Ribavirin use in pediatric patients with Crimean Congo Hemorrhagic Fever: is it really necessary?

Tezer, Hasan; Özkaya-Parlakay, Aslınur; Gülhan, Belgi̇n; Kanık-Yüksek, Saliha

doi:10.1016/j.bjid.2015.11.012

Cited by 5 publications

(5 citation statements)

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“…Of those studies covered by the descriptive analysis, four studies included children only (Sharifi-Mood 2006; Tuygun 2012; Gayretli Aydin 2015; Tezer 2016). Three studies did not report the method used to confirm cases of CCHF (Metanat 2005; Tulek 2012; Sharifi-Mood 2013a), all other studies used either Ig ELISA or PCR.…”

Section: Resultsmentioning

confidence: 99%

“…At least one participant was included in no‐ribavirin group due to gastrointestinal haemorrhage and severe disease. Criteria for use of ribavirin changed during period and largely historical controls were used Tezer 2016 Critical Confounders not controlled for. No methods for controlling potential confounders such as severity of disease and time since onset of symptoms are discussed.…”

Section: Resultsmentioning

confidence: 99%

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Ribavirin for treating Crimean Congo haemorrhagic fever

Johnson

Maayan

Mills

et al. 2018

Cochrane Database of Systematic Reviews

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BackgroundCrimean Congo haemorrhagic fever (CCHF) is a tick-borne disease that occurs in parts of Asia, Europe and Africa. Since 2000 the infection has caused epidemics in Turkey, Iran, Russia, Uganda and Pakistan. Good-quality general supportive medical care helps reduce mortality. There is uncertainty and controversy about treating CCHF with the antiviral drug ribavirin.ObjectivesTo assess the effects of ribavirin for treating people with Crimean Congo haemorrhagic fever.Search methodsWe searched the Cochrane Infectious Diseases Group Specialized Register; the Central Register of Controlled Trials (CENTRAL); MEDLINE (PubMed); Embase (OVID); Science Citation Index-Expanded, Social Sciences Citation index, conference proceedings (Web of Science); and CINAHL (EBSCOHost). We also searched the WHO International Clinical Trials Registry Platform (ICTRP) and ClinicalTrials.gov for trials in progress. We conducted all searches up to 16 October 2017. We also contacted experts in the field and obtained further studies from these sources.Selection criteriaWe evaluated studies assessing the use of ribavirin in people with suspected or confirmed Crimean Congo haemorrhagic fever. We included randomised control trials (RCTs); non-randomised studies (NRSs) that included more than 10 participants designed as cohort studies with comparators; and case-control studies.Data collection and analysisTwo review authors assessed eligibility, risk of bias, and extracted data. For non-randomized studies we used the ROBINS-I tool to assess risk of bias. The main effects analysis included all studies where we judged the risk of bias to be low, moderate or high. We summarized dichotomous outcomes using risk ratios (RRs) and continuous outcomes using mean differences (MDs), and used meta-analyses where appropriate. We carried out a subsidiary appraisal and analysis of studies with critical risk of bias for the primary outcome, as these are often cited to support using ribavirin.Main resultsFor the main effects analysis, five studies met our inclusion criteria: one RCT with 136 participants and four non-randomized studies with 612 participants. We excluded 18 non-randomized studies with critical risk of bias, where none had attempted to control for confounding.We do not know if ribavirin reduces mortality (1 RCT; RR 1.13, 95% confidence interval (CI) 0.29 to 4.32; 136 participants; very low-certainty evidence; 3 non-randomized studies; RR 0.72, 95% CI 0.41 to 1.28; 549 participants; very low-certainty evidence). We do not know if ribavirin reduces the length of stay in hospital (1 RCT: mean difference (MD) 0.70 days, 95% CI -0.39 to 1.79; 136 participants; and 1 non-randomized study: MD -0.80, 95% CI -2.70 to 1.10; 50 participants; very low-certainty evidence). We do not know if it reduces the risk of patients needing platelet transfusions (1 RCT: RR 1.23, 95% CI 0.77 to 1.96; 136 participants; very low-certainty evidence). For adverse effects (including haemolytic anaemia and a need to discontinue treatment), we do not know whether there is a...

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Ribavirin for treating Crimean Congo haemorrhagic fever

Johnson

Maayan

Mills

et al. 2018

Cochrane Database of Systematic Reviews

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“…84 In Ankara, Turkey, patients receiving ribavirin did not show significant difference in mortality, recovery time, and hospital stay. 43 The specificity, sensitivity, negative predictive value, positive predictive value for predicting mortality was found to be 72%, 100%, 100%, and 79%. 85 In Turkey, CCHFV RNA was not the discharge criteria patients were discharged based on resolving symptoms and fever with no bleeding.…”

Section: Resultsmentioning

confidence: 91%

“…Ribavirin acts as an effective anti-viral agent against CCHFV by inhibiting its replication. 43 A recent study has demonstrated the synergistic effect of combination of two FDA approved molecules i.e., chloroquine or chlorpromazine and ribavirin against CCHFV. 44 Another novel molecule MxA belonging to interferoninduced GTPases family and dynamin superfamily inhibited CCHFV production and replication.…”

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confidence: 99%

Scoping Review of Crimean-Congo Hemorrhagic Fever (CCHF) Literature and Implications of Future Research

Wahid¹,

Altaf²,

Naeem³

et al. 2019

J Coll Physicians Surg Pak

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This disease is widely distributed all across the Globe, specifically Asia, Middle East, and Africa. Crimean-Congo hemorrhagic fever virus (CCHFV) infection is easily transmissible, highly pathogenic and causes Crimean-Congo hemorrhagic fever (CCHF) which has fatality rate of >40%. 1,2 The incidence of CCHFV has been increasing since 2008. 3 Different aspects of CCHFV are described below:History: CCHFV was first recognised in Tajikistan in the 12 th Century. In 1944, the evidence of CCHF was reported from the Crimean region of the former Soviet Union, followed by several other cases reported in several southern Soviet Republics, South Africa and Bulgaria during next few decades. The virus derived its current name 'Crimean-Congo hemorrhagic fever' because same disease was reported in 1969 in Congo region. 4

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“…Ribavirin acts as an effective anti-viral agent against CCHFV by inhibiting its replication. 14 A recent study has demonstrated the synergistic effect of combination of two FDA approved molecules i.e., chloroquine or chlorpromazine and ribavirin against CCHFV. 15 Another novel molecule MxA belonging to interferon induced GTPases family and dynamin superfamily inhibited CCHFV production and replication.…”

Section: Treatmentmentioning

confidence: 99%

An Overview of Crimean Congo Hemorrhagic Fever

Jakkula¹,

Nallagasha²,

Kadarla³

2019

WJCMPR

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Crimean Congo hemorrhagic fever (CCHF) is a zoonotic disease. It is caused by an RNA virus in wild and domestic mammals, birds and ticks. It is the family of Bunyaviridae from Arbovirus group. The main vector and reservoir of CCHF virus are hard-body ticks principally of the Hyalommagenus. The Hyalomma tick bite infection has the highest rate of nosocomial transmission especially due to direct human to human contact .India reported its first CCHF case in the year 2011 from Ahmadabad, Gujarat. Since then, several sporadic cases and outbreaks of CCHF have been reported the most from Gujarat and few from Rajasthan and Uttar Pradesh States of India .Animals do not show clinical signs but may act as a source of infection for humans. The virus is transmitted from animals to humans either by direct contact with blood or tissue of infected animal. Laboratory tests used to diagnose CCHF include reverse transcriptase (RT)-PCR, immunofluorescence assay (IFA), antibody (IgG, IgM) and antigen-capture ELISA, and isolation of virus. Ribavirin acts as effective anti-viral agent against CCHFV by inhibiting its replication. Supportive therapy including the administration of erythrocytes, thrombocytes, and fresh frozen plasma acts as an important strategy to control CCHF at an early stage. potential, high case fatality ratio (10-40%), and difficulties in

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Ribavirin use in pediatric patients with Crimean Congo Hemorrhagic Fever: is it really necessary?

Cited by 5 publications

References 8 publications

Ribavirin for treating Crimean Congo haemorrhagic fever

Ribavirin for treating Crimean Congo haemorrhagic fever

Scoping Review of Crimean-Congo Hemorrhagic Fever (CCHF) Literature and Implications of Future Research

An Overview of Crimean Congo Hemorrhagic Fever

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