在印度喜马偕尔邦Kangra区Jawali兽医医院探讨一种新的低成本皮肤内接触前和接触后狂犬病预防方案在家牛中的可行性

O. Bharti, Uppinder Kumar Sharma, Adarsh Kumar, Archana Phull
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引用次数: 3

摘要

牛是印度农村地区家庭经济的支柱,许多牛在被可能患有狂犬病的狗咬伤后死亡,尽管目前建议进行五次肌肉注射狂犬病疫苗接种,作为暴露后预防(PEP)。2016年,在西姆拉市,被接种了狂犬病疫苗的狂犬病狗咬伤的21头牛中有7头死于狂犬病。这种情况促使作者在人类研究的基础上寻找一种合适的方案来拯救动物。我们在牛身上测试了不同剂量的IDRV,发现在第0天、第3天、第7天、第14天和第28天,在颈部中部1/3处注射0.2 ml剂量的IDRV,并伴有eRIG局部伤口浸润,即使被CRI测试中实验室确认的狂犬病狗/猫猫咬伤,也能充分产生免疫原性并挽救它们的生命。Rabivac Vet是一种细胞培养狂犬病疫苗,每瓶1毫升,用于IDRV的水平。注射疫苗时,会缓慢出现≥1cm的凸起丘疹,引起橘色样疹。经RFFIT检测的60份牛血清在IDRV后第14天的滴度均大于0.5 IU/ml。此后,共有150只动物在暴露于临床或实验室确认的狂犬病狗/猫鼬后,接受5剂IDRV作为PEP,有或没有RIG,所有动物都存活了一年以上。在第14天收集被实验室确认的狂犬病狗/猫鼬咬伤的15只动物的血清样本,并通过NIMHANS Bangalore的RFFIT检测RVNA,所有动物的所需抗体滴度均高于0.5 IU/ml,未出现任何免疫抑制。所有组中55%的牛在一年后的RFFIT滴度都是足够的,并且100%的牛在一年后对单次0.2 ml的增强剂有遗忘反应。牛很少,甚至有一匹马(马)。图4)在附近的一些兽医医院进行PEP接种了IM狂犬疫苗,局部eRIG浸润也存活下来。局部eRIG浸润似乎已经覆盖了通过IM途径在牛体内产生较长窗口期所需的空白,这些窗口期在第14天不能充分产生。虽然在这种低成本方案中使用的疫苗减少了五倍,但与传统的IM方案相比,其存活率为66%,存活率为100%。发现暴露前预防在第0、3、7天接种0.2 ml IDRV是有效的,并且在1年后接种一次0.2 ml疫苗增强剂后,所有牛的滴度在第7天都高于期望的滴度。我们的研究指出,有可能在有或没有局部RIG(取决于伤口是否存在)的牛中短期接种三针IDRV疫苗作为PEP,而单针IDRV疫苗作为PrEP,但需要对大量动物进行进一步的研究。我们的研究还指出,允许在动物中皮内使用,并标记疫苗,因为与IM给药相比,这是低成本的,更具免疫原性,更少痛苦。
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Exploring the Feasibility of a New Low Cost Intra-Dermal Pre & Post Exposure Rabies Prophylaxis Protocol in Domestic Bovine in Jawali Veterinary Hospital, District Kangra, Himachal Pradesh, India
Cattle are the backbone of household economy in rural areas of India and many of them die after bites by potentially rabid dogs, despite being given currently recommended five shots of intramuscular (IM) rabies vaccination as Post Exposure Prophylaxis (PEP). In 2016, seven of 21 bovine bitten by rabid dogs given IM rabies vaccination died due to rabies in Shimla Municipality. This scenario prompted the authors to look for a suitable protocol, based on human studies, to save animals. We tested various schedules of IDRV in bovine and found that a schedule of 0.2 ml given in middle 1/3rd of neck on day 0, 3, 7, 14 and 28 along with local wound infiltration of eRIG is sufficiently immunogenic and life saving in all of them, even if bitten by lab confirmed rabid dogs/mongoose as tested by CRI. Rabivac Vet, a Cell Culture Rabies Vaccine, available as 1 ml per vial was used off level for IDRV. While injecting the vaccine, a raised papule of ≥1 cm will appear slowly causing a peau d’orange appearance. All 60 bovine serum samples tested by RFFIT after IDRV, had titers more than 0.5 IU/ml on day 14. Thereafter, a total of 150 animals were given five doses of IDRV as PEP, with or without RIG, after their exposure to clinically or lab confirmed rabid dogs/mongoose and all survived for more than a year. Serum samples from 15 animals bitten by lab confirmed rabid dogs/mongoose were collected on day 14 and tested for RVNA by RFFIT from NIMHANS Bangalore and all had desired antibody titers above 0.5 IU/ml, without any immunosuppression. The RFFIT titers in 55% bovine in all groups were more than adequate after one year and 100% of them had anamnestic response to a single 0.2 ml booster given at one year. Few of the bovine and even one equine (Horse. Figure 4) brought for PEP at some of nearby vet hospitals were given IM rabies vaccine with local eRIG infiltration also survived. Local eRIG infiltration appeared to have covered the lacuna of longer window period required for indigenous antibodies production through IM route in bovine that are not sufficiently produced by day 14. While five times less vaccine was used in this low cost protocol and the survival was 100% compared to traditional IM protocol where survival was 66%. Pre-exposure prophylaxis was found to be effective as 0.2 ml dose of IDRV on day 0, 3, 7 and all bovine had titers higher than the desired by day seven after single 0.2 ml vaccine booster at one year. Our study points towards a possibility of having short schedules of three shots IDRV vaccination in bovine with or without local RIG (depending on presence or absence of wound/s) as PEP and single shot IDRV as PrEP, but further studies are required on a large number of animals. Our study also points out for allowing intra-dermal use in animals as well and labeling vaccines for the same as this is low cost more immunogenic and less painful compare to IM administration.
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