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 |
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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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