Evaluation of Pediatric Cases with Suspected Rabies Exposure in the Pediatric Emergency Department

Yıl 2022, , 139 - 144, 30.09.2022

Yalçın Kara , Mahmut Can Kızıl , Ömer Kılıç , Sabiha Sahin , Ener Dınleyıcı, Md

https://doi.org/10.54996/anatolianjem.1052024

Öz

Aim: Rabies is a public health problem that can be prevented by vaccination and prophylaxis practices both in our country and in the world. It has a high risk of death if it cannot be prevented. In this study, we aimed to investigate the clinical and epidemiological characteristics of children admitted to the pediatric emergency department of our hospital with the suspicion of rabies.

Material and Methods: In this study, patients who applied to the Pediatric Emergency Department of Eskişehir Osmangazi University Faculty of Medicine between January 2013 and June 2021 with contact with an animal with an animal at risk of rabies were evaluated retrospectively. Epidemiological and clinical features of 746 pediatric cases included in the study were evaluated.

Results: 55% of 746 patients included in the study were male and the mean age was 102 months (4 months-216 months). 94% of the cases reside in the city and 6% reside in the countryside. There was cat contact in 54% and dog contact in 46% of the cases. Of the contact animals, 84% were stray and 89% were unvaccinated. While 82% of suspected rabies contacts were in category 2, 60% had upper extremity contact, and 21% had lower extremity contact. While wound cleaning was performed in all cases, rabies vaccine was administered to 99%, rabies immunoglobulin to 10%, tetanus prophylaxis to 32%, and antibiotic treatment to 21%. Immunoglobulin, antibiotics, tetanus prophylaxis, suturing and hospitalization were higher in the dog contact group than in the cat contact group. Compliance with the rabies vaccination schedule was high in both groups.

Conclusion: Our study shows that the contact cases with suspected rabies are mostly with stray and unvaccinated animals, and precautions such as vaccination and housing of stray animals should be increased. Rabies, which is still a deadly public health problem for the whole world and for our country, can be prevented by vaccination, post-exposure prophylaxis practices, and community education.

Anahtar Kelimeler

Rabies, pediatric, emergency, exposure

Destekleyen Kurum

Ek kurum desteği yok

Proje Numarası

Proje yok

Teşekkür

.

Çocuk Acil Servise Kuduz Şüpheli Hayvan Teması İle Başvuran Pediatrik Olguların Değerlendirilmesi

Öz

Amaç: Kuduz hem ülkemizde hem de dünyada aşı ve profilaksi uygulamaları ile önlenebilen, önlenemediği takdirde ölüm riski yüksek bir halk sağlığı sorunudur. Bu çalışmada hastanemiz çocuk acil servisine kuduz teması şüphesiyle başvuran çocukların klinik ve epidemiyolojik özelliklerini araştırmayı amaçladık.

Gereç ve Yöntemler: Çalışmamızda Ocak 2013-Haziran 2021 tarihleri arasında Eskişehir Osmangazi Üniversitesi Tıp Fakültesi Çocuk Acil Servisi'ne kuduz riski taşıyan bir hayvanla temas ile başvuran çocuk hastalar retrospektif olarak değerlendirildi. Çalışmaya dahil edilen 746 pediatrik olgunun epidemiyolojik ve klinik özelliklleri değerlendirildi.

Bulgular: Çalışmaya alınan 746 olgunun %55'i erkekti ve yaş ortalaması 102 ay (4 ay-216 ay) idi. Vakaların %94'ü şehirde, %6'sı kırsalda ikamet etmektedir. Vakaların %54'ünde kedi, %46'sında köpek teması vardı. Temaslı hayvanların %84'ü sahipsizdi ve %89'u aşısızdı. Şüpheli kuduz temaslılarının %82'si kategori-2'de iken, %60'ında üst ekstremite teması ve %21'inde alt ekstremite teması vardı. Tüm olgularda yara temizliği yapılırken, %99'una kuduz aşısı, %10'una kuduz immünoglobulin, %32'sine tetanoz profilaksisi ve %21'ine antibiyotik tedavisi uygulandı. İmmünoglobulin, antibiyotik, tetanoz profilaksisi, dikiş atma ve hastaneye yatış, köpek temas grubunda kedi temas grubuna göre daha yüksekti. Her iki grupta da kuduz aşı takvimine uyum yüksekti.

Sonuç: Çalışmamız, kuduz şüphesi olan temas vakalarının çoğunlukla sahipsiz ve aşısız hayvanlarla olması, sokak hayvanlarının aşılanması ve barındırılması gibi önlemlerin artırılması gerektiğini göstermektedir. Tüm dünya ve ülkemiz için halen ölümcül bir halk sağlığı sorunu olan kuduz, aşılama, temas sonrası korunma uygulamaları ve toplum eğitimi ile önlenebilir.

Anahtar Kelimeler

Kuduz, çocuk, acil servis, temas

Proje Numarası

Proje yok

Kaynakça

• WHO. Rabies: World health organization; 2019. https://www.who.int/news-room/fact- sheets/detail/rabies (2/22/2021).
• Willoughby RE. Rabies. In: Kliegman R, Stanton B, St. Geme JW, Schor NF, Behrman RE, Eds. Nelson Textbook of Pediatrics. Ed. 20th, Philadelphia; Elsevier; 2016: p. 1641-3.
• T.R. Ministry of health. Kuduz Saha Rehberi Ankara: T.C. Sağlık Bakanlığı; 2019. Available from:https://dosyaism.saglik.gov.tr/Eklenti/21615,kuduz-saha-rehberipdf.pdf?0[10/1/2020].
• Alfred DeMaria, J., MD, M. Martin S Hirsch, et al. Rabies immune globulin and vaccine. Jul 2017: p. http://www.uptodate.com/contents/rabies-immune-globulin-and-vaccine.
• Aldemir-Kocabaş B. Retrospective assessment of children exposed to animals and the anti-rabies prophylaxis practices in our clinic. Turkish J Pediatr Dis 2018; 2:104-7. doi: 10.12956/tjpd.2017.297.
• Karadaş MA, Yılmaz F, Demir TA, et al. Evaluation of animal contacted patients with rabies suspected. Exposures presented to antalya training and research hospital emergency service. Acta Medica Alanya 2018; 2:163-9.
• Hemachudha T, Laothamatas J, Rupprecht C.E, Human rabies: a disease of complex neuropathogenetic mechanisms and diagnostic challenges. The Lancet Neurology, 2002. 1(2): p. 101-109.
• Aker S, Şahin M.K, An Evaluation of Cases of Rabies Risk Contact Kuduz Riskli Temas Olgularının Değerlendirilmesi. Ankara Medical Journal, 2016. 16(3). 17.
• Ichhpujani, R, Chhabra M, Mittal V, et al., Knowledge, attitude and practices about animal bites and rabies in general community--a multi-centric study. The Journal of communicable diseases, 2006. 38(4): p. 355-361.
• Tarantola, A., S. Ly, S. In, et al., Rabies vaccine and rabies immunoglobulin in Cambodia: use and obstacles to use. Journal of travel medicine, 2015. 22(5): p. 348-352.
• Mansfield K.L., Andrews N, Goharriz H, et al., Rabies pre-exposure prophylaxis elicits long-lasting immunity in humans. Vaccine, 2016. 34(48): p. 5959-5967.
• Sögüt Ö, Sayhan M.B, Gökdemir M, A Preventable Public Health Challenge in Southeastern Turkey: Rabies Risk-Contact Cases. Journal of Academic Emergency Medicine; Ankara Vol. 10, Iss. 1, (Mar 2011): 14-17.
• Yılmaz, F., Akbulut A.S, Taş M, et al., Evaluation of Cases with Rabies Risk Presenting to Emergency Department. Journal of Clinical and Analytical Medicine, 2014. 5(1).
• Sengoz, G, Yasar K.K, Karabela S.N, et al., Evaluation of cases admitted to a center in Istanbul, Turkey in 2003 for rabies vaccination and three rabies cases followed up in the last 15 years. Japanese journal of infectious diseases, 2006. 59(4): p. 254.
• Gülaçti U, Üstün C, Gürger M, et al., Epidemiology of Cases with Rabies-Suspected Animal Contact and the Evaluation of Post Exposure Prophylaxis, Journal of Medical Sciences; Balgat Vol. 32, Iss. 3, (2012): 759-765.
• Ostanello F,Gherardi A, Caprioli A, et al., Incidence of injuries caused by dogs and cats treated in emergency departments in a major Italian city. Emergency medicine journal, 2005. 22(4): p. 260-262.
• Boland T.A, McGuone D, Jindal J, et al.,Phylogenetic and epidemiologic evidence of multiyear incubation in human rabies. Annals of neurology, 2014. 75(1): p. 155-160.
• Ramezankhani R, Shirzadi MR, Ramezankhani A, et al., Comparative Study on the Adverse Reactions of Purified Chick Embryo Cell Vaccine (PCECV) and Purified Vero Cell Rabies Vaccine (PVRV). Arch Iran Med. 2016 Jul;19(7):502-7.
• Tiembre I, Benie J, Attoh-Touré H, et al., Discontinuation of postexposure prophylaxis at the anti-rabies Center of Abidjan, Côte d'Ivoire. Bull Soc Pathol Exot 2013; 106(4):272-7.
• Tepsumethanon S, Tepsumethanon V, Tantawichien T et al., Problems in human rabies post-exposure prophylaxis management. Travel Med Infect Dis 2007; 5(3):189-93.