Pre-exposure rabies prophylaxis: a systematic review.
Pre-exposure rabies prophylaxis: a systematic review.
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DOI：
10.2471/blt.16.173039
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发表时间：
2017-03-01
影响因子：
11.1
通讯作者：
Briggs D
中科院分区：
文献类型：
--
作者：
Kessels JA;Recuenco S;Navarro-Vela AM;Deray R;Vigilato M;Ertl H;Durrheim D;Rees H;Nel LH;Abela-Ridder B;Briggs D
审查暴露前狂犬病预防的安全性和免疫原性（包括加速方案、与其他疫苗联合接种和加强剂量）、其成本效益和使用建议，特别是在高风险环境中。我们检索了PubMed、国际农业和生物科学中心、科克伦图书馆和Web of Science数据库中2007年至2016年1月29日发表的关于暴露前狂犬病预防的论文。我们审查了秘鲁和菲律宾暴露前预防活动的现场数据。暴露前狂犬病预防在儿童和成人中是安全的和免疫原性的，当与常规儿童疫苗接种和日本脑炎疫苗联合接种时也是如此。现有证据表明，较短的方案和涉及较少剂量的方案是安全和免疫原性的，加强间隔可延长至10年。为数不多的几项关于成本的研究表明，按照目前的疫苗和接种成本，在大多数情况下，接触前预防运动不具有成本效益。虽然提倡对高危人群进行接触前预防，但只有秘鲁和菲律宾实施了适当的国家方案。在未来，加速治疗方案和新型疫苗可以简化交付并提高可负担性。暴露前狂犬病预防是安全和免疫原性的，应考虑：（i）在获得暴露后预防是有限的或延迟;（ii）在暴露的风险很高，可能无法识别;（iii）在动物水库控制狂犬病是困难的。暴露前预防不应分散犬疫苗接种工作、提供暴露后预防或教育以提高当地社区对狂犬病的认识。
To review the safety and immunogenicity of pre-exposure rabies prophylaxis (including accelerated schedules, co-administration with other vaccines and booster doses), its cost–effectiveness and recommendations for use, particularly in high-risk settings. We searched the PubMed, Centre for Agriculture and Biosciences International, Cochrane Library and Web of Science databases for papers on pre-exposure rabies prophylaxis published between 2007 and 29 January 2016. We reviewed field data from pre-exposure prophylaxis campaigns in Peru and the Philippines. Pre-exposure rabies prophylaxis was safe and immunogenic in children and adults, also when co-administered with routine childhood vaccinations and the Japanese encephalitis vaccine. The evidence available indicates that shorter regimens and regimens involving fewer doses are safe and immunogenic and that booster intervals could be extended up to 10 years. The few studies on cost suggest that, at current vaccine and delivery costs, pre-exposure prophylaxis campaigns would not be cost-effective in most situations. Although pre-exposure prophylaxis has been advocated for high-risk populations, only Peru and the Philippines have implemented appropriate national programmes. In the future, accelerated regimens and novel vaccines could simplify delivery and increase affordability. Pre-exposure rabies prophylaxis is safe and immunogenic and should be considered: (i) where access to postexposure prophylaxis is limited or delayed; (ii) where the risk of exposure is high and may go unrecognized; and (iii) where controlling rabies in the animal reservoir is difficult. Pre-exposure prophylaxis should not distract from canine vaccination efforts, provision of postexposure prophylaxis or education to increase rabies awareness in local communities.