Lancetissa rabieksesta uutta

http://www.who.int/bulletin/volumes/95/3/16-173039.pdf

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  Introduction
  Rabies is a preventable yet fatal disease that is responsible for
  approximately 59000 deaths each year.
  However, widespread underreporting of rabies cases means that the actual number
  of deaths is likely to be higher. Poor and rural populationsare disproportionately affected, with the majority of deathsoccurring in children younger than 15years in Asia and Af-rica.
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  Ninety-nine per cent of human rabies cases result from dog bites and, once symptoms begin, the disease is almostinvariably fatal.
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  Human rabies is preventable through canine vaccination to eliminate rabies at its source or by administering rabies vaccines and immunoglobulin following bites,scratches or saliva exposure from suspected rabid mammals (i.e. postexposure prophylaxis).
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  Another preventive strategy is pre-exposure prophylaxis, which involves giving a series of intramuscular or intradermal injections of rabies vaccine to prime the immune system. This enables fast recall of memory immune responses once a person is re-exposed to the virus.
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  Moreover, people who have received pre-exposure prophylaxis require fewer doses of postexposure rabies vaccine and can be treated without rabies immunoglobulin, which is costly and difficult to procure.
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  Although preventing rabies in dogs is the most cost-effective way of preventing human rabies deaths, pre-exposure prophylaxisis valuable for people at a high disease risk,
  

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    particularly inareas where controlling disease in the animal reservoir is difficult or has
     not been implemented and in areas where access to postexposure prophylaxis and rabies immunoglobulin is unreliable or nonexistent. National pre-exposure prophylaxis
     programmes for high-risk populations have been implemented in Peru and the Philippines.
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    In 2010, a World Health Organization (WHO) position paper on rabies vaccines called
     for studies on the feasibility, cost–effectiveness and long-term impact of incorporating
    vaccines derived from cell culture or embryonated eggs into immunization programmes
     for children where canine rabies is a public health problem.
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    The paper also made recommendations on pre-exposure prophylaxis regimens and on the
    frequency of booster vaccinations and serological surveillance for at-risk individuals, 
    such as veterinarians. The aim of this study was to review the scientific literature published between 2007 and 2016, as well as field data, to assess the current use and cost–
    effectiveness of pre-exposure rabies prophylaxis(excluding travel vaccines), particularly in children and in high-risk settings, in the context of recommendations made in
    the 2010 WHO rabies vaccine position paper on pre-exposure prophylaxis and booster vaccine administration