Centers for Disease Control and Prevention, Atlanta, GA, USA.
J Travel Med. 2022 Jul 14;29(4). doi: 10.1093/jtm/taac046.
Assessing the global risk of rabies exposure is a complicated task requiring individual risk assessments, knowledge of rabies epidemiology, surveillance capacity and accessibility of rabies biologics on a national and regional scale. In many parts of the world, availability of this information is limited and when available is often dispersed across multiple sources. This hinders the process of making evidence-based health and policy recommendations to prevent the introduction and spread of rabies.
CDC conducted a country-by-country qualitative assessment of risk and protective factors for rabies to develop an open-access database of core metrics consisting of the presence of lyssaviruses (specifically canine or wildlife rabies virus variants or other bat lyssaviruses), access to rabies immunoglobulins and vaccines, rabies surveillance capacity and canine rabies control capacity. Using these metrics, we developed separate risk scoring systems to inform rabies prevention guidance for travelers and regulations for the importation of dogs. Both scoring systems assigned higher risk to countries with enzootic rabies (particularly canine rabies), and the risk scoring system for travelers also considered protective factors such as the accessibility of rabies biologics for post-exposure prophylaxis. Cumulative scores were calculated across the assessed metrics to assign a risk value of low, moderate or high.
A total of 240 countries, territories and dependencies were assessed, for travelers, 116 were identified as moderate to high risk and 124 were low or no risk; for canine rabies virus variant importation, 111 were identified as high-risk and 129 were low or no risk.
We developed a comprehensive and easily accessible source of information for assessing the rabies risk for individual countries that included a database of rabies risk and protective factors based on enzootic status and availability of biologics, provided a resource that categorizes risk by country and provided guidance based on these risk categories for travelers and importers of dogs into the United States.
评估狂犬病暴露的全球风险是一项复杂的任务，需要进行个体风险评估，了解狂犬病流行病学、国家和地区的监测能力和狂犬病生物制剂的可及性。在世界上许多地方，这种信息的可用性有限，而且即使有，也往往分散在多个来源中。这阻碍了制定基于证据的卫生和政策建议，以防止狂犬病的传入和传播。
CDC 对狂犬病的风险和保护因素进行了逐国定性评估，以开发一个开放获取的核心指标数据库，其中包括存在弹状病毒（特别是犬或野生动物狂犬病病毒变体或其他蝙蝠狂犬病病毒）、获得狂犬病免疫球蛋白和疫苗、狂犬病监测能力和犬类狂犬病控制能力。使用这些指标，我们开发了单独的风险评分系统，为旅行者提供狂犬病预防指南，并为进口犬只制定法规。这两个评分系统都将风险较高的国家确定为存在地方性狂犬病（特别是犬类狂犬病），旅行者的风险评分系统还考虑了保护因素，如狂犬病生物制剂在接触后预防中的可及性。对评估指标进行了累积评分，以确定低、中或高风险值。
总共评估了 240 个国家、领土和属地，对于旅行者，有 116 个被确定为中高风险，124 个为低风险或无风险；对于犬类狂犬病病毒变体的进口，有 111 个被确定为高风险，129 个为低风险或无风险。
我们开发了一个全面且易于获取的信息来源，用于评估单个国家的狂犬病风险，其中包括基于地方病状态和生物制剂可用性的狂犬病风险和保护因素数据库，提供了一个按国家分类风险的资源，并为旅行者和美国进口犬只提供了基于这些风险类别的指南。
