Intradermal rabies post-exposure prophylaxis can be abridged with no measurable impact on clinical outcome in Cambodia, 2003-2014

Autor: Chanthy Hing, Philippe Buchy, Chandara Phoen, Arnaud Tarantola, Sowath Ly, Philippe Dussart, Simon Cauchemez, Jean-Yves Mary, Sotheary In, Yiksing Peng, Chun Navy Taing, Hervé Bourhy, Malen Chan, Sovann Ly
Přispěvatelé: Unité d'Épidémiologie et de Santé Publique, Institut Pasteur du Cambodge, Réseau International des Instituts Pasteur (RIIP)-Réseau International des Instituts Pasteur (RIIP), Institut Pasteur de Nouvelle-Calédonie, Réseau International des Instituts Pasteur (RIIP), Ministry of Health [Phnom Penh], Modélisation mathématique des maladies infectieuses - Mathematical modelling of Infectious Diseases, Institut Pasteur [Paris]-Centre National de la Recherche Scientifique (CNRS), GlaxoSmithKline, Glaxo Smith Kline, Centre National de Référence de la Rage-Dynamique des Lyssavirus et adaptation à l'hôte (CNR), Institut Pasteur [Paris], Centre Collaborateur de l'OMS pour la Rage - Dynamique des lyssavirus et adaptation à l'hôte (CC-OMS), Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité (CRESS (U1153 / UMR_A_1125 / UMR_S_1153)), Institut National de la Recherche Agronomique (INRA)-Université Paris Diderot - Paris 7 (UPD7)-Université Paris Descartes - Paris 5 (UPD5)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Pasteur, Unité d'Épidémiologie et de Santé Publique [Phnom Penh], Institut Pasteur [Paris] (IP)-Centre National de la Recherche Scientifique (CNRS), Institut Pasteur [Paris] (IP)
Rok vydání: 2018
Předmět:
Adult
Male
Pediatrics
medicine.medical_specialty
Adolescent
Injections
Intradermal
Rabies
medicine.medical_treatment
030231 tropical medicine
03 medical and health sciences
Indirect costs
Young Adult
0302 clinical medicine
[SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases
Medicine
Humans
030212 general & internal medicine
Bites and Stings
Post-exposure prophylaxis
Aged
Retrospective Studies
General Veterinary
General Immunology and Microbiology
business.industry
Public Health
Environmental and Occupational Health
Retrospective cohort study
Middle Aged
medicine.disease
Verbal autopsy
Survival Analysis
Confidence interval
3. Good health
Vaccination
Regimen
Infectious Diseases
Treatment Outcome
Rabies Vaccines
Molecular Medicine
Female
business
Cambodia
Post-Exposure Prophylaxis
Zdroj: Vaccine
Vaccine, Elsevier, 2018, ⟨10.1016/j.vaccine.2018.10.054⟩
Vaccine, 2018, ⟨10.1016/j.vaccine.2018.10.054⟩
ISSN: 1873-2518
0264-410X
Popis: International audience; Rabies causes 60,000 deaths worldwide annually. Rabies post-exposure prophylaxis is highly effective but often geographically and financially beyond reach in endemic developing countries. We conducted a retrospective study on clinical outcome at ≥6 months in 3318 Cambodians who received intradermal Vero cell vaccine post-exposure prophylaxis after a bite by a rabid or sick-looking but untested dog in 2003-2014. An external expert panel examined verbal autopsy reports to identify rabies deaths. 1739 (93.65%) persons bitten by rabid- and 1066 (72.96%) bitten by sick-looking but untested dogs were traced and 513 were lost to follow-up. Among the former, 1591 (91.49%) and 129 (7.42%) patients referred for 4+ and 3 post-exposure prophylaxis sessions, respectively. Three persons died of probable rabies so that the overall percentage of survival was 99.83% (95% exact confidence interval: 99.49-99.96%) in post-exposure prophylaxis recipients bitten by confirmed rabid dogs. No significant difference was found in survival among patients who received 3 vs. 4+ sessions (with or without rabies immunoglobin). The power of the study, however, was limited. The current four sessions/one month intradermal regimen can be reduced to a three sessions/one week at no detectable added risk to patients, with the limitation of study power at 49%. A clinical follow-up system should be adopted by rabies prevention centers, especially to monitor implementation of an abridged course. The Institut Pasteur in Cambodia regimen will improve vaccine equity by treating 33% more patients with available doses, reduce direct cost of vaccination, transportation and other indirect costs to vaccinees.
Databáze: OpenAIRE
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