Department of the Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland.
Unité d'Epidémiologie, Institut Pasteur de Nouvelle-Calédonie, Nouméa, New Caledonia; Unité d'Epidémiologie et de Santé Publique, Institut Pasteur du Cambodge, Phnom Penh, Cambodia.
Vaccine. 2019 Oct 3;37 Suppl 1:A107-A117. doi: 10.1016/j.vaccine.2019.01.041. Epub 2019 Feb 5.
Rabies is a fatal zoonotic disease preventable through timely and adequate post-exposure prophylaxis (PEP) to potentially exposed persons i.e. wound washing and antisepsis, a series of intradermal (ID) or intramuscular (IM) rabies vaccinations, and rabies immunoglobulin in WHO category III exposures. The 2010 WHO position on rabies vaccines recommended PEP schedules requiring up to 5 clinic visits over the course of approximately one month. Abridged schedules with less doses have potential to save costs, increase patient compliance, and thereby improve equitable access to life-saving PEP for at-risk populations. We systematically reviewed new evidence since that considered for the 2010 position paper to evaluate (i) the immunogenicity and effectiveness of PEP schedules of reduced dose and duration; (ii) new evidence on effective PEP protocols for special populations; and (iii) the effect of changing routes of administration (ID or IM) during a single course of PEP. Our search identified a total of 14 relevant studies. The identified studies supported a reduction in dose or duration of rabies PEP schedules. The 1-week, 2-site ID PEP schedule was found to be most advantageous, as it was safe, immunogenic, supported by clinical outcome data and involved the least direct costs (i.e. cost of vaccine) compared to other schedules. To supplement this evidence, as yet unpublished additional data were reviewed to support the strength of the recommendations. Evidence suggests that changes in the rabies vaccine product and/or the route of administration during PEP is possible. Few studies have evaluated PEP schedules in persons with suspect or confirmed rabies exposures. Gaps exist in understanding the safety and immunogenicity of novel PEP schedules in special populations such as infants and immunocompromised individuals. Available data indicate that administering rabies vaccines during pregnancy is safe and effective.
狂犬病是一种致命的人兽共患疾病，通过及时和充分的暴露后预防（PEP）可以预防，即对可能暴露的人员进行伤口清洗和消毒、一系列皮内（ID）或肌肉内（IM）狂犬病疫苗接种，以及在世界卫生组织 III 类暴露中使用狂犬病免疫球蛋白。2010 年世界卫生组织狂犬病疫苗立场文件建议 PEP 方案需要在大约一个月的时间内进行多达 5 次诊所就诊。简化方案减少了剂量，有节省成本、提高患者依从性的潜力，从而为高危人群提供公平获得救命 PEP 的机会。我们系统地回顾了自 2010 年立场文件以来的新证据，以评估：（i）减少剂量和持续时间的 PEP 方案的免疫原性和有效性；（ii）特殊人群有效 PEP 方案的新证据；以及（iii）在单一 PEP 疗程中改变给药途径（ID 或 IM）的效果。我们的搜索总共确定了 14 项相关研究。已确定的研究支持减少狂犬病 PEP 方案的剂量或持续时间。发现 1 周、2 部位 ID PEP 方案最有利，因为它是安全的、具有免疫原性，得到临床结果数据的支持，并且与其他方案相比，涉及的直接成本（即疫苗成本）最少。为了补充这一证据，还审查了尚未发表的额外数据，以支持这些建议的强度。有证据表明，在 PEP 期间改变狂犬病疫苗产品和/或给药途径是可能的。很少有研究评估了在疑似或确诊狂犬病暴露的人群中的 PEP 方案。在了解特殊人群（如婴儿和免疫功能低下者）中的新型 PEP 方案的安全性和免疫原性方面存在差距。现有数据表明，在怀孕期间接种狂犬病疫苗是安全有效的。
