Helmick C G, Tauxe R V, Vernon A A
Rev Infect Dis. 1987 May-Jun;9(3):511-8. doi: 10.1093/clinids/9.3.511.
The number of persons in the United States potentially in contact with rabid humans has increased in recent years because of labor-intensive medical care, longer survival times, and care in two or more hospitals. Many of these persons request rabies prophylaxis, and their physicians prescribe it because of their insecurity, a situation that is expensive and often unnecessary. Records of the Centers for Disease Control and the literature were reviewed to examine the current practice of prophylaxis of contacts and the actual need for it. Rabies virus is present in a variety of human fluids and tissues during the first five weeks of illness, but there are only four well-documented reports of human-to-human transmission--all in corneal transplant recipients. Prophylaxis of contacts of 14 rabid patients was predominantly for saliva exposure to open wounds or mucous membranes and was given most often to medical personnel having the greatest contact with the patient. Although it has never been documented, human-to-human transmission of rabies following saliva exposure remains a theoretical possibility. Virus shedding by rabid patients should be studied thoroughly in the future. Recommendations for managing contacts of rabid patients are presented.
近年来，由于劳动密集型医疗护理、更长的存活时间以及在两家或更多医院接受治疗，美国可能接触狂犬病患者的人数有所增加。这些人中许多人要求进行狂犬病预防，而他们的医生因他们的不安全感而开出处方，这种情况既昂贵又往往没有必要。审查了疾病控制中心的记录和文献，以研究当前对接触者进行预防的做法以及实际需求。在患病的前五周内，狂犬病病毒存在于多种人体体液和组织中，但仅有四例有充分记录的人传人病例报告——均为角膜移植受者。对14名狂犬病患者接触者的预防主要是针对唾液接触开放性伤口或黏膜，且最常给予与患者接触最多的医务人员。尽管从未有过记录，但唾液接触后狂犬病的人传人仍是一种理论上的可能性。未来应彻底研究狂犬病患者的病毒排泄情况。本文提出了管理狂犬病患者接触者的建议。
