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动物咬伤:现行管理指南

Animal bites: the current management guidelines.

作者信息

Chhabra Mala, Ichhpujani R L

机构信息

Zoonosis Division, National Institute of Communicable Diseases (NICD), Dte. General of Health Services, 22-Sham Nath Marg, Delhi-110 054.

出版信息

Indian J Pediatr. 2003 Mar;70 Suppl 1:S11-6.

Abstract

Rabies is a major public health problem in India. It is mainly transmitted by stray dogs, which form an overwhelming population in the country. Dogs are responsible for upto 95% of animal bites requiring antirabies treatment. In view of the exceptionally high fatality rate of human rabies, the prevention of infection after exposure is of utmost importance. With the availability of safe and effective tissue culture vaccines prevention of this dreaded disease is virtually assured by immediate and appropriate post exposure treatment. This is a three pronged approach including proper wound management, judicious use of antirabies serum and modern tissue culture vaccines. In India, Neural Tissue Vaccine is still used for post exposure treatment in public sector, though effective, this vaccine has serious side effects. The production and use of tissue culture vaccine should be encouraged with the aim to phase out neural tissue vaccine. WHO recommends use of intradermal route of inoculation of Tissue Culture Vaccine which makes the treatment very economical. However, this route as yet, is not approved by Drug Controller, Government of India (DCGI). There are no uniform guidelines for management of animal bite cases in India. In this article an attempt is made to discuss various aspects of animal bite management.

摘要

狂犬病是印度一个重大的公共卫生问题。它主要通过流浪狗传播,流浪狗在该国数量众多。在需要接受抗狂犬病治疗的动物咬伤病例中,狗造成的咬伤占比高达95%。鉴于人类狂犬病极高的致死率,暴露后预防感染至关重要。有了安全有效的组织培养疫苗,通过及时且恰当的暴露后治疗,实际上可以确保预防这种可怕的疾病。这是一种三管齐下的方法,包括妥善的伤口处理、合理使用抗狂犬病血清以及现代组织培养疫苗。在印度,公共部门仍使用神经组织疫苗进行暴露后治疗,这种疫苗虽有效,但有严重的副作用。应鼓励生产和使用组织培养疫苗,以期逐步淘汰神经组织疫苗。世界卫生组织建议采用皮内接种组织培养疫苗的途径,这使得治疗成本非常低。然而,这一途径尚未得到印度政府药品监管局(DCGI)的批准。印度对于动物咬伤病例的处理没有统一的指导方针。在本文中,将尝试探讨动物咬伤处理的各个方面。

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