《2011APP美国狂犬病预防策略更新》内容预览

INTRODUCTION
Rabies is a rapidly progressive encephalomyelitis with a very high case fatality rate. Approximately 55 000 people worldwide, nearly half of whom are children, die annually of rabies. Rabies is caused by RNA viruses in the family Rhabdoviridae, genus lyssavirus. In the Americas, only type 1 lyssavirus (rabies virus) circulates and is common in wild animals, particularly bats, coyotes, foxes, raccoons, and skunks, in the United States. Virus is transmitted in the saliva of rabid mammals after a bite or through contamination of an open wound or mucous mem-brane. The incubation period (1–3 months) is long enough to render immunization a highly effective strategy for postexposure prophylaxis (PEP). Approximately 20 000 to 30 000 persons receive PEP in the United States each year, and 1 to 3 cases of human rabies occurs annually.
Between 2000 and 2007, 20 of 25 cases of human rabies reported in the United States were acquired within the United States. Among the 20 indigenously acquired cases, 17 were associated with bat rabies virus variants.
In the United States, animal rabies is common. Education of children to avoid contact with stray or wild animals is of primary importance. PEP is indicated once an exposure has occurred. PEP has never failed in the United States since the introduction of modern cell-derived vaccines in the 1970s. Keys to effective PEP have included prompt washing of the wound with copious amounts of soap and water, infiltration of human rabies immunoglobulin into and around the wound, and a 5-dose schedule of intramuscular vaccine administered over 28 days.

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