Oxford Vaccine Group, University of Oxford, Centre for Clinical Vaccinology & Tropical Medicine, Churchill Hospital, Old Rd, Headington, Oxford OX3 7LE, United Kingdom.
Vaccine. 2019 Feb 21;37(9):1131-1136. doi: 10.1016/j.vaccine.2019.01.019. Epub 2019 Jan 26.
Rabies is fatal in all unvaccinated patients bitten by dogs, and so post-exposure vaccine regimens must be robust enough to ensure their survival under all conditions. Treatment tends to be excessive for most people, but there is justified anxiety about reducing vaccine dosage and shortening regimens. Recently, World Health Organisation (WHO) recommended one week primary post-exposure intradermal regimens requiring 3 clinic visits, but these are unlikely to prove economical where rabies vaccination is most needed, in deprived rural areas of Africa and Asia. A highly immunogenic regimen involving two doses of intradermal vaccine given one week apart has advantages over other regimens. Anyone exposed to a possibly rabid animal would be given intradermal (ID) injections at 4 sites using a whole vial of vaccine. Those who had not been previously vaccinated would be given 2-site ID injections using half a vial one week later. Those who might be immunosuppressed could be given an optional single ID dose on day 28. The rationale for this regimen is discussed in the context of the recently revised WHO recommendations for rabies prophylaxis.
狂犬病在所有未接种疫苗的被狗咬伤的患者中都是致命的，因此暴露后疫苗接种方案必须足够强大，以确保在所有情况下都能存活。对于大多数人来说，治疗往往过于激进，但人们有理由担心减少疫苗剂量和缩短接种方案。最近，世界卫生组织（WHO）推荐了一种一周的初级暴露后皮内方案，需要 3 次就诊，但在非洲和亚洲贫困农村地区最需要狂犬病疫苗接种的地方，这些方案不太可能具有经济性。一种高度免疫原性的方案，包括两周皮内疫苗，每间隔一周接种一次，优于其他方案。任何接触到可能患有狂犬病的动物的人都将在 4 个部位接受皮内（ID）注射，使用一整瓶疫苗。那些以前没有接种过疫苗的人将在一周后使用半瓶疫苗进行 2 部位 ID 注射。那些可能免疫功能低下的人可以在第 28 天选择进行单次 ID 剂量注射。这种方案的基本原理将根据最近修订的世界卫生组织狂犬病预防建议进行讨论。
