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.
Diagnosis of Human Rabies
The diagnosis of rabies in humans relies on clinical presentation and a history of exposure to suspected rabies animals or rabies virus (RABV). No diagnostic test can detect RABV infection before symptoms appear. After symptoms appear, there is no known effective treatment. Diagnostic tests are performed primarily to determine the cause of death, provide final conclusions to families, and initiate community health interventions (eg, case investigation, dog vaccination, education, and surveillance).
For suspected clinicalsymptomsrabies Rabies vaccine should not be administered rabies because a reaction to the vaccine may interfere with the interpretation of pre-mortem diagnostic tests and may speed up the clinical course, leading to faster disease progression.
BiteIntegrated CaseManagement (IBCM)
Programs with integrated animal and human health coping mechanisms called “bite cases‘s after reporting RABV (rabies virus) exposures) strong>Integrated Management(IBCM)“. With well-established rabies prevention and control programmes, IBCM can support the targeted use of PEP (post-exposure prophylaxis) based on risk assessment and diagnosis to:
• Improve detection of individuals exposed to RABV;
• Strengthen adherence to vaccination recommendations;
• Reduce unnecessary vaccine or RIG (rabies immune globulin) shots.
IBCM(Integrated Management of Bite Cases) involves the use of a A risk assessment algorithm, based on professional assessment factors for animal and human health, informs the decision whether to postpone PEP (post-exposure prophylaxis).
It should only be considered if the following criteria are metIBCM(bite cases General Management):
1. The ability of medical personnel to accurately assess the severity of rabies exposure:
– Medical staff trained in RABV epidemiology and pathogenesis to understand the risks associated with bite severity, anatomical location, age and victim health.
2. The ability of animal health professionals to accurately assess signs and symptoms of rabies in animals:
– Animal health professionals trained in the epidemiology and signs of rabies in infected animals.
– Animal health professionals demonstrate high levels of accuracy in their assessment decisions.
– Healthy dogs, cats, or ferrets can be reliably observed at home or in a specialized facility for at least 10 days following suspected RABV exposure.
– Animals showing signs of rabies can be humanely euthanized and samples collected for testing.
3. The following animal rabies diagnostic facilities are available:
– Only perform WOAH (World Organization for Animal Health) approved diagnostic tests.
– Participate in regular competency assessments.
– Possess a commensurate national or international certificate.
– Able to receive, test and report results promptly after an exposure event (otherwise the test results are provided too late to be used as a basis for decision-making in PEP)
4 Health facilities receive case investigation results and laboratory results in a very timely manner.
5 If a risk assessment cannot be completed at the initial visit, the bite victim should not be expected to travel long distances or overpay for follow-up visits. If there are concerns about a patient’s ability to return after completing a risk assessment, PEP should be initiated with great caution.
References:
World Health Organization. (2022). Guide to introducing human rabies vaccine into nationalimmunization programs. World Health Organization. 29 July 2022, https://apps.who.int/iris/handle/10665/360978. License: CC BY-NC-SA 3.0 IGO.
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