番茄社区

SAN DIEGO -- Emergency rooms appear to be ignoring guidelines that advise physicians to treat suspected rabies patients with both the rabies vaccine and the highly costly human rabies immune globulin (HRIG), a new study found.

HRIG is seriously underutilized, with only 17% of treated patients receiving HRIG, and only 15% receiving the recommended treatment regimen of both the vaccine and HRIG, reported Christopher Blanchette, PhD, of the University of North Carolina at Charlotte, here at the American College of Emergency Physicians meeting.

"HRIG is very important in the process as it provides immediate antibodies for individuals not previously vaccinated and allows time for the body to respond to the vaccine and create antibodies on its own," Blanchette told 番茄社区.

It's not clear why hospitals aren't choosing to use HRIG, Blanchette said, but there has been a worldwide discussion over the use of HRIG because of its scarcity and expense. In the U.S., the cost of the drug can run , often leaving patients in debt.

According to the CDC, only 1 to 3 fatal cases of rabies occur in the U.S. each year, which can include cases where the disease was contracted in other countries. From 2008 to 2017, exposure to rabid bats accounted for nearly all rabies deaths in the U.S.

The agency attributes the near-disappearance of the once-dreaded disease to post-exposure prophylaxis -- an -- and to rabies vaccinations in animals.

Via the Nationwide Emergency Department Sample, the authors analyzed 118,710 emergency department visits in the U.S. for cases of suspected rabies from 2006 to 2015. Most cases (51%) were in the Northeast, while another 31% were in the South. More than 80% of the cases were treated in metropolitan hospitals. Just over half (53%) involved girls or women, 32% were in children. The average patient age was 34.

The study found that 77% of cases were not reported as treated, though the high rate could be misleading and due to a problem with coding, Blanchette noted.

More importantly he said, only 17% of the treated cases received treatment with HRIG. The other 82% were treated with vaccine alone.

According to the CDC, "rabies post-exposure prophylaxis consists of a dose of human rabies immune globulin and rabies vaccine given on the day of the exposure, and then a dose of vaccine given again on days 3, 7, and 14."

HRIG is not required if a person has been vaccinated previously.

Earlier this year, the that HRIG only be administered after rabies exposure in certain cases such as bites, scratches, and direct exposure to bats.

Even in the absence of HRIG, the WHO report explained, data show that "wound washing with immediate vaccine administration and completion of [the vaccination protocol] saves 99% of patients."

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