Department of Infectious Disease,Singapore Clinical Group, Singapore General Hospital, Outram Road, Singapore.
J Travel Med. 2011 Jul-Aug;18(4):257-61. doi: 10.1111/j.1708-8305.2011.00522.x. Epub 2011 Jun 14.
In 2009, 58.6 million UK residents traveled abroad. Of these, 49.5 million (84.5%) visits were to Europe and North America and 9.1 million (15.5%) were to other parts of the world. Rabies is widely distributed and continues to be a major public health issue in many developing countries. The UK is free of rabies in carnivore host species, although cases of rabies in bats have been reported. This study examined the rabies postexposure prophylaxis (PEP) service from 2000 to July 2009 at the Liverpool School of Tropical Medicine.
Medical records of patients who attended the clinic for rabies PEP were reviewed.
During the study period, 139 patients were treated for possible rabies exposure. The mean age was 35 years. Thailand and Turkey each accounted for 31 (22.3%) cases. Sixty-nine (49.6%) of those seen were due to dog bites. Most injuries involved a lower limb (n = 67, 48.2%) or hands (n = 26, 18.7%). Eighty-six (61.9%) cases had initiated rabies PEP overseas, but only 3 of the 78 (3.8%) meeting UK criteria for rabies immunoglobulin (RIG) received it while overseas. Only an additional 11 patients received RIG on return to the UK; most were seen more than 7 days after initiation of PEP. The median time from exposure to receiving rabies PEP was 1 day (range: 0-1,720). Only 14 (10.1%) had received preexposure rabies vaccination.
The majority of travelers seeking PEP at this clinic initiated treatment overseas. Most had not received RIG abroad, when it would have been appropriate. Initiation of appropriate treatment is often delayed and is a concern to those without preexposure rabies immunization. In view of the scarcity of RIG, travelers need to be aware of the risks, consider preexposure immunization, and present early for PEP.
2009 年，有 5860 万英国居民出国旅行。其中，4950 万人（84.5%）前往欧洲和北美，910 万人（15.5%）前往世界其他地区。狂犬病广泛分布，在许多发展中国家仍然是一个主要的公共卫生问题。英国的肉食动物宿主中没有狂犬病，但已报告蝙蝠感染狂犬病的病例。本研究检查了 2000 年至 2009 年 7 月期间利物浦热带医学院的狂犬病暴露后预防（PEP）服务。
对到诊所接受狂犬病 PEP 的患者的病历进行了回顾。
在研究期间，共有 139 名患者因可能接触狂犬病而接受治疗。平均年龄为 35 岁。泰国和土耳其各占 31 例（22.3%）。就诊者中有 69 例（49.6%）是因狗咬伤。大多数受伤部位为下肢（n=67，48.2%）或手部（n=26，18.7%）。86 例（61.9%）是在国外开始狂犬病 PEP 的，但在符合英国狂犬病免疫球蛋白（RIG）标准的 78 例中，只有 3 例在国外时接受了 RIG。只有另外 11 例在返回英国后接受了 RIG；大多数是在开始 PEP 后超过 7 天就诊的。从暴露到接受狂犬病 PEP 的中位数时间为 1 天（范围：0-1720）。只有 14 例（10.1%）接受过狂犬病暴露前预防接种。
在该诊所寻求 PEP 的旅行者中，大多数在国外开始治疗。大多数人在国外时没有接受 RIG，而这是合适的。适当治疗的开始往往被延迟，这对那些没有狂犬病暴露前免疫的人来说是一个问题。鉴于 RIG 的稀缺性，旅行者需要了解风险，考虑暴露前免疫，并尽早接受 PEP。
