Mattner Frauke, Henke-Gendo Cornelia, Martens Andreas, Drosten Christian, Schulz Thomas F, Heim Albert, Suerbaum Sebastian, Kuhn Sabine, Bruderek Juliane, Gastmeier Petra, Strueber Martin
Institute of Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Hannover, Germany.
Infect Control Hosp Epidemiol. 2007 May;28(5):513-8. doi: 10.1086/513614. Epub 2007 Mar 30.
Rabies virus was inadvertently transmitted to a lung transplant recipient through donor lungs. The patient was given ventilatory assistance and cared for postoperatively for 6 weeks before a diagnosis of rabies virus infection was made. Postexposure prophylaxis (PEP) was offered to potentially exposed healthcare workers (HCWs).
Only HCWs classified as belonging to possible and/or proven contact groups (according to a standardized interview) received PEP. The risk of individual HCWs being exposed to rabies virus was reassessed on the basis of viral concentrations measured in the patient's excretions and body fluids. HCWs who were vaccinated as part of PEP were followed up prospectively according to a standardized procedure.
Of 179 HCWs and other patient contacts, 132 met the eligibility criteria for PEP (118 [89.4%] with possible contact and 14 [10.6%] with proven contact with the patient's excretions and/or body fluids). One hundred thirty-one individuals started PEP, and 126 met the inclusion criteria for analysis. Of these, 48 (38%) developed at least 1 adverse effect (8 [6.3%] had fever, 37 [29.4%] had headache, 3 [2.4%] had lymphadenopathy, 17 [13.5%] had dizziness, and 6 [4.8%] had paresthesia). No HCW or other patient contact developed rabies or serious PEP-related adverse effects. Reassessment of the individual's risk of infection as a function of the viral concentration in the patient's excretions and/or body fluids (up to 5.12 x 10(7) copies/mL) revealed that 103 HCWs (78.0%) had contact with high-risk substances (89 [67.40%] had possible contact and 14 [10.7%] had proven contact).
HCWs can be exposed to significant viral concentrations in excretions and/or body fluids from rabies virus-infected lung transplant recipients. Because widespread use of PEP entails the possibility of significant health problems for HCWs considered to be at risk of contracting rabies, applying a rational indication for PEP is crucial.
狂犬病毒通过供体肺意外传播给一名肺移植受者。患者接受了通气支持，并在术后护理了6周，之后才确诊为狂犬病毒感染。对可能暴露的医护人员（HCW）提供了暴露后预防（PEP）。
只有被归类为属于可能和/或已证实接触组的医护人员（根据标准化访谈）接受了PEP。根据在患者排泄物和体液中测得的病毒浓度，重新评估了个体医护人员接触狂犬病毒的风险。作为PEP一部分进行疫苗接种的医护人员按照标准化程序进行前瞻性随访。
在179名医护人员和其他患者接触者中，132人符合PEP的资格标准（118人[89.4%]可能接触，14人[10.6%]已证实接触患者的排泄物和/或体液）。131人开始接受PEP，126人符合分析的纳入标准。其中，48人（38%）出现至少1种不良反应（8人[6.3%]发热，37人[29.4%]头痛，3人[2.4%]淋巴结病，17人[13.5%]头晕，6人[4.8%]感觉异常）。没有医护人员或其他患者接触者感染狂犬病或出现与PEP相关的严重不良反应。根据患者排泄物和/或体液中的病毒浓度（高达5.12×10⁷拷贝/mL）重新评估个体感染风险，结果显示103名医护人员（78.0%）接触了高危物质（89人[67.40%]可能接触，14人[10.7%]已证实接触）。
医护人员可能接触到狂犬病病毒感染的肺移植受者排泄物和/或体液中的高浓度病毒。由于广泛使用PEP可能给被认为有感染狂犬病风险的医护人员带来重大健康问题，因此合理确定PEP的适应证至关重要。
