Rabies Vaccines

狂犬病疫苗
  • 文章类型: Journal Article
    2024年3月,人类首例狂犬病病例,在被狗咬伤之后,在东帝汶被发现。本文简要讨论了传输的情况,临床表现,对病例的姑息治疗和采取的公共卫生措施。东帝汶以前被认为没有狂犬病。任何人被可能传播狂犬病病毒的动物(尤其是狗)咬伤或抓伤,蝙蝠,应评估东帝汶的猴子或猫),以考虑提供狂犬病暴露后预防。
    In March 2024, the first ever human case of rabies, following a dog bite, was detected in Timor-Leste. This paper briefly discusses the circumstances of transmission, clinical presentation, palliative care of the case and public health measures taken. Timor-Leste was previously considered rabies-free. Any person who is bitten or scratched by an animal that could potentially transmit rabies virus (especially dogs, bats, monkeys or cats) in Timor-Leste should be assessed for consideration of provision of rabies post-exposure prophylaxis.
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  • 文章类型: Case Reports
    该病例强调了在狂犬病疫苗接种后出现急性胸痛的患者中考虑非阻塞性冠状动脉心肌梗死(MINOCA)的重要性。强调需要提高认识,并进一步研究MINOCA与狂犬病疫苗接种之间的关联。
    狂犬病是一种疫苗可预防的致命病毒性疾病,在亚洲和非洲流行,每年导致数千人死亡。狂犬病前(PrEP)和暴露后预防(PEP)在消除狂犬病相关死亡方面非常有效。狂犬病疫苗接种后的不良反应通常是轻微的。非阻塞性冠状动脉心肌梗死(MINOCA)是一种罕见的疾病,它与狂犬病疫苗接种的联系是前所未有的。我们介绍了一例43岁男性在狂犬病PEP后患有MINOCA的病例。一个43岁的男性,不吸烟和不酗酒,在完成第三剂皮内狂犬病疫苗后,向ER提出急性发作左侧胸痛的投诉,其临床特征,ECG变化和实验室报告提示下壁MI的急性表现。进行了冠状动脉造影,然而,这表明冠状动脉正常,仅在左前降支(LAD)动脉中观察到缓慢的血流。超声心动图后来显示正常研究,没有其他相关诊断在进一步的研究中公布。因此,对疫苗诱导的MINOCA进行了诊断。治疗包括抗血小板治疗,他汀类药物,和β受体阻滞剂。狂犬病疫苗接种后的MINOCA是一个前所未有的发现。这背后的明确病因无法确定。病人的治疗是常规的,强调在MINOCA诊断和管理方面需要进一步研究和临床试验。这种情况突出表明,在狂犬病疫苗接种后急性胸痛患者中,临床医生需要考虑MINOCA。进一步的研究对于解开MINOCA和狂犬病疫苗接种之间的关联至关重要,为优化管理策略铺平道路。
    UNASSIGNED: This case underscores the importance of considering myocardial infarction with nonobstructive coronary arteries (MINOCA) in patients experiencing acute chest pain following rabies vaccination, emphasizing the need for heightened awareness and further research into the association between MINOCA and Rabies vaccination.
    UNASSIGNED: Rabies is a vaccine-preventable deadly viral disease prevalent in Asia and Africa that causes thousands of deaths annually. Rabies pre (PrEP) and postexposure prophylaxis (PEP) is highly effective in annulling rabies-associated deaths. The adverse reactions following rabies vaccination are typically mild. Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a rare condition, and its association with rabies vaccination is unprecedented. We present a case of a 43-year-old male with MINOCA following Rabies PEP. A 43-year-old male, nonsmoker and nonalcoholic, presented to the ER with complaints of acute onset left sided chest pain following the completion of the third dose of intradermal rabies vaccine, whose clinical features, ECG changes and lab reports were suggestive of acute presentation of inferior wall MI. Coronary angiography was performed, which however revealed normal coronaries with only slow flow being noted in the left anterior descending (LAD) artery. Echocardiography later showed a normal study with no other relevant diagnosis unveiled on further investigations. Hence a diagnosis of vaccine-induced MINOCA was made. Treatment included antiplatelet therapy, statins, and beta-blockers. MINOCA following rabies vaccination is an unprecedented finding. The clear etiology behind this couldn\'t be ascertained. The patient\'s treatment was conventional, emphasizing the need for further research and clinical trials in MINOCA diagnosis and management. This case highlights the need for clinicians to consider MINOCA in patients with acute chest pain post-rabies vaccination. Further research is essential to unravel the association between MINOCA and rabies vaccination, paving the way for optimal management strategies.
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  • 文章类型: Journal Article
    背景:该分析评估了提交给剧院医疗数据存储(TMDS)和可报告医疗事件(RME)系统的前向部署狂犬病咨询委员会的DD2341表格(动物咬伤潜在狂犬病暴露报告)的潜在报告差异(RME),以确定可以导致改进最佳实践的报告差距,以确保将潜在狂犬病暴露后预防(PEP)记录到服务成员的电子记录(SM)中。
    方法:该项目比较了向Arifjan营地提交的服务成员动物暴露DD2341报告的数量,科威特狂犬病咨询委员会将从2018年1月1日至2019年12月31日在同一前方部署地点的战区内治疗电子记录记录在TMDS和RME数据库中。记录包括部署到美国中央司令部(USCENTCOM)责任区六个国家的现役和预备役SM。分析比较了一些人口统计信息,潜在狂犬病暴露类型(例如,无论是咬伤还是刮伤),用人类狂犬病免疫球蛋白(HRIG)对狂犬病进行PEP,人类狂犬病疫苗(HRV),或两者在报告系统之间。
    结果:来自TMDS数据记录的PEP记录比来自剧院书面报告的记录少44条。电子记录数据显示85编码狂犬病暴露诊断。22人接受了HRV,没有接受HRIG,而4人接受了PEP的HRIG和HRV。在接受狂犬病PEP的26个SM中,只有7个具有与电子记录相关的确认RME。有116份SM动物暴露书面报告,有70个报告PEP。有41条记录表明SM作为PEP的一部分接受了HRIG和HRV,而29例报告显示患者仅接受HRVPEP。在接收HRIG的41个SM中,32的暴露来自猫的划痕或咬伤。指定HRIG的7条记录已用于治疗,但在该地点不可用;因此,HRV是唯一可用的治疗方法。书面报告中指出的未接受狂犬病PEP的最常见原因是未根据动物暴露的风险类别指示治疗。
    结论:这项研究首次将电子病历数据与手术室报告中的狂犬病暴露进行了比较。分析表明,在USCENTCOM战区生成的某些书面形式未输入SM军事卫生系统电子病历,这表明,在部署的环境中,电子病历可能比狂犬病计划监测的手术室报告更不敏感。TMDS和RME数据库中狂犬病PEP的电子病历报告不足。根据武装部队健康监测司的指南和病例定义,狂犬病PEP是RME。需要将DD2341更好地集成到电子病历系统中。
    BACKGROUND: This analysis evaluates potential reporting discrepancies of the DD2341 Form (Report of Animal Bite-Potential Rabies Exposure) submitted to a forward-deployed Rabies Advisory Board to the Theater Medical Data Store (TMDS) and Reportable Medical Event (RME) systems to identify reporting gaps that can lead to improved best practices that ensure documentation of Post Exposure Prophylaxis (PEP) of potential rabies exposures into service members (SMs) electronic medical records.
    METHODS: The project compares the number of Service Member animal exposure DD2341 reports submitted to the Camp Arifjan, Kuwait Rabies Advisory Board to in-theater treatment electronic records at the same forward deployed locations from January 1, 2018 to December 31, 2019 recorded in the TMDS and RME databases. Records included active duty and reserve SM deployed to six countries in the United States Central Command (USCENTCOM) area of responsibility. The analysis compared some demographic information, type of potential rabies exposure (e.g., whether a bite or scratch), and PEP to rabies with Human Rabies Immune Globulin (HRIG), Human Rabies Vaccine (HRV), or both between the reporting systems.
    RESULTS: There were 44 fewer records of PEP from the TMDS data records than reported from in theater written reports. Electronic record data showed 85 coded rabies exposure diagnoses. Twenty-two received HRV and no HRIG, while four received HRIG and HRV for PEP. Only seven of the 26 SM receiving rabies PEP had a confirmed RME associated with the electronic record. There were 116 SM animal exposure written reports, with 70 reporting PEP. There were 41 records indicating the SM received HRIG and HRV as part of PEP, while 29 reports indicated that the patient received only HRV PEP. Of the 41 SM receiving HRIG, 32 of the exposures were from cat scratches or bites. Seven records specified HRIG was indicated for treatment but not available at the location; therefore, HRV was the only treatment available. The most common reason indicated on the written report for not receiving rabies PEP was that treatment was not indicated based on the risk category of animal exposure.
    CONCLUSIONS: This study is the first to compare the electronic medical record data to in theater reports for potential rabies exposure in a theater of operations. The analysis suggests that some written forms generated in the USCENTCOM theater are not entered into SM Military Health System electronic medical records, indicating that electronic medical records may be a less sensitive method than in-theatre reports for rabies program surveillance in a deployed setting. There is under-reporting in electronic medical records of rabies PEP in both TMDS and RME databases. Rabies PEP is an RME according to the Armed Forces Health Surveillance Division guidelines and case definitions. There needs to be better integration of the DD2341 into the electronic medical records system.
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  • 文章类型: Case Reports
    背景:在包括不丹在内的许多发展中国家,狂犬病继续构成重大的公共卫生挑战。我们医院收治了一例可能的狂犬病病例,其报告导致发现了家畜和野生动物的爆发。我们讨论了在资源有限的情况下狂犬病诊断和管理的挑战。
    方法:一名35岁男性出现间歇性发热,迅速进展的双侧下肢无力,伴有心悸和出汗的尿失禁。他在右下大腿上咬伤了III类,有四个咬痕,由流浪狗造成的。他接受了真皮内抗狂犬病疫苗的暴露后预防。在初步检查中,病人很痛苦,但合作接受采访。他的脉搏率从60到100/min不等,伴有出汗和心悸发作,但毛细血管血糖正常.在下肢,肌肉力量为零,下肢肌腱反射缺失,T10水平以下腹部反射受损。他有T8以下的感觉过度,恐惧症,畏气和畏光。他在大腿和右三角肌都有多个自发的肌束,后来又累及肋间肌,颈部和面部肌肉。他改变了感觉和去饱和,因此需要机械通气。脑脊液和唾液中狂犬病病毒的聚合酶链反应阴性。狂犬病病毒中和抗体在脑脊液中呈阴性,但在血清中具有高滴度。入院后接受人狂犬病免疫球蛋白治疗。他在重症监护室接受治疗,23天后死亡。接到通知后,在现场部署了一个快速反应小组,并发现了当地动物的狂犬病爆发。
    结论:该案例要求对该国在2030年前实现零狂犬病死亡的努力进行认真评估。此案的管理确定了不丹针对具体情况的干预措施的几个关键领域。还迫切需要提高国家参考实验室的诊断能力,并提高医护人员在管理狗咬伤病例方面的技术能力。
    BACKGROUND: Rabies continues to pose significant public health challenges in many developing countries including Bhutan. A probable case of rabies was admitted to our hospital and its reporting led to the uncovering of an outbreak in domestic and wild animals. We discuss the challenges in the diagnosis and management of rabies in a resource-limited setting.
    METHODS: A 35-year-old male presented with intermittent fever, bilateral lower limb weakness that was rapidly progressive, urinary incontinence with episodes of palpitations and sweating. He had sustained a Category III bite on the right lower thigh with four bite marks, inflicted by a stray dog. He had received post-exposure prophylaxis with intra-dermal anti-rabies vaccine. On initial examination, the patient was in distress but cooperative for the interview. He had pulse rate ranging from 60 to 100/min with episodes of diaphoresis and palpitations, but with normal capillary blood glucose. In the lower limb, the muscle power was zero with absent tendon reflexes in the lower limb and impaired abdominal reflex below T10 level. He had hyperaesthesia below T8, hydrophobia, aerophobia and photophobia. He had multiple spontaneous fasciculations in both the thighs and right deltoid and these later involved the intercostal muscles, neck and face muscles. He had altered sensorium and desaturation for which he required mechanical ventilation. Polymerase chain reaction for rabies virus was negative in cerebrospinal fluid and saliva. Rabies virus neutralizing antibody was negative in cerebrospinal fluid but had high titres in the serum. He received Human Rabies Immunoglobulin after admission. He was managed in the intensive care unit and died 23 days later. After this case was notified, a rapid response team was deployed in the field, and uncovered rabies outbreak in animals in the locality.
    CONCLUSIONS: This case called for a serious evaluation of the country\'s efforts in achieving zero rabies deaths by 2030. The management of this case identified several critical areas of context-specific interventions in Bhutan. There is also an urgent need to improve diagnostic capabilities at the national reference laboratory and enhance the technical competencies of healthcare workers in the management of dog bite cases.
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  • 文章类型: Case Reports
    背景:狂犬病暴露后预防继发的血清病在医学文献中没有很好的记载。我们的案例描述了一名年轻成年男性暴露于人源狂犬病免疫球蛋白(HRIG)和三种人二倍体狂犬病疫苗(HDCV)后的血清病。
    方法:一名30岁以前健康的男性患者因发烧而向急诊科就诊,皮疹,和黄疸,并有一个住院过程并发胆道狭窄可能继发于反应性门脉周围淋巴结病。他的初始实验室值显示阻塞性黄疸和补体成分4水平略有升高。这些症状可能是由于患者在家中暴露于狂犬病阳性蝙蝠后完成的HRIG和HDCV疫苗的过程。病人住院8天,在此期间,他接受了内镜逆行胰胆管造影术,括约肌切开术和胆道支架置入术。他因括约肌切开术导致的急性失血性贫血而再次住院,不需要输血或进一步干预。肝活检显示胆汁淤积性肝炎。为什么急诊医生应该意识到这一点?:尽管暴露后狂犬病预防在医疗保健中具有普遍性,但描述血清病或因暴露于HRIG或HDCV而发生的血清病样反应的医学文献很少。重要的是要教育从业者这种潜在的并发症,并强调下一个潜在的咨询和治疗。
    Serum sickness secondary to rabies postexposure prophylaxis is not well documented in the medical literature. Our case describes serum sickness after exposure to human-derived rabies immunoglobulin (HRIG) and three human diploid rabies vaccines (HDCV) in a young adult male.
    A 30-year-old previously healthy male patient presented to the Emergency Department with complaints of fever, rash, and jaundice, and had a hospital course complicated by biliary stenosis likely secondary to reactive periportal lymphadenopathy. His initial laboratory values demonstrated obstructive jaundice and slightly elevated complement component 4 levels. These symptoms likely are due to the course of HRIG and HDCV vaccines the patient completed after being exposed to a rabies-positive bat in his home. The patient was hospitalized for 8 days, during which he underwent an endoscopic retrograde cholangiopancreatography with sphincterotomy and biliary stenting. He had one repeat hospitalization for acute blood loss anemia attributed to sphincterotomy, which did not require transfusion or further intervention. Liver biopsy showed cholestatic hepatitis. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Medical literature describing serum sickness or a serum sickness-like reaction occurring from exposure to HRIG or HDCV is sparse despite the commonality of postexposure rabies prophylaxis in health care. It is important to educate practitioners on this potential complication and highlight next potential consultations and treatments.
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  • 文章类型: Case Reports
    一个来自马哈拉施特拉邦的3.5岁男孩,印度,在一只流浪狗的右手遭受严重咬伤后约1个月,表现出脑膜脑炎的特征。他接受了四剂暴露后的皮内狂犬病疫苗接种(在咬伤的第0、3和7天,错误地在第20天,而不是更新的泰国红十字会方案中建议的第28天)以及局部和全身注射马狂犬病免疫球蛋白。在通过检测脑脊液中的狂犬病病毒中和抗体证实狂犬病脑炎之前,该儿童最初被诊断为急性脑炎综合征并接受治疗。在紧急时期,他还收到了抗疟药青蒿琥酯,最近报道对狂犬病病毒有抗病毒作用。在重症监护和支持性护理下,在接下来的几周里,这个孩子的临床症状有了很大的改善。他现在已经在疾病发作后存活了10个多月,尽管有严重的神经系统后遗症,包括弥漫性脑和小脑萎缩。
    A 3.5-year-old male child from Maharashtra, India, presented with features of meningoencephalitis approximately 1 month after sustaining severe bite injuries on the right hand from a stray dog. He had received four doses of post-exposure intradermal rabies vaccination (on days 0, 3, and 7 of the bite and erroneously on day 20, instead of day 28 as recommended in the updated Thai Red Cross regimen) as well as local and systemic injections of equine rabies immune globulin. The child was initially diagnosed with and treated for acute encephalitis syndrome before rabies encephalitis was confirmed by detection of rabies virus neutralizing antibodies in the cerebrospinal fluid. During the emergent period, he also received the antimalarial drug artesunate, recently reported to have antiviral effects against rabies virus. With intensive and supportive care, the child showed substantial clinical improvement over the next few weeks. He has now survived for more than 10 months after disease onset, albeit with severe neurological sequelae including diffuse cerebral and cerebellar atrophy.
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  • 文章类型: Journal Article
    成功的预防,control,由于资源不足和位置不足,消除狗介导的狂犬病具有挑战性。集成的狗咬伤病例管理(IBCM)系统加上狗疫苗接种可以帮助解决这些挑战。根据海地IBCM系统的数据,我们对新建立的IBCM系统加上持续疫苗接种进行了成本效益评估,并将其与1)无咬伤病例管理(NBCM)和2)非基于风险(NRB)计划进行了比较,无论风险评估如何,在健康诊所就诊的咬伤受害者都将接受暴露后预防。我们还为正在进行的IBCM系统和次优的狗疫苗接种覆盖率提供成本效益指导,考虑到并非所有具有成本效益的干预措施都是负担得起的。成本效益结果包括避免人类死亡的平均成本(美元/避免死亡)和获得生命年的平均成本(LYG)。分析采用了政府视角。考虑到持续5年的实施,70%的狗疫苗接种覆盖率,IBCM避免的平均死亡费用(IBCM:$7,528,NBCM:$7,797,NRB:$15,244)和每个LYG的费用(IBCM:$152,NBCM:$158,NRB:$308)低于NBCM和NRB计划。作为敏感性分析,我们估计了狗疫苗接种覆盖率较低的替代方案的成本效益(30%,55%)和较低的实施成本。我们的结果表明,与新建立的IBCM计划(每生命年节省152美元)相比,继续实施IBCM计划(每生命年节省118美元)可以实现更好的健康和成本效益结果。我们的结果表明,IBCM比非整合计划更具成本效益,可以消除狗介导的人类狂犬病。
    The successful prevention, control, and elimination of dog-mediated rabies is challenging due to insufficient resource availability and inadequate placement. An integrated dog bite case management (IBCM) system plus dog vaccination can help address these challenges. Based on data from the IBCM system in Haiti, we conducted a cost-effectiveness evaluation of a newly established IBCM system plus sustained vaccination and compared it with 1) a no bite-case management (NBCM) and 2) a non-risk-based (NRB) program, where bite victims presenting at a health clinic would receive post-exposure prophylaxis regardless of risk assessment. We also provide cost-effectiveness guidance for an ongoing IBCM system and for sub-optimal dog vaccination coverages, considering that not all cost-effective interventions are affordable. Cost-effectiveness outcomes included average cost per human death averted (USD/death averted) and per life-year gained (LYG). The analysis used a governmental perspective. Considering a sustained 5-year implementation with 70% dog vaccination coverage, IBCM had a lower average cost per death averted (IBCM: $7,528, NBCM: $7,797, NRB: $15,244) and cost per LYG (IBCM: $152, NBCM: $158, NRB: $308) than NBCM and NRB programs. As sensitivity analysis, we estimated cost-effectiveness for alternative scenarios with lower dog-vaccination coverages (30%, 55%) and lower implementation costs. Our results suggest that better health and cost-effectiveness outcomes are achieved with the continued implementation of an IBCM program ($118 per life-year saved) compared with a newly established IBCM program ($152 per life-year saved). Our results suggest that IBCM is more cost-effective than non-integrated programs to eliminate dog-mediated human rabies.
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  • 文章类型: Clinical Trial Protocol
    背景:有人提出,高死亡率人群中的儿童疫苗可能会对死亡率产生重大影响,而这些影响无法通过预防目标疾病来解释,相反,疫苗的典型预期不良反应,这些非特异性效应(NSE)通常在女性中更明显。这些影响的存在,以及对疫苗开发和疫苗接种计划设计以提高安全性的任何影响,仍然有争议。争议的一个领域是报道的非活疫苗与女性死亡率增加的关联。在先前的随机对照试验(RCT)中,我们观察到,非活的明矾佐剂动物狂犬病疫苗(ARV)与年轻的女性死亡率增加有关,但与男性死亡率无关。自由漫游的狗.相反,非活的无佐剂的人狂犬病疫苗(NRV)在儿童中具有有益的非特异性效应.明矾佐剂已被证明可以抑制Th1对病原体的反应,引导我们推测,通过调节对传染性和/或寄生虫病的免疫反应,幼犬的明矾佐剂狂犬病疫苗对雌性存活有不利影响。在本文中,我们提出了一个3臂RCT比较明矾佐剂狂犬病疫苗的效果的协议,非佐剂狂犬病疫苗和安慰剂对全因死亡率的影响,自由漫游的狗种群,通过对RCT的因果中介分析和嵌套病例对照研究来检验这一假设。
    方法:采用巢式病例对照研究的随机对照试验。
    结论:我们预计,在安慰剂组中,男性将因更高的病原体负荷和更严重的疾病而导致更高的死亡率,由血液学参数和炎症生物标志物确定。在女性中,我们预计NRV组和安慰剂组之间的死亡率没有差异,但是抗逆转录病毒组的死亡率更高,再次介导更高的病原体负荷和更严重的疾病。我们预计,在这些变化之前,女性的关键血清细胞因子浓度会向抗炎免疫反应转移。如果确认,这些结果将为在高死亡率人群中减轻非活疫苗的有害NSE提供合理的依据.
    BACKGROUND: It has been proposed that childhood vaccines in high-mortality populations may have substantial impacts on mortality rates that are not explained by the prevention of targeted diseases, nor conversely by typical expected adverse reactions to the vaccines, and that these non-specific effects (NSEs) are generally more pronounced in females. The existence of these effects, and any implications for the development of vaccines and the design of vaccination programs to enhance safety, remain controversial. One area of controversy is the reported association of non-live vaccines with increased female mortality. In a previous randomized controlled trial (RCT), we observed that non-live alum-adjuvanted animal rabies vaccine (ARV) was associated with increased female but not male mortality in young, free-roaming dogs. Conversely, non-live non-adjuvanted human rabies vaccine (NRV) has been associated with beneficial non-specific effects in children. Alum adjuvant has been shown to suppress Th1 responses to pathogens, leading us to hypothesize that alum-adjuvanted rabies vaccine in young dogs has a detrimental effect on female survival by modulating the immune response to infectious and/or parasitic diseases. In this paper, we present the protocol of a 3-arm RCT comparing the effect of alum-adjuvanted rabies vaccine, non-adjuvanted rabies vaccine and placebo on all-cause mortality in an owned, free-roaming dog population, with causal mediation analysis of the RCT and a nested case-control study to test this hypothesis.
    METHODS: Randomised controlled trial with a nested case-control study.
    CONCLUSIONS: We expect that, among the placebo group, males will have higher mortality caused by higher pathogen loads and more severe disease, as determined by haematological parameters and inflammatory biomarkers. Among females, we expect that there will be no difference in mortality between the NRV and placebo groups, but that the ARV group will have higher mortality, again mediated by higher pathogen loads and more severe disease. We anticipate that these changes are preceded by shifts in key serum cytokine concentrations towards an anti-inflammatory immune response in females. If confirmed, these results will provide a rational basis for mitigation of detrimental NSEs of non-live vaccines in high-mortality populations.
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  • 文章类型: Case Reports
    对于患有自身免疫性疾病的患者,疫苗接种是有争议的。在自身免疫性疾病患者中使用疫苗接种是有争议的。有许多关于各种疫苗接种后继发血栓性血小板减少性紫癜病例的报道。血栓性血小板减少性紫癜是一种罕见的血栓性微血管病变,以微血管病理性溶血性贫血为特征。严重的血小板减少症,和缺血性器官损害,致死率很高。我们报告了一例狂犬病疫苗接种后系统性红斑狼疮患者的血栓性血小板减少性紫癜。接种疫苗近一个月后,她出现了胃肠道出血。实验室测试证实ADAMTS13严重缺乏和ADAMTS13自身抗体的存在。通过早期发现血栓性血小板减少性紫癜,免疫抑制治疗,和血浆置换治疗,病人从危险中获救。这种情况表明,减毒疫苗也可能对长期使用免疫抑制药物和自身免疫性疾病的患者产生意想不到的副作用。据我们所知,这是一例因接种狂犬病疫苗而继发的系统性红斑狼疮患者的血栓性血小板减少性紫癜。
    For patients with autoimmune diseases, vaccination is controversial. The use of vaccination in patients with autoimmune diseases is controversial. There are many reports of secondary thrombotic thrombocytopenic purpura cases after various vaccinations. Thrombotic thrombocytopenic purpura is a rare thrombotic microangiopathy characterized by microvascular pathological hemolytic anemia, severe thrombocytopenia, and ischemic organ damage with a very high fatality rate. We report a case of thrombotic thrombocytopenic purpura in a patient with systemic lupus erythematosus after rabies vaccination. She developed gastrointestinal bleeding nearly a month after the vaccination. Laboratory tests confirmed a severe deficiency of ADAMTS13 and the presence of ADAMTS13 autoantibodies. Through early identification of thrombotic thrombocytopenic purpura, immunosuppressive therapy, and plasma exchange treatment, the patient was saved from danger. This case suggests that attenuated vaccines may also have unexpected adverse effects in patients with long-term use of immunosuppressive drugs and autoimmune diseases. To our knowledge, this is the first case report of thrombotic thrombocytopenic purpura in a patient with systemic lupus erythematosus secondary to rabies vaccination.
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  • 文章类型: Journal Article
    如果达到至少70%的狗疫苗接种覆盖率,则狗疫苗接种是控制狂犬病的有效途径。六十多年来,布基纳法索已将狗疫苗接种作为狂犬病控制措施的一部分。然而,犬类人群所需的疫苗接种覆盖率仍然具有挑战性,狂犬病流行。这项研究描述了使用系统思维来探索狗疫苗接种复杂性引起的动态,并解释了狗种群疫苗接种覆盖率低的可能原因。在三个行政区进行了深入访谈,包括各种利益攸关方。进行了主题分析以分析获得的叙述。随后,开发了因果循环图(CLD),描绘了狗疫苗接种覆盖率低的原因。CLD由增强环和平衡环组成,可视化不同的变量,包括社会,经济,技术,影响该国狂犬病疫苗接种实施的政治和组织因素是因果关系。总的来说,结果显示了提高社区意识的重要性,加强疫苗接种队伍,加强狗疫苗接种动态的治理和领导。该研究呼吁广泛考虑可能影响狗疫苗接种覆盖率的所有驱动因素和因素,用于制定任何狂犬病控制策略或疫苗接种计划。除了狗的疫苗接种问题,这项研究的方法和结果可以应用于其他关键的狂犬病相关问题,如暴露后预防,流行病学监测,狗种群管理,实验室诊断,和一个健康合作问题,了解和改善狂犬病控制。
    Dog vaccination is an effective pathway to control rabies if a minimum of 70% dog vaccination coverage is achieved. For more than six decades, dog vaccination has been adopted as part of the rabies control measures in Burkina Faso. However, the required vaccination coverage in canine population remains challenging and rabies endemic. This study describes the use of systems thinking to explore the dynamics arising from dog vaccination complexity and explain the possibles causes of low vaccination coverage in the dog population. In-depth interviews were conducted in three administrative regions and included various stakeholders. A thematic analysis was performed to analyze the obtained narratives. Subsequently, causal loop diagrams (CLDs) were developed, depicting the causes of low dog vaccination coverage. The CLDs were composed of reinforcing loops and balancing loops, visualizing how different variables including social, economic, technical, political and organizational factors that affect the implementation of rabies vaccination in the country are causally interrelated. Overall, the results revealed the importance of community awareness raising, strengthening the vaccination workforce, enhanced governance and leadership in the dynamics of dog vaccination. The study calls for wide consideration of all drivers and factors that may affect dog vaccination coverage, for the development of any rabies control strategy or vaccination program. Beyond the dog vaccination problem, the methods and findings from this study could be applied to other critical rabies-related questions such as postexposure prophylaxis, epidemiological surveillance, dog population management, laboratory diagnosis, and the One Health collaboration issues, to understand and improve rabies control.
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