Saito Nobuo, Inton Karren L, Mauhay Jaira D, Solante Rontgene M, Guzman Ferdinand D, Yamada Kentaro, Kamiya Yasuhiko, Saito-Obata Mariko, Quiambao Beatriz P, Yahiro Takaaki, Kimitsuki Kazunori, Nishizono Akira
Research Center for Global and Local Infectious Diseases, Oita University, Yufu, Japan.
Department of Microbiology, Faculty of Medicine, Oita University, Yufu, Japan.
Front Microbiol. 2024 Jul 8;15:1425766. doi: 10.3389/fmicb.2024.1425766. eCollection 2024.
While rabies remains a global concern, detailed studies on human rabies, particularly regarding causal animals and the reasons for not receiving postexposure prophylaxis (PEP), are lacking.
We conducted a 3-year prospective study (October 2019-September 2022) at the Philippines' largest rabies referral center. We interviewed patients with suspected rabies and their families. We used LN34 qRT-PCR and rapid fluorescent focus inhibition test on saliva samples. We also compared our findings with two retrospective studies at the same hospital.
We enrolled 151 patients, including 131 with potential rabies exposure. Similar to retrospective studies, the participants were predominantly males (75.5%), adults (76.8%), low-income individuals (91.4%), and rural dwellers (62.3%). The causal animals were mainly dogs (97.0%), with similar incubation periods, clinical symptoms, and a high proportion not receiving vaccines or immunoglobulins (93.2%). Most causal animals were owned by either the patients' households or their neighbors (60.2%), with a significant proportion being puppies (58.8%). Most patients had knowledge of rabies; however, reasons for not seeking PEP included misconceptions about minor bites not causing rabies (51.3%), beliefs in traditional healers (33.9%), and economic constraints (22.6%). Despite completing the WHO regimen, two PEP failures were observed. LN34 qRT-PCR detected 98 positive cases (sensitivity, 64.9%; 95% CI 56.7-72.5). These strains belong to the Southeast Asia 4 subclade.
In conclusion, this study highlights the role of puppies as primary causal animals and the presence of misconceptions that preclude patients from acquiring PEP.
尽管狂犬病仍是全球关注的问题，但关于人类狂犬病的详细研究，特别是关于致病动物以及未接受暴露后预防（PEP）的原因，仍较为缺乏。
我们在菲律宾最大的狂犬病转诊中心进行了一项为期3年的前瞻性研究（2019年10月至2022年9月）。我们采访了疑似狂犬病患者及其家属。我们对唾液样本进行了LN34 qRT-PCR和快速荧光灶抑制试验。我们还将我们的研究结果与同一家医院的两项回顾性研究进行了比较。
我们纳入了151名患者，其中131名有潜在的狂犬病暴露。与回顾性研究相似，参与者主要为男性（75.5%）、成年人（76.8%）、低收入个体（91.4%）和农村居民（62.3%）。致病动物主要是狗（97.0%），潜伏期、临床症状相似，且未接种疫苗或免疫球蛋白的比例较高（93.2%）。大多数致病动物为患者家庭或其邻居所拥有（60.2%），其中很大一部分是幼犬（58.8%）。大多数患者了解狂犬病；然而，未寻求PEP的原因包括认为轻微咬伤不会导致狂犬病的误解（51.3%）、相信传统治疗师（33.9%）和经济限制（22.6%）。尽管完成了世界卫生组织的治疗方案，但仍观察到两例PEP失败。LN34 qRT-PCR检测到98例阳性病例（敏感性，64.9%；95%CI 56.7-72.5）。这些毒株属于东南亚4分支。
总之，本研究强调了幼犬作为主要致病动物的作用，以及存在妨碍患者获得PEP的误解。
