A Large-scale, Rapid Public Health Response to Rabies in an Organ Recipient and the Previously Undiagnosed Organ Donor
A Large-scale, Rapid Public Health Response to Rabies in an Organ Recipient and the Previously Undiagnosed Organ Donor
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DOI：
10.1111/zph.12105
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发表时间：
2014-12-01
影响因子：
2.4
通讯作者：
Feldman, K. A.
中科院分区：
文献类型：
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作者：
Wallace, R. M.;Stanek, D.;Feldman, K. A.
本文描述并对比了两例人类狂犬病病例的公共卫生反应：一名器官接受者在症状发作后几天内被诊断，而移植供体在症状发作后18个月被诊断。针对2013年诊断出的一例与器官移植相关的狂犬病病例，多个公共卫生机构进行了器官捐献者和受体调查。对可能暴露于感染性患者材料的人员进行狂犬病病毒暴露评估。进行了暴露调查，以确定器官捐献者感染的来源。来自20多个机构的100多人花费了2700多小时在医疗保健、军事和社区环境中进行接触调查。评估的564人包括417名医护人员[5.8%建议进行暴露后预防（PEP）]，96名社区接触者（15.6%建议进行PEP），30名尸检人员（50%建议进行PEP）和21名其他人员（4.8%建议进行PEP）。捐赠者接触者代表188人，其中20.2%建议进行PEP，而306名接受者接触者中有5.6%建议进行PEP。人类狂犬病病例导致公共卫生和医疗资源的大量使用，特别是在诊断延误时。虽然罕见，但临床医生在不明原因的脑炎病例中应考虑狂犬病，特别是可能导致器官捐赠的病例。
This article describes and contrasts the public health response to two human rabies cases: one organ recipient diagnosed within days of symptom onset and the transplant donor who was diagnosed 18months post-symptom onset. In response to an organ-transplant-related rabies case diagnosed in 2013, organ donor and recipient investigations were conducted by multiple public health agencies. Persons with potential exposure to infectious patient materials were assessed for rabies virus exposure. An exposure investigation was conducted to determine the source of the organ donor's infection. Over 100 persons from more than 20 agencies spent over 2700h conducting contact investigations in healthcare, military and community settings. The 564 persons assessed include 417 healthcare workers [5.8% recommended for post-exposure prophylaxis (PEP)], 96 community contacts (15.6% recommended for PEP), 30 autopsy personnel (50% recommended for PEP), and 21 other persons (4.8% recommended for PEP). Donor contacts represented 188 assessed with 20.2% recommended for PEP, compared with 5.6% of 306 recipient contacts recommended for PEP. Human rabies cases result in substantial use of public health and medical resources, especially when diagnosis is delayed. Although rare, clinicians should consider rabies in cases of encephalitis of unexplained aetiology, particularly for cases that may result in organ donation.