Rabies post-exposure treatment in metropolitan Sydney residents, 2013–2023: A retrospective case-series analysis

IF 6.3 3区 医学 Q1 INFECTIOUS DISEASES
Alice Self , Troy McNeill , Andrew Ingleton , Thomas R. Browne , Leena Gupta
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Abstract

Background

The nature and frequency of rabies and Australian Bat Lyssavirus (ABLV) exposures requiring post-exposure treatment (PET) in metropolitan Sydney residents has not previously been described. We assessed the trends in PET use in this population, the nature of exposures, geographic distribution, and timeliness and completeness of PET provided, comparing between local and overseas exposures.

Methods

A retrospective case series analysis of potential rabies and ABLV exposures in residents of Sydney Local Health District reported to the public health unit between January 1, 2013 and December 31, 2023.

Results

Data were available for 595 exposed persons; 477 (80 %) were overseas exposures, and 118 (20 %) were local ABLV exposures. PET was administered in 587 (99 %) exposures. Overseas exposures were mostly due to bites from monkeys, and the majority occurred in Asia (92 %), specifically in Indonesia. Local exposures were mostly due to megabat injuries. Bat testing occurred following 25 % of local exposures, with a 20 % ABLV positivity rate. Inadequate wound management was reported in 45 % of exposures. PET was markedly delayed (commenced greater than 14 days after exposure or a mid-schedule delay) in 26 % of overseas and 7 % of local exposures and incomplete in 15 % of overseas and 4 % of local exposures. Only 8 % of exposed persons received pre-exposure prophylaxis (PrEP).

Conclusion

Cost reduction strategies and measures to improve adherence and accessibility to PET, such as prepositioned stock and standing orders, should be explored. Improving public health risk communication about animal avoidance and appropriate treatment if exposed may also reduce delayed and incomplete PEP. Australian travelers to rabies-endemic countries should be routinely counselled on the benefits of PrEP.
2013-2023年悉尼市区居民狂犬病暴露后治疗:回顾性病例系列分析
背景:悉尼市区居民暴露狂犬病和需要暴露后治疗(PET)的澳大利亚蝙蝠溶血病毒(ABLV)的性质和频率以前没有被描述过。我们评估了该人群PET使用的趋势、暴露的性质、地理分布、PET提供的及时性和完整性,并比较了本地和海外暴露。方法回顾性分析2013年1月1日至2023年12月31日悉尼当地卫生区向公共卫生部门报告的潜在狂犬病和ABLV暴露病例系列。结果595名暴露者获得数据;477例(80%)为境外暴露,118例(20%)为本地ABLV暴露。在587例(99%)暴露中使用PET。海外暴露主要是由于猴子的咬伤,大多数发生在亚洲(92%),特别是在印度尼西亚。局部暴露主要是由于特大伤害。在25%的局部暴露后进行蝙蝠检测,ABLV阳性率为20%。45%的暴露报告伤口处理不当。在26%的海外和7%的本地暴露中PET明显延迟(暴露后超过14天开始或中期延迟),在15%的海外和4%的本地暴露中PET不完全。只有8%的暴露者接受了暴露前预防(PrEP)。结论应探索降低成本的策略和措施,提高PET的依从性和可及性,如预置库存和常备订单。改善关于动物躲避和暴露后适当治疗的公共卫生风险沟通,也可减少延迟和不完整的PEP。前往狂犬病流行国家的澳大利亚旅行者应定期接受PrEP益处方面的咨询。
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来源期刊
Travel Medicine and Infectious Disease
Travel Medicine and Infectious Disease PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH-INFECTIOUS DISEASES
CiteScore
19.40
自引率
1.70%
发文量
211
审稿时长
49 days
期刊介绍: Travel Medicine and Infectious Disease Publication Scope: Publishes original papers, reviews, and consensus papers Primary theme: infectious disease in the context of travel medicine Focus Areas: Epidemiology and surveillance of travel-related illness Prevention and treatment of travel-associated infections Malaria prevention and treatment Travellers' diarrhoea Infections associated with mass gatherings Migration-related infections Vaccines and vaccine-preventable disease Global policy/regulations for disease prevention and control Practical clinical issues for travel and tropical medicine practitioners Coverage: Addresses areas of controversy and debate in travel medicine Aims to inform guidelines and policy pertinent to travel medicine and the prevention of infectious disease Publication Features: Offers a fast peer-review process Provides early online publication of accepted manuscripts Aims to publish cutting-edge papers
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