ประสิทธิผลและความปลอดภัยของแชมพูสารสกัดใบยอผสมข่า เปรียบเทียบกับโลชั่นเบนซิลเบนโซเอต ในการกำจัดเหา Efficacy and Safety of Indian Mulberry Leaf Mixed with Galanga Extract Shampoo versus Benzyl Benzoate Lotion for the Treatment of Head Lice Infestation

บทคัดย่อ วัตถุประสงค์: เพื่อศึกษาประสิทธิผลและความปลอดภัยของแชมพูสารสกัดใบยอและข่าเปรียบเทียบกับโลชั่นเบนซิลเบนโซเอตในการกำจัดเหา วิธีการศึกษา: ตัวอย่างเป็นเด็กนักเรียนหญิงชั้นประถมศึกษา โรงเรียนบ้านหนองมะค่า อ.โคกเจริญ จ.ลพบุรี ที่เป็นเหาจำนวน 36 คน แบ่งเป็นกลุ่มทดลองที่ใช้แชมพูสารสกัดใบยอและข่า 18 คน และกลุ่มควบคุมที่ใช้โลชั่นเบนซิลเบนโซเอต 18 คนนาน 28 วัน ใช้แบบประเมินการตรวจนับเหา แบบประเมินความปลอดภัยในการใช้แชมพูสารสกัดใบยอและข่าและโลชั่นเบนซิลเบนโซเอต และแบบประเมินความพึงพอใจ เพื่อเก็บข้อมูล สถิติที่ใช้ในการวิเคราะห์ข้อมูล ได้แก่ ค่าความถี่ ร้อยละ ค่าเฉลี่ย ส่วนเบี่ยงเบนมาตรฐาน ทดสอบความแตกต่างระหว่างกลุ่มด้วยไคว์สแควร์ และทีเทสต์  ผลการศึกษา: แชมพูสารสกัดใบยอและข่ามีประสิทธิผลในการกำจัดเหาดีกว่าและมีความปลอดภัยมากกว่าโลชั่นเบนซิลเบนโซเอตอย่างมีนัยสำคัญทางสถิติ (P-value < 0.05) ความพึงพอใจต่อการใช้แชมพูสารสกัดใบยอและข่าสูงกว่าโลชั่นเบนซิลเบนโซเอตอย่างมีนัยสำคัญ (P-value < 0.05) สรุป: แชมพูสารสกัดใบยอและข่ามีประสิทธิผลและความปลอดภัยที่ดีกว่าในการกำจัดเหาเมื่อเปรียบเทียบกับโลชั่นเบนซิลเบนโซเอต คำสำคัญ: เหา, แชมพู, ใบยอ, ข่า, เบนซิลเบนโซเอตAbstract Objective: To determine efficacy and safety of Indian mulberry leaf mixed with galanga extract shampoo versus benzyl benzoate lotion for the treatment of head lice infestation. Method: Thirty-six female students studying at primary school at Ban Nong Makha School, Khok Charern district, Lopburi province were recruited and randomized into the experimental (test shampoo) and control (benzyl benzoate lotion) groups of equal size. Treatment lasted 28 days. Data were collected using the lice counting evaluation form, safety assessment form, and satisfaction assessment form. Statistical data analysis included frequency with percentages and mean with standard deviation. Comparisons between groups were done usingchi-square test and independent t-test as appropriate. Results: Test shampoo was more efficacious and safer than benzyl benzoate lotion (P-value < 0.05) in treating head lice. Satisfaction toward the test shampoo was superior to that of benzyl benzoate lotion (P-value < 0.05). Conclusion: The Indian mulberry leaf mixed with galanga extract shampoo has better efficacy and safety in treating head lice compared with benzyl benzoate lotion. Keywords: head lice, shampoo, Indian mulberry leaf, galanga, benzyl benzoate

Immunogenicity of Simulated PCECV Postexposure Booster Doses 1, 3, and 5 Years after 2-Dose and 3-Dose Primary Rabies Vaccination in Schoolchildren

Objectives. To assess the immunogenicity of intradermal (ID) booster doses of Purified Chick Embryo Cell rabies vaccine (PCECV, Rabipur) administered to Thai schoolchildren one, three and five years after a primary ID pre-exposure (PrEP) vaccination series. Methods. In this follow-up study of a randomized, open-label, phase II clinical trial, two simulated post-exposure booster doses of PCECV were administered on days 0 and 3 intradermally to 703 healthy schoolchildren, one, three or five years after primary vaccination with either two or three ID doses of 0.1 mL PCECV. Blood was drawn immediately before and 7, 14 and 365 days after the first booster dose to determine rabies virus neutralizing antibody (RVNA) concentrations. Results. An anamnestic response of approximately 30-fold increase in RVNA concentrations was demonstrated within 14 days after booster. All children (100%) developed adequate RVNA concentrations above 0.5 IU/mL. No vaccine related serious adverse events were seen in any of the vaccinees. Conclusion. ID rabies PrEP with PCECV is safe and immunogenic in schoolchildren and the anamnestic response to a two booster dose vaccination series was found to be adequate one, three, and five years after a two- or three-dose primary PrEP vaccination series

Evaluation of cost-effective strategies for rabies post-exposure vaccination in low-income countries

<b>Background:</b> Prompt post-exposure prophylaxis (PEP) is essential in preventing the fatal onset of disease in persons exposed to rabies. Unfortunately, life-saving rabies vaccines and biologicals are often neither accessible nor affordable, particularly to the poorest sectors of society who are most at risk and upon whom the largest burden of rabies falls. Increasing accessibility, reducing costs and preventing delays in delivery of PEP should therefore be prioritized.<p></p> <b>Methodology/Principal Findings:</b> We analyzed different PEP vaccination regimens and evaluated their relative costs and benefits to bite victims and healthcare providers. We found PEP vaccination to be an extremely cost-effective intervention (from $200 to less than$60/death averted). Switching from intramuscular (IM) administration of PEP to equally efficacious intradermal (ID) regimens was shown to result in significant savings in the volume of vaccine required to treat the same number of patients, which could mitigate vaccine shortages, and would dramatically reduce the costs of implementing PEP. We present financing mechanisms that would make PEP more affordable and accessible, could help subsidize the cost for those most in need, and could even support new and existing rabies control and prevention programs.<p></p> <b>Conclusions/Significance:</b> We conclude that a universal switch to ID delivery would improve the affordability and accessibility of PEP for bite victims, leading to a likely reduction in human rabies deaths, as well as being economical for healthcare providers.<p></p&gt

Rabies Situation in Cambodia

In Cambodia, rabies still elicits fear in the communities. Since 1998 the Institut Pasteur in Cambodia (IPC), Phnom Penh has been the only source of free post-exposure prophylaxis (PEP) and post mortem diagnosis. During 1998–2007, on average ∼12,400 patients received PEP annually at IPC (range 8,907–14,475) and 63 fatal human cases presenting with encephalitis following a dog bite were reported including 73% who tested positive by fluorescent-antibody test on brain samples or/and by reverse-transcriptase polymerase chain reaction on skin, cerebrospinal fluid, or urine. In 2007, 14,475 patients received PEP (100 PEP/100,000 people in Cambodia) including 95% who resided in Phnom Penh city (615 PEP/100,000) or five neighboring provinces. Using a step-by-step probability model, we estimated that 810 human rabies deaths would occur in 2007 (95% confidence interval [CI] 394–1,607); an incidence of 5.8/100,000 (95%CI 2.8–11.5). As a result, despite high attendance at the IPC's PEP center most Cambodians living in peripheral provinces in Cambodia may not have adequate access to PEP. Finally, the model generated one of the highest incidences of rabies worldwide. A national rabies control program is needed to improve surveillance and access to PEP, and to initiate vaccination campaigns in dogs

The epidemiology of animal bite injuries in Uganda and projections of the burden of rabies.

OBJECTIVES: Rabies is a global problem, although it is often under-reported in developing countries. We aimed at describing the profile of patients presenting to health centres with animal bite injuries in Uganda, and use a predictive model to estimate the mortality of rabies at a national level. METHODS: We conducted a passive surveillance study in Uganda based in a random sample of health centres supplied with rabies vaccine to determine the characteristics of bite injury patients and establish the age and sex profiles of patients, the site of bites and their severity, wound management techniques and details of the vaccination course given. We also applied a decision tree model to the data to estimate the rabies mortality from the bite injury data using an established protocol. RESULTS: We found that most patients are bitten by dogs, and that a considerable proportion of these are young children, who are at greater risk of developing rabies in the absence of treatment due to the location of the bites they receive. From conservative parameter estimates, we estimate that in the absence of post-exposure prophylaxis (PET), 592 (95% CI 345-920) deaths would occur, and that if one dose of PET is sufficient for protection following a rabid animal bite, 20 (95% CI 5-50) deaths would occur annually. If a complete course of PET is required for protection following a rabid animal bite, up to 210 (95% CI 115-359) deaths would occur, as 41% of patients did not complete their course of PET. CONCLUSIONS: Active animal bite surveillance studies are required to improve our mortality estimates and determine the true burden of rabies in the Ugandan population. We emphasize the need for small-scale active case detection studies and improved data on the recognition of rabies in dogs as inputs for improving national-level estimates of rabies mortality

Programa quinquenal de eliminación de la rabia humana en una provincia con rabia canina endémica en Tailandia

A five-year project to prevent human deaths from rabies in Phetchabun Province, Thailand involved increasing accessibility of post-exposure treatment with the Thai Red Cross intradermal (2-2-2-0-1-1) regimen for humans exposed to potentially and confirmed rabid animals; intensifying documentation of post-exposure treatment; increasing educational awareness through advocacy in provincial schools, television programmes, and newspapers; reducing canine rabies by monitoring the dog population and implementing vaccination and sterilization programmes; increasing the cooperation between the Ministries of Public Health, Agriculture, and Education on a provincial level; and assessing the impact of the programme through intensified follow-up of patients exposed to suspected and laboratory-confirmed rabid animals. Between 1996 and 2001, 10 350 patients received post-exposure treatment; 7227 of these received the Thai Red Cross intradermal regimen. Fewer than 3% of exposed patients received rabies immunoglobulin. Seventy-three percent of all patients presented with WHO category III exposures. In a retrospective study, 188 patients exposed to laboratory-confirmed rabid animals were followed to determine their health status. Of these patients, 20 received the intramuscular Essen regimen and 168 the Thai Red Cross intradermal regimen (148 received 0.1 ml purified chick embryo cell rabies vaccine, 10 received 0.1 ml purified vero cell rabies vaccine, and 10 received 0.2 ml purified duck embryo cell rabies vaccine). All patients were alive one year after exposure. Two human deaths occurred in the first two years of the programme - neither patient had received vaccine or rabies immunoglobulin after exposure. No deaths occurred during the last three years of the programme, which indicated that the programme was successful