世卫组织狂犬病诊疗指南2010

(revised 15 June 2010)
3
Latest WHO recommendations on rabies vaccines and their use for rabies pre and post-exposure prophylaxis in WHO position paper on rabies vaccines WER, 2010, 85, pp 309-320
use immunoglobulin plus vaccine
Category II:
-minor scratches or abrasions without bleeding or and nibbling of uncovered skin
use vaccine alone
Category I : -touching, feeding of animals or licks on intact skin
World Health Organization – Department of Neglected Tropical Diseases – Neglected Zoonotic Diseases team
(revised 15 June 2010)
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World Health Organization – Department of Neglected Tropical Diseases – Neglected Zoonotic Diseases team
Definition of categories of contact and use of rabies biologicals:
Category III:
-single or multiple transdermal bites or scratches, licks on broken skin, contamination of mucous membrane with saliva (i.e. licks) and suspect contacts with bats:
(revised 15 June 2010)
5
2011
Professional groups and rabies awareness, risks and prevention



Veterinary and medical practitioners, animal welfare personnel, zoologists and animal conservationists, laboratory staff are some of the groups which must absolutely be aware of the nature of the risk, modes of transmission and prevention of rabies. Professionals, who are likely to be exposed to the live rabies virus through their work should receive pre-exposure vaccination. This include veterinarians, veterinary technicians working in rabies infected areas, particularly those directly involved in mass vaccination campaigns of dogs and wildlife and laboratory personnel handling suspect samples, animals and live rabies viruses. Performing unprotected necropsies or autopsies involves a particularly high risk. The use of mask, gloves and a gown as well as glasses when examining and handling a rabies suspected (human or animal) patient and conducting necropsies/autopsies is mandatory. This should protect staff from droplet infection to face and eyes, sites at greatest if not only risk.
World Health Organization – Department of Neglected Tropical Diseases – Neglected Zoonotic Diseases team
(revised 15 June 2010)
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WHO GUIDE
for
Rabies Pre and Post-exposure Prophylaxis in Humans
- nimals
WHO recommendations on all aspects of human and animal rabies surveillance prevention and control and elimination
2
WHO recommendations on human rabies vaccine and immunoglobulin production and control
at www.who.int/rabies
World Health Organization – Department of Neglected Tropical Diseases – Neglected Zoonotic Diseases team
(revised 15 June 2010)
7
General considerations in rabies PEP
World Health Organization – Department of Neglected Tropical Diseases – Neglected Zoonotic Diseases team
(revised 15 June 2010)
8
Animal-related considerations in PEP
If the animal at the origin of exposure is suspected of being rabid and is not apprehended, PEP should be instituted immediately. initiation of PEP should not await the results of veterinary laboratory diagnosis or be delayed by dog observation when rabies is suspected, In areas where canine or wildlife rabies is enzootic, adequate laboratory surveillance is in place, and data from laboratory and field experience indicate that there is no infection in the species involved, local health authorities may not recommend anti-rabies prophylaxis.
no exposure therefore no prophylaxis if history reliable
(revised 15 June 2010)
World Health Organization – Department of Neglected Tropical Diseases – Neglected Zoonotic Diseases team
Discontinuing or deferring PEP: must be an exception in rabies endemic countries or areas!

Post-exposure prophylaxis may be discontinued if the animal involved is a dog or cat that remains healthy for an observation period of 10 days after the exposure occurred; or if the animal is humanely killed and proven to be negative for rabies by a reliable diagnostic laboratory using a prescribed test.
WHO Standards for Rabies Control
(prevention of human infection, professional hazards)
F.X.Meslin,
T. Hemachuda, H. Wilde and G.Gongal
At the occasion of the OIE Global Conference on Rabies Control : towards sustainable prevention at the source, Incheon (Republic of Korea 7-9 September 2011)



World Health Organization – Department of Neglected Tropical Diseases – Neglected Zoonotic Diseases team
(revised 15 June 2010)
9
Rabies PEP modalities
(revised 15 June 2010)
World Health Organization – Department of Neglected Tropical Diseases – Neglected Zoonotic Diseases team
World Health Organization – Department of Neglected Tropical Diseases – Neglected Zoonotic Diseases team
World Health Organization – Department of Neglected Tropical Diseases – Neglected Zoonotic Diseases team
(revised 15 June 2010)
1
- National Programme for the control of rabies in dog - Control of rabies in wildlife - Rabies-free and provisionally free countries and areas
Immediate washing/flushing and disinfection of the wound plus rapid administration of purified immunoglobulin and vaccine according to the modalities described in these guidelines assure prevention of infection in almost all circumstances