Krzowska-Firych Joanna, Tomasiewicz Krzysztof, Kozøowska Agata
a Department of Infectious Diseases , Medical University of Lublin , Lublin , Poland.
b Medical University of Lublin , Lublin , Poland.
Hum Vaccin Immunother. 2017 Jun 3;13(6):1-6. doi: 10.1080/21645515.2017.1285474. Epub 2017 Feb 6.
Rabies continues to be one of the most important viral diseases and remains a significant threat to public health across the globe. The post-exposure prophylaxis in humans can effectively prevent death after exposure to a potentially infected animal. In Poland, recommendations for rabies PEP followed the national guidelines which recommend that people should receive PEP when bitten by an animal suspected to be infected by rabies. PEP in humans includes cleansing and disinfecting the wound or point of contact, and administering anti-rabies immunization. Rabies vaccine should be given for contacts of category II and category III exposures. RIG should be given for category III contact. The vaccination schedule includes 5 doses given within a 30 day period (the Essen regimen).
The aim of our study was to determine the frequency of post-exposure prophylaxis among patients exposed to animals and also to assess the animal species suspected as a source of rabies exposure.
We have retrospectively analyzed medical records from the years 2012-2015 of all adult patients who were exposed to animals and consulted at the Dispensary of Rabies Prophylaxis in the Department of Infectious Diseases at the Medical University in Lublin, Poland. All consulted patients were asked to give an informed consent in case of decision to use collected data for future research work. Ethical approval was obtained from the Ethics Committee of the Medical University of Lublin, Poland, and all patients included in this study gave an informed consent during consultation after the exposure to animals.
During the studied 4-year period, 511 persons exposed to animals were consulted and prophylactic procedure consisting of active immunization were applied in 54.2% of the total consulted. Dogs and cats were the most common animal species suspected as the source of the rabies exposure. Anti-rabies prophylaxis was applied in 45.8% of all vaccinated patients exposed to dogs, and in 24.2% exposed to cats. All patients with bite wounds were consulted at the Department of Surgery and wound care followed surgical recommendations. In the study group, 45 patients had category III contact. There were 38 patients exposed to dogs, and 7 exposed to cats. There were no people exposed to wildlife in this group. All animals were available for veterinary observation. During and after exposure, none of the animals that serve as a potential source of infection presented with symptoms of rabies. The local epidemiological data indicated that during exposures of our patients, there were no confirmed cases of rabies among animals in Lublin province. Based on the data mentioned above, RIG was not applied. During the studied period in Lublin province, rabies was confirmed mainly in wildlife, and only in 2 dogs.
In Lublin province, people are still at risk of exposure to rabid animals. The majority of our patients were vaccinated after domestic animals exposure, but rabies was confirmed mainly in wildlife, and since 2013, there were no cases of rabies among domestic animals.
狂犬病仍然是最重要的病毒性疾病之一，对全球公共卫生构成重大威胁。人类暴露后预防可有效预防接触潜在感染动物后的死亡。在波兰，狂犬病暴露后预防的建议遵循国家指南，该指南建议人们被疑似感染狂犬病的动物咬伤后应接受暴露后预防。人类暴露后预防包括清洁和消毒伤口或接触部位，并进行抗狂犬病免疫接种。狂犬病疫苗应给予II类和III类暴露的接触者。III类接触应给予狂犬病免疫球蛋白。接种程序包括在30天内给予5剂（埃森方案）。
我们研究的目的是确定动物暴露患者中暴露后预防的频率，并评估疑似狂犬病暴露源的动物种类。
我们回顾性分析了2012年至2015年在波兰卢布林医科大学传染病科狂犬病预防门诊咨询的所有成年动物暴露患者的病历。所有咨询患者在决定将收集的数据用于未来研究工作时均被要求给予知情同意。获得了波兰卢布林医科大学伦理委员会的伦理批准，本研究纳入的所有患者在动物暴露后咨询期间均给予了知情同意。
在研究的4年期间，511名动物暴露患者接受了咨询，54.2%的总咨询患者接受了包括主动免疫在内的预防程序。狗和猫是最常见的疑似狂犬病暴露源动物种类。45.8%暴露于狗的接种疫苗患者和24.2%暴露于猫的接种疫苗患者接受了抗狂犬病预防。所有有咬伤伤口的患者都在外科就诊，伤口护理遵循外科建议。在研究组中，45名患者有III类接触。38名患者暴露于狗，7名患者暴露于猫。该组中没有人与野生动物接触。所有动物都可供兽医观察。在暴露期间和之后，作为潜在感染源的动物均未出现狂犬病症状。当地流行病学数据表明，在我们患者暴露期间，卢布林省的动物中没有确诊的狂犬病病例。基于上述数据，未应用狂犬病免疫球蛋白。在卢布林省研究期间，狂犬病主要在野生动物中得到确诊，仅在2只狗中确诊。
在卢布林省，人们仍有接触狂犬病动物的风险。我们的大多数患者在家畜暴露后接种了疫苗，但狂犬病主要在野生动物中得到确诊，自2013年以来，家畜中没有狂犬病病例。
