Rabies situation in Cambodia.
Rabies situation in Cambodia.
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柬埔寨的狂犬病情况。
DOI：
10.1371/journal.pntd.0000511
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发表时间：
2009-09-08
影响因子：
3.8
通讯作者：
Vong, Sirenda
中科院分区：
文献类型：
--
作者：
Ly, Sowath;Buchy, Philippe;Heng, Nay Yim;Ong, Sivuth;Chhor, Nareth;Bourhy, Herve;Vong, Sirenda
狂犬病是一种致命但可预防的人畜共患病，是发展中国家的一个主要公共卫生问题。在柬埔寨，疾病负担在很大程度上被低估，因为被狗咬伤后患脑炎的患者很少住院并在家中死亡。自 1998 年柬埔寨巴斯德研究所 (IPC) 以来，金边一直是免费暴露后预防 (PEP) 和尸检诊断的唯一来源。对 IPC 编制的 1998-2007 年数据进行了分析，描述了所有接受 PEP 治疗的患者、人体测试结果和狂犬病确诊病例以及动物测试结果。根据狗咬伤的特征，我们将人类疑似狂犬病狗咬伤（SRDBI）定义为无缘无故的咬伤、自死亡的狗咬伤或报告患病的狗咬伤。我们应用确定性概率模型，根据狂犬病狗咬伤的估计发生率、咬伤伤口的身体分布以及 PEP 获得的概率来估计 2007 年全国狂犬病人类死亡率。 1998年至2007年期间，有124,749名患者在IPC接受了PEP（平均12,470名；范围8,907-14,475名），报告了63例被狗咬伤后出现脑炎的致命人类病例，其中73%通过直接免疫荧光测定或逆转录酶聚合酶链反应证实狂犬病呈阳性。 1998 年至 2007 年间，IPC 测试了 1,255 个动物大脑样本； 1,214 份 (97%) 来自狗，其中 610 份 (49%) 呈阳性样本。 2007年，14,475名患者接受了PEP（柬埔寨100 PEP/100,000人），其中95%居住在金边（615 PEP/100,000人）或五个邻近省份。预测模型估计 2007 年将有 810 例人类狂犬病死亡（95% 置信区间 [CI] 394-1,607），发病率为 5.8/100,000（95% CI 2.8-11.5）。获得 PEP 仅足以满足金边居民的需求。 2007年，狂犬病相关死亡率估计超过了疟疾和登革热。需要制定国家狂犬病控制计划来改善监测和 PEP 的获取，并启动狗的疫苗接种活动。在柬埔寨，狂犬病仍然引起社区的恐惧。自 1998 年以来，位于金边的柬埔寨巴斯德研究所 (IPC) 一直是免费的暴露后预防 (PEP) 和尸检诊断的唯一来源。 1998年至2007年期间，平均每年约有12,400名患者在IPC接受PEP（范围为8,907-14,475名），报告了63例被狗咬伤后出现脑炎的致命人类病例，其中73%通过脑样本荧光抗体测试或/和皮肤、脑脊液或尿液逆转录酶聚合酶链反应检测呈阳性。 2007年，14,475名患者接受了PEP（柬埔寨100 PEP/100,000人），其中95%居住在金边市（615 PEP/100,000人）或五个邻近省份。使用逐步概率模型，我们估计 2007 年将有 810 例人类狂犬病死亡（95% 置信区间 [CI] 394-1,607）；发生率为 5.8/100,000 (95%CI 2.8–11.5)。因此，尽管 IPC 的 PEP 中心的出席率很高，但居住在柬埔寨周边省份的大多数柬埔寨人可能无法充分获得 PEP。最后，该模型产生了全球狂犬病发病率最高的模型之一。需要制定国家狂犬病控制计划来改善监测和 PEP 的获取，并启动狗的疫苗接种活动。
Rabies, a fatal but preventable zoonosis, is a major public health problem in developing countries. In Cambodia the disease burden is largely underestimated because patients with encephalitis following dog bites are rarely hospitalized and die at home. Since 1998 Institut Pasteur in Cambodia (IPC), Phnom Penh has been the only source of free post-exposure prophylaxis (PEP) and post-mortem diagnosis. The 1998–2007 data compiled by IPC was analyzed to describe all treated patients for PEP, results of human testing and confirmed rabies cases, and results of animal testing. From dog bites' characteristics, we defined a suspected rabid dog bite injury (SRDBI) in humans as a bite that was unprovoked, from a dog that died spontaneously, or from a dog that was reported sick. We applied a deterministic probability model to estimate 2007 rabies human mortality nationwide from the estimated incidence of rabid dog bites, the body distribution of bite wounds, and the probability of PEP access. During 1998–2007, 124,749 patients received PEP at IPC (average 12,470; range 8,907–14,475), and 63 fatal human cases presenting with encephalitis following a dog bite were reported, in which 73% were confirmed positive for rabies by direct immunofluorescence assay or by reverse-transcriptase polymerase chain reaction. During 1998–2007, IPC tested 1,255 animal brain samples; 1,214 (97%) were from dogs including 610 (49%) positive samples. In 2007, 14,475 patients received PEP (100 PEP/100,000 people in Cambodia) including 95% who resided in Phnom Penh (615 PEP/100,000) or five neighboring provinces. The predictive model estimated 810 human rabies deaths would occur in 2007 (95%confidence interval [CI] 394–1,607), an incidence of 5.8/100,000 (95% CI 2.8–11.5). Access to PEP is only sufficient for Phnom Penh residents. In 2007, the estimated rabies related mortality exceeded that of malaria and that of dengue. A national rabies control program is needed to improve surveillance and access to PEP, and to initiate vaccination campaigns in dogs. In Cambodia, rabies still elicits fear in the communities. Since 1998 the Institut Pasteur in Cambodia (IPC), Phnom Penh has been the only source of free post-exposure prophylaxis (PEP) and post mortem diagnosis. During 1998–2007, on average ∼12,400 patients received PEP annually at IPC (range 8,907–14,475) and 63 fatal human cases presenting with encephalitis following a dog bite were reported including 73% who tested positive by fluorescent-antibody test on brain samples or/and by reverse-transcriptase polymerase chain reaction on skin, cerebrospinal fluid, or urine. In 2007, 14,475 patients received PEP (100 PEP/100,000 people in Cambodia) including 95% who resided in Phnom Penh city (615 PEP/100,000) or five neighboring provinces. Using a step-by-step probability model, we estimated that 810 human rabies deaths would occur in 2007 (95% confidence interval [CI] 394–1,607); an incidence of 5.8/100,000 (95%CI 2.8–11.5). As a result, despite high attendance at the IPC's PEP center most Cambodians living in peripheral provinces in Cambodia may not have adequate access to PEP. Finally, the model generated one of the highest incidences of rabies worldwide. A national rabies control program is needed to improve surveillance and access to PEP, and to initiate vaccination campaigns in dogs.
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影响因子：
5.1
作者：
Kamoltham, Thavatchai;Thinyounyong, Wirawan;Malerczyk, Claudius
通讯作者：
Malerczyk, Claudius
影响因子：
4.2
作者：
Kitala, PM;McDermott, JJ;Dye, C
通讯作者：
Dye, C
影响因子：
8.4
作者：
Sudarshan, M. K.;Madhusudana, S. N.;Gangaboraiah
通讯作者：
Gangaboraiah
影响因子：
5.5
作者：
Cleaveland, S;Kaare, M;Barrat, J
通讯作者：
Barrat, J
影响因子：
5.5
作者：
Quiambao, BP;Dimaano, EM;Malerczyk, C
通讯作者：
Malerczyk, C