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美国CDC狂犬病专家回复关于眼部暴露的提问

已有 15486 次阅读 2013-11-28 15:48 |个人分类:狂犬病防治|系统分类:科普集锦|关键词:美国 CDC 狂犬病 专家 回复 眼部 暴露| 美国, 回复, CDC, 狂犬, ∽

博友mz91 向美国CDC的狂犬病专家Sergio Recuenco 博士咨询狂犬病毒抗体能不能彻底清除侵入人眼睛里的狂犬病毒,Recuenco 博士的回复是充分肯定的:

The PEP interrupts such migration and will result in destruction of the virus inoculated in the current exposure, disregarding the entry point.

PEP可以阻止这种(病毒从眼部向脑)迁移,并导致此次暴露中病毒增殖被中止,不管病毒是从何处进入的。)

 

以下是mz91咨询和Recuenco 博士回信的原文和参考译文:

 

[15587]mz91  2013-11-2700:37

尊敬的严老师您好!这是我咨询美国CDC的医生关于狂犬病毒抗体能不能彻底清除侵入人眼睛里的狂犬病毒的邮件,严老师您有何见解???


我(mz91

Dear doctor I want to ask you a question about rabies. The question is as follows. Can the rabies virus antibody in the human body kill all the rabies virus in a person's eyes? My situation is that some saliva of a rabid dog got directly into my eyes one month ago , and I was given rabies vaccine in my local CDC at once. Now I am certain that I have enough rabies virus antibody in my body for I had detection of serum antibody by RFFIT after given all the rabies vaccine. But some people say that the rabies virus antibody in the human body can not kill all the rabies virus in a person's eyes. And some people say that whether the rabies virus antibody in the human body can kill all the rabies virus in a person's eyes or not is uncertain at present. I am anxious about it and I do not know the scientific and correct conclusions, so I write this email to ask you for help. I'm looking forward to your reply. Thank you very much!!!


我(mz91 自己提供的译文

亲爱的医生,我想向您询问一个关于狂犬病的问题,问题如下。人体内的狂犬病毒抗体能够杀死人眼睛里所有的狂犬病毒吗?我的情况是:一个月前,一条狂犬的一些唾液直接进入到我的眼睛里去了,我立刻在当地的CDC接种了狂犬疫苗。现在我能够确信我体内有足够的狂犬病毒抗体,因为我在接种全程狂犬疫苗后使用RFFIT方法检测过抗体。但是一些人说人体内的狂犬病毒抗体不能杀死人眼睛里的狂犬病毒,一些人说目前并不清楚人体内的狂犬病毒是否能够杀死人眼睛里的狂犬病毒,我对此感到焦虑不安,我不知道科学正确的结论,因此写了这封邮件向您寻求帮助,我期待着您的回复,非常感谢您!!!


美国CDC Dr. Sergio Recuenco)的回复:
       We appreciate your concerns and I hope the answer below satisfies your consultation.

By your email Iunderstand you had a rabies exposure, and you were administered a completerabies post-exposure prophylaxis (PEP), including human rabies immunoglobulin(one dose calculated by body weight on day 0, probably given in several shotsthe same day) and a total of 4 doses of rabies vaccine administered and days 0,3, 7 and 14 of the start of vaccination.
   If the PEP was given correctly and the RFFIT values (antibody titers) after completion  of the vaccination is adequate, then that means your immune system is able to produce the needed antibodies to prevent rabies successfully.

The rabies virus has affinity with nervous tissue and will migrate using the nervous tissue cells towards the brain, contamination of mucosae (such as the walls of mouth/oral cavity, nose, and eyes ) are of concern for the possibility of inflammation or openings (e.g. cuts, scratches) that will easily allow entry ofthe rabies virus to the nervous endings present there, and for the close proximity with the brain. However, an intact mucosae is not expected to allowentry of the virus, but that could be hard to determine, and PEP can beindicated in potential rabies exposures to mucosae.  If the exposure involves the eye,  then the virus is expected to follow their attemptto reach the brain. The PEP interrupts such migration and will result in destruction of the virus inoculated in the current exposure, disregarding theentry point.
   Additionally, I would like to say that if in the future you are exposed again to rabies you will only need 2 booster doses of the rabies vaccine, as indicated for patient that received a full PEP in the past.
   Thanks for your consultation.

   Best regards,

          Dr. Sergio Recuenco
          Rabies Program-CDC


参考译文:

感谢您的关注,希望对你的咨询的下述回答能使你满意。
   通过您的电子邮件,我知道你曾有狂犬病暴露,而你进行了一次完整的狂犬病暴露后预防(PEP),包括人狂犬病免疫球蛋白(按体重计算在第0天的一次剂量,可能需要在当天分多针接种)和总共4剂量的狂犬病疫苗,分别在疫苗开始接种后的第03714天接种。(注:原信中并未说接种了免疫球蛋白,此处的接种程序为美国CDC推荐的4针程序)

如果PEP正确进行,而RFFIT值(抗体滴度)在接种完成后是足够的,那么这就意味着你的免疫系统能够产生所需要的抗体,从而表明你已成功预防狂犬病。
   狂犬病毒与神经组织有亲和性,将利用神经组织的细胞向脑移动,粘膜(如口腔外壁/口腔、鼻和眼)受病毒污染同时又可能有炎症或破口(如割伤、擦伤),则可能很容易让狂犬病毒进入,到达其中存在的神经末稍,并进一步向脑靠近。当然,完整的粘膜预期不会容许病毒进入,但这可能很难完全确定,所以通常还是要求在粘膜有暴露于狂犬病的潜在可能时,采取PEP措施。如果暴露涉及眼睛,那么病毒移动到达大脑的“企图”也可能得逞。而PEP则可以阻止这种迁移,并导致此次暴露中病毒增殖被中止,不管病毒是从何处进入的。

另外,我想提醒你,如果将来再次发生狂犬病暴露,你在进行狂犬疫苗加强接种时只需要接种2剂,在过去接受过完整的PEP处置的病人都应当照此办理。

感谢您的咨询。 

最好的问候,

 

博主回复 (2013-11-27  08:40)

美国CDC当然代表了当今全球狂犬病研究的最高水平,英文水平好的人直接与他们交流可以获得最前沿、最可靠的资讯。
   当然,也要考虑美国人均GDP比中国高得多,医保制度也比中国健全,而美国每年人狂犬病的病例数很少(接近于0),所以他们的有些以防万一的举措不一定完全适合于中国。例如美国每因狂犬病死一个人,通常就会轰动全国,还会兴师动众地对死者周围的所有人进行风险分析,筛选一部分人作预防性疫苗接种。这在中国很难做到,也不一定真有必要。
   Dr. SergioRecuenco 的回复讲得很好。你能将信件译成中文让更多英文不太好的人分享吗?

 

附:mz91 的再次留言  

[15619]mz91  2013-11-2801:41

尊敬的严老师您好!我是下面的 15587楼,我的英文也不好,只是知道邮件的大概意思,很多地方不知道怎么翻译才妥当,因此,请严老师有空给出专业的翻译,并且恳请老师能写一篇博文,来从整体上正确地认识抗体能不能彻底清除眼睛里的狂犬病毒这个问题,让大家对狂犬病有科学正确的认识,不再受错误的观点所误导,不再恐惧狂犬病!我附上我的提问的中文翻译,也翻译得不太好,如有不妥当的,请老师帮我纠正过来,真诚地从内心感谢严老师!!!
   我的提问的中文翻译(注:已置于转载的英文提问后面)。




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