Epidemiology & Public Health Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia; Epidemiology Unit, Institut Pasteur de Nouvelle-Calédonie, Nouméa, New Caledonia.
Epidemiology & Public Health Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia.
Vaccine. 2019 Oct 3;37 Suppl 1:A118-A127. doi: 10.1016/j.vaccine.2018.10.054. Epub 2018 Nov 16.
Rabies causes 60,000 deaths worldwide annually. Rabies post-exposure prophylaxis is highly effective but often geographically and financially beyond reach in endemic developing countries. We conducted a retrospective study on clinical outcome at ≥6 months in 3318 Cambodians who received intradermal Vero cell vaccine post-exposure prophylaxis after a bite by a rabid or sick-looking but untested dog in 2003-2014. An external expert panel examined verbal autopsy reports to identify rabies deaths. 1739 (93.65%) persons bitten by rabid- and 1066 (72.96%) bitten by sick-looking but untested dogs were traced and 513 were lost to follow-up. Among the former, 1591 (91.49%) and 129 (7.42%) patients referred for 4+ and 3 post-exposure prophylaxis sessions, respectively. Three persons died of probable rabies so that the overall percentage of survival was 99.83% (95% exact confidence interval: 99.49-99.96%) in post-exposure prophylaxis recipients bitten by confirmed rabid dogs. No significant difference was found in survival among patients who received 3 vs. 4+ sessions (with or without rabies immunoglobin). The power of the study, however, was limited. The current four sessions/one month intradermal regimen can be reduced to a three sessions/one week at no detectable added risk to patients, with the limitation of study power at 49%. A clinical follow-up system should be adopted by rabies prevention centers, especially to monitor implementation of an abridged course. The Institut Pasteur in Cambodia regimen will improve vaccine equity by treating 33% more patients with available doses, reduce direct cost of vaccination, transportation and other indirect costs to vaccinees.
狂犬病每年在全球导致 60,000 人死亡。狂犬病暴露后预防非常有效，但在流行地区的发展中国家，往往在地理和经济上都无法实现。我们对 2003 年至 2014 年间 3318 名柬埔寨人进行了一项回顾性研究，这些人在被疑似患有狂犬病或其他疾病的狗咬伤后，接受了皮内注射vero 细胞狂犬病疫苗暴露后预防。一个外部专家小组检查了死因推断报告，以确定狂犬病死亡病例。1739 名（93.65%）被疑似患有狂犬病的狗咬伤和 1066 名（72.96%）被疑似患有其他疾病但未经检测的狗咬伤的人被追踪，513 人失访。在前者中，分别有 1591 名（91.49%）和 129 名（7.42%）患者接受了 4+和 3 次暴露后预防治疗。3 名疑似狂犬病患者死亡，因此接受确认患有狂犬病的狗咬伤的暴露后预防治疗的患者总体存活率为 99.83%（95%确切置信区间：99.49-99.96%）。在接受 3 次或 4+次治疗的患者中（有无狂犬病免疫球蛋白），生存率没有显著差异。然而，该研究的效力有限。目前每月一次皮内注射四剂方案可减少为每周三次，不会给患者带来可检测的额外风险，但研究效力限制在 49%。狂犬病预防中心应采用临床随访系统，特别是要监测简化疗程的实施情况。柬埔寨巴斯德研究所的方案将提高疫苗的公平性，用现有剂量治疗 33%更多的患者，降低疫苗接种的直接成本、运输和其他对受种者的间接成本。
