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Rabies remains a serious public health problem in China. The disease is preventable through timely provision of adequate post-exposure prophylaxis (PEP), and designated PEP clinics exist in China to provide PEP treatment. This study aimed to understand the characteristics of outpatients in rabies PEP clinics to provide a basis for follow-up work. Data in this study was from an electronic, PEP clinic-based case registration system, including case information, exposure history, PEP recommendations, and vaccination status, which covered all 91 clinics in Tianjin Municipality from January 1 to December 31, 2020. Among all the 126,133 first-visit cases, more than 90% of the patients washed the wound by themselves and went to PEP clinics within 24 hours after exposure; 97.04% of the outpatients received the first dose of the rabies vaccine; and 94.64% of the outpatients completed the whole schedule of doses (5-doses/2-1-1 regimen). The result showed that most of the outpatients have knowledge of rabies. To better control rabies, we need to pay more attention to people who do not know about rabies and help them establish awareness of PEP.
A total of 126,133 first-visit cases sought a consultation to PEP clinics in Tianjin Municipality from January 1 to December 31, 2020. The reported exposure rate was 909.66/100,000 population. Among all the cases, 50.97% were female (n=64,291). The mean age was 36.3 years (range: 3 months to 99 years). The major exposure animal was dogs (56.06%) and cats (40.78%); most of the animals were domesticated with identified owners (92.20%), and 69.47% of them had rabies vaccination history. Among total exposures, 50.38% (n=63,381) were classified as category III (single or multiple transdermal bites or scratches, etc.). Hands (56.56%, n=65,032) and legs (21.09%, n=26,000) were the most common sites for exposures. More than 90% of patients washed their wounds before arriving to PEP clinics and 57.98% of the cases finished wound-washing in the PEP clinics; 89.40% of the cases went to the PEP clinics within 24 hours after exposure (Table 1).
Characteristics No. of reported exposures Percent (%) Sex Male 61,842 49.03 Female 64,291 50.97 Exposure category I 2,859 2.01 II 59,893 47.61 III 63,381 50.38 Exposure site Hands 65,032 51.56 Legs 26,600 21.09 Arms 16,244 12.88 Foots 7,900 6.26 Head/face/neck 5,372 4.26 Trunks 4,985 3.95 Multi-sites (more than one area) 2,668 2.12 Animal Dog 70,707 56.06 Cat 51,433 40.78 Other 3,993 3.16 Owner status Owned 116,292 92.2 Not owned 9,841 7.80 Animal vaccination history At lease one 80,793 64.54 Never/unknown 45,340 35.46 Type of exposure Bite 77,417 61.38 Scratches 45,011 35.69 Others 3,705 2.93 Interval between exposure and medical attention 2 hours 50,974 40.41 2–6 hours 21,828 17.31 24 hours 39,953 31.68 >24 hours 13,378 10.60 Wound washing By one’s own 116,164 92.10 By the clinics 72,944 57.83 History of exposure and
re-exposureWithin 6 months 3,528 2.27 6 months to 1 year 4,785 3.79 1–3 years 8,192 6.49 Table 1. Characteristics of the patients visited post-exposure prophylaxis clinics in Tianjin Municipality, China, 2020.
Among the 106,769 persons with category II or III exposure who had no history of prior rabies vaccination (or re-exposure >3 years), 96.68% (n=103,221) received the first dose of rabies vaccination. Nearly 95% of the cases completed the whole schedule of doses. Adherence to rabies is shown in Table 2. Only 25.21% (n=15,979) of the cases with category III received the rabies immunoglobulin (RIG).
Dose No. of people actually vaccinated No. of people should be vaccinated
(5 doses/2-1-1 regimin)Completion rate (%) 1 103,221 106,769 96.68 2 102,470 106,769 95.97 3 101,917 106,769 95.46 4 101,415 106,769 94.99 5 95,488 100,899 94.64 Table 2. Adherence to rabies vaccination advice among persons who visited the post-exposure prophylaxis clinics in Tianjin Municipality, China, 2020.
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