Zanetti C R, Chaves L B, Silva A C, Lee L M, Pereira O A
Instituto Pasteur, São Paulo, Brasil.
Rev Inst Med Trop Sao Paulo. 1995 Jul-Aug;37(4):349-52. doi: 10.1590/s0036-46651995000400011.
The currently used pre-exposure anti-rabies immunization schedule in Brazil is the one called 3+1, employing suckling mouse brain vaccine (3 doses on alternate days and the last one on day 30). Although satisfactory results were obtained in well controlled experimental groups using this immunization schedule, in our routine practice, VNA levels lower than 0.5 IU/ml are frequently found. We studied the pre-exposure 3+1 schedule under field conditions in different cities on the State of São Paulo, Brazil, under variable and sometimes adverse circumstances, such as the use of different batches of vaccine with different titers, delivered, stored and administered under local conditions. Fifty out of 256 serum samples (19.5%) showed VNA titers lower than 0.5 IU/ml, but they were not distributed homogeneously among the localities studied. While in some cities the results were completely satisfactory, in others almost 40% did not attain the minimum VNA titer required. The results presented here, considered separately, question our currently used procedures for human pre-exposure anti-rabies immunization. The reasons determining this situation are discussed.
巴西目前使用的暴露前抗狂犬病免疫程序是所谓的3+1程序，使用乳鼠脑疫苗（3剂，隔日接种，最后一剂在第30天接种）。尽管在使用该免疫程序的严格控制的实验组中获得了满意的结果，但在我们的常规实践中，经常发现中和抗体（VNA）水平低于0.5 IU/ml。我们在巴西圣保罗州不同城市的现场条件下，在可变且有时不利的情况下研究了暴露前3+1程序，例如使用不同批次、不同效价的疫苗，并在当地条件下进行运送、储存和接种。256份血清样本中有50份（19.5%）的VNA效价低于0.5 IU/ml，但它们在所研究的地区中分布不均匀。在一些城市，结果完全令人满意，而在另一些城市，近40%的样本未达到所需的最低VNA效价。单独来看，这里呈现的结果对我们目前使用的人类暴露前抗狂犬病免疫程序提出了质疑。本文讨论了导致这种情况的原因。
