Activities of the Reference Centre for Rabies and Antirabies Clinic of Dr. Andrija Štampar Institute of Public Health from 2008 to 2013

Abstract

Bjesnoća je apsolutno smrtonosna bolest, bez obzira na nekoliko najnovijih slučajeva preživljavanja koja su opisana u literaturi. Zbog visoke smrtnosti od 55 000 slučajeva godišnje, virus bjesnoće nalazi se na osmom mjestu najsmrtonosnijih virusa u svijetu. Zbog te činjenice, bjesnoća je i dalje veliki javnozdravstveni problem pogotovo u slabije razvijenim zemljama Afrike i Azije. Bez dobro organizirane pomoći lokalnih zajednica, financijske potpore državnih ili drugih institucija ili organizacija te suradnje humane i veterinarske medicine, ova velika brojka smrtnih slučajeva, neće se početi smanjivati. Zadnji slučaj humane bjesnoće u Republici Hrvatskoj, dogodio se prije 50 godina, davne 1964. godine. Od tada su zabilježena dva importirana slučaja humane bjesnoće u Republici Hrvatskoj iz Bosne i Hercegovine, prvi 1989., te drugi 1995. godine. Referentni centar za bjesnoću obavlja niz aktivnosti na području humane antirabične zaštite te u tom segmentu surađuje s brojnim veterinarskim organizacijama, ustanovama i institucijama te koordinira rad županijskih zavoda za javno zdravstvo diljem Republike Hrvatske, a njegovi djelatnici sudjeluju u brojnim stručnim, nastavnim i edukacijskim aktivnostima. U razdoblju od 2008. do 2013. godine, u Republici Hrvatskoj pregledano je zbog sumnje na izloženost bjesnoći 32 697 osoba, od čega je njih 9 368 odnosno 28,6% primilo postekspozicijsku antirabičnu profilaksu (PEP) zbog ugriza, ogrebotine, kontakta sa slinom preko oštećene kože ili sluznica ili kontakta s domaćom ili divljom, bijesnom ili na bjesnoću sumnjivom životinjom ili kontaminiranim materijalom. Od navedenog broja u 8 668 osoba primijenjena je PEP samo s cjepivom protiv bjesnoće, dok je u 700 osoba primijenjena PEP u kombinaciji antirabičnog cjepiva i humanog antirabičnog imunoglobulina. U sklopu Referentnog centra za bjesnoću pri Nastavnom zavodu za javno zdravstvo "Dr. Andrija Štampar" nalazi se antirabična ambulanta, koja osim suradnje s veterinarskim organizacijama, obavlja preglede ugriženih osoba, upisuje ih u registar, izdaje medicinsku dokumentaciju te prema indikaciji obavlja PEP. U razdoblju od 2008. do 2013. godine pregledano je i obra|eno ukupno 3 690 pacijenata (2 094 muških i 1 596 ženskih), od čega je u 961 osoba (555 muških i 406 ženskih) postavljena indikacija za PEP. Ovi podaci odnose se na područje grada Zagreba. Ovdje nisu uključeni pacijenti s područja Zagrebačke županije koji su se od strane županijskih epidemiologa ciljano upućivali u našu ustanovu, radi pregleda te postavljanja indikacije za PEP.Rabies is an absolutely deadly disease, regardless of the few documented cases of survival, lately reported in the literature. Due to its deadly rate of 55 000 estimated deaths annually, rabies virus is eight among the world\u27s most deadly viruses. Having this in mind, rabies is still a major public health problem in less developed countries of Africa and Asia. Without well organised help of local communities, financial support of governmental or other institutions, and cooperation between human and veterinarian medicine, this number will not begin to decrease. The last case of human rabies in the Republic of Croatia was registered 50 years ago, in 1964. Apart from this, there were two imported human rabies cases reported in the Republic of Croatia, both from Bosnia and Herzegovina. The first one in 1989, and the second in 1995. The Reference Centre (RC) for Rabies is performing numerous activities in the area of human rabies protection, and therefore cooperates with many veterinary organisations, facilities and institutions and is supervising the antirabies activities of county public health institutes in the Republic of Croatia. The employees of the RC are included in numerous professional, teaching and educational activities. In the period from 2008 to 2013 in the Republic of Croatia, a total of 32 697 persons were examined after being in contact with various types of animals, of whom 9 368 (28,6%) received postexposure rabies prophylaxis (PEP) after being bitten, scratched, having contact with saliva against broken skin or mucous membranes or having contact with domestic or wild rabid or suspect rabid animal or having contact with contaminated material (such as fox bait with oral rabies vaccine /ORV/). Out of this number, 8 668 persons received PEP with antirabies vaccine only, while 700 persons received PEP with antirabies vaccine and human rabies immune globulin.At the Dr. Andrija Štampar Institute of Public Health, as part of the Reference Centre for Rabies, an Antirabies Clinic has been established. Apart from cooperating with veterinary organisations, the medical team in this ambulance is performing physical examination of bitten patients, collects and records data in the register, keeps and issues patient medical documentation, and performs PEP according to indications. In the period from 2008 to 2013, there were 3 690 examined patients (2 094 male and 1596 female) at Antirabies Clinic, of whom 961 persons (555 male and 406 female) received PEP based on medical indications. These data refer only to the region of the city of Zagreb. Patients who came to the Zagreb Antirabies Clinic from the Zagreb county were not included in this report because they were referred to our Clinic directly by the county epidemiologists