狂犬病风险和美国暴露后预防药物管理的影响
Kelly Charniga1, Yoshinori Nakazawa1, Jen Brown2
1Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia.
JAMA network open
|June 9, 2023
概括
这项研究开发了一个模型来评估狂犬病风险,并估计推暴露后预防 (PEP) 的门. 这些发现旨在防止不必要的PEP管理,降低患者的成本和不良影响.
科学领域:
- 流行病学 流行病学
- 公共卫生 公共卫生
- 传染病建模 传染病建模
背景情况:
- 在美国,狂犬病暴露后预防 (PEP) 经常在没有适当的区域风险评估的情况下进行.
- 这种做法可能会导致不必要的患者费用和PEP的不良影响,特别是在低风险暴露的情况下.
研究的目的:
- 开发一个模型,估计暴露动物中狂犬病病毒 (RABV) 阳性的概率.
- 估计没有PEP暴露后狂犬病死亡的概率.
- 根据模型输出和公共卫生官员的投入,提出PEP建议的风险值.
主要方法:
- 使用超过90万个RABV测试结果 (2011-2020) 的决策分析建模.
- 使用贝叶斯规则和文献综述估计概率.
- 对美国公共卫生官员的调查,以确定在标准化暴露场景中PEP推门.
主要成果:
- 该模型量化了动物RABV阳性和暴露后人类狂犬病死亡率的概率.
- 动物RABV阳性的中位数概率在3×10−7到0.97.7之间.
- 估计风险值为0.0004,表明在这种概率以下可能不建议使用PEP.
结论:
- 为狂犬病PEP决策制定了一种定量,区域特定的方法.
- 该研究提供了一个框架,以告知医疗保健和公共卫生专业人员关于狂犬病PEP的适当性.
- 估计的风险值可以帮助优化PEP的管理,避免不必要的治疗.
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