Foreword:This July29Day, < /strong>WHOofficial website published a manual in English titled “Guide to introducing human rabies vaccine into national immunization programmes( /strong>Incorporating Human Rabies Vaccine into National Immunization Program Guidelines)” (see References), which comprehensively introduces WHO’s use of rabies vaccine and related issues in its main text and appendix authoritative answer. This blog will gradually introduce some of them for readers.
Risk assessment for rabies
In countries with reliable community- and laboratory-based animal rabies surveillance, health care workers handling animal bite victims or suspected rabies exposure should be trained to Conduct a risk assessment before rabies vaccination. This prevents unnecessary use of the rabies vaccine. Risk assessment includes:
• Clinical evaluation of the offending animal by a trained and skilled veterinarian or public health officer;
•Assess the category and location of exposure.
Clinical evaluation of the culprit animal:
In countries with a high burden of canine rabies, post-exposure prophylaxis (PEP) should be initiated immediately when a biting animal meets the definition of a suspected or probable case of rabies (Appendix 1). ) instead of waiting for lab results. When determining the need for post-exposure prophylaxis (PEP), animals that cannot be assessed or tested should be presumed to have rabies. However, PEP is rarely required after exposure to small mammals such as rodents (mice), rabbits, and hares, as these animals rarely develop rabies. Vaccination can be discontinued if laboratory tests show that the animal is free of rabies. People who have completed at least two vaccinations before stopping vaccination should be considered to have completed PrEP.
Assess class and location of exposure:
Even if the condition is assessed as low risk, if other risk factors are present (eg bites to the head, neck or other areas of high nerve density; bites in young children; multiple or deep wounds), PEP should also be initiated immediately.
Deferred initiation of PEP (post-exposure prophylaxis)
If the results of inspections and assessments demonstrate that community- and laboratory-based animal rabies surveillance is robust, reliable and sensitive, then only under such conditions A limited deferral of rabies vaccination while testing or veterinary evaluation can be considered may be considered. In this case, and in the absence of other risk factors, if the biting domestic animal (such as a dog, cat, or ferret) is assessed to be healthy by a trained professional and is If you remain healthy during the 10-day observation period, you can delay starting PEP after being bitten by such an animal.
According to a trained professional, as stated in the relevant guidelines, for an apparently healthy domestic animal observed to be Still healthy at the end of the day, you can also stop rabies vaccination accordingly.
Retrospective Risk Assessment
If an animal is identified as a suspected, probable or confirmed case of rabies, a retrospective risk assessment should be performed to determine the A period beginning 10 days before the onset of clinical symptoms) to any person who may have had contact with the animal before the animal’s death. These people can even benefit from vaccination months after exposure.
References:
World Health Organization. (2022). Guide to introducing human rabies vaccine into national immunization programs. World Health Organization. 29 July 2022, https:https://apps.who.int /iris/handle/10665/360978. License: CC BY-NC-SA 3.0 IGO.
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