Warmerdam Anouk M T, Luppino Floriana S, Visser Leo G
Leiden University Medical Centre, Leiden, the Netherlands.
Eurocross Assistance, Leiden, the Netherlands.
Trop Dis Travel Med Vaccines. 2023 Aug 15;9(1):11. doi: 10.1186/s40794-023-00193-x.
Prompt administration of post-exposure prophylaxis (PEP) is crucial to prevent a fatal rabies infection after an animal associated injury (AAI), preferably within 24 h. PEP, especially in case of a type III injury for which rabies immune globulin (RIG) is needed, is difficult to obtain abroad. This, along with the fear of potentially having contracted a lethal disease, might be an important source for anxiety and distress. We investigated the occurrence and extent of self-reported anxiety and distress at different timepoints among Dutch travellers after encountering an AAI, and the involved factors.
A retrospective quantitative observational study was conducted including insured Dutch travellers who actively contacted Eurocross Assistance after encountering an AAI abroad. An online questionnaire was designed to measure anxiety and distress levels, using the HADS (Hospital Anxiety and Depression Scale) and distress thermometer at three time points: departure from home (T1), post-AAI (T2), and treatment administration (T3). Statistical analyses included T-tests, Chi-square tests, and ANCOVA analyses.
We showed a significant increase in mean anxiety and distress scores at T2, and a significant decrease at T3. Women were more often anxious and distressed. Between T1 and T2, PrEP, and being aware of the risks were positively associated with anxiety levels, and PrEP and WHO region Africa with distress levels. Between T2 and T3, anxiety levels remained higher for monkey-induced injury, thoracic injuries, and WHO region Southeast Asia. PEP-delay between 24-48 h resulted in decreased distress levels at this time period, while type II injury elevated distress levels.
This study showed significant anxiety and distress levels after an AAI among the vast majority of travellers, which is detrimental to their health-related quality of life (HR-QOL). This highlights the importance of proper pre-travel information. In the context of rabies prevention, these results suggest that pre-travel advice and policy makers should also take aspects of HR-QOL into consideration.
暴露后预防（PEP）的及时给药对于预防动物致伤（AAI）后致命的狂犬病感染至关重要，最好在24小时内进行。在国外，PEP很难获得，尤其是在需要狂犬病免疫球蛋白（RIG）的III级伤口情况下。这一点，再加上担心可能感染致命疾病，可能是焦虑和痛苦的一个重要来源。我们调查了荷兰旅行者在遭遇AAI后不同时间点自我报告的焦虑和痛苦的发生情况及程度，以及相关因素。
进行了一项回顾性定量观察研究，纳入了在国外遭遇AAI后主动联系欧洲交叉援助组织的参保荷兰旅行者。设计了一份在线问卷，使用医院焦虑抑郁量表（HADS）和痛苦温度计在三个时间点测量焦虑和痛苦水平：离家时（T1）、AAI后（T2）和开始治疗时（T3）。统计分析包括t检验、卡方检验和协方差分析。
我们发现T2时平均焦虑和痛苦得分显著增加，T3时显著降低。女性更常出现焦虑和痛苦。在T1和T2之间，暴露前预防（PrEP）以及意识到风险与焦虑水平呈正相关，PrEP和世界卫生组织非洲区域与痛苦水平呈正相关。在T2和T3之间，猴子致伤、胸部损伤以及世界卫生组织东南亚区域的焦虑水平仍然较高。24至48小时的PEP延迟导致该时间段内痛苦水平降低，而II级伤口则会提高痛苦水平。
本研究表明，绝大多数旅行者在遭遇AAI后存在显著的焦虑和痛苦水平，这对他们的健康相关生活质量（HR-QOL）有害。这凸显了提供适当旅行前信息的重要性。在狂犬病预防方面，这些结果表明旅行前建议和政策制定者也应考虑HR-QOL的各个方面。
