Tomasiewicz K, Fota-Markowska H, Krzowska-Firych J, Krawczuk G
post-exposure vaccinations is observed. Incidence of animal rabies has decreased due to the massive vaccination of wild animals, mainly red foxes, that was introduced in Poland in 1993 .
Mortality rate in rabies is the highest among all known infectious diseases. Rabies is almost invariably fatal, and only a few cases of recovery from rabies have been reported [7, 8].
Although the worldwide incidence of human rabies is not known, it is considered to range between 30,000- 70,000 per year. More than 90% of cases reported to the WHO occurred in developing countries and the highest numbers of human rabies deaths were noted in India, Thailand and Philippines. The importance of this distribu- tion of the disease is enhanced by increasing number of travellers in these parts of Asia [15, 16]. In Poland, the last case of human rabies was reported in 2000 and was the first one that has occurred since 1986 .
Because animal rabies is still present in Poland and the disease has a fatal course and invariably bad prognosis, prophylactic activities of medical and veterinary services are of great importance. Moreover, a large number of people exposed to animal bites or with nonbite exposure is evaluated for prophylaxis each year.
Table 1. Numbers of persons consulted and vaccinated in the dispensary of rabies prophylaxis in the Department of Infectious Diseases of Medical University of Lublin.
Number of consulted
Patients with passive and active prophylaxis
accurate epidemiological history to be taken, considering the type of exposure, animal species and behaviour of the animal, and current epizootic situation.
In Lublin province, 26 cases of animal rabies were reported in 2004, including 21 in wild species (2 in martens and 19 in foxes) and 5 cases in domestic cats. In 2005 there were no rabies cases in domestic animals and only 3 in wild ones (in 1 marten and 2 foxes) .
The aim of this study was to perform the analysis of patients admitted to the dispensary of rabies prophylaxis in the Department of Infectious Diseases of Medical University of Lublin in 2004-2005 in whom anti-rabies prophylaxis was applied.
Neutralization of source of infection or stamping out of epizootic by cessation of roots of transmission is very difficult, therefore, both passive antibody administration and vaccination are the only efficient methods of prophylaxis [8, 11]. The basic guidelines concerning postexposure prophylaxis are determined by some legal regulations of the Ministry of Agriculture (Dz.U. of 2001, No. 126, item 1384; and Dz.U. of 2003, No 45, item 391), and instructions of the Main Sanitary Inspectorate.
According to the recommendations of the Expert Group of WHO, in 1985 vaccines derived from human diploid cells and/or purified chick embryo cell vaccines were introduced. Imovax-Rabies Vero from Pasteur-Merieux is widely used in Poland and is considered safe, well- tolerated and effective. Protective activity of the vaccine was demonstrated in the 90s. Both extracellular virus neutralization and suppressive action on intracellular viral RNA transcription were proved. In passive immunization, Immogam Rage from Aventis Pasteur has been accepted since 2001 [1, 8, 11].
In clinical practice, the most important and difficult question is whether or not to initiate specific immunoprophylaxis at all, and what kind of prophylaxis should be eventually introduced. The decision requires
PATIENTS AND METHODS
Databases and medical documentation of the dispensary of rabies prophylaxis in the Department of Infectious Diseases of Medical University of Lublin in 2004-2005 were reviewed. Patients with active only and both passive and active anti-rabies prophylaxis were selected for further study. The demographic data of patients and animal species were analyzed.
The numbers of persons consulted and vaccinated in the dispensary of rabies prophylaxis in the Department of Infectious Diseases of Medical University of Lublin are shown in Table 1. 801 patients were admitted in 2004- 2005 (399 in 2004 and 402 in 2005). Prophylactic procedures were applied in 120 persons (14.98% of total consulted). Passive immunization, i.e. rabies immune globulin, was administered in 1 person (0.12%) and active immunization (vaccination) in all 120 persons (14.98%). In 2004, 64 persons (7.99%) received active vaccination, and 56 patients (6.99%) were vaccinated in 2005. In the
Table 2. Demographics of anti-rabies vaccinated persons.