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Post-exposure antirabies prophylaxis

339

n

%

n

%

Dog (Canis familiaris)

38

59.38

29

51.78

Cat (Felis catus)

19

29.69

14

25.0

Norway rat (Rattus norvegicus)

4

6.25

4

7.14

Squirrel (Sciurus vulgaris)

1

1.56

3

5.36

Red fox (Vulpes vulpes)

0

0

2

3.57

Big-eared rat (Plecotus auritus)

1

1.56

1

1.79

House mouse (Mus musculus)

0

0

2

3.57

Mole (Talpa europaea)

0

0

1

1.79

Hedgehog (Erinaceus europaeus)

1

1.56

0

0

Total

64

100.0

56

100.0

Table 3. Numbers of persons vaccinated in the dispensary of rabies prophylaxis in the Department of Infectious Diseases of Medical University of Lublin after exposure to particular species of rabid or rabies-suspected animals.

Animal species suspected as a source of exposure

2004

Vaccinated persons 2005

group of vaccinated patients, 57 (47.5%) were women and 63 (52.5%) men. The age of vaccine recipients ranged from 1-78 years. 21 persons (17.5%) were under 14 years of age and 99 (82.5%) were more then 14 years old. In the group of vaccine recipients, 92 persons (76.7%) resided in cities and 28 (23.3%) lived in small villages (Tab. 2).

The most common animal species suspected as a source of rabies exposure were dogs (38 in 2004 and 29 in 2005) and cats (19 cases in 2004 and 14 in 2005) (Tab. 3). Rabies post-exposure prophylaxis was also applied in people exposed to rats (4 cases each year), foxes (2 in

  • 2005)

    , mice (2 in 2005), squirrels (1 in 2004 and 3 in

  • 2005)

    , mole (1 in 2005) and hedgehog (1 in 2004). Rabies

was confirmed in 1 cat in 2004, and no case of rabies was diagnosed in 2005 in animals that were responsible for application of rabies post-exposure prophylaxis.

DISCUSSION

Although rabies is one of the oldest known human diseases it still remains an epizootic, epidemiologic and economic problem [3]. Since obligatory dog vaccination and the programme of oral vaccination for foxes were introduced, the epizootic situation of animal rabies has improved. There are still a number of cases reported in Wielkopolskie province and in Eastern Poland, including Lublin province, where oral vaccination was started later compared to other parts of Poland. The presence of small epizootics is the reason of vaccination of large number of humans exposed to animals in which rabies could not be ruled out [8].

On the basis of analysis of cases consulted in the dispensary for rabies prophylaxis in the Department of Infectious Diseases in Lublin, it can be concluded that the number of people with exposure to animals (bites, scratches, etc.) was rather stable during last 2 years. When

compared with the data we published 5 years ago, the number of vaccinated persons in 2000 was similar to those reported in the present work (67 in 2000 versus 64 in 2004 and 56 in 2005) [3].

Among 120 vaccinated patients, passive immunization with specific immune globulin was administered in 1, who had been exposed to a cat with confirmed rabies. The data from other regions of Poland have shown that cats are considered the domestic species with the highest incidence of rabies [8, 10, 17]. Nevertheless, our own observation has revealed that about half of the vaccinated persons received their prophylaxis after dog bites.

It should be mentioned that in 2000 in 11 cases anti- rabies vaccination was applied in patients bitten by animals with confirmed rabies [3]. Extensive and obligatory vaccination of domestic dogs has lowered significantly the incidence of rabies in these animals, so that only a small number of sporadic cases is observed each year in Poland [2, 3, 5, 10, 12].

Demographic analysis of vaccinated patients has shown that most of them were more than 14 years old. There were no statistic differences between numbers of male and female patients. It is particularly interesting that more than 3/4 of them lived in urban area where the risk of rabies should be lower. On the other hand, in a crowded urban population the risk to be bitten by unknown domestic animals is higher. Most vaccinations are performed when animals suspected of being rabid bite patients. These are predominantly domestic animals - dogs and cats – that have run away or died and there was no opportunity to test them for rabies. The problem is also increasing, compared to 2000, with regard to the number of bats and small rodents. Reported cases of rabies in these species in other parts of the country have caused the fear of possible rabies when one is exposed to these animals. Most of them cannot be caught and observed [3, 17].

Concerning rare sporadic cases of rabies in domestic animals, even in cities or suburbs, the decision whether prophylaxis is necessary should be made carefully. Difficulties that are met in practice may justify starting

vaccination against this fatal disease.

CONCLUSIONS

1. The

results

of epidemiological

analysis

and

evaluation of post-exposure vaccinations revealed that the numbers of vaccinated patients during last 2 years were similar.

2. Most of the vaccinated patients lived in urban areas where the risk of rabies should be lower; however, in cities like Lublin there is a higher risk of being bitten by homeless animals.

3. The decrease of number of patients bitten by animals with confirmed rabies in Lublin province, and of the number of cases of animal rabies may indicate that oral vaccination of red foxes, representing a main reservoir of rabies virus in Poland, has been shown to be effective.

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