世卫组织狂犬病诊疗指南2010

1WorldHealthOrganization–DepartmentofNeglectedTropicalDiseases–NeglectedZoonoticDiseasesteam(revised15June2010)WHOStandardsforRabiesControl(preventionofhumaninfection,professionalhazards)F.X.Meslin,T.Hemachuda,H.WildeandG.GongalAttheoccasionoftheOIEGlobalConferenceonRabiesControl:towardssustainablepreventionatthesource,Incheon(RepublicofKorea7-9September2011)2WorldHealthOrganization–DepartmentofNeglectedTropicalDiseases–NeglectedZoonoticDiseasesteam(revised15June2010)WHOrecommendationsonhumanrabiesvaccineandimmunoglobulinproductionandcontrol-NationalProgrammeforthecontrolofrabiesindog-Controlofrabiesinwildlife-Rabies-freeandprovisionallyfreecountriesandareas-InternationaltransferofanimalsWHOrecommendationsonallaspectsofhumanandanimalrabiessurveillancepreventionandcontrolandelimination3WorldHealthOrganization–DepartmentofNeglectedTropicalDiseases–NeglectedZoonoticDiseasesteam(revised15June2010)4WorldHealthOrganization–DepartmentofNeglectedTropicalDiseases–NeglectedZoonoticDiseasesteam(revised15June2010)LatestWHOrecommendationsonrabiesvaccinesandtheiruseforrabiespreandpost-exposureprophylaxisinWHOpositionpaperonrabiesvaccinesWER,2010,85,pp309-3205WorldHealthOrganization–DepartmentofNeglectedTropicalDiseases–NeglectedZoonoticDiseasesteam(revised15June2010)20116WorldHealthOrganization–DepartmentofNeglectedTropicalDiseases–NeglectedZoonoticDiseasesteam(revised15June2010)Professionalgroupsandrabiesawareness,risksandpreventionVeterinaryandmedicalpractitioners,animalwelfarepersonnel,zoologistsandanimalconservationists,laboratorystaffaresomeofthegroupswhichmustabsolutelybeawareofthenatureoftherisk,modesoftransmissionandpreventionofrabies.Professionals,whoarelikelytobeexposedtotheliverabiesvirusthroughtheirworkshouldreceivepre-exposurevaccination.Thisincludeveterinarians,veterinarytechniciansworkinginrabiesinfectedareas,particularlythosedirectlyinvolvedinmassvaccinationcampaignsofdogsandwildlifeandlaboratorypersonnelhandlingsuspectsamples,animalsandliverabiesviruses.Performingunprotectednecropsiesorautopsiesinvolvesaparticularlyhighrisk.Theuseofmask,glovesandagownaswellasglasseswhenexaminingandhandlingarabiessuspected(humanoranimal)patientandconductingnecropsies/autopsiesismandatory.Thisshouldprotectstafffromdropletinfectiontofaceandeyes,sitesatgreatestifnotonlyrisk.7WorldHealthOrganization–DepartmentofNeglectedTropicalDiseases–NeglectedZoonoticDiseasesteam(revised15June2010)RabiesPreandPost-exposureProphylaxisinHumansat–DepartmentofNeglectedTropicalDiseases–NeglectedZoonoticDiseasesteam(revised15June2010)Immediatewashing/flushinganddisinfectionofthewoundplusrapidadministrationofpurifiedimmunoglobulinandvaccineaccordingtothemodalitiesdescribedintheseguidelinesassurepreventionofinfectioninalmostallcircumstancesGeneralconsiderationsinrabiesPEP9WorldHealthOrganization–DepartmentofNeglectedTropicalDiseases–NeglectedZoonoticDiseasesteam(revised15June2010)Post-exposureprophylaxismaybediscontinuediftheanimalinvolvedisadogorcatthatremainshealthyforanobservationperiodof10daysaftertheexposureoccurred;oriftheanimalishumanelykilledandproventobenegativeforrabiesbyareliablediagnosticlaboratoryusingaprescribedtest.Iftheanimalattheoriginofexposureissuspectedofbeingrabidandisnotapprehended,PEPshouldbeinstitutedimmediately.initiationofPEPshouldnotawaittheresultsofveterinarylaboratorydiagnosisorbedelayedbydogobservationwhenrabiesissuspected,Inareaswherecanineorwildliferabiesisenzootic,adequatelaboratorysurveillanceisinplace,anddatafromlaboratoryandfieldexperienceindicatethatthereisnoinfectioninthespeciesinvolved,localhealthauthoritiesmaynotrecommendanti-rabiesprophylaxis.DiscontinuingordeferringPEP:mustbeanexceptioninrabiesendemiccountriesorareas!Animal-relatedconsiderationsinPEP10WorldHealthOrganization–DepartmentofNeglectedTropicalDiseases–NeglectedZoonoticDiseasesteam(revised15June2010)CategoryI:-touching,feedingofanimalsorlicksonintactskinnoexposurethereforenoprophylaxisifhistoryreliableRabiesPEPmodalitiesCategoryIII:-singleormultipletransdermalbitesorscratches,licksonbrokenskin,contaminationofmucousmembranewithsaliva(i.e.licks)andsuspectcontactswithbats:useimmunoglobulinplusvaccineCategoryII:-minorscratchesorabrasionswithoutbleedingorandnibblingofuncoveredskinusevaccinealoneDefinitionofcategoriesofcontactanduseofrabiesbiologicals:11WorldHealthOrganization–DepartmentofNeglectedTropicalDiseases–NeglectedZoonoticDiseasesteam(revised15June2010)InfiltrateintothedepthofthewoundandaroundthewoundasmuchasanatomicallyfeasibleoftheRIGshouldbeinfiltratedaroundthewoundremainderifanyshouldbeinjectedatanintramuscularsitedistantfromthatofvaccineinoculatione.g.intotheanteriorthighQuantities/volumeofRIG:20IU/kgforHumanRIG(HRIG)or40IU/kgofEquineRIG(ERIG)RabiesPEPmodalitiesAdministrationofrabiesimmunoglobulin(RIG)woundsinfiltrationwithRIGisofupmostimportanceincategory3exposuremanagement12WorldHealthOrganization–DepartmentofNeglectedTropicalDiseases–NeglectedZoonoticDiseasesteam(revised1