6/24/2019 1 Evaluating Rabies Pre‐exposure Prophylaxis Vaccination Schedules: PATRICK SOENTJENS CHIEF PHYSICIAN, POLYCLINIC, ITM, ANTWERP CHAIR, BELGIAN STUDY GROUP TRAVEL MEDICINE MED LT COL, HEAD, CENTER FOR INFECTIOUS DISEASES, MILITARY HOSPITAL BRUSSELS No disclosures Disclosures Background Rabies PrEP Rabies PrEP: prospective studies Rabies PrEP: retrospective studies Discussion Conclusion Rabies “The Belgium experience” Rabies causes fatal encephalitis ‐ an estimated 59.000 ‐ 70.000 human deaths every year in endemic regions ‐ estimated risk for an animal bite in travellers: calculated 0,4 % per month staying in an endemic country ‐ 3 deaths per year in travellers Background Hampson et al. PloS Negl Trop Dis 2015 WHO Wkly Epidemiol Rec 2010 Gautret: JTravelMed 2012; Vaccine 2012; Curr Opin Infect Dis 2012 5 Institut Pasteur de Paris The 10th of October 2017 Un cas de rage importé en France chez un enfant Hospitalisé à Lyon, le garçon de 10 ans avait été mordu par un chien contaminé lors d’un séjour en août 2017 au Sri Lanka. Background Only the seventh known case in the United Kingdom since 2000. England's health service issued a reminder Monday for travellers to avoid coming into contact with animals when travelling to rabies affected countries, particularly those in Asia and Africa The 12 th of Nov 2018 58 old Briton dies from rabies after cat bite in Morocco 1 2 3 4 5 6
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PD1 - Rabies Vaccination Panel - Patrick Soentjens€¦ · D0 D56 D0 D7 D0 D3 D0 N = 360 subjects 2IM N Age Rabies PreP ID PEP ID Day0 ( ‐3) RFFIT ≥ 0,5IU/ml GMT 2007 N = 84 ‐8
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6/24/2019
1
Evaluating Rabies Pre‐exposure Prophylaxis
Vaccination Schedules:
PATRICK SOENTJENS
CHIEF PHYSICIAN, POLYCLINIC, ITM, ANTWERPCHAIR, BELGIAN STUDY GROUP TRAVEL MEDICINE
MED LT COL, HEAD, CENTER FOR INFECTIOUS DISEASES, MILITARY HOSPITAL BRUSSELS
No disclosures
Disclosures
Background
Rabies PrEP
Rabies PrEP: prospective studies
Rabies PrEP: retrospective studies
Discussion
Conclusion
Rabies
“The Belgium experience” Rabies causes fatal encephalitis
‐ an estimated 59.000 ‐ 70.000 human deaths every year in endemic regions
‐ estimated risk for an animal bite in travellers:
calculated 0,4 % per month staying in an endemic country
Hospitalisé à Lyon, le garçon de 10 ans avait été mordu par un chien contaminé lors d’un séjour en août 2017 au Sri Lanka.
Background
Only the seventh known case in the United Kingdom since 2000.
England's health service issued a reminder Monday for travellers to avoid coming into contact with animals when travelling to rabies affected countries, particularly those in Asia and Africa
The 12th of Nov 201858 old Briton dies from rabies after cat bite in Morocco
1 2
3 4
5 6
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The 6th of May 2019
Norwegian woman dies from rabiesafter Philippines puppy bite
Birgitte Kallestad, 24 year old, was on holiday withfriends when they found the puppy on a street.
She fell ill soon after returning to Norway, and died on Monday at the hospital where she worked.
Family statement of Brigitte the 15th of May at www.promed.org
"Our dear Birgitte loved animals. Our fear is that such fate may happen to others who have a warm heart like her. We want rabies vaccine to be included in the program for travellers to locations where the disease is present, and that people become more aware of the danger. If we manage to achieve this, the death of our sunbeam can save others. Warm greetings from the family."
Rabies risk during travel: low risk – animal bite: high risk
Background
Steffen: J Travel Med 2015 and adapted 2018
Start PEPimmediately
Rabies risk: prevention
Increase awareness
Avoid contact with street dogs, monkeys and other mammals
Background
Shlim: J Travel Med 2019
Rabies risk: have a back‐up plan
Travel insurance
Background
Shlim: J Travel Med 2019
Rabies risk: start Rabies PEP procedure in time
Washing ‐ Soap ‐ Desinfection
Respective PEP schedule and HRIG
Background
WHO report 2018
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9 10
11 12
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Rabies risk: difficulties with Human Rabies Immunoglobulins (HRIG)
In time ‐ Availability ‐ Costs?
Equine Rabies Immunoglobulins?
Background
Belgian Rabies PEP data 2017 with use of HRIG in BE
N = 75
44 of the cases (58%) were female.
Mean age was 33 years (interquartile range 24 ‐ 51; range: 4 ‐ 85).
Mean time delay between exposure and the administered HRIG was 8.7 days:
‐ 9.6 days (IQR 2,5 ‐ 9) for abroad travel‐ 6 days (IQR 1 ‐ 4) for inland bat‐related risks.
Mean time delay between exposure and the first administered dose of rabies vaccine was 7.7 days:
‐ 8.3 days (IQR 0 ‐ 8,5) for abroad travel‐ 6 days (IQR 1 ‐ 4) for inland bat‐related risks
Background
Soentjens et al Acta Clin Belgica 2019
Immunescence following Rabies PEP: research gaps
Belgian Rabies PEP data 2017 ITMN = 63 (of 75)
One single patient had no response (RFFIT < 0.5 IU/mL) after a full 51IM PEP schedule with HRIG
The timing of the vaccinations and the serology test were in accordance
Age = 80 years
Serology testing (RFFIT) is crucial in Rabies PEP when decreasing PrEP and PEP doses
Background
Soentjens et al Acta Clin Belgica 2019 Clin Infect Dis 2012
Concept BOOST
Rabies pre‐ and postexposure prophylaxis (PEP without PrEP)