Institut Pasteur, centre national de référence de la rage, centre collaborateur de l'Organisation mondiale de la santé (OMS) de référence et de recherche pour la rage, unité dynamique des lyssavirus et adaptation à l'hôte, 25, rue du Docteur Roux, 75724 Paris Cedex 15, France.
Medecine sciences: M/S (Impact Factor: 0.67). 01/2013; 29(1):47-55. DOI: 10.1051/medsci/2013291013
Source: PubMed


Rabies virus, a neurotropic lyssavirus responsible for unavoidable fatal encephalitis, is transmitted by saliva of infected animals through bite, scratch or licking of broken skin or a mucous membrane. Infection can be prevented by timely prevention (wash for several minutes, antisepsis and vaccination completed by antirabies immunoglobulins [Ig] according to the severity of exposure). The 55,000 human deaths estimated annually worldwide result mainly from uncontrolled canine rabies in enzootic countries (particularly in Africa and in Asia), attributable to a lack of resources or interest for this disease. Bat rabies, henceforth first cause of human's rabies in many countries in America, affects a very small number of individuals but seems more difficult to control. Shortened vaccine protocols, rationalized use of Ig and development of products of substitution should enhance access of exposed patients to prevention. Finally, research on the biological cycle, the pathogeny and on escape of virus-induced mechanisms from the immune system should continue to pave the way for presently unknown treatments of clinical rabies.

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    ABSTRACT: Benefit-risk of different anti-rabies post-exposure prophylaxis (PEP) strategies after scratches or bites from dogs with unknown rabies status is unknown in very low rabies risk settings. A cost-effectiveness analysis in metropolitan France using a decision-tree model and input data from 2001 to 2011. A cohort of 2807 patients, based on the mean annual number of patients exposed to category CII (minor scratches) or CIII (transdermal bite) dog attacks in metropolitan France between 2001 and 2011. Five PEP strategies: (A) no PEP for CII and CIII; (B) vaccine only for CIII; (C) vaccine for CII and CIII; (D) vaccine+ rabies immunoglobulin (RIG) only for CIII; and (E) vaccine for CII and vaccine+ RIG for CIII. The number of deaths related to rabies and to traffic accidents on the way to anti-rabies centers (ARC), effectiveness in terms of years of life gained by reducing rabies cases and avoiding traffic accidents, costs, and incremental cost-effectiveness ratios (ICER) associated with each strategy. Strategy E led to the fewest rabies cases (3.6×10(-8)) and the highest costs (€1,606,000) but also to 1.7×10(-3) lethal traffic accidents. Strategy A was associated with the most rabies cases (4.8×10(-6)), but the risk of traffic accidents and costs were null; therefore, strategy A was the most effective and the least costly. The sensitivity analysis showed that, when the probability that a given dog is rabid a given day (PA) was >1.4×10(-6), strategy D was more effective than strategy A; strategy B became cost-effective (i.e. ICER vs strategy A <3×French Gross Domestic Product per capita) when PA was>1.4×10(-4). In the metropolitan France's very low rabies prevalence context, PEP with rabies vaccine, administered alone or with RIG, is associated with significant and unnecessary costs and unfavourable benefit-risk ratios regardless to exposure category. Copyright © 2015. Published by Elsevier Ltd.
    Vaccine 03/2015; 33(20). DOI:10.1016/j.vaccine.2015.02.075 · 3.62 Impact Factor