The Faculty of Veterinary Science, University of Sydney, Camden 2570, New South Wales, Australia.
Vaccine. 2011 May 31;29(24):4094-101. doi: 10.1016/j.vaccine.2011.03.106. Epub 2011 Apr 15.
The aim of this study was to understand the use and distribution of human rabies post exposure prophylaxis (PEP) vaccine in Bhutan and to identify risk factors for receiving an incomplete course of the vaccine. We analyzed post exposure treatment records from 28 medical hospitals from 2005 to 2008. Males (59%) accounted for significantly more PEP events than females (41%) across all age groups (P<0.001). Children - particularly 5-9 years of age - received more rabies PEP than other age groups. Animal bite and non-bite accounted for 27% (n=2239) and 16% (n=1303) of rabies PEP, respectively, whilst 57% (n=4773) of the PEP events had no recorded information about the reasons for post exposure treatment. Post exposure treatment was provided throughout the year with a higher number during the winter and spring months. The number of PEP events significantly (P<0.001) increased between 2005 and 2008, from <1000 to >2800 events, respectively. Significantly (P<0.001) more PEP events were reported from the southern parts of Bhutan that are endemic for rabies or those areas in eastern Bhutan that have reported rabies outbreaks than other parts of Bhutan. Forty percent (n=3360) of the patients received an incomplete course of vaccine (<5-doses of vaccine intramuscular). Results suggest that patients with animal bite injury were less likely to receive an incomplete vaccine course than non-bite recipients, and patients presented to hospitals in rabies endemic or outbreak areas were less likely to receive an incomplete course than in non-rabies areas or rabies free areas. Similarly, patients presenting to hospitals for PEP during spring and summers months were less likely to receive an incomplete vaccine course than those during other seasons. Public education campaigns need to be conducted in Bhutan to reduce dog bite incidents and also to prevent mass exposures to rabies. A thorough assessment of each individual case based on the WHO guidelines would reduce unnecessary PEP (and therefore costs) in Bhutan.
本研究旨在了解不丹人用狂犬病暴露后预防（PEP）疫苗的使用和分布情况，并确定接受不完全疫苗接种的风险因素。我们分析了 2005 年至 2008 年 28 家医院的暴露后治疗记录。在所有年龄段，男性（59%）接受 PEP 的人数明显多于女性（41%）（P<0.001）。儿童——尤其是 5-9 岁的儿童——比其他年龄组接受了更多的狂犬病 PEP。动物咬伤和非咬伤分别占狂犬病 PEP 的 27%（n=2239）和 16%（n=1303），而 57%（n=4773）的 PEP 事件没有记录暴露后治疗的原因。全年都提供了暴露后治疗，冬季和春季的治疗人数较多。2005 年至 2008 年，PEP 事件的数量显著增加（P<0.001），分别从<1000 例增加到>2800 例。与不丹其他地区相比，来自狂犬病流行地区或报告发生狂犬病暴发地区的南部地区的 PEP 事件报告数量明显更多（P<0.001）。40%（n=3360）的患者接受了不完全疫苗接种（<5 剂肌肉注射疫苗）。结果表明，与非咬伤接受者相比，动物咬伤患者接受不完全疫苗接种的可能性较小，而在狂犬病流行或暴发地区就诊的患者接受不完全疫苗接种的可能性小于非狂犬病地区或无狂犬病地区。同样，在春季和夏季接受 PEP 治疗的患者比其他季节接受不完全疫苗接种的可能性较小。不丹需要开展公众教育活动，减少狗咬伤事件，并防止大量暴露于狂犬病。根据世界卫生组织的指南对每个病例进行全面评估，将减少不必要的 PEP（因此也会降低成本）。
