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J Pediatr Infect Dis 2020; 15(05): 248-256
DOI: 10.1055/s-0040-1714708
Original Article

The Story of Post-exposure Rabies Prophylaxis at the Pediatric Emergency Department

Gökce Celep 
1   Department of Pediatrics, Amasya University, Faculty of Medicine, Amasya, Turkey
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Abstract

Objectives This study aimed to determine the epidemiological and medical features of suspected rabies exposures at a pediatric emergency department in a small city center in middle-northern Turkey.

Methods Data were abstracted from a standard “Rabies Suspected Animal Contact Cases Examination Form.” The following information was recorded: sociodemographic and clinical features of the victim, history of rabies vaccination, date of event, time to hospital administration, animal species and its vaccination history with owner records, type of suspected contact, wound care, tetanus prophylaxis, rabies vaccination, and forensic notifications. Immunoprophylaxis was determined as “appropriate” or “inappropriate” in accordance with the Rabies Field Guideline (2014).

Discussion A total of 306 cases were evaluated at the emergency department of the hospital. The age of the victims ranged between 1.5 and 17 years old, and 61.4% of them were males. Cat scratches were the most common source of suspected rabies exposure. Meanwhile, primary wound care and tetanus immunoprophylaxis were the frequent inappropriate medical applications. Rabies prophylaxis was completed in 76.5% of the cases. However, forensic notifications were missing. In addition, the rate of animal immunization was lower than it should be.

Conclusion Our city is rabies free; however, risky exposures are frequent among children. Lack of knowledge about first aid and animal vaccination is revealed to be a major public health problem. Health care workers should follow current guidelines to provide a holistic approach to the treatment of potential rabies exposures.

Keywords

rabies - post-exposure prophylaxis - children - central nervous system


Publication History

Received: 28 February 2020

Accepted: 10 June 2020

Article published online:
26 August 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Stuttgart · New York

 

  • References

  • 1 Hampson K, Coudeville L, Lembo T. , et al. Global Alliance for Rabies Control Partners for Rabies Prevention. Estimating the global burden of endemic canine rabies. PLoS Negl Trop Dis 2015; 9 (04) e0003709
    CrossrefPubMedGoogle Scholar
  • 2 World Health Organization. The Immunological Basis for Immunization Series: Module 17: Rabies Vaccines. Geneva: World Health Organization; 2017
    Google Scholar
  • 3 Wunner WH. Rabies Virus. In: Jackson AC, Wunner WH. , eds. Rabies. 2nd ed. Amsterdam: Elsevier Academic Press; 2007: 23-68
    CrossrefGoogle Scholar
  • 4 Hemachudha T, Laothamatas J, Rupprecht CE. Human rabies: a disease of complex neuropathogenetic mechanisms and diagnostic challenges. Lancet Neurol 2002; 1 (02) 101-109
    CrossrefPubMedGoogle Scholar
  • 5 Srinivasan A, Burton EC, Kuehnert MJ. Transmission of rabies virus from an organ donor to four transplant recipients. N Engl J Med 2005; 352: 1103-1111
    CrossrefPubMedGoogle Scholar
  • 6 Sağlık Bakanlığı TC. Kuduz Saha Rehberi, 2019. Ankara: Sağlık Bakanlığı Yayınları; 2019
    Google Scholar
  • 7 Krzowska-Firych J, Tomasiewicz K, Kozøowska A. Post-exposure rabies prophylaxis in humans exposed to animals in Lublin province (Eastern Poland) in 2012-2015—a retrospective study. Hum Vaccin Immunother 2017; 13 (06) 1-6
    CrossrefPubMedGoogle Scholar
  • 8 Kassiri H, Kassiri A, Mosavi R, Jashireh A, Lotfi M. Prevalence rate and epidemiological determinants of animal bite in Ahvaz County, Khuzestan Province, Southwestern Iran. J Acute Dis 2014; 3: 51-55
    CrossrefPubMedGoogle Scholar
  • 9 Sağlık Bakanlığı TC. Kuduz Saha Rehberi, 2014. Ankara: Sağlı Bakanlığı Yayınları; 2014
    Google Scholar
  • 10 Derinöz O, Akar T. Animal bites cases presented to a University Hospital Pediatric Emergency Room. J Pediatr Emerg Intensive Care Med 2017; 4: 22-26
    CrossrefPubMedGoogle Scholar
  • 11 American Academy of Pediatrics. Bite wounds. In: Kimberlin DW, Brady MT, Jackson MA, Long SS. , eds. Red Book: 2018 Report of the Committee on Infectious Diseases. 31st ed. Itasca, IL: American Academy of Pediatrics; 2018: 189-195
    Google Scholar
  • 12 Giesen A, Gniel D, Malerczyk C. 30 years of rabies vaccination with Rabipur: a summary of clinical data and global experience. Expert Rev Vaccines 2015; 14 (03) 351-367
    CrossrefPubMedGoogle Scholar
  • 13 Palacio J, León M, García-Belenguer S. Epidemiological aspects of dog bites [in Spanish]. Gac Sanit 2005; 19 (01) 50-58
    CrossrefPubMedGoogle Scholar
  • 14 Sahu KK, Manar MK, Singh SK, Singh H. Epidemiological characteristics of patients attending for rabies post-exposure prophylaxis at the infectious diseases hospital of Lucknow, India. J Glob Infect Dis 2015; 7 (01) 30-32
    CrossrefPubMedGoogle Scholar
  • 15 Dağar S, Şahin S, Oray D, Akkaya A, Kama A, Uçan G. Rabies suspected animal contact cases in a city with animal husbandry and the appropriateness of prophylactic procedures. Turk J Emerg Med 2016; 15 (02) 79-84
    CrossrefPubMedGoogle Scholar
  • 16 İlhanErkal S, Sancar B, Bulut C. Kuduz şüpheli hayvanlarla temastan sonrası yapılan ilk yardım girişimlerinin araştırılması. Ankara Sağlık Bilimleri Dergisi. 2012; 1 (02) 101-114 . Doi: 10.1501/Asbd_0000000021. (in Turkish)
    CrossrefPubMedGoogle Scholar
  • 17 Vançelik S, Set T, Aktürk Z, Çalıkoğlu O, Koşan Z. The changing rate of suspected rabies bites after begin to act animal shelter in Erzurum city. Eurasian J Med 2014; 46 (03) 151-155
    CrossrefPubMedGoogle Scholar
  • 18 Kılıç B, Ünal B, Semin S, Konakci SK. An important public health problem: rabies suspected bites and post-exposure prophylaxis in a health district in Turkey. Int J Infect Dis 2006; 10 (03) 248-254
    CrossrefPubMedGoogle Scholar
  • 19 UmumiHıfzısıhhaKanunu. Available at: http://www.mevzuat.gov.tr/MevzuatMetin/1.3.1593.pdf (PMID: . Accessed February 2020)
    Google Scholar
  • 20 Turkish Law of Crime. Available at: https://www.tbmm.gov.tr/kanunlar/k5237.html (PMID: . Accessed February 2020)
    Google Scholar
  • 21 Güzel S, Balcı Y, Çetin G. TürkCezaKanunu'ndaTanımlananYaralamaSuçlarınınAdli Tıp AçısındanDeğerlendirilmesi. 2013 . Available at: http://www.atk.gov.tr/haber14.06.html (PMID: . Accessed February 2020)
    Google Scholar
  • 22 Kocabaş AB. Kuduz Riskli Temas Sonrası Başvuran Çocuk Olgularınve Profilaksi Uygulamalarımızın Geriye Dönük Değerlendirilmesi. Türkiye Çocuk Hastalıkları Dergisi 2018; 12: 104-107
    PubMedGoogle Scholar
  • 23 De Nardo P, Gentilotti E, Vairo F. , et al. A retrospective evaluation of bites at risk of rabies transmission across 7 years: the need to improve surveillance and reporting systems for rabies elimination. PLoS One 2018; 13 (07) e0197996
    CrossrefPubMedGoogle Scholar
  • 24 Gautret P, Le Roux S, Faucher B, Gaudart J, Brouqui P, Parola P. Epidemiology of urban dog-related injuries requiring rabies post-exposure prophylaxis in Marseille, France. Int J Infect Dis 2013; 17 (03) e164-e167
    CrossrefPubMedGoogle Scholar
  • 25 Kamoltham T, Singhsa J, Promsaranee U, Sonthon P, Mathean P, Thinyounyong W. Elimination of human rabies in a canine endemic province in Thailand: five-year programme. Bull World Health Organ 2003; 81 (05) 375-381
    PubMedGoogle Scholar
  • 26 Chhabra M, Ichhpujani RL, Tewari KN, Lal S. Human rabies in Delhi. Indian J Pediatr 2004; 71 (03) 217-220
    CrossrefPubMedGoogle Scholar
  • 27 Song M, Tang Q, Wang DM. , et al. Epidemiological investigations of human rabies in China. BMC Infect Dis 2009; 9: 210
    CrossrefPubMedGoogle Scholar
  • 28 Morgan M, Palmer J. Dog bites. BMJ 2007; 334 (7590): 413-417
    CrossrefPubMedGoogle Scholar
  • 29 Mindekem R, Lechenne MS, Naissengar KS. , et al. Cost description and comparative cost efficiency of post-exposure prophylaxis and canine mass vaccination against rabies in N'Djamena, Chad. Front Vet Sci 2017; 4: 38
    CrossrefPubMedGoogle Scholar
  • 30 Ghosh S, Rana MS, Islam MK. , et al. Trends and clinico-epidemiological features of human rabies cases in Bangladesh 2006–2018. Sci Rep. 2020; 10 (01) 2410 . Doi:10.1038/s41598-020-59109-w
    CrossrefPubMedGoogle Scholar