RESUMO
Category III rabies post-exposure prophylaxis (PEP) encompasses wound cleansing, infiltration of rabies immunoglobulins (RIG) and rabies vaccination. A Manila-based prospective prescription monitoring one-year follow-up study enrolled 193 patients, aged 16 months-79 years. Patients received PEP, including infiltration of highly purified equine RIG (pERIG, Favirab), following exposure to animals confirmed rabid by direct fluorescence antibody test (dFAT). No serious adverse events were considered related to PEP. One-year post-exposure, 191 of the 193 patients (99%) were in good health. Two deaths occurred, one due to myocardial infarction (unrelated to rabies) in a 73-year-old man, 291 days post-exposure, and one due to rabies infection in a six-year-old boy, 28 days post-exposure. The results show the recommended PEP treatment is highly effective. The single rabies fatality demonstrates the importance of ensuring immediate and complete application of recommended PEP, sustained education and training in rabies management.
Assuntos
Imunoglobulinas/uso terapêutico , Profilaxia Pós-Exposição , Vacina Antirrábica/uso terapêutico , Raiva/prevenção & controle , Raiva/terapia , Adolescente , Adulto , Idoso , Animais , Mordeduras e Picadas/tratamento farmacológico , Criança , Pré-Escolar , Cães , Feminino , Seguimentos , Nível de Saúde , Cavalos/imunologia , Humanos , Imunoglobulinas/administração & dosagem , Lactente , Masculino , Pessoa de Meia-Idade , Filipinas/epidemiologia , Estudos Prospectivos , Raiva/epidemiologia , Adulto JovemRESUMO
BACKGROUND: Recommended treatment for severe rabies exposure in unvaccinated individuals includes wound cleaning, administration of rabies immunoglobulins (RIG), and rabies vaccination. We conducted a survey of rabies treatment outcomes in the Philippines. METHODS: This was a case series involving 7,660 patients (4 months to 98 years of age) given purified equine RIG (pERIG) at the Research Institute for Tropical Medicine (Muntinlupa, Philippines) from July 2003 to August 2004 following Category II or III exposures. Data on local and systemic adverse reactions (AR) within 28 days and biting animal status were recorded; outcome data were obtained by telephone or home visit 6-29 months post-exposure. RESULTS: Follow-up data were collected for 6,464 patients. Of 151 patients with laboratory-confirmed rabies exposure, 143 were in good health 6-48 months later, seven could not be contacted, and one 4-year-old girl died. Of 16 deaths in total, 14 were unrelated to rabies exposure or treatment. Two deaths were considered PEP failures: the 4-year old girl, who had multiple deep lacerated wounds from a rabid dog of the nape, neck, and shoulders requiring suturing on the day of exposure, and an 8-year-old boy who only received rabies PEP on the day of exposure. CONCLUSIONS: This extensive review of outcomes in persons with Category III exposure shows the recommended treatment schedule at RITM using pERIG is well tolerated, while survival of 143 laboratory-confirmed rabies exposures confirms the intervention efficacy. Two PEP intervention failures demonstrate that sustained education and training is essential in rabies management.