Dreesen D W, Hanlon C A
Department of Medical Microbiology, University of Georgia, Athens, USA.
Drugs. 1998 Nov;56(5):801-9. doi: 10.2165/00003495-199856050-00005.
Once onset of clinical rabies develops in an individual, death is inevitable. Thus, it is imperative that, for persons exposed or potentially exposed to rabies virus, prophylaxis must be instituted as soon as possible following the exposure. Local wound management is an essential part of postexposure rabies prophylaxis. Exposed persons should receive a recommended series of a tissue culture or cell culture origin vaccine. The number of doses and route of vaccination differ in various regions of the world and are discussed in the text. The administration of a rabies immune globulin is generally recommended in conjunction with the first dose of the rabies vaccine. Nerve tissue origin vaccines, although used extensively in some parts of the world, are not recommended if cell or tissue culture vaccines are available. Decision trees are presented in the text to aid in determining if rabies vaccine is necessary following a known or presumed exposure to the virus, along with a table outlining the various rabies vaccines available in the World. Rabies pre-exposure immunisation is recommended for those individuals at risk of exposure to the virus. Pre-exposure prophylaxis consists of 3 doses of an approved rabies vaccine administered either intramuscularly or intradermally on days 0, 7, and 21 or 28 with periodic booster doses or titre determination depending on the level of risk of potential exposure to the virus.
一旦个体出现临床狂犬病发作，死亡将不可避免。因此，对于暴露于或可能暴露于狂犬病病毒的人来说，在暴露后必须尽快开始预防措施。局部伤口处理是暴露后狂犬病预防的重要组成部分。暴露者应接种推荐的一系列源自组织培养或细胞培养的疫苗。疫苗的剂量和接种途径在世界不同地区有所不同，本文将对此进行讨论。通常建议在接种第一剂狂犬病疫苗的同时给予狂犬病免疫球蛋白。如果有细胞或组织培养疫苗，不推荐使用神经组织来源的疫苗，尽管其在世界某些地区广泛使用。本文提供了决策树，以帮助确定在已知或疑似暴露于病毒后是否需要接种狂犬病疫苗，同时还有一个表格列出了世界上现有的各种狂犬病疫苗。对于有暴露于病毒风险的个体，建议进行狂犬病暴露前免疫。暴露前预防包括在第0、7和21或28天肌肉注射或皮内注射3剂经批准的狂犬病疫苗，并根据潜在暴露于病毒的风险水平定期进行加强剂量接种或抗体滴度测定。
