RESUMO
This text serves to familiarize readers with animal bites and attacks. Topics include appropriate management of animal bite wounds, postexposure prophylaxis for possible rabies exposures, and unique infectious diseases transmitted through animal vectors. Large mammal attacks are discussed, in addition to the management of smaller animal attacks and exposures.
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Mordeduras e Picadas , Raiva , Mordeduras e Picadas/terapia , Animais , Humanos , Raiva/terapia , Raiva/prevenção & controle , Raiva/diagnóstico , Profilaxia Pós-ExposiçãoRESUMO
Mammal bites account for over 5 million visits to Emergency Departments (EDs) annually. Nurse Practitioners (NPs) need to stay abreast of current guidelines, changes to antibiotic regimens that are now most effective, and understand in what circumstances collaboration with other specialists is indicated. It is not enough to care for the wound, itself, but rather understand in what presentations additional care may be needed despite the fact that there is no clear evidence at the time of evaluation of the need for advanced care. Additionally, NPs should understand what resources are available within their community for wound care that may exceed the scope and ability of the facility in which they practice. Health departments may need to be utilized in the care of ED patients who present with wounds that are suspicious for rabies. Finally understanding what constitutes a high, medium, and low risk bite will aide NPs in delivering optimal care within the communities they serve while also minimizing patient morbidity.
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Mordeduras e Picadas , Serviço Hospitalar de Emergência , Profissionais de Enfermagem , Humanos , Mordeduras e Picadas/terapia , Animais , Raiva/terapia , Raiva/prevenção & controle , Mamíferos , Enfermagem em EmergênciaRESUMO
Rabies is a deadly neurotropic viral infection but is preventable through vaccination. Its impact on human and animal health is often devastating. Despite advances in research and control of this disease, along with an effective vaccine, rabies continues to be a lingering threat in many parts of the world. Its high incidence reinforces the constant need to address it with scientific and public health measures. In this review article, we will explore the most important characteristics of the disease, its distribution, symptoms, prevention methods, and the global efforts that have been made to eradicate this deadly disease. The most recent research and advancements in the field of rabies will also be discussed in an effort to understand and combat this deadly disease more effectively.
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Profilaxia Pós-Exposição , Vacina Antirrábica , Raiva , Raiva/epidemiologia , Raiva/prevenção & controle , Raiva/terapia , Humanos , Vacina Antirrábica/administração & dosagem , Animais , Profilaxia Pré-Exposição , Saúde Global , IncidênciaRESUMO
Introduction: Dog-mediated rabies is enzootic in Vietnam, resulting in at least 70 reported human deaths and 500,000 human rabies exposures annually. In 2016, an integrated bite cases management (IBCM) based surveillance program was developed to improve knowledge of the dog-mediated rabies burden in Phu Tho Province of Vietnam. Methods: The Vietnam Animal Rabies Surveillance Program (VARSP) was established in four stages: (1) Laboratory development, (2) Training of community One Health workers, (3) Paper-based-reporting (VARSP 1.0), and (4) Electronic case reporting (VARSP 2.0). Investigation and diagnostic data collected from March 2016 to December 2019 were compared with historical records of animal rabies cases dating back to January 2012. A risk analysis was conducted to evaluate the probability of a rabies exposure resulting in death after a dog bite, based on data collected over the course of an IBCM investigation. Results: Prior to the implementation of VARSP, between 2012 and 2015, there was an average of one rabies investigation per year, resulting in two confirmed and two probable animal rabies cases. During the 46 months that VARSP was operational (2016 - 2019), 1048 animal investigations were conducted, which identified 79 (8%) laboratory-confirmed rabies cases and 233 (22%) clinically-confirmed(probable) cases. VARSP produced a 78-fold increase in annual animal rabies case detection (one cases detected per year pre-VARSP vs 78 cases per year under VARSP). The risk of succumbing to rabies for bite victims of apparently healthy dogs available for home quarantine, was three deaths for every 10,000 untreated exposures. Discussion: A pilot IBCM model used in Phu Tho Province showed promising results for improving rabies surveillance, with a 26-fold increase in annual case detection after implementation of a One Health model. The risk for a person bitten by an apparently healthy dog to develop rabies in the absence of rabies PEP was very low, which supports the WHO recommendations to delay PEP for this category of bite victims, when trained animal assessors are available and routinely communicate with the medical sector. Recent adoption of an electronic IBCM system is likely to expedite adoption of VARSP 2.0 to other Provinces and improve accuracy of field decisions and data collection.
Assuntos
Mordeduras e Picadas , Raiva , Humanos , Cães , Animais , Raiva/epidemiologia , Raiva/terapia , Raiva/veterinária , Administração de Caso , Vietnã/epidemiologia , Aceitação pelo Paciente de Cuidados de Saúde , Medição de Risco , Mordeduras e Picadas/epidemiologiaRESUMO
Rabies is an infectious disease of animal origin with a high mortality rate. In the early stages of rabies, the rabies virus (RABV) is usually undetectable in saliva and cerebrospinal fluid (CSF). In addition, there are still no effective drugs and treatments. Here, we present a case in which blood purification alleviated multisystem failures. The patient was a 45-year-old woman who presented with the fear of water and wind, restlessness, and hyperactivity. RABV was detected in her saliva by high-throughput sequencing Next Generation Sequencing (NGS) and polymerase chain reaction (PCR). Based on typical clinical symptoms and the result of NGS and PCR, the patient was diagnosed as a confirmed case of rabies. Hemodialysis combined with antiviral therapy and intensive care unit (ICU) treatment can effectively relieve circulatory failure, respiratory failure, and renal failure. Finally, she died of brain death on the 34th day of admission. The case report showed that blood purification was positive for rabies-induced organ failure. Blood purification combined with antiviral therapy can prolong the lives of patients with rabies to some extent.
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Vírus da Raiva , Raiva , Animais , Feminino , Humanos , Raiva/terapia , Raiva/diagnóstico , Vírus da Raiva/genética , Reação em Cadeia da Polimerase , Saliva , Antivirais/uso terapêuticoRESUMO
Objetivo: Analisar os atendimentos antirrábicos humanos de profilaxia pós-exposição no Brasil. Métodos: Estudo descritivo utilizando dados do Sistema de Informação de Agravos de Notificação no Brasil, de 2014 a 2019. Resultados: Foram notificados 4.033.098 atendimentos antirrábicos, com média de 672.183 ao ano. Houve maior percentual de atendimentos em pessoas do sexo masculino (n = 2.111.369; 52,4%), menores de 19 anos de idade (n = 1.423.433; 35,3%), residentes em área urbana (n = 3.386.589; 88,1%), agredidas por cães (n = 3.281.190; 81,5%) e com mordeduras (n = 3.575.717; 81,9%), principalmente em mãos e pés (n = 1.541.201; 35,3%). A conduta profilática mais frequente foi observação e vacina (n = 1.736.036; 44,2%). A conduta profilática foi adequada em 57,8% (n = 2.169.689) e inadequada em 42,2% (n = 1.582.411) dos casos. Conclusão: Apesar das condutas profiláticas adequadas, foram observadas indicações inadequadas que, quando insuficientes, podem acarretar casos de raiva humana e, quando desnecessárias, desperdícios, inclusive desabastecimento de imunobiológicos.
Objetivo: Analizar la atención antirrábica humana de profilaxis post exposición en Brasil, de 2014 a 2019. Métodos: Estudio descriptivo utilizando datos del Sistema de Información de Agravamientos de Notificación en Brasil, de 2014 a 2019. Resultados: Se notificaron 4.033.098 atendimientos antirrábicos, con un promedio de 672.183 al año. Hubo mayor porcentual de atención a personas del sexo masculino (n = 2.111.369; 52,4%), menores de 19 años (n = 1.423.433; 35,3%), residentes en área urbana (n = 3.386.589; 88,1%), agredidas por perros (n = 3.281.190; 81,5%) y con mordidas (n = 3.575.717; 81,9%), principalmente en las manos y pies (n = 1.541.201; 35,3%). La conducta profiláctica más frecuente fue la observación y vacuna (n = 1.736.036; 44,2%). La conducta profiláctica fue adecuada en 57,8% (n = 2.169.689) e inadecuada en 42,2% (n = 1.582.411) de los casos. Conclusión: A pesar de las conductas profilácticas adecuadas, se observaron indicaciones inadecuadas que, cuando insuficientes, pueden resultar en casos de rabia humana y, cuando desnecesarias, desperdicios, incluso desabastecimiento de inmunobiológicos.
Objective: To analyze human anti-rabies post-exposure prophylaxis notifications in Brazil. Methods: This was a descriptive study using data from the Notifiable Diseases Information System in Brazil, from 2014 to 2019. Results: A total of 4,033,098 anti-rabies medical consultations were notified, averaging 672,183 a year. Percentage care was higher among males (n = 2,111,369; 52.4%), those under 19 years old (n = 1,423,433; 35.3%), living in urban areas (n = 3,386,589; 88.1%), attacked by dogs (n = 3,281,190; 81.5%) and bitten (n = 3,575,717; 81.9%), mainly on the hands and feet (n = 1,541,201; 35.3%). The most frequent prophylactic procedure was observation plus vaccination (n = 1,736,036; 44.2%). Prophylactic procedure was appropriate in 57.8% (n = 2,169,689) of cases and inappropriate in 42.2% (n = 1,582,411) of cases. Conclusion: Although there were appropriate prophylactic procedures, we also found procedures that were inappropriate and which, when insufficient, can result in cases of human rabies and, when unnecessary, can result in waste, including shortage of immunobiological products.
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Humanos , Animais , Raiva/terapia , Raiva/epidemiologia , Profilaxia Pós-Exposição/estatística & dados numéricos , Mordeduras e Picadas/virologia , Brasil/epidemiologia , Vacina Antirrábica/uso terapêutico , Notificação de Doenças , Doenças Negligenciadas/epidemiologiaRESUMO
If the goal of eliminating dog-mediated human rabies by 2030 is to be achieved, effective mass dog vaccination needs to be complemented by effective prophylaxis for individuals exposed to rabies. Aptamers and short-interfering RNAs (siRNAs) have been successful in therapeutics, but few studies have investigated their potential as rabies therapeutics. In this study, siRNAs and aptamers-using a novel selection method-were developed and tested against rabies virus (RABV) in a post-infection (p.i.) scenario. Multiple means of delivery were tested for siRNAs, including the use of Lipofectamine and conjugation with the developed aptamers. One siRNA (N53) resulted in an 80.13% reduction in viral RNA, while aptamer UPRET 2.03 demonstrated a 61.3% reduction when used alone at 2 h p.i. At 24 h p.i., chimera UPRET 2.03-N8 (aptamer-siRNA) resulted in a 36.5% inhibition of viral replication. To our knowledge, this is the first study using siRNAs or aptamers that (1) demonstrated significant inhibition of RABV using an aptamer, (2) tested Lipofectamine RNAi-Max as a means for delivery, and (3) produced significant RABV inhibition at 24 h p.i. This study serves as a proof-of-concept to potentially use aptamers and siRNAs as rabies immunoglobulin (RIG) replacements or therapeutic options for RABV and provides strong evidence towards their further investigation.
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Vírus da Raiva , Raiva/prevenção & controle , Raiva/terapia , Animais , Aptâmeros de Nucleotídeos , Células Cultivadas , Ensaios Clínicos como Assunto , Gerenciamento Clínico , Modelos Animais de Doenças , Terapia Genética/métodos , Humanos , Pré-Medicação , Interferência de RNA , RNA Interferente Pequeno/genética , Raiva/virologia , Vírus da Raiva/genética , Técnica de Seleção de Aptâmeros , Replicação Viral/genéticaRESUMO
Rabies is a rare, yet nearly universally fatal diagnosis, responsible for over 59,000 deaths worldwide annually. Appropriate use of pre- and postexposure prophylaxis can eliminate the risk of developing rabies if administered according to the United States Centers for Disease Control and Prevention Advisory Committee on Immunization Practices guidelines. Though rabies is very rare, rapid recognition of potential exposures is vital to patient care and protection of public health. This review focuses on the challenges of managing patients who are at risk for or have had a potential rabies exposure, indications and guidelines for administering pre- or postexposure prophylaxis, and requirements for reporting, testing, and monitoring. Evidence regarding management of patients presenting with suspected clinical rabies is also reviewed.
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Serviço Hospitalar de Emergência , Raiva/diagnóstico , Raiva/terapia , Animais , Diagnóstico Diferencial , Humanos , Profilaxia Pós-Exposição , Profilaxia Pré-Exposição , Raiva/epidemiologia , Raiva/veterinária , Estados Unidos/epidemiologiaRESUMO
A 4-year-old boy was admitted with an acute onset fever for 4 days and drowsiness for 3 days, followed by progressive flaccid weakness of both lower limbs and encephalopathy soon after admission. He had sustained a WHO Class III stray dog bite 2 weeks previously and had received three doses of post-exposure rabies vaccination with purified vero cell vaccine but not rabies immunoglobulin. He was diagnosed with rabies based on the presence of rabies virus neutralising antibody in CSF (Day 1 1:128 and Day 26 1:2048) and typical findings on neuro-imaging. Rabies viral RNA was not detected in CSF, in saliva or on nuchal skin. The child survived with supportive treatment alone but he has extensive neurological sequelae. This report demonstrates the detailed clinico-investigative profile of a child who survived rabies following inadequate post-exposure prophylaxis and adds to the sparse knowledge of this usually fatal condition. ABBREVIATIONS: ADEM, acute disseminated encephalomyelitis; CBNAAT, cartridge-based nucleic acid amplification test; CSF, cerebrospinal fluid; EEG, electroencephalogram; GCS, Glasgow coma scale; EVM, eye opening, best verbal response, best motor response; IM, intramuscular; IVIg, intravenous immunoglobulin; MRC, Medical Research Council; MRI/FLAIR, magnetic resonance imaging/fluid attenuation inversion recovery; PCR, polymerase chain reaction; RFFIT, rapid fluorescent focus inhibition test; RIg, rabies immunoglobulin; RNA, ribonucleic acid; WBC, white blood cells; WHO, World Health Organization.
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Raiva/terapia , Anticorpos Antivirais/líquido cefalorraquidiano , Pré-Escolar , Humanos , Imageamento por Ressonância Magnética , Masculino , RNA Viral/análise , SobreviventesRESUMO
OBJECTIVES: To determine the epidemiological features of patients and animals after bites/scratches from rabies-suspected animals in Zenica-Doboj Canton, Bosnia and Herzegovina. METHODS: Data from all patients (and the causative animals) admitted to the Antirabies Service of the Institute for Health and Food Safety Zenica in the 2009-2017 period were analyzed, including age, sex, anatomical site of the bite/scratch, animal type (stray/owned/wildlife), veterinary observations of the animal, and whether antirabies post-exposure prophylaxis (PEP) was indicated and/or administered. RESULTS: In total, 1716 patients were admitted. Bites/scratches were most frequently recorded during April and May (n=181, 10.5% and n=163, 9.5%, respectively). The persons admitted were mostly from the Zenica municipality (n=1278, 74.5%; incidence: 11.55/ 1000), which is 66.6% urbanized. Males were more frequently represented (n=1089, 63.6%). The patients were mostly 50-64 and 25-49 years of age (n=425, 24.7% and n=390, 22.7%, respectively). Dog bites were the most common cause (n=1634, 95.1%, of which n=1258, 77.0% were caused by stray dogs). PEP was indicated for 997 (58.1%) patients. Only 340 (19.9%) animals underwent veterinary observations (3.1% of stray and 76.1% of owned animals). The largest number of injuries were presented at lower extremities, 1044 (60.8%) cases. CONCLUSIONS: Zenica-Doboj Canton is a rabies-free region. Due to the high rate of stray animals not undergoing veterinary observations, the non-existence of a unique dog registry, and the consequent lack of information about stray animals in terms of number, vaccination, neutering, and euthanasia, there is an urgent need for improving the prevention and control of rabies within the One Health framework.
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Mordeduras e Picadas/complicações , Raiva/terapia , Adolescente , Adulto , Idoso , Animais , Comportamento Animal , Mordeduras e Picadas/epidemiologia , Bósnia e Herzegóvina , Gatos , Criança , Pré-Escolar , Cães , Feminino , Humanos , Lactente , Masculino , Camundongos , Pessoa de Meia-Idade , Profilaxia Pós-Exposição/métodos , Profilaxia Pós-Exposição/estatística & dados numéricos , Coelhos , Raiva/epidemiologia , Estudos Retrospectivos , Vacinação/métodos , Vacinação/estatística & dados numéricosRESUMO
On January 4, 2019 an eight-year-old girl child was bitten by a suspected rabid dog over the left parotid region. After a 17-h delay, the child was brought for rabies postexposure prophylaxis (PEP) at Civil Hospital Theog and was administered complete PEP. On January 29, 2019, the child was again brought to Theog Hospital with complaints of having fever, difficulty in walking, neck drop, and ptosis. On examination, pediatrician found photophobia, phonophobia, and hydrophobia and subsequently the patient died of cardiac arrest. On postmortem examination, the facial nerve was found dissected and injured at the inner end of the parotid gland. A severed end toward the brain was swollen and edematous. The entire brain was extracted and sent to Central Research Institute Kasauli for confirmation of rabies, where it tested positive for rabies by Fluorescent Antibodies Test and Biological Test. In situations where sensitive parts such as the face are involved, a thorough wound wash with soap and water and application of antiseptics along with immediate PEP may save some lives by not allowing the virus enough time to attach to and infect the nerve cells.
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Mordeduras e Picadas , Nervo Facial/virologia , Profilaxia Pós-Exposição , Raiva/prevenção & controle , Animais , Criança , Cães , Nervo Facial/patologia , Evolução Fatal , Feminino , Humanos , Raiva/terapia , Falha de TratamentoRESUMO
Revision of the rabies policy in the Netherlands The WHO aims to eliminate dog-transmitted rabies deaths in humans by 2030 ('zero by 30'). The Dutch rabies policy advisory board has revised its national rabies guidelines on the basis of the WHO guidelines revised in 2018. In the revised Dutch guidelines, there is increased focus on the importance of instant wound care after potential exposure to the rabies virus. Pre-exposure prophylaxis (PrEP) is limited to two vaccines given on days 0 and 7, rather than the previous regime of three vaccines. Post-exposure prophylaxis (PEP) no longer consists of five vaccines for unvaccinated individuals; instead it is four vaccines on days 0, 3, 7, and 14-28. For type III wounds, when indicated, rabies immunoglobulin (RIG) is only injected into and around the wound bed; residual volumes are no longer administered intramuscularly. RIG no longer needs to be administered in cases of potential mucosal contact exposure to the rabies virus where there is no injury. The vaccination scheme for PrEP (3) and PEP (5) does not change for immunocompromised patients, and RIG is administered regardless of the vaccination status of the affected individual.
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Política de Saúde , Raiva/terapia , Humanos , Fatores Imunológicos/uso terapêutico , Países Baixos , Profilaxia Pós-Exposição/métodos , Profilaxia Pós-Exposição/normas , Guias de Prática Clínica como Assunto , Profilaxia Pré-Exposição/métodos , Profilaxia Pré-Exposição/normas , Vacina Antirrábica/administração & dosagem , Organização Mundial da Saúde , Técnicas de Fechamento de FerimentosRESUMO
Notwithstanding the availability of effective vaccines, 40 - 60 thousand rabies cases in humans are reported every year. Almost always the disease is fatal because therapeutic treatment of lyssavirus encephalitis has not been developed. Since 1970 the number of reports on rare cases of convalescence including those using experimental treatment protocols has been gradually increasing 20 cases of convalescence, "partial" convalescence or long-term survival of humans (1970-2015) were selected as they were complaint with laboratory criteria of active lyssavirus infection. Children and teenagers were predominant in the analyzed group (85%). The cases were irregularly spread between the continents: Asia - 6 cases, North America - 6 cases, Africa - 2 cases and Europe - 1 case. India and the USA were on the top of the list of countries by the number of described cases. More than 60% humans were infected from dogs, three cases got infection from bats and 2 cases were allegedly associated with an unknown lyssavirus and an unidentified infection source. 70% cases were vaccinated and 10% cases were treated with gamma globulin before the disease onset. Serological tests for detection of antibodies to lyssaviruses in cerebrospinal fluid of infected humans were typically used for diagnostic laboratory verification. Less than 30% IFA and PCR positives were obtained. Lyssaviruses were never detected. Only 4 convalescent patients were treated using experimental protocols. 80% cases demonstrated severe neurological consequences, four (may be more) patients died afterwards within the period from two months to four years. Different perspectives on prospects of Milwaukee protocol use and other therapeutic techniques are given.
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Convalescença , Lyssavirus , Raiva , Animais , Cães , Encefalite Viral/diagnóstico , Encefalite Viral/epidemiologia , Encefalite Viral/genética , Encefalite Viral/terapia , Humanos , Lyssavirus/genética , Lyssavirus/metabolismo , Raiva/diagnóstico , Raiva/epidemiologia , Raiva/genética , Raiva/terapiaRESUMO
Zoonotic pathogens such as Ebola and rabies pose a major health risk to humans. One proven approach to minimizing the impact of a pathogen relies on reducing its prevalence within animal reservoir populations using mass vaccination. However, two major challenges remain for vaccination programs that target free-ranging animal populations. First, limited or challenging access to wild hosts, and second, expenses associated with purchasing and distributing the vaccine. Together, these challenges constrain a campaign's ability to maintain adequate levels of immunity in the host population for an extended period of time. Transmissible vaccines could lessen these constraints, improving our ability to both establish and maintain herd immunity in free-ranging animal populations. Because the extent to which vaccine transmission could augment current wildlife vaccination campaigns is unknown, we develop and parameterize a mathematical model that describes long-term mass vaccination campaigns in the US that target rabies in wildlife. The model is used to investigate the ability of a weakly transmissible vaccine to (1) increase vaccine coverage in campaigns that fail to immunize at levels required for herd immunity, and (2) decrease the expense of campaigns that achieve herd immunity. When parameterized to efforts that target rabies in raccoons using vaccine baits, our model indicates that, with current vaccination efforts, a vaccine that transmits to even one additional host per vaccinated individual could sufficiently augment US efforts to preempt the spread of the rabies virus. Higher levels of transmission are needed, however, when spatial heterogeneities associated with flight-line vaccination are incorporated into the model. In addition to augmenting deficient campaigns, our results show that weak vaccine transmission can reduce the costs of vaccination campaigns that are successful in attaining herd immunity.
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Vacinação em Massa/métodos , Vacina Antirrábica/administração & dosagem , Vírus da Raiva/imunologia , Raiva/prevenção & controle , Raiva/veterinária , Zoonoses/prevenção & controle , Administração Oral , Animais , Reservatórios de Doenças/veterinária , Reservatórios de Doenças/virologia , Humanos , Imunidade Coletiva/imunologia , Modelos Teóricos , Prevalência , Raiva/epidemiologia , Raiva/terapia , Vacina Antirrábica/imunologia , Vírus da Raiva/patogenicidade , Guaxinins/imunologia , Guaxinins/virologia , Estados Unidos/epidemiologia , Zoonoses/epidemiologia , Zoonoses/terapia , Zoonoses/virologiaAssuntos
Mordeduras e Picadas/complicações , Haplorrinos , Viagem , Viroses/etiologia , Viroses/transmissão , Adulto , Animais , Antivirais/uso terapêutico , Comportamento Animal , Mordeduras e Picadas/virologia , Feminino , Infecções por Herpesviridae/tratamento farmacológico , Infecções por Herpesviridae/etiologia , Infecções por Herpesviridae/prevenção & controle , Infecções por Herpesviridae/transmissão , Humanos , Masculino , Raiva/etiologia , Raiva/prevenção & controle , Raiva/terapia , Raiva/transmissão , Resultado do Tratamento , Viroses/tratamento farmacológico , Viroses/prevenção & controle , Adulto JovemRESUMO
Rabies is an ancient and neglected zoonotic disease caused by the rabies virus, a neurotropic RNA virus that belongs to the Rhabdoviridae family, genus Lyssavirus. It remains an important public health problem as there are cost and health concerns imposed by the current human post exposure prophylaxis therapy. The use of monoclonal antibodies (mAbs) is therefore an attractive alternative. Rabies mostly affects people that reside in resource-limited areas where there are occasional failures in the cold-chain. These environmental changes may upset the stability of the mAbs. This study focused on mAbs 62-71-3 and E559; their structures, responses to freeze/thaw (F/T) and exposure to reactive oxygen species were therefore studied with the aid of a wide range of biophysical and in silico techniques in order to elucidate their stability and identify aggregation prone regions. E559 was found to be less stable than 62-71-3. The complementarity determining regions (CDR) contributed the most to its instability, more specifically: peptides 99EIWD102 and 92ATSPYT97 found in CDR3, Trp33 found in CDR1 and the oxidised Met34. The constant region "158SWNSGALTGHTFPAVL175" was also flagged by the special aggregation propensity (SAP) tool and F/T experiments to be highly prone to aggregation. The E559 peptides "4LQESGSVL11 from the heavy chain and 4LTQSPSSL11 from the light chain, were also highly affected by F/T. These residues may serve as good candidates for mutation, in the aim to bring forward more stable therapeutic antibodies, thus paving a way to a more safe and efficacious antibody-based cocktail treatment against rabies.
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Anticorpos Monoclonais/química , Anticorpos Antivirais/química , Vírus da Raiva/imunologia , Raiva/terapia , Anticorpos Monoclonais/genética , Anticorpos Monoclonais/metabolismo , Anticorpos Monoclonais/uso terapêutico , Anticorpos Antivirais/genética , Anticorpos Antivirais/metabolismo , Anticorpos Antivirais/uso terapêutico , Temperatura Baixa/efeitos adversos , Regiões Determinantes de Complementaridade/química , Regiões Determinantes de Complementaridade/genética , Simulação por Computador , Estabilidade de Medicamentos , Armazenamento de Medicamentos , Humanos , Testes de Neutralização , Plantas Geneticamente Modificadas/genética , Plantas Geneticamente Modificadas/metabolismo , Engenharia de Proteínas/métodos , Proteólise , Raiva/imunologia , Raiva/virologia , Espécies Reativas de Oxigênio/química , Nicotiana/genética , Nicotiana/metabolismoRESUMO
Rabies is still a public health threat in China. Evaluating the exposure history, clinical characteristics, and post-exposure prophylaxis (PEP) of the cases could help in identifying approaches to reducing the number of these preventable deaths. We analysed data collected from 10,971 case-investigations conducted in China from 2006 to 2012. Most cases (n = 7,947; 92.0%) were caused by animal bites; 5,800 (55.8%) and 2,974 (28.6%) exposures were from domestic and free-roaming dogs, respectively. Only 278 (4.8%) of these domestic dogs had previously received rabies vaccination. Among all cases, 5,927 (59.7%) cases had category III wounds, 1,187 (11.7%) cases initiated the rabies PEP vaccination and 234 (3.9%) cases with category III wounds received rabies immunoglobulin. In our adjusted logistic regression model, male cases (adjusted odds ratio [aOR] = 1.25, 95% confidence interval [CI]: 1.09-1.44) and farmers (aOR = 1.39, 95% CI: 1.10-1.77) and person older than 55 years (aOR = 1.48, 95% CI: 1.01-2.17) were less likely than females and persons in other occupations or younger than 15 years to initiate PEP vaccination. The median incubation period was 66 days (interquartile range (IQR): 33-167 days). To reduce the number of human deaths due to rabies, rabies prevention campaigns targeting males and farmers and older people should be conducted. Increasing routine rabies vaccination among domestic dogs will be essential in the long term.
Assuntos
Profilaxia Pós-Exposição/métodos , Raiva/epidemiologia , Raiva/terapia , Fatores Etários , Anticorpos Antivirais/administração & dosagem , China/epidemiologia , Feminino , Humanos , Imunoglobulina G/administração & dosagem , Masculino , Pessoa de Meia-Idade , Exposição Ocupacional/estatística & dados numéricos , Raiva/patologia , Vacina Antirrábica/administração & dosagem , Fatores SexuaisRESUMO
This article presented the World Health Organization's (WHO) recommendations on the use of Rabies vaccines excerpted from the Rabies vaccines: WHO position paper - April 2018 published in the Weekly Epidemiological Record [1] This position paper replaces the 2010 WHO position paper on rabies vaccines [2]. It presents new evidence in the field of rabies and the use of rabies vaccines, focussing on programmatic feasibility, simplification of vaccination schedules and improved cost-effectiveness. The recommendations concern the 2 main immunization strategies, namely vaccination for post-exposure prophylaxis and vaccination for pre-exposure prophylaxis. In the context of post-exposure prophylaxis, recommendations are also provided on the use of rabies immunoglobulins. Footnotes to this paper provide a number of core references including references to grading tables that assess the quality of the scientific evidence, and to the evidence-to-recommendation tables. In accordance with its mandate to provide guidance to Member States on health policy matters, WHO issues a series of regularly updated position papers on vaccines and combinations of vaccines against diseases that have an international public health impact. These papers are concerned primarily with the use of vaccines in large-scale immunization programmes; they summarize essential background information on diseases and vaccines, and conclude with WHO's current position on the use of vaccines in the global context. Recommendations on the use of cholera vaccines were discussed by the Strategic Advisory Group of Experts (SAGE) in October 2017; evidence presented at these meetings can be accessed at: http://www.who.int/immunization/sage/meetings/2017/october/presentations_background_docs/en/.
Assuntos
Imunização/normas , Profilaxia Pós-Exposição/normas , Vacina Antirrábica/uso terapêutico , Raiva/prevenção & controle , Organização Mundial da Saúde , Política de Saúde , Humanos , Programas de Imunização/organização & administração , Programas de Imunização/estatística & dados numéricos , Saúde Pública , Raiva/terapia , Vacina Antirrábica/efeitos adversosRESUMO
Once a person is exposed to the rabies virus, it is universally fatal unless postexposure prophylaxis (PEP) is administered promptly. In the United States, determining whether PEP recommeded is often a collaborative effort where health departments work with both animal and human healthcare professionals to enact animal quarantines (or rabies testing), recommending PEP when appropriate. A failure in the knowledge base of either profession can result in incorrect PEP recommendations and an increased risk of adverse outcomes. To assess rabies knowledge in licensed physicians and veterinarians practicing in Washington, DC, we conducted a survey from December 2, 2016, to January 2, 2017, assessing their knowledge of the clinical signs, epidemiology and the primary vectors of rabies. These responses were compared between the two groups. Physician-specific or veterinary-specific questions regarding the correct PEP schedule and administration site or animal quarantine recommendations, respectively, were also included. Nine hundred and fifty-two physicians and 125 veterinarians responded. Veterinarians were more likely to select the correct vectors and clinical signs in animals than physicians. Physicians more likely selected the correct transmission routes. Less than half of physicians identified the correct PEP schedule (39.4%) and administration site (49.0%). Half of veterinarians (50.0%) correctly identified quarantine length for wildlife-exposed vaccinated dogs compared to only 19.4% for unvaccinated dogs. Several knowledge gaps were identified amongst physicians and veterinarians. Due to the fatal nature of rabies, it is important that all healthcare providers have an understanding of current recommendations. Health departments can work to correct these gaps and serve as a bridge between human and animal healthcare professionals.