评估狂犬病暴露的全球风险是一项复杂的任务,需要进行个人风险评估。狂犬病流行病学知识,国家和地区范围内狂犬病生物制剂的监测能力和可及性。在世界许多地方,这些信息的可用性是有限的,并且在可用时通常分散在多个来源中。这阻碍了制定循证健康和政策建议的过程,以防止狂犬病的引入和传播。
疾病预防控制中心对狂犬病的风险和保护因素进行了逐国定性评估,以开发一个开放获取的核心指标数据库,其中包括存在的狂犬病病毒(特别是犬或野生动物狂犬病病毒变体或其他蝙蝠狂犬病病毒)。获得狂犬病免疫球蛋白和疫苗,狂犬病监测能力和犬狂犬病控制能力。使用这些指标,我们开发了单独的风险评分系统,为旅行者提供狂犬病预防指南和狗只进口法规。两种评分系统都将较高的风险分配给有地方性狂犬病(尤其是犬狂犬病)的国家。旅行者的风险评分系统还考虑了保护因素,例如狂犬病生物制剂用于暴露后预防的可及性。在评估的指标上计算累积分数,以分配低风险值,中等或高。
共有240个国家,领土和属地进行了评估,对于旅行者来说,116个被确定为中度至高度风险,124个为低风险或无风险;对于犬狂犬病病毒变体输入,111人被确定为高风险,129人被确定为低风险或无风险。
我们开发了一个全面且易于获取的信息来源,用于评估各个国家的狂犬病风险,其中包括一个基于植物性传染病状况和生物制剂可用性的狂犬病风险和保护因素数据库。提供了按国家/地区对风险进行分类的资源,并根据这些风险类别为进入美国的旅行者和犬只进口商提供了指导。
Assessing the global risk of rabies exposure is a complicated task requiring individual risk assessments, knowledge of rabies epidemiology, surveillance capacity and accessibility of rabies biologics on a national and regional scale. In many parts of the world, availability of this information is limited and when available is often dispersed across multiple sources. This hinders the process of making evidence-based health and policy recommendations to prevent the introduction and spread of rabies.
CDC conducted a country-by-country qualitative assessment of risk and protective factors for rabies to develop an open-access database of core metrics consisting of the presence of lyssaviruses (specifically canine or wildlife rabies virus variants or other bat lyssaviruses), access to rabies immunoglobulins and vaccines, rabies surveillance capacity and canine rabies control capacity. Using these metrics, we developed separate risk scoring systems to inform rabies prevention guidance for travelers and regulations for the importation of dogs. Both scoring systems assigned higher risk to countries with enzootic rabies (particularly canine rabies), and the risk scoring system for travelers also considered protective factors such as the accessibility of rabies biologics for post-exposure prophylaxis. Cumulative scores were calculated across the assessed metrics to assign a risk value of low, moderate or high.
A total of 240 countries, territories and dependencies were assessed, for travelers, 116 were identified as moderate to high risk and 124 were low or no risk; for canine rabies virus variant importation, 111 were identified as high-risk and 129 were low or no risk.
We developed a comprehensive and easily accessible source of information for assessing the rabies risk for individual countries that included a database of rabies risk and protective factors based on enzootic status and availability of biologics, provided a resource that categorizes risk by country and provided guidance based on these risk categories for travelers and importers of dogs into the United States.