Is Reye Syndrome Less Common than It Used to Be?

  • Medical Editor: William C. Shiel Jr., MD, FACP, FACR
    William C. Shiel Jr., MD, FACP, FACR

    William C. Shiel Jr., MD, FACP, FACR

    Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

Ask the experts

Is Reye syndrome less common than it used to be?

Doctor's response

In a word, YES! "Disappearing" may not be entirely correct but Reye (pronounced rye) syndrome does appear to be on the wane.

Starting in 1980, warnings were issued about giving aspirin (salicylate) to children with the flu (influenza) or chickenpox (varicella) because of the risk of Reye syndrome. (Reye syndrome usually occurs after a bout of flu [influenza] or chickenpox [varicella] and is characterized by a brain disorder [encephalopathy] and degeneration of the liver.)

A team at the Centers for Disease Control and Prevention (CDC) led by E.D. Belay now has published a remarkable report on Reye syndrome in the United States. The report appeared in the May 6, 1999 issue of The New England Journal of Medicine.

The CDC analyzed national surveillance data that had been collected from 1981-1997. Their aim was to describe the pattern of the disease, the characteristics of the patients, and the risk factors for "poor outcomes."

The CDC's system of surveillance was based on the reporting by doctors of cases of Reye's syndrome. During the surveillance years (1981-97), a total of 1207 cases of Reye syndrome in children under 18 years of age were reported to the CDC.

The number of reported cases of Reye syndrome declined sharply after the association of Reye syndrome with aspirin was reported. The peak year came in 1980 with 555 cases. There have been no more than 36 cases a year since 1987.

About a third of the children with Reye syndrome in the CDC study died. (The "overall case fatality rate" was 31%.) The fatality rate was highest in children under 5 years of age. Another predictor was a high ammonia level in the blood.

The CDC researchers conclude that since 1980 when the connection was first reported between Reye syndrome and the use of aspirin in children with chickenpox or a flu-like illness, there has been a dramatic reduction in the number of infants and children reported with Reye syndrome.

Reye syndrome is now so rare that the CDC recommends that any child now thought to have it be tested for a treatable genetic disorder that can mimic Reye syndrome.

Source: Belay ED, Bresee JS, Holman RC, Khan AS, Shahriari A, Schonberger LB. Reye's Syndrome n the United States from 1981 through 1997. N Engl J Med 1999;340:1377-82.

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Reviewed on 1/11/2018
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