Deray Raffy, Rivera Cesar, Gripon Shiela, Ulanday Corazon, Roces Maria Concepcion, Amparo Anna Charinna, Attlan Michael, Demont Clarisse, Kieffer Alexia, Miranda Mary Elizabeth
National Center for Disease Prevention and Control, Department of Health, Manila, Philippines.
Municipal Health Office, El Nido, Palawan, Philippines.
PLoS One. 2018 Jan 2;13(1):e0189596. doi: 10.1371/journal.pone.0189596. eCollection 2018.
Rabies remains endemic in the Philippines. A study was conducted in El Nido, Palawan, Philippines to: (i) detect the true incidence of animal bites in school children aged 5-14 years using active surveillance and compare these data to estimates from the existing passive surveillance system, (ii) evaluate the impact of rabies prevention education and pre-exposure prophylaxis (PrEP) on animal bite incidence, and (iii) assess the health economic impact of the interventions.
A cohort of 4,700 school children was followed-up for any suspect rabies exposures between January 2011 and December 2012. Data on animal bite incidence from the study cohort were compared to that obtained from a review of consultation records at the Animal Bite Treatment Center (ABTC). PrEP was offered to children in all 27 public elementary schools in El Nido (in January to February 2012). Teachers were given a manual for integrating rabies in the public elementary school curriculum during the school year 2012-13. Active surveillance of the cohort revealed a higher incidence of suspect rabies exposures than that from passive surveillance. Despite a decrease in the number of Category III bites, there was no significant decrease in overall bite incidence as a result of the interventions. However, there was an increase in rabies awareness among school children in all grade levels. There was also a high level of acceptability of PrEP. Children who received PrEP and subsequently were bitten only needed two booster doses for post-exposure prophylaxis, resulting in substantial cost-savings.
CONCLUSIONS/SIGNIFICANCE: The true burden of animal bites remains underestimated in ABTC records. PrEP is advantageous in selected population groups, i.e. school-aged children in rabies endemic areas with limited access to animal and human rabies prevention services. Educating school children is beneficial. Strengthening veterinary interventions to target the disease at source is important.
狂犬病在菲律宾仍然流行。在菲律宾巴拉望省爱妮岛开展了一项研究，目的是：（i）通过主动监测确定5至14岁学龄儿童动物咬伤的真实发病率，并将这些数据与现有被动监测系统的估计值进行比较；（ii）评估狂犬病预防教育和暴露前预防（PrEP）对动物咬伤发病率的影响；（iii）评估这些干预措施对健康经济的影响。
2011年1月至2012年12月期间，对4700名学龄儿童队列进行随访，以了解任何可疑的狂犬病暴露情况。将研究队列中动物咬伤发病率的数据与动物咬伤治疗中心（ABTC）咨询记录审查获得的数据进行比较。2012年1月至2月，为爱妮岛所有27所公立小学的儿童提供了PrEP。在2012 - 2013学年，教师获得了一本将狂犬病纳入公立小学课程中的手册。对该队列的主动监测显示，可疑狂犬病暴露的发病率高于被动监测。尽管III级咬伤数量有所减少，但干预措施并未使总体咬伤发病率显著下降。然而，所有年级的学龄儿童对狂犬病的认识有所提高。PrEP的接受度也很高。接受PrEP并随后被咬伤的儿童在暴露后预防时仅需两剂加强针，从而节省了大量成本。
结论/意义：ABTC记录中动物咬伤的真实负担仍然被低估。PrEP在特定人群中具有优势，即狂犬病流行地区、获得动物和人类狂犬病预防服务机会有限的学龄儿童。对学龄儿童进行教育是有益的。加强源头针对该疾病的兽医干预措施很重要。
