Hayvan ısırığına maruz kalmış kişilerde kuduz aşılaması sonrası antikor düzeyinin araştırılması
Küçük Resim Yok
Tarih
2009
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Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Kuduz, gelişmekte olan ülkelerde hala önemli bir halk sağlığı problemi olmaya devam etmektedir. Kuduz virusuna maruz kalması muhtemel bir kişinin, hayvan ısırmasından sonra mümkün olan en kısa zamanda aşılama programına alınması gerekmektedir. Daha önce aşılanmış kişilerin kuduz virusu ile tekrar karşılaşması durumunda aşılama programının yinelenmesi gerekliliği ise açık değildir. Bu çalışmada kuduz aşısı uygulanan kişilerde koruyucu antikor düzeyinin araştırılması ve aşılama sayısı ile koruyucu antikor titresi arasındaki ilişkinin belirlenmesi amaçlanmıştır. Çalışmaya, Manisa Devlet Hastanesi Kuduz Takip Merkezine şüpheli hayvan ısırığı nedeniyle başvuran 2-90 yaş arasında (yaş ortalaması: 35.7 yıl) toplam 186 kişi (60 kadın, 126 erkek) dahil edilmiştir. Bu bireylerin 135'ine Dünya Sağlık Örgütü (DSÖ) tarafından önerilen iki farklı aşılama programı uygulanırken, 51 kişinin aşılaması gözlem süresinde ısıran hayvanın kuduz olmadığının anlaşılması nedeniyle 2. ya da 3. dozdan sonra durdurulmuştur. Beş dozluk birinci aşılama programı (O, 3, 7, 14 ve 30. günler) 20 bireye, 4 dozluk diğer aşı programı (O, 2, 7, 21. günler) ise 115 fireye uygulanmıştır. Uygulama, HDCV aşısının kas içi enjeksiyonu şeklinde yapılmış; aşılama programından 3-36 ay sonra tekrar çağırılan aşılananlardan alınan serumlarda kuduz virusuna özgül nötralizan IgG antikor titreleri ticari bir ELISA kiti ile (Platelia Rabies II, Bio-Rad, France) araştırılmıştır. İki veya daha fazla dozda HDCV aşısı uygulanan toplam 186 bireyin 116 (%62.4)'sında IgG antikorları koruyucu düzeyde (pozitif 0.5 lU/ml) bulunurken, 70 (%37.6)'inde koruyucu düzeyin altında (negatif) saptanmıştır. IgG pozitiflik oranı 2 ve 3 doz aşı yapılan gruplarda (sırasıyla; %54.5 ve %55.1), 4 ve 5 doz aşı yapılan gruplara (sırasıyla; %64.3 ve %70) göre daha düşük görünmekle birlikte gruplar arasındaki fark istatistiksel olarak anlamlı bulunmamıştır (p 0.05). Sonuç olarak, aşılama programı tamamlanmış bireylerde bile koruyucu antikor.pozitiflik oranının düşük (%70) düzeyde kalmasının, aşılanan kişinin yaşı, aşılamadan sonra geçen zaman, aşılamanın sayısı ve aşının saklanma/taşınma koşulları ile ilişkili olduğu düşünülmüş ve bu kişilerin kuduz virusuna tekrar maruz kalma durumunda olanak varsa antikor titrelerinin koruyucu olup olmadığının kontrol edilmesi, yoksa düşük antikor düzeyi ihtimalinden dolayı özellikle de bir yıldan uzun süre geçmişse tekrar aşılanması gerektiği kanısına varılmıştır.
Rabies is still an important public health problem in developing countries. Vaccination against rabies should be initiated as soon as possible following the suspicious bite. It is not yet clear whether previously vaccinated people should be re-vaccinated in case of re-exposure to rabies virus. In this study it is aimed to determine the antibody titer in sera of vaccinated people and also to evaluate the relation between the antibody titer and number of vaccination. The study group consisted of 186 persons (60 female, 126 male) aged between 2-90 years (mean: 35.7 years) and who were admitted to Manisa State Hospital Rabies Follow-up Center, Turkey. Hundred and thirty five of the cases were vaccinated according to the programmes advised by WHO's reference protocol for post-exposure rabies vaccination. However, vaccination was discontinued for 51 of the cases since the follow-up of the suspicious animal revealed that it was not rabid. Five-dose vaccination programme (on days 0, 3, 7, 14, and 30) was applied to 20 cases and four-dose programme (on days 0, 2, 7, 21) was applied to 115 cases. HDCV vaccine was applied as intramuscular injection and after 3-36 months following vaccination, rabies specific neutralizing IgG antibody titers were determined by using a commercial ELISA kit (Platelia Rabies II, BioRad, France). While the titer of IgG antibodies were within the protective limits (positive, > or 0.5 IU/ml) in 116 (62.4%) of the 186 cases who were given two or more doses of HDCV, the titer was below the protective level (negative) in 70 (37.6%) of the cases. Although the rates of IgG positivity in two and three dose vaccine applied group (54.5% and 55.1%, respectively) were lower than the rates in four and five dose applied group (64.3% and 70%, respectively), the difference was not statistically significant (p> 0.05). These results denoted that the rate of protective antibody positivity was low (70%) even in full programme vaccinated cases and this might be attributed to age of the person, the length of time after vaccination, number of vaccinations and storage/transport condition of the vaccine. Thus in case of reexposure of vaccinated people to rabies virus, it is recommended to check the anti-rabies antibody titers if possible or to re-vaccinate those people with a history of prior vaccination exceeding one year since there is high probability of low level of protective antibodies.
Rabies is still an important public health problem in developing countries. Vaccination against rabies should be initiated as soon as possible following the suspicious bite. It is not yet clear whether previously vaccinated people should be re-vaccinated in case of re-exposure to rabies virus. In this study it is aimed to determine the antibody titer in sera of vaccinated people and also to evaluate the relation between the antibody titer and number of vaccination. The study group consisted of 186 persons (60 female, 126 male) aged between 2-90 years (mean: 35.7 years) and who were admitted to Manisa State Hospital Rabies Follow-up Center, Turkey. Hundred and thirty five of the cases were vaccinated according to the programmes advised by WHO's reference protocol for post-exposure rabies vaccination. However, vaccination was discontinued for 51 of the cases since the follow-up of the suspicious animal revealed that it was not rabid. Five-dose vaccination programme (on days 0, 3, 7, 14, and 30) was applied to 20 cases and four-dose programme (on days 0, 2, 7, 21) was applied to 115 cases. HDCV vaccine was applied as intramuscular injection and after 3-36 months following vaccination, rabies specific neutralizing IgG antibody titers were determined by using a commercial ELISA kit (Platelia Rabies II, BioRad, France). While the titer of IgG antibodies were within the protective limits (positive, > or 0.5 IU/ml) in 116 (62.4%) of the 186 cases who were given two or more doses of HDCV, the titer was below the protective level (negative) in 70 (37.6%) of the cases. Although the rates of IgG positivity in two and three dose vaccine applied group (54.5% and 55.1%, respectively) were lower than the rates in four and five dose applied group (64.3% and 70%, respectively), the difference was not statistically significant (p> 0.05). These results denoted that the rate of protective antibody positivity was low (70%) even in full programme vaccinated cases and this might be attributed to age of the person, the length of time after vaccination, number of vaccinations and storage/transport condition of the vaccine. Thus in case of reexposure of vaccinated people to rabies virus, it is recommended to check the anti-rabies antibody titers if possible or to re-vaccinate those people with a history of prior vaccination exceeding one year since there is high probability of low level of protective antibodies.
Açıklama
Anahtar Kelimeler
Mikrobiyoloji
Kaynak
Mikrobiyoloji Bülteni
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Scopus Q Değeri
Cilt
43
Sayı
1
