Abandon of intramuscular administration of rabies immunoglobulin for post-exposure prophylaxis in the revised guidelines in the Netherlands in 2018: cost and volume savings.

Imke Schreuder, Cornelis De Pijper, Rob van Kessel, Leo Visser, Hans van den Kerkhof
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引用次数: 7

Abstract

The World Health Organization (WHO) issued an updated position paper on rabies in 2018, mainly focusing on simplification of vaccination schedules and use of rabies immunoglobulin (RIG). The maximum amount of RIG anatomically feasible should be infiltrated exclusively in and around the wound and will no longer be calculated solely based on body weight. We describe the practical guideline implementing the revised RIG policy in the Netherlands on how to determine the amount of RIG for local administration. We calculated savings achieved through the revised WHO policy. We used information from a national database including rabies consultations in the Netherlands and clinical information from a public health service, clinical practitioners and national data on the amount of distributed RIG. Between 2008 and 2019, 5,164 consultations were registered. The most frequently affected anatomical location was hand or leg (43%). Around 80% concerned minor injuries (< 2 cm). From January 2016 to end December 2019, 7,361 mL RIG were distributed for 1,042 possible rabies exposures (EUR 1.4 million). Since implementing the revised policy, the amount of RIG distributed per order has sharply decreased (59%). Infiltrating RIG only locally saved large quantities of human RIG (EUR 1.1 million during 4 years) in the Netherlands.

Abstract Image

2018年荷兰修订指南中放弃暴露后预防狂犬病免疫球蛋白肌肉注射:节省成本和数量
世界卫生组织(世卫组织)于2018年发布了一份关于狂犬病的最新立场文件,主要侧重于简化疫苗接种时间表和狂犬病免疫球蛋白(RIG)的使用。解剖学上可行的RIG的最大量应该完全浸润在伤口内部和周围,不再仅仅根据体重来计算。我们描述了在荷兰实施修订后的RIG政策的实际指导方针,即如何确定地方政府的RIG数量。我们计算了通过修订世卫组织政策实现的节约。我们使用了来自国家数据库的信息,包括荷兰的狂犬病咨询和来自公共卫生服务、临床从业人员的临床信息以及关于分布式RIG数量的国家数据。2008年至2019年期间,登记了5164次咨询。最常受影响的解剖部位是手或腿(43%)。约80%涉及轻伤(
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