Wallace R M, Stanek D, Griese S, Krulak D, Vora N M, Pacha L, Kan V, Said M, Williams C, Burgess T H, Clausen S S, Austin C, Gabel J, Lehman M, Finelli L N, Selvaggi G, Joyce P, Gordin F, Benator D, Bettano A, Cersovsky S, Blackmore C, Jones S V, Buchanan B D, Fernandez A I, Dinelli D, Agnes K, Clark A, Gill J, Irmler M, Blythe D, Mitchell K, Whitman T J, Zapor M J, Zorich S, Witkop C, Jenkins P, Mora P, Droller D, Turner S, Dunn L, Williams P, Richards C, Ewing G, Chapman K, Corbitt C, Girimont T, Franka R, Recuenco S, Blanton J D, Feldman K A
Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology (DHCPP), Centers for Disease Control and Prevention, Atlanta, GA, USA; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Zoonoses Public Health. 2014 Dec;61(8):560-70. doi: 10.1111/zph.12105. Epub 2014 Mar 27.
This article describes and contrasts the public health response to two human rabies cases: one organ recipient diagnosed within days of symptom onset and the transplant donor who was diagnosed 18 months post-symptom onset. In response to an organ-transplant-related rabies case diagnosed in 2013, organ donor and recipient investigations were conducted by multiple public health agencies. Persons with potential exposure to infectious patient materials were assessed for rabies virus exposure. An exposure investigation was conducted to determine the source of the organ donor's infection. Over 100 persons from more than 20 agencies spent over 2700 h conducting contact investigations in healthcare, military and community settings. The 564 persons assessed include 417 healthcare workers [5.8% recommended for post-exposure prophylaxis (PEP)], 96 community contacts (15.6% recommended for PEP), 30 autopsy personnel (50% recommended for PEP), and 21 other persons (4.8% recommended for PEP). Donor contacts represented 188 assessed with 20.2% recommended for PEP, compared with 5.6% of 306 recipient contacts recommended for PEP. Human rabies cases result in substantial use of public health and medical resources, especially when diagnosis is delayed. Although rare, clinicians should consider rabies in cases of encephalitis of unexplained aetiology, particularly for cases that may result in organ donation.
一例是器官接受者在症状出现数天内被确诊，另一例是移植供者在症状出现18个月后被确诊。针对2013年诊断出的一例与器官移植相关的狂犬病病例，多个公共卫生机构对器官供者和接受者展开了调查。对可能接触传染性患者材料的人员进行了狂犬病病毒暴露评估。开展了一项暴露调查以确定器官供者的感染源。来自20多个机构的100多人花费了超过2700小时在医疗保健、军事和社区环境中进行接触者调查。接受评估的564人包括417名医护人员[5.8%建议接受暴露后预防（PEP）]、96名社区接触者（15.6%建议接受PEP）、30名尸检人员（50%建议接受PEP）以及21名其他人员（4.8%建议接受PEP）。供者接触者中有188人接受了评估，20.2%建议接受PEP，相比之下，接受评估的306名接受者接触者中有5.6%建议接受PEP。人类狂犬病病例会大量消耗公共卫生和医疗资源，尤其是在诊断延迟的情况下。尽管罕见，但临床医生在病因不明的脑炎病例中应考虑狂犬病，特别是对于可能导致器官捐赠的病例。
