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Immunopathogenetic Aspects and Effectiveness of Combination Therapy for Influenza A (H1N1)pdm2009 in Children.
Paediatrics Eastern Europe ; 8(3):396-408, 2020.
Article in Russian | EMBASE | ID: covidwho-2281560
ABSTRACT
Introduction. The continuing circulation of influenza A (H1N1)pdm2009 virus poses a threat of a new epidemic rise. It is known that influenza A (H1N1)pdm2009 is characterized by a severe course, development of life-threatening complications, and high mortality, which is associated not only with the biological features of the pathogen, but also with the induction of deep immunosuppression, especially the interferon system and the cellular-type immune response. The role of influenza in the development of severe forms of the new coronavirus infection COVID-19 has been revealed. The increase of the number of virus strains resistant to various classes of antiviral drugs is of unfavorable importance. This requires the development of new approaches to the treatment of influenza A (H1N1)pdm2009 with the combined use of drugs with complex antiviral and immunocorrective activity. Purpose. To substantiate the combination therapy of influenza A (H1N1)pdm2009 in children using oseltamivir (Tamiflu) and recombinant interferon-alpha2b (Viferon). Materials and methods. Clinical and laboratory examination of 85 children aged from 3 to 5 years with moderate (43) and severe forms (42) of influenza A (H1N1)pdm2009 was carried out. Results and discussion. In patients with severe forms of A(H1N1)pdm2009 influenza, a higher frequency of anamnestic risk groups (85.7%), frequent development of febrile fever (100%), severe intoxication symptoms (100%), symptoms of laryngitis (28.6%), tracheitis (57.1%), bronchitis (76.2%), dyspeptic (42.9%) and cerebral syndromes (62.9%), other complications (80.9%) were revealed. In these patients, more significant changes of the indicators of the cellular type of the immune response were found - the decrease of CD3, CD4, CD8, the humoral type of immune response - the increase of CD20, IgM, circulating immune complexes, the decrease of IgA and IgG, innate immunity factors - the decrease of the metabolic activity of neutrophils, moderate increase of CD16. The combined administration of recombinant interferon-alpha2b (Viferon) and oseltamivir (tamiflu) compared with oseltamivir (tamiflu) monotherapy reduced the duration of fever (Me 2, IQI 1-4 days and Me 3, IQI 2-4 days), intoxication (Me 3, IQI 2-4.5 days and Me 4.5, IQI 3-7 days), symptoms of rhinitis (Me 5, IQI 4-7 days and Me 6.5, IQI 4.5-7.5 days), pharyngitis (Me 5, IQI 4-7 days and Me 6.5, IQI 4.5-7.5 days), tracheitis (Me 2, IQI 1-3 days and Me 3.5, IQI 2-4 days), bronchitis (Me 3, IQI 2-5 days and Me 5, IQI 4-6 days). In this group, the complications developed less frequently (4.5% and 33.3%);there was the decrease of hospitalization time (Me 5, IQI 4-7 days and Me 6.5, IQI 5-7 days). There was the increase of the number of children, who (after 10 days from the start of therapy) had sanitation of the nasopharynx from the virus (90.9% and 61.9%). Conclusion. The high frequency of anamnestic risk groups and the induction of deep immunosuppression, especially the cellular component of immunity, are the cause of the formation of severe forms of influenza A (H1N1)pdm2009. This justified the appointment of combination therapy using the neuraminidase inhibitor oseltamivir (Tamiflu) and recombinant interferon-alpha2b (Viferon), which not only inhibits virus replication, but also has immunocorrective activity against the interferon system and cellular immunity. The high efficiency of the combined administration of recombinant interferon-alpha2b (Viferon) and oseltamivir (Tamiflu) lets to recommend the inclusion of these drugs in the treatment of severe forms of influenza A(H1N1)pdm2009 in children.Copyright © 2020, Professionalnye Izdaniya. All rights reserved.
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Full text: Available Collection: Databases of international organizations Database: EMBASE Type of study: Experimental Studies Language: Russian Journal: Paediatrics Eastern Europe Year: 2020 Document Type: Article

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Full text: Available Collection: Databases of international organizations Database: EMBASE Type of study: Experimental Studies Language: Russian Journal: Paediatrics Eastern Europe Year: 2020 Document Type: Article