WHO
2006
SAGE
2007
12
http://www.who.int/immunization/documents/positionpapers/en/index. html
100 99% 33 1
5.5 2 2.4 15 40% 5 2
2/10 4/10 5 15 14
1 2
Knobel DL et al. Re-evaluating the burden of rabies in Africa and Asia. Bulletin of the World Health Organization, 2005, 83:360–368. WHO Expert Consultation on Rabies: first report. Geneva, World Health Organization, 2005 (WHO Technical Report Series, No. 931; http://whqlibdoc.who.int/trs/WHO_TRS_931_eng.pdf). 1
1500 32.7 1
RABV 2009 11 G RNA 5
1
3
/ 3,4,5
30%
CSF 6,7,8,9 3 4 5 6 7 8 9
Laothamatas J et al. MR imaging in human rabies. American Journal of Neuroradiology, 2003, 24:1102–1109. Hemachudha T et al. Pathophysiology of human paralytic rabies. Journal of Neurovirology, 2005,11:93–100. Jackson AC. Human disease. In: Jackson AC, Wunner AH, eds. Rabies, 2nd ed. London, Elsevier Academic Press, 2007:309–340. Crepin P et al. Intra vitam diagnosis of human rabies by PCR using saliva and CSF. Journal of Clinical Microbiology, 1998, 36: 1117–1121. Dietzschold B et al. Concepts in the pathogenesis of rabies. Future Virology, 2008, 3:481–490. Dacheux L et al. A reliable diagnosis of human rabies based on analysis of skin biopsy specimens. Clinical Infectious Diseases, 2008, 47:1410–1417. Wacharapluesadee S et al. Ante- and post-mortem diagnosis of rabies using nucleic acid-amplification tests. 2
CSF
CSF 8
10
11
100%
12
40 CCEEVs
CCV
EEV
CCEEVs 2 1
27.2
CCEEVs Vero 13
Vero
CCVs
CCVs
2°C 6 8
8°C
Expert review of molecular diagnostics, 2010,10:207–218. 10 Hemachudha T et al. Antemortem diagnosis of human rabies. Clinical Infectious Diseases, 2004, 39:1085–1086. 11 Bourhy H et al. Comparative field evaluation of the fluorescent-antibody test, virus isolation from tissue culture, and enzyme immunodiagnosis for rapid laboratory diagnosis of rabies. Journal of Clinical Microbiololgy, 1989, 27:519–523. 12 Lembo T et al. Evaluation of a direct, rapid immunohistochemical test for rabies diagnosis. Emerging Infectious Diseases, 2006, 12:310–313. 13 Plotkin S et al. Rabies vaccines. In: Plotkin SA, Orenstein WA, Offit PA, eds. Vaccines, 5th edition. Saunders Elsevier, 2008:687–714. 3
CCVs 0.5ml 1.0ml
2.5IU
CCVs CCVs 60% 80%14,15,16,17,18 19,20,21 16,17
1
2
II “ 22
III
” CCEEVs CCEEVs G 0.5 IU/ml RFFIT FAVN
23
14
14 15 16
17
18
19
20
21 22 23
Warrell MJ et al. Economical multiple-site intradermal immunisation with human diploid- cell-strain vaccine is effective for post-exposure rabies prophylaxis. Lancet, 1985, 1:1059–1062. WHO Expert Commitee on Rabies, 8th report. Geneva, World Health Organization, 1992 (WHO Technical Report Series, No. 824). Briggs DJ et al. Antibody response of patients after postexposure rabies vaccination with small intradermal doses of purified chick embryo cell vaccine or purified Vero cell rabies vaccine. Bulletin of the World Health Organization, 2000, 78:693–698. Quiambao BP et al. Reducing the cost of post-exposure rabies prophylaxis: efficacy of 0.1 ml PCEC rabies vaccine administered intradermally using the Thai Red Cross post-exposure regimen in patients severely exposed to laboratory-confirmed rabid animals. Vaccine, 2005, 23:1709–1714. Ambrozaitis A et al. Rabies post-exposure prophylaxis vaccination with purified chick embryo cell vaccine (PCECV) and purified Vero cell rabies vaccine (PVRV) in a four-site intradermal schedule (4-0-2-0-1-1): an immunogenic, cost-effective and practical regimen. Vaccine, 2006, 24:4116–4121. Human and dog rabies prevention and control: report of the WHO/Bill & Melinda Gates Foundation consultation, Annecy, France, 7–9 October 2009. Geneva, World Health Organization. (WHO/HTM/NTD/NZD/2010.1); http://whqlibdoc.who.int/hq/2010/WHO_HTM_NTD_NZD_2010.1_eng.pdf.) Beran J et al. Potency requirements of vaccines administered intradermally using the Thai Red Cross regimen: investigation of the immunogenicity of serially diluted purified chick embryo cell rabies vaccine. Vaccine, 2005, 23:3902–3907. Sudarshan MK et al. Assessing the relationship between antigenicity and immunogenicity of human rabies vaccines. Results of a meta-analysis. Human Vaccines, 2005, 1:187–190. Franka R et al. Rabies virus pathogenesis in relationship to intervention with inactivated and attenuated rabies vaccines. Vaccine, 2009, 27:7149–7155. WHO Expert Consultation on Rabies. First report (p.121). Geneva, World Health Organization, 2004 (WHO Technical Report Series, No. 931). 4
24
CCVs CCVs CCVs CCEEVs 26 24,25
27 28
CCEEVs 5 29 31,32 16,33
21 30
24
25
26
27 28 29 30 31 32 33
WHO Expert Committee on Biological Strandardization. Recommendations for inactivated rabies vaccine for human use produced in cell substrates and embryonated eggs. Annex 2. 56th meeting of the Expert Committee on Biological Standardization, October 2005. Geneva, World Health Organization, 2005 (http://www.who.int/biologicals/publications/trs/areas/vaccines/rabies/en/index.html). Kamoltham T et al. Rabies PrEP in children: anamnestic immune response to PCECV booster doses up to 5 years after primary vaccination. In: Proceedings of the second rabies in Asia conference, Hanoi, 9–11 September 2009 (www.rabiesinasia.org). I (CCVs / (http://www.who.int/entity/immunization/rabies_grad_efficacy.pdf). Wilde H. Failures of rabies post-exposure prophylaxis. Vaccine, 2007, 25:7605–7609. Shantavasinkul P et al. Failure of rabies postexposure prophylaxis in patients presenting with unusual manifestations. Clinical Infectious Diseases, 2010, 50:77–79. Suwansrinon K et al. Survival of neutralizing antibody in previously rabies-vaccinated subjects: a prospective study showing long-lasting immunity. Vaccine, 2006, 24:3878–3880. Brown D et al. Intradermal pre-exposure rabies vaccine elicits long-lasting immunity. Vaccine, 2008, 26:3909–3912. Horman JT et al. Antibody response after a two-year intradermal booster of rabies human diploid cell vaccine. Journal of the American Veterinary Medical Association, 1987, 191:185–187. Gherardin AW et al. Early rabies antibody response to intramuscular booster in previously intradermally immunized travellers using human diploid cell rabies vaccine. Journal of Travel Medicine, 2001, 8:122–126. II (CCVs 10 (http://www.who.int/entity/immunization/rabies_grad_duration_protection.pdf). 5
CCEEVs 45% 16,35,36
16,34
35 /
5
15% 17,36,37
AEFI AEFIs 815.pdf 38,39
http://www.who.int/vaccinesdocuments/DocsPDF05/
( HIV/AIDS ) 40 41
15
20
III 21
II “ ”
F(ab´)2
F(ab´)2
1/45 000 34
42,43
35 36
37
38 39
40 41 42 43
Ajjan N et al. Comparative study of the safety and protective value, in pre-exposure use, of rabies vaccine cultivated on human diploid cells (HDCV) and of the new vaccine grown on Vero cells. Vaccine, 1989,7:125–128. Dreesen DW et al. Immune complex-like disease in 23 persons following a booster dose of rabies human diploid cell vaccine. Vaccine, 1986, 4:45–49. Fishbein DB et al. Human diploid cell rabies vaccine purified by zonal centrifugation: a controlled study of antibody response and side-effects following primary and booster pre-exposure immunizations. Vaccine, 1989, 7:437–442. Lang J et al. Immunogenicity and safety in adults of a new chromatographically purified Vero-cell rabies vaccine (CPRV): a randomized, double-blind trial with purified Vero-cell rabies vaccine (PVRV). Biologicals, 1998, 26:299–308. Dobardzic A et al. Safety review of the purified chick embryo cell rabies vaccine: data from the Vaccine Adverse Event Reporting System (VAERS), 1997–2005. Vaccine, 2007, 25:4244–4251. III CCVs (http://www.who.int/entity/immunization/rabies_grad_safety.pdf). Thisyakorn U et al. Safety and immunogenicity of pre-exposure rabies vaccination in children infected with human immunodeficiency virus type 1. Clinical Infectious Diseases, 2000, 30:218. Pappaioanou M et al. Antibody response to pre-exposure human diploid-cell rabies vaccine given concurrently with chloroquine. New England Journal of Medicine, 1986, 214:280–284. Wilde H et al. Purified ERIG: a safe and affordable alternative to human RIG. Bulletin of the World Health Organization, 1989, 67:731–736. Suwansrinon K et al. Sex- and age-related differences in rabies immunoglobulin hypersensitivity. Transactions of the Royal Society of Tropical Medicine and Hygiene, 2007, 101:206–208. 6
DALY 5.5 90% 174
1
CI 2.4 9.3 90% CI 75 293
DALYs 4
DALYs 5.835
90% CI 5.401
6.263
2005
10 CCEEVs 1,19
CCEEVs CCEEVs CCEEVs CCEEVs CCVs CCVs 0.1 ml 19
/
7
RABV
CCEEVs
0 2
7
21 2
28
1 ml
0.5 ml
0 7 21 8
28
0.1ml 6
CCEEVs ,
6 2 0.5 IU/ml
x x x
I II III
– – –
8
I III 15
II II III
CCEEV CCEEV
10
I-III
II 1ml 0.5ml 5 (i) 5 (ii) 4 0 1 7 0
III ) 4 3 7 14 2 21 1 28 1 2
4 0 3 7 14 44
2
0 3 7 16,17,45
28 II III
2
0.1ml
0 3 44 45
1
CCEEV CVV
Rupprecht CE et al. Evidence for a 4-dose vaccine schedule for human rabies postexposure prophylaxis in previously non-vaccinated individuals. Vaccine, 2009, 27:7141–7148. Phanuphak P et al. Humoral and cell-mediated immune responses to various economical regimens of purified Vero cell rabies vaccine. Asian Pacific Journal of Allergy and Immunology, 1987, 5:33–37. 9
1 4 4 0.1ml
2 0.5 IU/ml
/ 5 CCEEV 2 4
II
III
7 CCEEV 46
20IU/ 40IU/
F(ab’)2
19
47
Weekly Epidemiological Record. No.32, 2010, pp. 309-320
46 47
Khawplod P et al. What is an acceptable delay in rabies immune globulin administration when vaccine alone had been given previously? Vaccine, 1996,14:389–391. Rupprecht CE et al. Can rabies be eradicated? Developmental Biology, 2008, 131:95–121. 10