Warrell M J
Rev Sci Tech. 2018 Aug;37(2):629-647. doi: 10.20506/rst.37.2.2829.
Rabies is entirely preventable. All deaths are the result of failed prophylaxis. Rabies encephalomyelitis has never been reported in anyone who received both pre-exposure vaccination and a post-exposure booster. Awareness of the risk of contact with rabid animals is crucial. A lack of basic knowledge and the inaccessibility of expensive rabies vaccines can discourage patients bitten by suspected rabid animals from seeking prompt post-exposure prophylaxis. Similarly, people working with mammals, residents of areas where dog rabies is endemic, travellers, and others at risk often fail to take advantage of pre-exposure prophylaxis. However, since human infection by a dog rabies virus has always proved fatal in unvaccinated patients, there is understandable reluctance to accept any change in vaccine protocols. The intramuscular route of delivery is wasteful and the current, low-dose intradermal (ID) regimen is not always economical or universally trusted. A new, one-week ID regimen, using less vaccine, injected at multiple sites, and involving two clinic visits, could increase the accessibility of highly immunogenic prophylaxis and reduce the prohibitive cost. The recent 2018 World Health Organization recommendations for rabies prophylaxis are included.
狂犬病是完全可以预防的。所有死亡都是预防措施失败的结果。在接受过暴露前疫苗接种和暴露后加强免疫的人群中，从未报告过狂犬病脑脊髓炎病例。认识到接触狂犬病动物的风险至关重要。缺乏基本知识以及昂贵的狂犬病疫苗难以获取，可能会使被疑似狂犬病动物咬伤的患者不愿及时寻求暴露后预防措施。同样，从事与哺乳动物相关工作的人员、犬类狂犬病流行地区的居民、旅行者以及其他有风险的人群，往往未能利用暴露前预防措施。然而，由于未接种疫苗的患者感染犬类狂犬病病毒后总是被证明会致命，所以人们对接受疫苗方案的任何改变存在可以理解的抵触情绪。肌内注射方式浪费疫苗，而目前低剂量的皮内注射方案并不总是经济实惠或被普遍信任。一种新的为期一周的皮内注射方案，使用更少的疫苗，在多个部位注射，且需要就诊两次，可能会提高高免疫原性预防措施的可及性，并降低高昂的成本。文中还纳入了世界卫生组织2018年最新的狂犬病预防建议。
