Bourhy H, de Melo G D, Tarantola A
Unité lyssavirus, épidémiologie et neuropathologie, centre collaborateur de l'Organisation mondiale de la santé de référence et de recherche sur la rage, institut Pasteur, 28, rue du Docteur Roux, 75724 Paris cedex 15, France.
Bull Acad Natl Med. 2020 Dec;204(9):1000-1009. doi: 10.1016/j.banm.2020.09.036. Epub 2020 Sep 18.
Rabies still causes about 60,000 human deaths per year, mainly in poor populations in Africa and Asia. However, since Louis Pasteur developed the first vaccine 130 years ago, prophylactic measures have been considerably improved and simplified. They now consist of the vaccine combined with purified rabies immunoglobulins of equine or human origin. In general, however, post-exposure prophylaxis protocols are long and expensive. Furthermore, the immunoglobulins used for associated serotherapy are costly and not widely available in developing countries. Approaches have been developed to deal with these two issues that offer hope for a paradigm shift for the benefit of exposed populations. Finally, mass rabies vaccination in dogs, which are the most cost-effective measure for preventing rabies in humans, are difficult to implement and sometimes have moderate effectiveness. The identification and analysis of the epidemiological drivers conditioning the circulation of the virus in dog populations allow a better understanding of the key control points that need to be associated with these campaigns for a better efficacy.
狂犬病每年仍导致约6万人死亡,主要集中在非洲和亚洲的贫困人口中。然而,自130年前路易·巴斯德研发出第一种疫苗以来,预防措施已得到大幅改进和简化。现在的预防措施包括疫苗与马源或人源纯化狂犬病免疫球蛋白联合使用。然而总体而言,暴露后预防方案耗时且昂贵。此外,用于相关血清疗法的免疫球蛋白价格昂贵,在发展中国家无法广泛获取。人们已开发出应对这两个问题的方法,有望为受暴露人群带来范式转变。最后,犬类大规模狂犬病疫苗接种是预防人类狂犬病最具成本效益的措施,但实施起来困难重重,有时效果也一般。对影响病毒在犬类群体中传播的流行病学驱动因素进行识别和分析,有助于更好地理解为提高效果而需在这些疫苗接种活动中关联的关键控制点。