Rabies post-exposure prophylaxis in the Philippines: health status of patients having received purified equine F(ab’)(2) fragment rabies immunoglobulin (Favirab).
Abstract: Recommended treatment for severe rabies exposure in unvaccinated individuals includes wound cleaning, administration of rabies immunoglobulins (RIG), and rabies vaccination. We conducted a survey of rabies treatment outcomes in the Philippines. Methods: This was a case series involving 7,660 patients (4 months to 98 years of age) given purified equine RIG (pERIG) at the Research Institute for Tropical Medicine (Muntinlupa, Philippines) from July 2003 to August 2004 following Category II or III exposures. Data on local and systemic adverse reactions (AR) within 28 days and biting animal status were recorded; outcome data were obtained by telephone or home visit 6-29 months post-exposure. Results: Follow-up data were collected for 6,464 patients. Of 151 patients with laboratory-confirmed rabies exposure, 143 were in good health 6-48 months later, seven could not be contacted, and one 4-year-old girl died. Of 16 deaths in total, 14 were unrelated to rabies exposure or treatment. Two deaths were considered PEP failures: the 4-year old girl, who had multiple deep lacerated wounds from a rabid dog of the nape, neck, and shoulders requiring suturing on the day of exposure, and an 8-year-old boy who only received rabies PEP on the day of exposure. Conclusions: This extensive review of outcomes in persons with Category III exposure shows the recommended treatment schedule at RITM using pERIG is well tolerated, while survival of 143 laboratory-confirmed rabies exposures confirms the intervention efficacy. Two PEP intervention failures demonstrate that sustained education and training is essential in rabies management.
Publication Date: 2008-05-28 PubMed ID: 18509475PubMed Central: PMC2386244DOI: 10.1371/journal.pntd.0000243Google Scholar: Lookup
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- Journal Article
Summary
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This research investigates the effectiveness of a purified equine rabies immunoglobulin treatment, known as pERIG, in post-exposure prophylaxis against rabies in the Philippines. Results show it is well tolerated and effective, though two failures show the need for sustained education and training in the management of rabies.
Methodology:
- The study was conducted as a case series involving 7,660 patients, ranging from 4 months to 98 years old.
- These patients had been given purified equine RIG (pERIG) at the Research Institute for Tropical Medicine (RITM) within the period of July 2003 to August 2004.
- The patients had suffered Category II or III exposures, which are classified as moderate or severe exposure to rabies.
- Data on adverse reactions, either local or systemic, within 28 days and the biting animal status were recorded.
- Outcome data were then tracked by telephone or home visit 6 to 29 months post-exposure.
Results:
- Follow-up data were collected for 6,464 patients.
- Of 151 patients with laboratory-confirmed rabies exposure, 143 were in good health up to 48 months later.
- Out of 16 total deaths, only two were considered as PEP (Post-Exposure Prophylaxis) intervention failures.
- The two PEP failures comprised a 4-year old girl with multiple wounds from a rabid dog and an 8-year old boy who only received rabies PEP on the day of exposure.
- Seven patients could not be contacted while the remaining 14 deaths were unrelated to rabies exposure or treatment.
Conclusions:
- The recommended treatment schedule using pERIG at RITM showed good tolerance.
- Survival of 143 out of 151 patients with laboratory-confirmed rabies exposure confirms the effectiveness of the intervention.
- The two PEP intervention failures underline the importance of sustained education and training in the management of rabies.
Cite This Article
APA
Quiambao BP, Dytioco HZ, Dizon RM, Crisostomo ME, Laot TM, Teuwen DE.
(2008).
Rabies post-exposure prophylaxis in the Philippines: health status of patients having received purified equine F(ab’)(2) fragment rabies immunoglobulin (Favirab).
PLoS Negl Trop Dis, 2(5), e243.
https://doi.org/10.1371/journal.pntd.0000243 Publication
Researcher Affiliations
- Research Institute for Tropical Medicine, Alabang, Manila, Philippines.
MeSH Terms
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Animals
- Cats
- Child
- Child, Preschool
- Dogs
- Female
- Horses
- Humans
- Immunoglobulin Fragments / administration & dosage
- Immunoglobulin Fragments / adverse effects
- Immunoglobulin Fragments / therapeutic use
- Infant
- Male
- Middle Aged
- Philippines
- Post-Exposure Prophylaxis / methods
- Rabies / drug therapy
- Young Adult
Conflict of Interest Statement
BPQ and MEC received educational grants from Sanofi Pasteur for the post marketing surveillance study. HZD, RMD, and DET are full-time employees of Sanofi Pasteur.
References
This article includes 13 references
- Rupprecht CE. A tale of two worlds: public health management decisions in human rabies prevention (editorial commentary). Clin Infect Dis 2004;39:281–283.
- Anonymous. WHO Expert Consultation on Rabies: First Report. Geneva: WHO; 2005. Technical Report Series 931.
- Servat A, Lutsch C, Delore V, Lang J, Veitch K, Cliquet F. Efficacy of rabies immunoglobulins in an experimental post-exposure prohylaxis rodent model. Vaccine 2003;23:244–249.
- Lang J, Attanah P, Quiambao B. Evaluation of the safety, immunogenicity, and pharmacokinetic profile of a new, highly purified, heat-treated equine rabies immunoglobulin, administered either alone or in association with a purified, Vero-cell rabies vaccine. Acta Tropica 1998;70:317–333.
- Robles CG, Miranda NLJ. Comparative evaluation of the rabies fluorescent antibody test and direct microscopic examination at the Research Institute for Tropical Medicine. Phil J Microbiol Infect Dis 1992;21:69–72.
- Anonymous. Recommendations on rabies post-exposure treatment and the correct technique of intradermal immunization against rabies. 1996. No21WHO/EMS/ZOO 96.6 Geneva: WHO; 1996.
- Ali NS. Guidelines for prophylaxis of rabies in Pakistan. Pak J Med Sci 2003;219:61–65.
- Chantanakajornfung A, Narapron N, Khumphai W, Bejavongkulchai M, Mitmoonpitak C, Wilde H. A study of human rabies immune globulin manufactured by the Thai Red Cross. Vaccine 1999;17:979–981.
- Sudarshan MK, Madhusudana SN, Mahendra BJ. Assessing the burden of human rabies in India: results of a national multi-center epidemiological survey. Int J Infect Dis 2007;11:29–35.
- Suwansrinon K, Jaijaroensup W, Wilde HY, Sitprija V. Short Report: is injecting a finger with rabies immunoglobulin dangerous?. Am J Trop Med Hyg 2006;75:363–364.
- Hanlon CA, Niezgoda M, Morrill PA, Rupprecht CE. The incurable wound revisited: progress in human rabies prevention?. Vaccine 2001;19:2273–2279.
- Quiambao BP, Laot T, Castillo Y, Teuwen DE, Zinsou J-A. Rabies post-exposure prophylaxis (PEP) policy at RITM, Manila, Philippines (abstract) XVIth International Conference on Rabies in the Americas, Ottawa, Canada. 2005.
- Sampath G, Parikh S, Sangram P, Briggs DJ. Rabies post-exposure prophylaxis in malnourished children exposed to suspect rabid animals. Vaccine 2005;23:1102–1105.
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