Reye syndrome or not: an age-old enigma about influenza encephalopathy deaths in children
Bibliographic record
Abstract
Paediatric perspectives on occasional influenza morbidity and rare mortality in Hong Kong in the pre-COVID-19 era have been discussed.1,2 The world is now facing a rebound of viral respiratory infections, with an increase in paediatric intensive care admissions in the post-COVID-19 era. 3 Sadly, in 2024, the Centre for Health Protection reported two cases of influenza-related mortality.A fully influenza-vaccinated child developed fulminant encephalopathy and hepatopathy (with elevated intracranial pressure and cerebral herniation, coagulopathy, deranged liver function without jaundice, hyperammonaemia, or hypoglycaemia) and died within 2 days.4 There was no history of aspirin consumption, but the child had received herbal medicine prior to the development of encephalopathy.Earlier, another unvaccinated toddler died shortly after developing acute encephalopathy and cerebral oedema associated with influenza.5 Influenza has received global attention, except perhaps during the peak COVID-19 era from 2020 to 2022.It is a respiratory virus for which both prophylaxis through immunisation and treatment with specific antiviral medications are readily available.6 Severe influenza complications, particularly encephalopathy, occur every year, especially in unvaccinated children who do not receive antiviral treatment.1 In 2020, during the early period of the COVID-19 pandemic, we successfully managed a child with high fever, seizures, and an altered conscious state. 2 Nasopharyngeal aspirate testing confirmed influenza A H1-2009.The child was treated with the antiviral oseltamivir.Cerebral oedema was promptly relieved with dexamethasone, hypertonic saline, and mannitol infusion.The child stabilised after 48 hours of paediatric intensive care.Neither the mother nor the child had received the seasonal influenza vaccination.This case demonstrates that, despite potential serious sequelae, influenza-associated encephalopathy can be successfully treated with prompt critical care
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.005 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.003 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".