Institute of Zoology, Zoological Society of London, London, United Kingdom.
MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, United Kingdom.
PLoS Negl Trop Dis. 2020 Feb 13;14(2):e0007933. doi: 10.1371/journal.pntd.0007933. eCollection 2020 Feb.
Rabies has been a widely feared disease for thousands of years, with records of rabid dogs as early as ancient Egyptian and Mesopotamian texts. The reputation of rabies as being inevitably fatal, together with its ability to affect all mammalian species, contributes to the fear surrounding this disease. However, the widely held view that exposure to the rabies virus is always fatal has been repeatedly challenged. Although survival following clinical infection in humans has only been recorded on a handful of occasions, a number of studies have reported detection of rabies-specific antibodies in the sera of humans, domestic animals, and wildlife that are apparently healthy and unvaccinated. These 'seropositive' individuals provide possible evidence of exposure to the rabies virus that has not led to fatal disease. However, the variability in methods of detecting these antibodies and the difficulties of interpreting serology tests have contributed to an unclear picture of their importance. In this review, we consider the evidence for rabies-specific antibodies in healthy, unvaccinated individuals as indicators of nonlethal rabies exposure and the potential implications of this for rabies epidemiology. Our findings indicate that whilst there is substantial evidence that nonlethal rabies exposure does occur, serology studies that do not use appropriate controls and cutoffs are unlikely to provide an accurate estimate of the true prevalence of nonlethal rabies exposure.
狂犬病是一种令人们恐惧了几千年的疾病，古埃及和美索不达米亚的文献中就有关于狂犬病犬的记录。狂犬病具有不可避免的致命性，并且能够感染所有哺乳动物物种，这使得人们对这种疾病感到恐惧。然而，人们普遍认为接触狂犬病病毒总是致命的，这种观点已经多次受到挑战。尽管在人类中，只有少数临床感染病例存活下来，但有许多研究报告称，在显然健康且未接种疫苗的人类、家畜和野生动物的血清中检测到了狂犬病特异性抗体。这些“血清阳性”个体提供了可能的证据，表明接触了狂犬病病毒，但并未导致致命疾病。然而，检测这些抗体的方法存在差异，以及解释血清学检测的困难，导致了对其重要性的认识不清晰。在这篇综述中，我们考虑了健康、未接种疫苗的个体中狂犬病特异性抗体作为非致死性狂犬病暴露的指标的证据，以及这对狂犬病流行病学的潜在影响。我们的研究结果表明，虽然有大量证据表明非致死性狂犬病暴露确实会发生，但如果血清学研究不使用适当的对照和截止值，则不太可能准确估计非致死性狂犬病暴露的真实流行率。
