1. Time of administration of rabies immunoglobulins and adequacy of antibody response upon post-exposure prophylaxis: a descriptive retrospective study in Belgium
- Author
-
Marjan Van Esbroeck, Steven Van Gucht, Erika Vlieghe, Eric Florence, Isabel Brosius, Jan Clerinx, Mieke Croughs, Steven Declerq, Emmanuel Bottieau, Ula Maniewski, Johan van Griensven, Yven Van Herrewege, Katleen Balliauw, Lut Lynen, Steven Van Den Broucke, Caroline Theunissen, Sabrina H. van Ierssel, Chris Kenyon, Ralph Huits, Christoph Burm, and Patrick Soentjens
- Subjects
medicine.medical_specialty ,Rabies ,medicine.medical_treatment ,Antibodies, Viral ,03 medical and health sciences ,Pre-exposure prophylaxis ,Dogs ,0302 clinical medicine ,Belgium ,Internal medicine ,Animals ,Humans ,Medicine ,030212 general & internal medicine ,Post-exposure prophylaxis ,Retrospective Studies ,biology ,business.industry ,Retrospective cohort study ,General Medicine ,medicine.disease ,Antibody response ,Rabies Vaccines ,Rabies virus ,030220 oncology & carcinogenesis ,Antibody Formation ,biology.protein ,Human medicine ,Antibody ,Post-Exposure Prophylaxis ,business - Abstract
Background: Data on rabies post-exposure prophylaxis (PEP) and the use of human rabies immunoglobulins (HRIG) in Belgium are scarce. The main objective of this study was to evaluate the timely administration of HRIG after rabies exposure. The secondary objective was to evaluate the adequate antibody response following PEP. Methods: We reviewed all medical records from July 2017 to June 2018 of patients seeking care at, or referred to, the Institute of Tropical Medicine and the University Hospital, Antwerp for the administration of human rabies immunoglobulins following potential rabies exposure abroad or in Belgium. A timely response was defined as starting HRIG with a delay of 5.0 IU/mL in case of bat-related exposure and >3.0 IU/mL in case of exposure to other animals. Titers were measured 10 days after the last PEP vaccine dose, using the rapid fluorescent focus inhibition test (RFFIT). Results: Of the 92 cases treated with HRIG, 75 were evaluated. The majority of injuries were acquired in Asia (n = 26,34%) and in Western Europe (n = 18, 24%), of which 17 in Belgium. The five most frequently recorded countries overseas were Indonesia (n = 13), Thailand (n = 7), Morocco (n = 4), Peru (n = 3) and Costa Rica (n = 3). Administration of immunoglobulins was related to injuries by dogs (36%), monkeys (25%) or bats (22%). A timely response was observed in 16 (21,33%) and in 55 (73,33%) of subjects receiving HRIG (5.0 IU/ml. In 38 of 47 (81%) cases related to other animals the RFFIT titer was >3.0 IU/ml. All low-responders received additional rabies injections. Conclusion: This study showed a substantial time delay between the animal-related risk and the administration of HRIG, in particular when the injury occurred abroad. More targeted communication about the risks of rabies and preventable measures may reduce this delay. Furthermore, the antibody response was inadequate in some cases following full PEP administration according to the Belgian recommendation.
- Published
- 2019
- Full Text
- View/download PDF