Warrell Mary J
Oxford Vaccine Group, University of Oxford, Centre for Clinical Vaccinology and Tropical Medicine, Churchill Hospital, Headington, Oxford, UK.
Curr Opin Infect Dis. 2008 Jun;21(3):251-7. doi: 10.1097/QCO.0b013e3282fc705b.
Increased awareness of the long-neglected rabies virus could promote the highly effective methods of preventing human deaths. Rabies and rabies-related lyssaviruses have recently been appearing in unexpected places, sometimes with dire consequences. Although rabies of canine origin remains 100% fatal in human beings, should the surprising recovery of a single unvaccinated child influence treatment now?
Evidence of rabies-related lyssavirus infection of bats is increasing across continents and with new virus types. Human rabies has been misdiagnosed as cerebral malaria, or even drug abuse. Organ transplant recipients have been infected. The first unvaccinated patient, a teenager, bitten by a bat, recovered from rabies encephalitis, but why might this be? Highly effective control and prevention of infection is possible. Preexposure prophylaxis for schoolchildren could now become routine. Improved economical intradermal postexposure vaccine regimens could increase the availability of affordable treatment in developing countries. Controlling dog rabies could prevent 95% of human deaths, but education and resources are lacking.
The risks and problems of rabies and other lyssaviruses vary greatly across the world. Knowledge of epidemiology and prevention could save the lives of victims of animal bites and promote efforts to control and even eliminate dog rabies.
提高对长期被忽视的狂犬病病毒的认识，可能会推动预防人类死亡的高效方法。狂犬病及与狂犬病相关的狂犬病病毒最近出现在意想不到的地方，有时会带来可怕的后果。尽管犬源性狂犬病在人类中仍然100%致命，但一个未接种疫苗的孩子令人惊讶地康复，现在是否应该影响治疗呢？
各大洲与蝙蝠相关的狂犬病病毒感染证据不断增加，且出现了新的病毒类型。人类狂犬病曾被误诊为脑型疟疾，甚至药物滥用。器官移植受者也受到了感染。首例未接种疫苗的患者是一名青少年，被蝙蝠咬伤后从狂犬病脑炎中康复，但这是为什么呢？高效控制和预防感染是可行的。对学童进行暴露前预防现在可以成为常规做法。改进后的经济实惠的皮内暴露后疫苗接种方案，可以提高发展中国家可负担治疗的可及性。控制犬类狂犬病可以预防95%的人类死亡，但缺乏教育和资源。
狂犬病和其他狂犬病病毒的风险及问题在世界各地差异很大。了解流行病学和预防知识可以挽救动物咬伤受害者的生命，并推动控制甚至消除犬类狂犬病的努力。
