Epidemic Intelligence Service, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA, United States; Poxvirus and Rabies Branch, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA, United States.
U.S. Centers for Disease Control and Prevention Country Office in Vietnam, 2 Ngo Quyen, Hanoi, Viet Nam.
Vaccine. 2019 Oct 3;37 Suppl 1:A54-A63. doi: 10.1016/j.vaccine.2019.01.030. Epub 2019 Feb 2.
Adhering to post-exposure prophylaxis (PEP): wound treatment, vaccine, and rabies immunoglobulin (RIG) is a crucial step in preventing rabies mortality. When PEP is widely available, a lack of adherence to the recommended treatment guidelines can also lead to death. Our objective was to understand characteristics associated with adherence to the vaccine regimen and RIG in Vietnam.
We obtained individual-level data on PEP adherence from registries at 10 sites located in five provinces. From these registries, we extracted epidemiologic characteristics of patients including the timing of PEP initiation and completion. We used descriptive analyses and logistic regression to examine patient characteristics associated with initiation and completion of RIG and vaccine. Based on reported rabies mortality, the government defined provincial rabies burden as medium-burden (<5 and >2 deaths) and high-burden (≥5 deaths).
During 2014-2016, 15,646 patients received PEP in our study. Among 14,296 vaccinated patients, only 41.4% (5847) completed their five-dose intramuscular (IM) injections and 81.6% (133) of patients completed their eight-dose intradermal (ID) injections. Approximately 26% of patients received RIG. Patient characteristics associated with vaccine completion were females (44%), <15 years of age (44%), category 1 exposure (68%, bite location on leg (46%), bite from bat (56%), bite from a healthy animal (45%), high-burden province (86%), and district preventive center (49%). Disparities were revealed among provinces, with high-burden provinces having highest (86%) and lowest (7%) vaccine completion rates.
Vietnam has made tremendous progress towards reducing the burden of rabies. However, despite the wide availability of PEP, we found relatively low rates of vaccine completion. Our findings suggest provider training and patient education is needed to ensure appropriate treatment is completed. Moreover, our data suggest changes to information reported through the national surveillance system for monitoring good clinical practice for rabies prevention and control.
暴露后预防（PEP）包括伤口处理、疫苗和狂犬病免疫球蛋白（RIG），是预防狂犬病死亡的关键步骤。当 PEP 广泛可用时，不遵守推荐的治疗指南也可能导致死亡。我们的目的是了解与越南 PEP 依从性相关的特征。
我们从位于五个省的 10 个地点的登记处获得了关于 PEP 依从性的个体水平数据。从这些登记处，我们提取了患者的流行病学特征，包括 PEP 开始和完成的时间。我们使用描述性分析和逻辑回归来检查与 RIG 和疫苗起始和完成相关的患者特征。根据报告的狂犬病死亡率，政府将省级狂犬病负担定义为中负担（<5 例和>2 例死亡）和高负担（≥5 例死亡）。
2014 年至 2016 年期间，我们的研究中共有 15646 名患者接受了 PEP。在 14296 名接种疫苗的患者中，只有 41.4%（5847 人）完成了五剂肌内（IM）注射，81.6%（133 人）完成了八剂皮内（ID）注射。约 26%的患者接受了 RIG。与疫苗完成相关的患者特征为女性（44%）、<15 岁（44%）、1 类暴露（68%）、咬伤部位在腿部（46%）、由蝙蝠咬伤（56%）、由健康动物咬伤（45%）、高负担省份（86%）和区预防中心（49%）。各省之间存在差异，高负担省份的疫苗完成率最高（86%），最低（7%）。
越南在减少狂犬病负担方面取得了巨大进展。然而，尽管 PEP 广泛可用，但我们发现疫苗完成率相对较低。我们的研究结果表明，需要对提供者进行培训并对患者进行教育，以确保完成适当的治疗。此外，我们的数据表明，需要对通过国家监测系统报告的信息进行更改，以监测狂犬病预防和控制的良好临床实践。
