虽然狂犬病仍然是全球关注的问题,关于人类狂犬病的详细研究,特别是关于因果动物和未接受暴露后预防(PEP)的原因,缺乏。
我们在菲律宾最大的狂犬病转诊中心进行了一项为期3年的前瞻性研究(2019年10月至2022年9月)。我们采访了疑似狂犬病患者及其家属。我们对唾液样品进行了LN34qRT-PCR和快速荧光焦点抑制试验。我们还将我们的发现与同一家医院的两项回顾性研究进行了比较。
■我们招募了151名患者,包括131名可能暴露于狂犬病的患者.类似于回顾性研究,参与者主要是男性(75.5%),成人(76.8%),低收入个人(91.4%),和农村居民(62.3%)。因果动物主要是狗(97.0%),有相似的潜伏期,临床症状,没有接种疫苗或免疫球蛋白的比例很高(93.2%)。大多数因果动物由患者家庭或邻居拥有(60.2%),占很大比例的是小狗(58.8%)。大多数患者都有狂犬病知识;然而,不寻求PEP的原因包括对轻微叮咬不会引起狂犬病的误解(51.3%),对传统治疗师的信仰(33.9%),和经济约束(22.6%)。尽管完成了世界卫生组织的治疗方案,观察到两次PEP失败。LN34qRT-PCR检测98例阳性病例(敏感性、64.9%;95%CI56.7-72.5)。这些菌株属于东南亚4亚进化枝。
■总而言之,这项研究强调了幼犬作为主要因果动物的作用,以及存在阻碍患者获得PEP的误解.
UNASSIGNED: While rabies remains a global concern, detailed studies on human rabies, particularly regarding causal animals and the reasons for not receiving postexposure prophylaxis (PEP), are lacking.
UNASSIGNED: We conducted a 3-year prospective
study (October 2019-September 2022) at the Philippines\' largest rabies referral center. We interviewed patients with suspected rabies and their families. We used LN34 qRT-PCR and rapid fluorescent focus inhibition test on saliva samples. We also compared our findings with two retrospective studies at the same hospital.
UNASSIGNED: We enrolled 151 patients, including 131 with potential rabies exposure. Similar to retrospective studies, the participants were predominantly males (75.5%), adults (76.8%), low-income individuals (91.4%), and rural dwellers (62.3%). The causal animals were mainly dogs (97.0%), with similar incubation periods, clinical symptoms, and a high proportion not receiving vaccines or immunoglobulins (93.2%). Most causal animals were owned by either the patients\' households or their neighbors (60.2%), with a significant proportion being puppies (58.8%). Most patients had knowledge of rabies; however, reasons for not seeking PEP included misconceptions about minor bites not causing rabies (51.3%), beliefs in traditional healers (33.9%), and economic constraints (22.6%). Despite completing the WHO regimen, two PEP failures were observed. LN34 qRT-PCR detected 98 positive cases (sensitivity, 64.9%; 95% CI 56.7-72.5). These strains belong to the Southeast Asia 4 subclade.
UNASSIGNED: In conclusion, this
study highlights the role of puppies as primary causal animals and the presence of misconceptions that preclude patients from acquiring PEP.