狂犬病尽管在高负担环境中进行暴露后预防:疫苗失败还是医疗保健提供缺口?
Lonika Lodha1, Shipra Gupta1, M A Ashwini1
1Department of Neurovirology, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bengaluru, India.
概括
真正的狂犬病突破性感染很罕见. 大多数病例是由于暴露后预防 (PEP) 协议不完整而造成的,而不是疫苗失效. 提高PEP的坚持对于预防狂犬病至关重要.
科学领域:
- 动物传染病是动物传播的疾病.
- 感染性脑炎是一种传染性脑炎.
- 公共卫生 公共卫生
背景情况:
- 狂犬病是一种致命的动物性脑炎,可以通过暴露后预防 (PEP) 预防.
- 尽管有PEP,但仍然存在对狂犬病病例的担忧,质疑疫苗的有效性和协议的遵守.
- 这项研究调查了明显的狂犬病"突破"感染的患病率和原因.
研究的目的:
- 评估尽管暴露后预防 (PEP) 发生狂犬病病例的负担.
- 为了确定明显狂犬病"突破"感染的潜在原因.
- 评估PEP协议在预防狂犬病方面的有效性.
主要方法:
- 从2018年至2024年实验室确认的接受PEP的狂犬病病例的回顾性分析.
- 纳入标准:至少有一次记录的狂犬病疫苗剂量.
- "真正"突破的定义:尽管在两天内启动PEP并完成所有组件,但狂犬病仍然是狂犬病.
主要成果:
- 分析了89例病例;只有3例被归类为"真正"的突破性感染.
- 大多数病例是男性 (80.90%) 和15岁以下 (64.04%).
- 世卫组织第三类暴露率高 (80.9%),狗咬伤 (93.26%) 和头部/部伤害 (34.83%).
- 在PEP交付方面存在重大差距:及时启动 (57.3%),记录伤口护理 (56.18%),完成疫苗接种 (46.07%) 和狂犬病免疫球蛋白 (26.39%用于III类).
结论:
- "真正的"狂犬病突破性感染并不常见.
- 大多数明显的PEP失败源于医疗保健提供和协议遵守方面的缺陷.
- 加强卫生保健工作者和社区对PEP关键步骤的认识,对于保持公众对狂犬病预防的信心至关重要.
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