeniu innych przyczyn neurologicznych i wątrobowych.

Znaczący spadek zachorowań przypisuje się ograniczeniu stosowania aspiryny u dzieci oraz lepszej diagnostyce wrodzonych zaburzeń metabolicznych i identyfikacji toksyn imitujących zespół Reye’a. Mimo rzadkości choroby, konieczne jest utrzymanie wysokiej czujności klinicznej i zgłaszanie przypadków do systemów nadzoru epidemiologicznego. W diagnostyce różnicowej należy uwzględnić m.in. wrodzone błędy metabolizmu, toksyny, zapalenia mózgu i opon mózgowych. Profilaktyka opiera się na edukacji dotyczącej ryzyka stosowania aspiryny u dzieci podczas infekcji wirusowych oraz przesiewowych badaniach noworodków pod kątem zaburzeń utleniania kwasów tłuszczowych. Aktualne badania koncentrują się na lepszym zrozumieniu patogenezy, roli aspiryny oraz optymalizacji diagnostyki i leczenia zespołu Reye’a.

Epidemiologia zespołu Reye’a

Historia nadzoru epidemiologicznego
Trendy epidemiologiczne w Stanach Zjednoczonych
Epidemiologia w Europie

Charakterystyka demograficzna
Wpływ ostrzeżeń dotyczących aspiryny

Zmiana diagnoz i rozpoznawanie innych chorób

Wzorce sezonowe i związki z infekcjami
Definicja i kryteria nadzoru
Wezwania do kontynuacji nadzoru

Kontynuacja nadzoru w różnych krajach

Perspektywy na przyszłość

Kolejne rozdziały

Epidemiologia zespołu Reye’a

Zespół Reye’a jest rzadką, potencjalnie śmiertelną chorobą, która występuje niemal wyłącznie u dzieci. Charakteryzuje się on ostrą, niezapalną encefalopatią z obrzękiem mózgu oraz stłuszczeniem wątroby, które występują najczęściej po przebytej infekcji wirusowej, zwłaszcza grypie lub ospie wietrznej¹².

Historia nadzoru epidemiologicznego

Krajowy nadzór nad zespołem Reye’a w Stanach Zjednoczonych rozpoczął się w 1973 roku. Przed latami 70. większość przypadków spełniających kryteria zespołu Reye’a diagnozowana była jako zapalenie mózgu lub zatrucie lekami¹. W 1976 roku ustanowiono ciągły krajowy nadzór nad tą chorobą². W Wielkiej Brytanii natomiast nadzór nad zespołem Reye’a rozpoczął się w sierpniu 1981 roku jako przedsięwzięcie wspólne Brytyjskiego Towarzystwa Pediatrycznego i Publicznego Laboratorium Nadzoru nad Chorobami Zakaźnymi (CDSC)³.

Trendy epidemiologiczne w Stanach Zjednoczonych

Szczyt zachorowań na zespół Reye’a w USA zanotowano w latach 1979-1980, kiedy CDC zgłosiło 555 przypadków¹². W okresie od grudnia 1980 do listopada 1997 roku, CDC zarejestrowało 1207 przypadków zespołu Reye’a u pacjentów poniżej 18 roku życia³⁴. Częstość występowania w tym okresie wynosiła od 0,15 do 0,88 przypadków na 100 000 dzieci rocznie, osiągając nawet 6 przypadków na 100 000 podczas regionalnych epidemii grypy⁵.

W latach 1980-tych zaobserwowano gwałtowny spadek liczby przypadków zespołu Reye’a. Liczba zachorowań zmniejszyła się ze średnio 100 przypadków rocznie w latach 1985-1986 do średnio 36 przypadków rocznie w latach 1987-1993¹. Od 1994 roku notowano już mniej niż 2 przypadki rocznie²³. W latach 1991-1994 roczny wskaźnik hospitalizacji z powodu zespołu Reye’a w USA szacowano na poziomie 0,2-1,1 przypadku na milion osób poniżej 18 roku życia⁴⁵.

Epidemiologia w Europie

W Wielkiej Brytanii w latach 1981-1996 zgłoszono 597 przypadków zespołu Reye’a¹. Po wydaniu w 1986 roku ostrzeżeń dotyczących związku między zespołem Reye’a a stosowaniem aspiryny, częstość występowania zespołu Reye’a znacznie się zmniejszyła – z wysokiego poziomu 0,63 przypadku na 100 000 dzieci poniżej 12 roku życia w latach 1983-1984 do 0,11 przypadku na 100 000 w latach 1990-1991²³.

We Francji w okresie od listopada 1995 do listopada 1996 roku, krajowe badanie oddziałów pediatrycznych dla dzieci poniżej 15 roku życia z niewyjaśnioną encefalopatią i trzykrotnym (lub większym) wzrostem aminotransferazy i/lub amoniaku w surowicy doprowadziło do identyfikacji dziewięciu potwierdzonych przypadków zespołu Reye’a (0,79 przypadku na milion dzieci)¹². Osiem z dziewięciu dzieci z zespołem Reye’a miało kontakt z aspiryną³.

Charakterystyka demograficzna

Zespół Reye’a występuje prawie wyłącznie u dzieci, chociaż odnotowano nieliczne przypadki u dorosłych¹. W przeciwieństwie do dzieci, dorośli nie wydają się być tak podatni na trwałe uszkodzenia neurologiczne lub uszkodzenia wątroby².

Na podstawie danych z nadzoru CDC z lat 1980-1997 dla pacjentów poniżej 18 roku życia, częstość występowania zespołu Reye’a osiąga szczyt między 5 a 14 rokiem życia (mediana wieku – 6 lat; średni wiek – 7 lat)¹. Około 13,5% pacjentów było poniżej 1 roku życia². Choroba rzadko występuje u noworodków lub u dzieci powyżej 18 roku życia³.

Zespół Reye’a występuje równomiernie u obu płci¹. Pod względem rozkładu rasowego, w USA 93% przypadków stanowią biali, a 5% Afroamerykanie, przy czym pozostały odsetek to Azjaci, rdzenni Amerykanie i rdzenni mieszkańcy Alaski². Wśród pacjentów poniżej 1 roku życia, 67% stanowili Afroamerykanie, a 12% biali³.

Wpływ ostrzeżeń dotyczących aspiryny

W 1980 roku w Stanach Zjednoczonych wydano pierwsze powszechne ostrzeżenia przeciwko stosowaniu aspiryny u dzieci¹. Po wydaniu tych ostrzeżeń zaobserwowano gwałtowny spadek liczby zgłaszanych przypadków zespołu Reye’a². Podobne wzorce występowania odnotowano w Wielkiej Brytanii, gdzie w 1986 roku ostrzeżono przed stosowaniem aspiryny u dzieci poniżej 12 roku życia³.

W Wielkiej Brytanii od 1986 roku wymagane jest, aby produkty zawierające aspirynę miały etykiety ostrzegawcze, które w kwietniu 1998 roku rozszerzono na ulotki dla pacjentów¹. Częstość występowania klasycznego zespołu Reye’a spadła drastycznie wraz z wprowadzeniem tych ostrzeżeń. Ostatni zgłoszony przypadek klasycznego zespołu Reye’a w Wielkiej Brytanii miał miejsce w kwietniu 2002 roku²³.

Zmiana diagnoz i rozpoznawanie innych chorób

Dramatyczny spadek częstości występowania zespołu Reye’a od lat 80. XX wieku jest w dużej mierze przypisywany ograniczonemu stosowaniu aspiryny u dzieci, a także odkryciom i postępom w diagnostyce wrodzonych błędów metabolizmu oraz identyfikacji toksyn i leków zdolnych do wywoływania objawów naśladujących zespół Reye’a¹.

Niektóre badania wskazują, że znaczny odsetek przypadków, szczególnie u bardzo małych dzieci, jest później przeklasyfikowany na inne zaburzenia lub stany – nawet 25% w Wielkiej Brytanii i 50% w Australii². Przykładowo, raport z 2008 roku opisuje 14-letnią dziewczynkę z objawami bardzo podobnymi do zespołu Reye’a, u której ostatecznie zdiagnozowano niedobór dehydrogenazy acylo-CoA łańcuchów długich, zaburzenie metaboliczne³.

Wzorce sezonowe i związki z infekcjami

Początkowo w Stanach Zjednoczonych większość przypadków zespołu Reye’a występowała w okresie od grudnia do kwietnia, co korelowało ze szczytowym występowaniem wirusowych infekcji dróg oddechowych, szczególnie grypy¹. Od 1990 roku sezonowa zmienność jest mniej wyraźna niż sugerowała to ta początkowa obserwacja².

Najwyższa zgłaszana częstość występowania zespołu Reye’a miała miejsce w latach występowania grypy typu B i A (H1N1); zgłaszana częstość występowania w okresie występowania grypy A (H3N2) była nieco niższa¹. Regionalne epidemie zespołu Reye’a były związane z grypą A (H1N1) i B, ale nie z grypą A (H3N2)².

Badania nadzoru za rok 1989 – okres charakteryzujący się szerokim występowaniem grypy typu B – pokazały, że zgłoszono 25 przypadków zespołu Reye’a, co stanowi 25% najniższej liczby przypadków zgłoszonych wcześniej w roku z rozległą aktywnością grypy typu B¹. Całkowita liczba zgłoszonych przypadków zespołu Reye’a w 1989 roku była niższa niż można by oczekiwać w roku ze znaczną aktywnością grypy typu B. Przed rozpoznaniem związku między stosowaniem aspiryny a ryzykiem zespołu Reye’a, okresy zwiększonej aktywności grypy typu B charakteryzowały się znacznym wzrostem liczby przypadków zespołu Reye’a².

Definicja i kryteria nadzoru

Według klinicznej definicji zespołu Reye’a opracowanej przez Centra Kontroli i Zapobiegania Chorobom (CDC), choroba ta charakteryzuje się:¹

Ostrą, niezapalną encefalopatią udokumentowaną klinicznie przez:
- zmianę stanu świadomości i, jeśli dostępne,
- wynik badania płynu mózgowo-rdzeniowego zawierający mniej niż lub równo 8 leukocytów/mikrolitr lub próbkę histologiczną wykazującą obrzęk mózgu bez zapalenia okołonaczyniowego lub opon mózgowych
Hepatopatię udokumentowaną przez:
- biopsję wątroby lub wynik autopsji uznany za diagnostyczny dla zespołu Reye’a, lub
- trzykrotny lub większy wzrost poziomu AST, ALT lub amoniaku w surowicy
Brak bardziej racjonalnego wyjaśnienia dla nieprawidłowości mózgowych i wątrobowych (takich jak zapalenie mózgu, zapalenie opon mózgowych, toksyny, nowotwory, niewydolność wątroby, piorunujące zapalenie wątroby, zaburzenia utleniania kwasów tłuszczowych i inne zaburzenia metaboliczne, krwotok śródczaszkowy itp.)²

Diagnoza zespołu Reye’a opiera się w dużej mierze na wynikach klinicznych, po wykluczeniu innych przyczyn encefalopatii³.

Wezwania do kontynuacji nadzoru

W miarę jak zespół Reye’a staje się coraz rzadszy, zainteresowanie zgłaszaniem przypadków może również maleć. Pracownicy służby zdrowia i agencje zdrowia publicznego są zachęcani do dalszego zgłaszania przypadków do systemów nadzoru, aby zapewnić odpowiednie monitorowanie zmieniającej się epidemiologii tej choroby¹².

Mimo drastycznego spadku liczby przypadków, konieczne jest, aby klinicyści zachowali wysoką świadomość diagnostyczną zespołu Reye’a i zaburzeń podobnych do zespołu Reye’a¹. Ponieważ zespół Reye’a jest obecnie rzadki, każdy podejrzany przypadek powinien być dokładnie zbadany w celu wykluczenia stanów, które mogą go naśladować².

Kontynuacja nadzoru w różnych krajach

W Wielkiej Brytanii nadzór nad zespołem Reye’a początkowo prowadzony przez CDSC został przeniesiony do British Paediatric Surveillance Unit (BPSU) w czerwcu 1986 roku. Administracja systemu została przeniesiona z CDSC do Wydziału Pediatrii w Sheffield w 1995 roku i zakończyła się w 2001 roku. Od tego czasu jedynym rutynowo dostępnym źródłem informacji jest system zgłaszania niepożądanych reakcji na leki Medicines and Healthcare Regulatory Agency¹. W okresie 2003-2009 w Anglii i Walii odnotowano trzy przypadki zespołu Reye’a lub zaburzeń podobnych do zespołu Reye’a, które zostały stwierdzone przez system nadzoru nad niepożądanymi reakcjami na leki Medicines and Healthcare products Regulatory Agency (MHRA)².

W Oklahomie zespół Reye’a nie jest chorobą podlegającą obowiązkowemu zgłaszaniu¹.

W Indiach badania dotyczące zespołu Reye’a wskazują na potrzebę szerszego nadzoru nad wybuchami określonych chorób wirusowych¹. Do lat 90. XX wieku zgłoszono łącznie 71 przypadków zespołu Reye’a w Indiach².

Perspektywy na przyszłość

Obecnie prowadzona jest dalsza działalność badawcza mająca na celu odpowiedź na podstawowe pytania dotyczące zespołu Reye’a, w tym wyjaśnienie roli aspiryny w tej potencjalnie śmiertelnej chorobie. Ostatecznym celem badań jest poprawa naukowego zrozumienia, diagnostyki i leczenia zespołu Reye’a¹.

Mimo że zespół Reye’a jest obecnie rzadki, jego znaczenie jako problemu zdrowotnego nadal wymaga uwagi, zarówno pod względem profilaktyki, jak i wczesnego rozpoznawania¹. Ważne jest, aby kontynuować edukację dotyczącą ryzyka związanego ze stosowaniem aspiryny u dzieci, zwłaszcza podczas infekcji wirusowych².

Należy również zauważyć, że w przypadku niektórych pacjentów z niedoborami metabolicznymi, podawanie aspiryny może nadal stanowić ryzyko¹. Niektóre szpitale i placówki medyczne przeprowadzają badania przesiewowe noworodków w kierunku zaburzeń utleniania kwasów tłuszczowych, aby określić, które dzieci są bardziej narażone na rozwój zespołu Reye’a².

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Materiały źródłowe

#1 Reyeâs Syndrome: A Rare But Serious Pediatric Condition
https://www.uspharmacist.com/article/reyes-syndrome-a-rare-but-serious-pediatric-condition
Reyes syndrome is a rare and potentially fatal condition affecting children and adolescents, initially described by Australian pathologist R.D. Reye in 1963. Reyes syndrome is typically preceded by a viral illness, and generally presents with severe protracted vomiting, followed by encephalopathy that may progress to coma or death, or may spontaneously resolve. In 1977, 454 cases of Reyes syndrome were reported in the United States. Of the 373 cases with follow-up, 42% of these patients died, and 11% survived with residual neurologic damage. Incidence was increased with viral epidemics, especially influenza B and varicella. Reyes syndrome cases in the U.S. numbered 555 in 1980, but they have fallen drastically. From 1994 until 1997, identified cases in the U.S. were fewer than two per year. The mean mortality rate of Reyes syndrome is approximately 40% and appears to be higher in males than in females.
#1 Reye Syndrome: Background, Pathophysiology, Etiology
https://emedicine.medscape.com/article/803683-overview
In the United States, national surveillance for Reye syndrome began in 1973. It is believed that before the 1970s, most of the cases that met the criteria for Reye syndrome were diagnosed as encephalitis or drug intoxication. […] The peak annual incidence of 555 cases reported to the Centers for Disease Control and Prevention (CDC) was in 1979-1980. Between December 1, 1980, and November 30, 1997, 1207 cases of Reye syndrome in patients younger than 18 years were reported. […] During that period, the incidence was 0.15-0.88 cases per 100,000 children per year and as high as 6 cases per 100,000 during regional outbreaks of influenza. […] Cases of Reye syndrome declined in number after 1980, when the government began issuing warnings about the association between this syndrome and aspirin.
#1 Reye Syndrome – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK526101/
Reye syndrome is a rare diagnosis with fewer than 2 cases reported annually since 1994. […] National surveillance of Reye syndrome began in 1973. The CDC reported 555 cases between 1979 and 1980. Between December 1980 through November 1997, the CDC reported 1207 cases of Reye syndrome in the United States. The incidence fell from an average of 100 cases per year in 1985 and 1986 to an average of 36 cases per year between 1987 and 1993. Incidence has fallen off sharply since 1991 with 0.2 to 1.1 case per million reported in the United States between 1991 and 1994. […] Widespread warnings again the use of aspirin in children were issued in the United States in 1980. A sharp decline in the number of reported cases of Reye syndrome followed this issuance. Similar patterns of incidence were observed in the United Kingdom. In 1986, the United Kingdon warned against the use of aspirin in children under the age of 12. Following that warning, the incidence fell from 0.63 cases per 100,000 in 1983-1984 to 0.11 cases per 100,000 in 1990 through 1991. Similar declines were also observed in France.
#1 Reye Syndrome: Background, Pathophysiology, Etiology
https://emedicine.medscape.com/article/803683-overview
The dramatic decrease in the frequency of Reye syndrome since the 1980s is largely attributable to reduced aspirin use in children, as well as to discoveries of and advances in the diagnosis of inborn errors of metabolism (IEMs) and identification of toxins and drugs capable of producing symptoms that mimic Reye syndrome. […] Seasonal occurrence initially peaked from December to April, which correlated with the peak occurrence of viral respiratory infections, particularly influenza. Since 1990, the seasonal variation has been less pronounced than was suggested by this initial observation. […] In the United Kingdom, 597 cases were reported between 1981 and 1996. After warnings of the association between Reye syndrome and aspirin were issued in 1986, the incidence of Reye syndrome decreased substantially, from a high of 0.63 per 100,000 children younger than 12 years in 1983-1984 to 0.11 cases per 100,000 in 1990-1991.
#1 Reye syndrome – Wikipedia
https://en.wikipedia.org/wiki/Reye_syndrome
During the 1980s, a case-control study carried out in the United Kingdom also demonstrated an association between Reye syndrome and aspirin exposure. […] United Kingdom surveillance for Reye syndrome documented a decline in the incidence of the illness after 1986. […] From November 1995 to November 1996 in France, a national survey of pediatric departments for children under 15 years of age with unexplained encephalopathy and a threefold (or greater) increase in serum aminotransferase and/or ammonia led to the identification of nine definite cases of Reye syndrome (0.79 cases per million children).
#1 Reye’s_syndrome
https://www.bionity.com/en/encyclopedia/Reye%27s_syndrome.html
Reyes syndrome occurs almost exclusively in children although it has been reported to occur in adults. However, adults do not appear to be as vulnerable to permanent neural or liver damage. Unlike in the UK and Australia, the surveillance for Reyes syndrome in the US is focused on patients under 18 years of age. […] In 1980, after CDC began cautioning physicians and parents about the association between Reyes syndrome and the use of salicylates in children with chickenpox or virus-like illnesses, the incidence of Reye’s syndrome in the United States began to decline. In the United States between 1980 and 1997, the number of reported cases of Reyes syndrome decreased from 555 cases in 1980 to about 2 cases per year since 1994. During this time period 93% of reported cases for which racial data were available occurred in whites and the median age was six years. A viral illness occurred in 93% of cases in the preceding three week period. For the period 1991-1994, the annual rate of hospitalizations due to Reyes syndrome in the US was estimated to be between 0.2 and 1.1 per million population less than 18 years of age.
#1 Reye Syndrome: Background, Pathophysiology, Etiology
https://emedicine.medscape.com/article/803683-overview
Based on US CDC surveillance statistics for 1980-1997 for patients younger than 18 years, 1207 cases were reported in the United States. […] Incidence peaks between age 5 and 14 years (median, 6 years; mean, 7 years); 13.5% were younger than 1 year. Reye syndrome rarely occurs in newborns or in children older than 18 years. Reye syndrome is equally distributed between the sexes. The racial distribution of Reye syndrome is 93% White and 5% African American, with the remaining percentage Asian, American Indian, and Native Alaskan. Of those younger than 1 year, 67% were African American and 12% were White.
#1 About us – Reye’s syndrome
https://reyessyndrome.rcpch.ac.uk/about-us/
In 1984-85 a risk factor study mounted on the surveillance database, showed there is an association between Reyes syndrome and aspirin taken or given for relief of the symptoms of the viral infection which precedes it. Since 1986 there has been a requirement that products containing aspirin must carry warning labels which was extended to patient information leaflets from April 1998. The incidence of classic Reyes syndrome dropped dramatically with the introduction of these warnings. The last reported case of classic Reyes syndrome occurred in the UK in April 2002.
#1 National Surveillance for Reye Syndrome: A Five-Year Review | CoLab
https://colab.ws/articles/10.1542%2Fpeds.70.6.895
National surveillance for Reye syndrome conducted during five years, including the period 1973-1974 and December 1976 through November 1980, has resulted in the reporting of more than 2,000 cases of Reye syndrome. The highest reported incidence of Reye syndrome occurred during years of primary influenza B and A (H1N1) activity; the reported incidence during one period of influenza A (H3N2) activity was somewhat lower. […] Regional outbreaks of Reye syndrome have been associated with influenza A (H1N1) and B but not with influenza A (H3N2). […] Nationally, there has been a decline in the case-fatality ratio in recent years.
#1 Reye Syndrome Surveillance — United States, 1989
https://www.cdc.gov/Mmwr/preview/mmwrhtml/00001906.htm
Reye syndrome (RS) is an acute illness that occurs almost exclusively in children; it is characterized clinically by profuse vomiting and neurologic dysfunction, sometimes progressing to delirium, coma, and death. Continuous national surveillance for RS was established in December 1976. This report summarizes RS cases for the 1989 surveillance year (December 1, 1988-November 20, 1989). […] For the 1989 surveillance year–a period characterized by widespread influenza B activity–25 cases of RS were reported by state health departments to CDC’s National Reye Syndrome Surveillance System (NRSSS). This equals the lowest number of cases reported since continuous national surveillance began and is 25% of the lowest number previously reported during a year with extensive influenza B activity. […] The total number of reported RS cases in 1989 is lower than would be expected in a year with substantial influenza B activity. Before recognition of the association between aspirin use and risk for RS, periods of increased influenza B activity were characterized by substantial increases in the number of RS cases.
#1 Case Based Pediatrics Chapter
https://www.hawaii.edu/medicine/pediatrics/pedtext/s18c17.html
The Centers for Disease Control and Preventions (CDC) clinical definition of Reye syndrome is: 1) an acute, noninflammatory encephalopathy documented clinically by a) an alteration in consciousness and, if available, b) a record of the CSF containing less than or equal to 8 leukocytes/microliter or a histologic specimen demonstrating cerebral edema without perivascular or meningeal inflammation; 2) hepatopathy documented by either a) a liver biopsy or an autopsy considered to be diagnostic of Reye syndrome or b) a 3-fold or greater increased in the levels of AST, ALT, or serum ammonia; 3) lack of a more reasonable explanation for the cerebral and hepatic abnormalities (6). […] Thus, the diagnosis of Reye syndrome is based largely on clinical findings, after the exclusion of other causes of encephalopathy (encephalitis, meningitis, toxins, neoplasms, hepatic failure, fulminant hepatitis, fatty acid oxidation defects and other metabolic disorders, intracranial hemorrhage, etc.) (3,5).
#1 Reye Syndrome Surveillance — United States, 1989
https://www.cdc.gov/Mmwr/preview/mmwrhtml/00001906.htm
Preliminary results from 1990 surveillance indicate a continuing decline in the number of RS cases in the United States. As RS becomes increasingly rare, interest in reporting may also wane. Health-care personnel and public health agencies are urged to continue reporting to the NRSSS to assure adequate monitoring of the changing epidemiology of this illness.
#1 Causes – Reye’s syndrome
https://reyessyndrome.rcpch.ac.uk/about-reyes-syndrome/causes/
Although the exact incidence of the condition in the UK and Ireland is not known, reported cases have fallen dramatically from nearly a hundred in 1984 to only one in 2002. […] In the period 2003-2009 three cases of Reyes syndrome or Reye-like disorders in England and Wales have been ascertained by the adverse drug reaction surveillance scheme of the Medicines and Healthcare products Regulatory Agency (MHRA). […] It is thus essential that clinicians retain high diagnostic awareness of Reyes syndrome and Reye-like disorders. […] For further information on surveillance of Reyes syndrome see BPSUs past studies.
#1 About us – Reye’s syndrome
https://reyessyndrome.rcpch.ac.uk/about-us/
Epidemiological surveillance has been defined by the World Health Organisation as the collection, analysis and dissemination of high quality data relevant to the understanding, prevention and control of medical conditions of public health importance so as to satisfy the needs of health care professionals, science, government, voluntary organisations and the public at large. […] Surveillance of Reyes syndrome began in August 1981 as a venture shared between the (then) British Paediatric Association and the Public Health Laboratory Service Communicable Disease Surveillance (CDSC). Responsibility for case ascertainment was transferred to the British Paediatric Surveillance Unit (BPSU) in June 1986. The administration of the scheme was transferred from CDSC to the Department of Paediatrics at Sheffield in 1995. It ceased in 2001. Since then the only routinely available source of information is the adverse drug reaction reporting scheme of the Medicines and Healthcare Regulatory Agency.
#1 Reye Syndrome
https://oklahoma.gov/health/health-education/acute-disease-service/disease-information/reye-syndrome.html
Reye syndrome is not a reportable disease in Oklahoma. […] Reye syndrome is characterized by sudden acute brain damage and liver function problems. […] Symptoms of Reye syndrome commonly occur during recovery from a viral infection (influenza, common cold, and chickenpox), but may also develop 3 to 5 days after the onset of viral illness. […] Although Reye syndrome can occur at any age, it most often affects children ages 4-12 years. Most cases that occur with chickenpox are in children ages 5-9 years. Cases that occur with the flu are usually in children 10-14 years. […] Reye syndrome is not a reportable disease in Oklahoma.
#1
https://link.springer.com/article/10.1007/BF02761021
All articles reporting cases of Reye syndrome in India were studied. The total number of reported cases is 71. […] The importance of Reye syndrome as a health problem and the need for wider surveillance of outbreaks of certain viral illnesses is discussed.
#1 Reye’s Syndrome: Symptoms, Causes, Treatment & Outlook
https://my.clevelandclinic.org/health/diseases/6088-reyes-syndrome
Reyes syndrome is primarily a children’s disease, although it can occur at any age. Cases usually happen in the fall and winter seasons and are present in children younger than 18 years old. […] An estimated two children per year in the United States develop Reyes syndrome. […] The frequency of Reyes syndrome declined because of heightened awareness of the condition. […] If your child is sick, don’t give them aspirin to treat their symptoms. Vaccinations for the flu and chickenpox (varicella) are successful at preventing viral infections, which also contributes to a low number of cases each year. […] Studies show aspirin (salicylate) may trigger Reyes syndrome and increases the severity of symptoms. […] Much of the research on Reyes syndrome focuses on answering fundamental questions about the condition such as what role aspirin plays in this life-threatening condition. The ultimate goal of research is to improve scientific understanding, diagnosis and medical treatment of Reyes syndrome.
#1 Hand Gel Abuse, Reye’s Syndrome and Artificial Sweeteners – PediaCast 211 -PediaCast
https://www.pediacast.org/hand-gel-abuse-reyes-syndrome-and-artificial-sweeteners-pediacast-211/
So, if this is the case at this point, why not test everyone for fatty acid oxidation disorders and only have those people avoid aspirin? […] Many people today are walking around with undiagnosed, generally mild, metabolic disorders but when you give them a severe viral infection or you add aspirin on top of that, bam!, they could start down that Reye’s syndrome pathway.
#2 Reye Syndrome – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK526101/
Reye syndrome is a rare diagnosis with fewer than 2 cases reported annually since 1994. […] National surveillance of Reye syndrome began in 1973. The CDC reported 555 cases between 1979 and 1980. Between December 1980 through November 1997, the CDC reported 1207 cases of Reye syndrome in the United States. The incidence fell from an average of 100 cases per year in 1985 and 1986 to an average of 36 cases per year between 1987 and 1993. Incidence has fallen off sharply since 1991 with 0.2 to 1.1 case per million reported in the United States between 1991 and 1994. […] Widespread warnings again the use of aspirin in children were issued in the United States in 1980. A sharp decline in the number of reported cases of Reye syndrome followed this issuance. Similar patterns of incidence were observed in the United Kingdom. In 1986, the United Kingdon warned against the use of aspirin in children under the age of 12. Following that warning, the incidence fell from 0.63 cases per 100,000 in 1983-1984 to 0.11 cases per 100,000 in 1990 through 1991. Similar declines were also observed in France.
#2 Reye Syndrome Surveillance — United States, 1989
https://www.cdc.gov/Mmwr/preview/mmwrhtml/00001906.htm
Reye syndrome (RS) is an acute illness that occurs almost exclusively in children; it is characterized clinically by profuse vomiting and neurologic dysfunction, sometimes progressing to delirium, coma, and death. Continuous national surveillance for RS was established in December 1976. This report summarizes RS cases for the 1989 surveillance year (December 1, 1988-November 20, 1989). […] For the 1989 surveillance year–a period characterized by widespread influenza B activity–25 cases of RS were reported by state health departments to CDC’s National Reye Syndrome Surveillance System (NRSSS). This equals the lowest number of cases reported since continuous national surveillance began and is 25% of the lowest number previously reported during a year with extensive influenza B activity. […] The total number of reported RS cases in 1989 is lower than would be expected in a year with substantial influenza B activity. Before recognition of the association between aspirin use and risk for RS, periods of increased influenza B activity were characterized by substantial increases in the number of RS cases.
#2 Reye Syndrome: Background, Pathophysiology, Etiology
https://emedicine.medscape.com/article/803683-overview
In the United States, national surveillance for Reye syndrome began in 1973. It is believed that before the 1970s, most of the cases that met the criteria for Reye syndrome were diagnosed as encephalitis or drug intoxication. […] The peak annual incidence of 555 cases reported to the Centers for Disease Control and Prevention (CDC) was in 1979-1980. Between December 1, 1980, and November 30, 1997, 1207 cases of Reye syndrome in patients younger than 18 years were reported. […] During that period, the incidence was 0.15-0.88 cases per 100,000 children per year and as high as 6 cases per 100,000 during regional outbreaks of influenza. […] Cases of Reye syndrome declined in number after 1980, when the government began issuing warnings about the association between this syndrome and aspirin.
#2 Reye syndrome – Wikipedia
https://en.wikipedia.org/wiki/Reye_syndrome
Reye syndrome occurs almost exclusively in children. […] Unlike in the United Kingdom, the surveillance for Reye syndrome in the United States is focused on people under 18 years of age. […] In 1980, after the CDC began cautioning physicians and parents about the association between Reye syndrome and the use of salicylates in children with chickenpox or virus-like illnesses, the incidence of Reye syndrome in the United States began to decline, prior to the FDA’s issue of warning labels on aspirin in 1986. […] In the United States between 1980 and 1997, the number of reported cases of Reye syndrome decreased from 555 cases in 1980 to about two cases per year since 1994. […] For the period 1991-1994, the annual rate of hospitalization due to Reye syndrome in the United States was estimated to be between 0.3 – 1 per million population less than 18 years of age.
#2 Reye Syndrome: Background, Pathophysiology, Etiology
https://emedicine.medscape.com/article/803683-overview
The dramatic decrease in the frequency of Reye syndrome since the 1980s is largely attributable to reduced aspirin use in children, as well as to discoveries of and advances in the diagnosis of inborn errors of metabolism (IEMs) and identification of toxins and drugs capable of producing symptoms that mimic Reye syndrome. […] Seasonal occurrence initially peaked from December to April, which correlated with the peak occurrence of viral respiratory infections, particularly influenza. Since 1990, the seasonal variation has been less pronounced than was suggested by this initial observation. […] In the United Kingdom, 597 cases were reported between 1981 and 1996. After warnings of the association between Reye syndrome and aspirin were issued in 1986, the incidence of Reye syndrome decreased substantially, from a high of 0.63 per 100,000 children younger than 12 years in 1983-1984 to 0.11 cases per 100,000 in 1990-1991.
#2 Reye’s syndrome – New World Encyclopedia
https://www.newworldencyclopedia.org/entry/Reye%27s_syndrome
UK surveillance for Reyes syndrome documented a decline in the incidence of the illness after 1986. […] From November 1995 to November 1996 in France, a national survey of pediatric departments for children under 15 years-of-age with unexplained encephalopathy and a threefold (or greater) increase in serum aminotransferase and/or ammonia led to the identification of nine definite cases of Reyes syndrome (0.79 cases per million children).
#2 Reye’s syndrome – New World Encyclopedia
https://www.newworldencyclopedia.org/entry/Reye%27s_syndrome
Reyes syndrome occurs almost exclusively in children, and while a few rare adult cases reported over the years, adult cases do not typically show permanent neural or liver damage. […] Unlike in the United Kingdom, the surveillance for Reyes syndrome in the United States is focused on patients under 18 years-of-age. […] In the United States between 1980 and 1997, the number of reported cases of Reyes syndrome decreased from 555 cases in 1980 to about two cases per year since 1994. […] For the period 1991-1994, the annual rate of hospitalizations due to Reyes syndrome in the United States was estimated to be between 0.2 and 1.1 per million population less than 18 years-of-age. […] During the 1980s, a case-control study carried out in the United Kingdom also demonstrated an association between Reyes syndrome and aspirin exposure.
#2 Reye Syndrome: Background, Pathophysiology, Etiology
https://emedicine.medscape.com/article/803683-overview
Based on US CDC surveillance statistics for 1980-1997 for patients younger than 18 years, 1207 cases were reported in the United States. […] Incidence peaks between age 5 and 14 years (median, 6 years; mean, 7 years); 13.5% were younger than 1 year. Reye syndrome rarely occurs in newborns or in children older than 18 years. Reye syndrome is equally distributed between the sexes. The racial distribution of Reye syndrome is 93% White and 5% African American, with the remaining percentage Asian, American Indian, and Native Alaskan. Of those younger than 1 year, 67% were African American and 12% were White.
#2 Reye’s syndrome in the United States from 1981 through 1997 – PubMed
https://pubmed.ncbi.nlm.nih.gov/10228187/
Reye’s syndrome is characterized by encephalopathy and fatty degeneration of the liver, usually after influenza or varicella. […] To describe the pattern of Reye’s syndrome in the United States, characteristics of the patients, and risk factors for poor outcomes, we analyzed national surveillance data collected from December 1980 through November 1997. The surveillance system is based on voluntary reporting with the use of a standard case-report form. […] From December 1980 through November 1997 (surveillance years 1981 through 1997), 1207 cases of Reye’s syndrome were reported in patients less than 18 years of age. […] The number of reported cases of Reye’s syndrome declined sharply after the association of Reye’s syndrome with aspirin was reported. […] Since 1980, when the association between Reye’s syndrome and the use of aspirin during varicella or influenza-like illness was first reported, there has been a sharp decline in the number of infants and children reported to have Reye’s syndrome.
#2 About us – Reye’s syndrome
https://reyessyndrome.rcpch.ac.uk/about-us/
In 1984-85 a risk factor study mounted on the surveillance database, showed there is an association between Reyes syndrome and aspirin taken or given for relief of the symptoms of the viral infection which precedes it. Since 1986 there has been a requirement that products containing aspirin must carry warning labels which was extended to patient information leaflets from April 1998. The incidence of classic Reyes syndrome dropped dramatically with the introduction of these warnings. The last reported case of classic Reyes syndrome occurred in the UK in April 2002.
#2 Reye’s syndrome – wikidoc
https://www.wikidoc.org/index.php/Reye%27s_syndrome
Some studies indicate that a significant percentage of cases, particularly in very young children, are later re-categorized as other disorders or conditions — as high as 25% in the UK and 50% in Australia. […] The surveillance for Reyes syndrome in the US is focused on patients under 18 years of age.
#2 National Surveillance for Reye Syndrome: A Five-Year Review | CoLab
https://colab.ws/articles/10.1542%2Fpeds.70.6.895
National surveillance for Reye syndrome conducted during five years, including the period 1973-1974 and December 1976 through November 1980, has resulted in the reporting of more than 2,000 cases of Reye syndrome. The highest reported incidence of Reye syndrome occurred during years of primary influenza B and A (H1N1) activity; the reported incidence during one period of influenza A (H3N2) activity was somewhat lower. […] Regional outbreaks of Reye syndrome have been associated with influenza A (H1N1) and B but not with influenza A (H3N2). […] Nationally, there has been a decline in the case-fatality ratio in recent years.
#2 Case Based Pediatrics Chapter
https://www.hawaii.edu/medicine/pediatrics/pedtext/s18c17.html
The Centers for Disease Control and Preventions (CDC) clinical definition of Reye syndrome is: 1) an acute, noninflammatory encephalopathy documented clinically by a) an alteration in consciousness and, if available, b) a record of the CSF containing less than or equal to 8 leukocytes/microliter or a histologic specimen demonstrating cerebral edema without perivascular or meningeal inflammation; 2) hepatopathy documented by either a) a liver biopsy or an autopsy considered to be diagnostic of Reye syndrome or b) a 3-fold or greater increased in the levels of AST, ALT, or serum ammonia; 3) lack of a more reasonable explanation for the cerebral and hepatic abnormalities (6). […] Thus, the diagnosis of Reye syndrome is based largely on clinical findings, after the exclusion of other causes of encephalopathy (encephalitis, meningitis, toxins, neoplasms, hepatic failure, fulminant hepatitis, fatty acid oxidation defects and other metabolic disorders, intracranial hemorrhage, etc.) (3,5).
#2
http://medbox.iiab.me/modules/en-cdc/www.cdc.gov/mmwr/preview/mmwrhtml/00001389.htm
For the 1987 and 1988 surveillance years, 36 and 20 cases, respectively, of Reye syndrome (RS) were reported to the National Reye Syndrome Surveillance System. These years have the lowest number of cases reported since continuous national surveillance was established in December 1976. Approximately 75% of patients in both 1987 and 1988 were admitted to hospitals in precomatose stages of RS–stages 0, 1, or 2. The case-fatality rates for these 2 years were 29% and 30%, respectively, based on patients for whom short-term outcome was reported. The annual number of RS cases reported to CDC has decreased steadily since 1980. Health-care providers and public health agencies are urged to continue reporting to the National Reye Syndrome Surveillance System to assure adequate epidemiologic monitoring of this illness. […] Because 40%-65% of reported RS patients since 1985 have been greater than or equal to 10 years of age, health-care providers and public health agencies also should advise older children and their parents about warnings concerning aspirin use.
#2 Reye’s Syndrome Is Now Rarelogo-32logo-40logo-60NEJM Journal WatchnejmJW_1L_RGB-b
https://www.jwatch.org/jw199905210000003/1999/05/21/reyes-syndrome-now-rare
Reye’s syndrome (RS), acute encephalopathy with fatty liver degeneration, was a medical scourge less than two decades ago but has become rare, thanks mainly to epidemiology and health education. […] Thereafter, a massive public health campaign warning of the danger from aspirin in children with varicella and influenza was begun, and the National Reye Syndrome Surveillance System was established. […] RS was reported in 1,207 patients less than 18 years old from December 1980 through November 1997. […] From 1994 through 1997, no more than 2 cases of RS were reported each year. […] Because RS is now rare, each suspected case should be investigated thoroughly to rule out conditions that can mimic it.
#2 Causes – Reye’s syndrome
https://reyessyndrome.rcpch.ac.uk/about-reyes-syndrome/causes/
Although the exact incidence of the condition in the UK and Ireland is not known, reported cases have fallen dramatically from nearly a hundred in 1984 to only one in 2002. […] In the period 2003-2009 three cases of Reyes syndrome or Reye-like disorders in England and Wales have been ascertained by the adverse drug reaction surveillance scheme of the Medicines and Healthcare products Regulatory Agency (MHRA). […] It is thus essential that clinicians retain high diagnostic awareness of Reyes syndrome and Reye-like disorders. […] For further information on surveillance of Reyes syndrome see BPSUs past studies.
#2
https://link.springer.com/article/10.1007/BF02761021
All articles reporting cases of Reye syndrome in India were studied. The total number of reported cases is 71. […] The importance of Reye syndrome as a health problem and the need for wider surveillance of outbreaks of certain viral illnesses is discussed.
#2 Reye’s syndrome – Symptoms and causes – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/reyes-syndrome/symptoms-causes/syc-20377255
Reye’s syndrome is rare. […] Early diagnosis and treatment of Reye’s syndrome can save a child’s life. […] The exact cause of Reye’s syndrome is not known. The use of aspirin during a viral illness has most commonly been linked to Reye’s syndrome. […] Reye’s syndrome may develop after influenza or chickenpox in particular. […] The following risk factors usually when they occur together may lead to Reye’s syndrome: Using aspirin to treat a viral infection such as chickenpox, the flu or an upper respiratory infection. […] Most children and teenagers who have Reye’s syndrome survive. However, varying degrees of lasting brain damage are possible. Without proper diagnosis and treatment, Reye’s syndrome can cause death within a few days. […] To prevent Reye’s syndrome, do not give children or teenagers aspirin. This includes plain aspirin and medicines that contain aspirin. Aspirin has been linked to Reye’s syndrome in children and teenagers who have the flu or chickenpox. […] Some hospitals and medical facilities screen newborns for fatty acid oxidation disorders to determine which children are at greater risk of developing Reye’s syndrome.
#3 About us – Reye’s syndrome
https://reyessyndrome.rcpch.ac.uk/about-us/
Epidemiological surveillance has been defined by the World Health Organisation as the collection, analysis and dissemination of high quality data relevant to the understanding, prevention and control of medical conditions of public health importance so as to satisfy the needs of health care professionals, science, government, voluntary organisations and the public at large. […] Surveillance of Reyes syndrome began in August 1981 as a venture shared between the (then) British Paediatric Association and the Public Health Laboratory Service Communicable Disease Surveillance (CDSC). Responsibility for case ascertainment was transferred to the British Paediatric Surveillance Unit (BPSU) in June 1986. The administration of the scheme was transferred from CDSC to the Department of Paediatrics at Sheffield in 1995. It ceased in 2001. Since then the only routinely available source of information is the adverse drug reaction reporting scheme of the Medicines and Healthcare Regulatory Agency.
#3 Reye’s syndrome in the United States from 1981 through 1997 – PubMed
https://pubmed.ncbi.nlm.nih.gov/10228187/
Reye’s syndrome is characterized by encephalopathy and fatty degeneration of the liver, usually after influenza or varicella. […] To describe the pattern of Reye’s syndrome in the United States, characteristics of the patients, and risk factors for poor outcomes, we analyzed national surveillance data collected from December 1980 through November 1997. The surveillance system is based on voluntary reporting with the use of a standard case-report form. […] From December 1980 through November 1997 (surveillance years 1981 through 1997), 1207 cases of Reye’s syndrome were reported in patients less than 18 years of age. […] The number of reported cases of Reye’s syndrome declined sharply after the association of Reye’s syndrome with aspirin was reported. […] Since 1980, when the association between Reye’s syndrome and the use of aspirin during varicella or influenza-like illness was first reported, there has been a sharp decline in the number of infants and children reported to have Reye’s syndrome.
#3 Reye’s Syndrome Is Now Rarelogo-32logo-40logo-60NEJM Journal WatchnejmJW_1L_RGB-b
https://www.jwatch.org/jw199905210000003/1999/05/21/reyes-syndrome-now-rare
Reye’s syndrome (RS), acute encephalopathy with fatty liver degeneration, was a medical scourge less than two decades ago but has become rare, thanks mainly to epidemiology and health education. […] Thereafter, a massive public health campaign warning of the danger from aspirin in children with varicella and influenza was begun, and the National Reye Syndrome Surveillance System was established. […] RS was reported in 1,207 patients less than 18 years old from December 1980 through November 1997. […] From 1994 through 1997, no more than 2 cases of RS were reported each year. […] Because RS is now rare, each suspected case should be investigated thoroughly to rule out conditions that can mimic it.
#3 Reye’s_syndrome
https://www.bionity.com/en/encyclopedia/Reye%27s_syndrome.html
During the 1980s, a case-control study carried out in the United Kingdom also demonstrated an associate between Reyes syndrome and aspirin exposure. In June 1986, the United Kingdom Committee on Safety of Medicines issued warnings against the use of aspirin in children under 12 years of age and warning labels on aspirin-containing medications were introduced. UK surveillance for Reyes syndrome documented a decline in the incidence of Reyes syndrome following 1986. The reported incidence rate of Reyes syndrome decreased from a high of 0.63 per 100,000 population less than 12 years of age in 1983/84 to 0.11 in 1990/91. […] From November 1995 to November 1996 in France, a national survey of pediatric departments for children under 15 years of age with unexplained encephalopathy and a three fold (or greater) increase in serum aminotransferase and/or ammonia led to the identification of nine definite cases of Reyes syndrome (0.79 cases per million children). Eight of the nine children with Reyes syndrome were found to have been exposed to aspirin. In part because of this survey result, the French Medicines Agency reinforced the international attention to the relationship between aspirin and Reyes syndrome by issuing its own public and professional warnings about this relationship.
#3 Reye Syndrome: Background, Pathophysiology, Etiology
https://emedicine.medscape.com/article/803683-overview
Based on US CDC surveillance statistics for 1980-1997 for patients younger than 18 years, 1207 cases were reported in the United States. […] Incidence peaks between age 5 and 14 years (median, 6 years; mean, 7 years); 13.5% were younger than 1 year. Reye syndrome rarely occurs in newborns or in children older than 18 years. Reye syndrome is equally distributed between the sexes. The racial distribution of Reye syndrome is 93% White and 5% African American, with the remaining percentage Asian, American Indian, and Native Alaskan. Of those younger than 1 year, 67% were African American and 12% were White.
#3 Reye Syndrome – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK526101/
Reye syndrome is a rare diagnosis with fewer than 2 cases reported annually since 1994. […] National surveillance of Reye syndrome began in 1973. The CDC reported 555 cases between 1979 and 1980. Between December 1980 through November 1997, the CDC reported 1207 cases of Reye syndrome in the United States. The incidence fell from an average of 100 cases per year in 1985 and 1986 to an average of 36 cases per year between 1987 and 1993. Incidence has fallen off sharply since 1991 with 0.2 to 1.1 case per million reported in the United States between 1991 and 1994. […] Widespread warnings again the use of aspirin in children were issued in the United States in 1980. A sharp decline in the number of reported cases of Reye syndrome followed this issuance. Similar patterns of incidence were observed in the United Kingdom. In 1986, the United Kingdon warned against the use of aspirin in children under the age of 12. Following that warning, the incidence fell from 0.63 cases per 100,000 in 1983-1984 to 0.11 cases per 100,000 in 1990 through 1991. Similar declines were also observed in France.
#3 About us – Reye’s syndrome
https://reyessyndrome.rcpch.ac.uk/about-us/
The causes of Reye Syndrome are still not known but it predominantly affects children between the ages of four and 16. According to the National Reyes Syndrome Foundation, the disease affects all organs of the body, but most lethally the liver and the brain. Reyes Syndrome is a two-phase illness because it is almost always associated with a previous viral infection, such as influenza, cold, or chicken pox. […] There was a dramatic decline in classic aspirin-associated Reyes syndrome after warning labelling on aspirin was introduced in 1986, and subsequently revised in 2003. This is largely due to the work of the Foundations medical and scientific advisory board which has earned the sincere thanks of parents and the general public. There have been no reported cases of classical Reyes syndrome in the United Kingdom since April 2002.
#3 Reyeâs Syndrome: A Rare But Serious Pediatric Condition
https://www.uspharmacist.com/article/reyes-syndrome-a-rare-but-serious-pediatric-condition
There are several proposed causes for the drastically reduced rate of Reyes syndrome cases. Because of efforts to educate the public regarding the potential danger of using aspirin in children and adolescents, aspirin use in this population has been largely abandoned, except for several clinical scenarios in which aspirin is significantly beneficial, such as Kawasaki disease. […] In 2008, a report by Gosalakkal and Kamoji describes a 14-year-old girl presenting with symptoms very similar to Reyes syndrome. It was determined that the patient actually had long-chain acyl-coenzyme A (CoA) dehydrogenase deficiency, a metabolic disorder. […] Although the incidence of Reyes syndrome is certainly dropping, there are still reports in the literature. […] Reyes syndrome is a serious condition of children and adolescents that is rarely seen today. Aspirin is considered to be the most significant causative agent, although this association is often challenged.
#3 Case Based Pediatrics Chapter
https://www.hawaii.edu/medicine/pediatrics/pedtext/s18c17.html
The Centers for Disease Control and Preventions (CDC) clinical definition of Reye syndrome is: 1) an acute, noninflammatory encephalopathy documented clinically by a) an alteration in consciousness and, if available, b) a record of the CSF containing less than or equal to 8 leukocytes/microliter or a histologic specimen demonstrating cerebral edema without perivascular or meningeal inflammation; 2) hepatopathy documented by either a) a liver biopsy or an autopsy considered to be diagnostic of Reye syndrome or b) a 3-fold or greater increased in the levels of AST, ALT, or serum ammonia; 3) lack of a more reasonable explanation for the cerebral and hepatic abnormalities (6). […] Thus, the diagnosis of Reye syndrome is based largely on clinical findings, after the exclusion of other causes of encephalopathy (encephalitis, meningitis, toxins, neoplasms, hepatic failure, fulminant hepatitis, fatty acid oxidation defects and other metabolic disorders, intracranial hemorrhage, etc.) (3,5).
#4 Reye Syndrome: Background, Pathophysiology, Etiology
https://emedicine.medscape.com/article/803683-overview
Based on US CDC surveillance statistics for 1980-1997 for patients younger than 18 years, 1207 cases were reported in the United States. […] Incidence peaks between age 5 and 14 years (median, 6 years; mean, 7 years); 13.5% were younger than 1 year. Reye syndrome rarely occurs in newborns or in children older than 18 years. Reye syndrome is equally distributed between the sexes. The racial distribution of Reye syndrome is 93% White and 5% African American, with the remaining percentage Asian, American Indian, and Native Alaskan. Of those younger than 1 year, 67% were African American and 12% were White.
#4 Reye syndrome – Wikipedia
https://en.wikipedia.org/wiki/Reye_syndrome
Reye syndrome occurs almost exclusively in children. […] Unlike in the United Kingdom, the surveillance for Reye syndrome in the United States is focused on people under 18 years of age. […] In 1980, after the CDC began cautioning physicians and parents about the association between Reye syndrome and the use of salicylates in children with chickenpox or virus-like illnesses, the incidence of Reye syndrome in the United States began to decline, prior to the FDA’s issue of warning labels on aspirin in 1986. […] In the United States between 1980 and 1997, the number of reported cases of Reye syndrome decreased from 555 cases in 1980 to about two cases per year since 1994. […] For the period 1991-1994, the annual rate of hospitalization due to Reye syndrome in the United States was estimated to be between 0.3 – 1 per million population less than 18 years of age.
#5 Reye Syndrome: Background, Pathophysiology, Etiology
https://emedicine.medscape.com/article/803683-overview
In the United States, national surveillance for Reye syndrome began in 1973. It is believed that before the 1970s, most of the cases that met the criteria for Reye syndrome were diagnosed as encephalitis or drug intoxication. […] The peak annual incidence of 555 cases reported to the Centers for Disease Control and Prevention (CDC) was in 1979-1980. Between December 1, 1980, and November 30, 1997, 1207 cases of Reye syndrome in patients younger than 18 years were reported. […] During that period, the incidence was 0.15-0.88 cases per 100,000 children per year and as high as 6 cases per 100,000 during regional outbreaks of influenza. […] Cases of Reye syndrome declined in number after 1980, when the government began issuing warnings about the association between this syndrome and aspirin.
#5 Reye’s_syndrome
https://www.bionity.com/en/encyclopedia/Reye%27s_syndrome.html
Reyes syndrome occurs almost exclusively in children although it has been reported to occur in adults. However, adults do not appear to be as vulnerable to permanent neural or liver damage. Unlike in the UK and Australia, the surveillance for Reyes syndrome in the US is focused on patients under 18 years of age. […] In 1980, after CDC began cautioning physicians and parents about the association between Reyes syndrome and the use of salicylates in children with chickenpox or virus-like illnesses, the incidence of Reye’s syndrome in the United States began to decline. In the United States between 1980 and 1997, the number of reported cases of Reyes syndrome decreased from 555 cases in 1980 to about 2 cases per year since 1994. During this time period 93% of reported cases for which racial data were available occurred in whites and the median age was six years. A viral illness occurred in 93% of cases in the preceding three week period. For the period 1991-1994, the annual rate of hospitalizations due to Reyes syndrome in the US was estimated to be between 0.2 and 1.1 per million population less than 18 years of age.