Kreindel S M, McGuill M, Meltzer M, Rupprecht C, DeMaria A
Bureau of Communicable Disease Control, Massachusetts Department of Public Health, Boston 02130, USA.
Public Health Rep. 1998 May-Jun;113(3):247-51.
This study was undertaken to evaluate trends in the use of rabies postexposure prophylaxis (PEP) before, during, and following an epidemic of raccoon rabies in Massachusetts.
The authors reviewed initiation of PEP as reported to the Massachusetts Department of Public Health (MDPH) from August 1994 to December 1995 and surveyed hospital pharmacies to determine the number of vials of Human Rabies Immune Globulin (HRIG) dispensed from 1991 through 1995 and charges to patients per vial.
PEP use increased dramatically, from 1.7 per 100,000 population in 1991 (pre-epidemic) to 45 per 100,000 in 1995 (after the first stages of the epidemic). The median costs per patient for biologics was $1646 (range: $632-$3435). Including physician and emergency room charges, per-patient median costs were $2376 (range: $1038-$4447). Total health care charges for PEP in Massachusetts in 1995 were estimated at $2.4 million to $6.4 million.
Given the rapid increase in use of PEP, further studies should be undertaken to determine the appropriateness of use, and other alternatives, such as oral wildlife vaccines, should be considered.
本研究旨在评估马萨诸塞州浣熊狂犬病流行之前、期间及之后狂犬病暴露后预防（PEP）的使用趋势。
作者回顾了1994年8月至1995年12月向马萨诸塞州公共卫生部（MDPH）报告的PEP启动情况，并对医院药房进行了调查，以确定1991年至1995年期间人狂犬病免疫球蛋白（HRIG）的发放瓶数以及每瓶向患者收取的费用。
PEP的使用量急剧增加，从1991年（流行前）的每10万人1.7例增至1995年（流行第一阶段后）的每10万人45例。生物制品的人均费用中位数为1646美元（范围：632美元至3435美元）。包括医生和急诊室费用，人均费用中位数为2376美元（范围：1038美元至4447美元）。1995年马萨诸塞州PEP的医疗总费用估计为240万美元至640万美元。
鉴于PEP使用量的迅速增加，应开展进一步研究以确定使用的适当性，并应考虑其他替代方法，如口服野生动物疫苗。
