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Recent developments have shed light on the case of a British Columbia teenager who became the first critically ill pediatric patient with avian influenza in North America this fall, along with updates on her recovery process.
This information was revealed in a case summary published in the New England Journal of Medicine, authored by medical professionals from the B.C. Centre for Disease Control, BC Children’s Hospital, and the Public Health Agency of Canada.
Prior to this publication, the B.C. Ministry of Health had been reticent in sharing updates about the teen’s health status, stating they would do so only if necessary from a public health standpoint.
The case summary indicates that the affected 13-year-old girl had a prior history of mild asthma and an elevated body mass index (BMI). She initially presented to a B.C. emergency room on November 4 with symptoms including fever and conjunctivitis in both eyes. However, she was discharged without treatment.
Her condition worsened, leading her to return to the emergency department on November 7 with additional symptoms such as a cough, vomiting, and diarrhea. On November 8, her rapid decline necessitated her transfer to BC Children’s Hospital, where she experienced severe complications including respiratory failure, pneumonia, and acute kidney injury.
In her treatment, doctors initiated a regimen of three antiviral medications and implemented supportive measures that included intubation, the use of an ECMO oxygenation machine, and renal replacement therapy.
Remarkably, tests indicated that the virus had not developed resistance to the antiviral drugs. By November 22, medical staff were able to remove her from the ECMO machine due to improving respiratory function, and by November 28, she was extubated.
By the following day, she was determined to no longer be infectious and was transferred to a pediatric ward on December 4. By December 18, she had recovered sufficiently to no longer require supplemental oxygen.
Despite the extensive treatment efforts, the medical team was unable to pinpoint the sources of the girl’s exposure to the H5N1 virus. Genetic analysis of the virus showed concerning mutations that might enhance its affinity for human airway receptors.
Human infections with avian influenza A(H5N1) are uncommon, typically arising from close contact with infected birds, animals, or highly contaminated environments. Dr. Bonnie Henry, the Provincial Health Officer, noted that the virus strain involved in this case was H5N1 Clade B.2.3.4.4B, Genotype D1.1, which have been identified in wild birds and poultry farm outbreaks in British Columbia.
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globalnews.ca