Virus hợp bào hô hấp (RSV)

Cúm là gì?

Respiratory syncytial virus (RSV) is a virus that causes both upper and lower respiratory tract infections. Children under 1 year of age, individuals with underlying medical conditions (e.g. chronic cardiac and lung disease), the older population and immunocompromised people are more likely to experience serious disease requiring hospitalisation. 

Cần để ý những gì

Cold-like symptoms such as rhinorrhoea (runny nose), fever, wheeze, headache and cough are common. Symptoms generally appear 1 to 5 days after exposure and can last 8 to 15 days.  

Symptoms may progress to shortness of breath, wheezing, bronchospasm and feeding problems (in children). One third of children develop otitis media (ear infections).  

Whilst most infections are mild, bronchiolitis (inflammation of the small airways) and pneumonia (lung infection) can occur and may lead to hospitalisation for supportive measures such as oxygen therapy and rehydration. It is estimated that bacterial co-infections occur in around 30% of hospitalised patients. In older adults, RSV can exacerbate chronic obstructive pulmonary disease or lead to heart failure.  

Bệnh lây truyền qua đường nào

RSV is highly contagious and can be transmitted via the inhalation of droplets containing the virus. RSV can also be transmitted when a person touches a contaminated surface and then touches their face. 

People with RSV are generally considered infectious for 3 to 8 days. However, some people continue to spread the virus for up to 4 weeks. 

Dịch tễ học

Children and older adults have the highest rates of RSV infection. Almost all children will have experienced infection by the age of 2 years. Aboriginal and Torres Strait Islander adults are at greater risk of RSV-associated hospitalisation than non-Indigenous adults. Reinfection occurs throughout the lifetime since natural infection does not provide long-term immunity. 

RSV infections are commonly seasonal, with a peak in cases usually seen over autumn and winter in temperate climates, and during the rainy season in tropical climates.  In recent years, RSV notification rates have increased significantly in Australia.  

Phòng ngừa

PractiSing good hand hygiene is important in preventing infections. Previous infection with RSV Có thể provide some immunity but this protection is not long term.

Monoclonal antibodies

Monoclonal antibodies are a type of immunoglobulin, or immune system proteins. They are a medication that can aid the body’s immune response to help prevent disease. There are two monoclonal antibodies approved for use to prevent RSV in Australia:  

  • Palivizumab (Synagis) 
  • Nirsevimab (Beyfortus) 

Palivizumab is available for some infants who are considered at higher risk of developing severe disease from RSV infection (due to medical conditions such as prematurity, chronic lung disease and specific cardiac conditions). Doses are calculated according to the infant’s weight and administered via intramuscular injection every month over the winter period (usually May to October in southern Australia). Palivizumab can be privately purchased and may be funded for infants by their individual hospital. 

Nirsevimab can be administered from birth as a single intramuscular injection offering protection for at least 5 months. It is recommended for all infants entering their first RSV season. Children with a high risk of severe RSV disease due to medical conditions may also consider another dose before going into their second RSV season. Nirsevimab is not currently funded through the NIP, however various jurisdictions have announced state-funded programs. 

Co-administration with vaccines 

Nirsevimab or Palivizumab can be given on the same day as tất cả vắc-xin.  

Phản ứng phụ 

Side effects from monoclonal antibodies are not common but can include injection site tenderness and swelling, mild respiratory symptoms and rash. Nirsevimab can in rare circumstances cause fever within 7 days.  

Vắc-xin

Arexvy is a vaccine available for the prevention of RSV infection. It is an adjuvanted recombinant vaccine requiring a single dose of 0.5 mL administered intramuscularly. It can be co-administered with all other vaccines and can be administered at any time of year. Arexvy is currently only available through private purchase.  

Whilst Arexvy is registered and available or use in all individuals aged 60 years and over, ATAGI khuyến nghị its use in: 

  • all adults aged 75 years and over  
  • Aboriginal and Torres Strait Islander adults aged 60-74 years 
  • adults 60-74 years with specified medical conditions. 

Booster doses of Arexvy are not currently recommended. 

Phản ứng phụ

Common side effects following administration of Arexvy include phản ứng tại chỗ tiêm (pain, redness and swelling), malaise, headache and fatigue. These side effects generally occur in the first 48 hours following vaccination and last 1-2 days.  

Symptoms can be managed at home with supportive measures such as a cold compress and oral analgesia. Antibiotics, antihistamines and steroids are không recommended to treat injection site reactions, which are caused by an inflammatory response to the vaccine and are not the result of an infection or allergy.

Precautions and contraindications

Use of Arexvy is contraindicated in any person who has experienced anaphylaxis to a previous dose or anaphylaxis to any component of Arexvy.  

It should not be administered to infants or pregnant women due to a lack of safety and efficacy data. Should inadvertent administration occur, a report to a vaccine safety service (SAEFVIC in Victoria) should be submitted and the patient informed using the open disclosure process. Adverse events should be monitored. 

Các tác giả: Georgina Lewis (Giám đốc lâm sàng SAEFVIC, Viện nghiên cứu trẻ em Murdoch) và Rachael McGuire (Điều phối viên y tá giáo dục MVEC)

Được xem xét bởi: Rachael McGuire (Điều Phối Viên Y Tá Giáo Dục MVEC)

Ngày: April 2024

Tài liệu trong phần này được cập nhật khi có thông tin mới và có vắc-xin. Nhân viên của Trung Tâm Giáo Dục Vắc-xin Melbourne (MVEC) thường xuyên xem xét độ chính xác của các tài liệu.

You should not consider the information on this site to be specific, professional medical advice for your personal health or for your family’s personal health. For medical concerns, including decisions about vaccinations, medications and other treatments, you should always consult a healthcare professional.


Các loại vắc-xin bổ sung được khuyến nghị mua cho đến 20 tuổi (không được tài trợ)

Did you know there are additional vaccines recommended by vaccine experts that are available for private purchase? They are not free as they are not listed on the National Immunisation Program (NIP) or funded by the government. Most councils will offer some additional vaccines for purchase or alternatively all these vaccines are available for purchase with a prescription from your GP.

Influenza vaccine

Influenza vaccine is recommended annually for everyone from the age of 6-months.

Who is eligible for the free vaccine?

  • Influenza vaccine is routinely funded for all children aged 6-months to less than 5-years of age, all Aboriginal & Torres Strait Islander people ≥ 6-months of age, pregnant women and for people with specific medical risk factors who are at risk of complications from influenza, regardless of age.

Recommended but not funded:

  • For children (> 5-years), adolescents and adults. Influenza vaccines can be purchased and administered at most council community immunisation sessions or alternatively with a prescription from your GP or from pharmacist immunisers for people aged 10-years and over.
  • Children less than 9-years of age require 2 doses, 1 month apart, in the first year they receive the vaccine.

Tài nguyên:

Meningococcal vaccines

Viêm não mô cầu ACWY

Meningococcal ACWY (MenACWY) vaccine is recommended for any person who wants to protect themselves against invasive meningococcal disease (IMD) and can be administered from as early as 6-weeks of age. MenACWY provides protection against four strains of meningococcal disease, A, C, W and Y.

Who is eligible for the free vaccine?

  • A single dose of Nimenrix® is currently provided at 12-months of age on the National Immunisation Program (NIP)
  • Catch-up dose for any person aged under 20 years who did not receive a meningococcal C containing vaccine at 12-months of age
  • Young people aged 15 to 16-years or in Year 10 of secondary school as a school based vaccine program
  • All young people aged 15-19 years of age who have not received the vaccine at secondary school
  • People of all ages with some specified medical conditions that increase the risk of IMD (complement deficiency, current or future treatment with eculizumab, asplenia) [see resources].

Recommended but not funded:

Some local councils offer Nimenrix® (Meningococcal ACWY) as a fee for service if patients wish to be protected but do not meet the criteria on the NIP. Alternatively, this vaccine is available at the GP on private prescription.

não mô cầu B

Meningococcal B (MenB) vaccine provides protection against B strain meningococcal disease and can be administered from as early as 6-weeks of age.

Who is eligible for the free vaccine?

  • People of all ages with some specified medical conditions that increase the risk of IMD (complement deficiency, current or future treatment with eculizumab, asplenia) [see resources]
  • Aboriginal and Torres Strait Islander infants from 2-months of age [see resources]

There are currently 2 vaccines available on the private market for the protection of meningococcal B disease.

  • Bexsero® is for use from 6-weeks of age
  • Trumenba® is licensed for use in ≥ 10-years of age

Meningococcal B vaccines brands are not interchangeable.

Some local councils offer Bexsero® as a fee for service if patients wish to be protected but do not meet the criteria on the NIP. Alternatively, this vaccine is available at the GP on private prescription.

Tài nguyên:

Chickenpox (varicella) vaccine

2 doses of varicella-containing vaccine provide 15-20% more protection against (mild) breakthrough varicella (chickenpox) in children <14 years of age, however a 2thứ dose is not included on the National Immunisation Program schedule.

Who is eligible for the free vaccine?

  • A single dose of the live-attenuated varicella vaccine is currently funded on the NIP for children at age 18 months of age in a combined measles-mumps-rubella-chickenpox (MMRV) vaccine.
  • For those ≥ 14 years of age, 2 doses (administered 4 weeks apart) are required for the protection of non-immune individuals.
  • MMRV combination vaccine is not recommended for use in people from >14 years of age.

Recommended but not funded

  • If parents or carers wish to minimise the risk of breakthrough varicella in children <14 years of age, a 2nd dose of varicella-containing vaccine is recommended and can be purchased at some council community immunisation sessions or purchased by prescription from the GP.
  • Children can receive a chickenpox vaccine from as young as 12 months of age. This can provide earlier protection against varicella, which may be appropriate in the context of childcare, travel or a varicella outbreak. There is no safety concern if the child still receives the dose scheduled at 18 months of age.
  • The minimum interval between doses of varicella-containing vaccine is 4 weeks.

Tài nguyên:

Special risk groups

Những người có nguy cơ cao mắc các bệnh có thể phòng ngừa bằng vắc-xin (VPD) được xếp vào nhóm 'nguy cơ đặc biệt' trong Sổ tay Chủng ngừa Úc.

Điều này bao gồm các quần thể có nguy cơ đặc biệt (ví dụ: Thổ dân và Người đảo Torres Straight) và những người có nhu cầu tiêm vắc-xin bổ sung (ví dụ: tiêm phòng cho bà mẹ; trẻ sinh non). Nó cũng có các phần chi tiết về những người có nguy cơ đặc biệt do ức chế miễn dịch (bệnh và/hoặc điều trị), ví dụ như Asplenia, ung thư/hóa trị.

Tài nguyên:

Additional resources

Further information about childhood vaccination can be found at:

Các tác giả: Georgina Lewis (SAEFVIC Clinical Manager, Murdoch Children’s Research Institute), Francesca Machingaifa (SAEFVIC Research Nurse, Murdoch Children’s Research Institute) and DHHS Immunisation Nurses (Immunisation Section, Health Protection Branch, Department of Health and Human Services).

Đượcxem xét bởi: Francesca Machingaifa (SAEFVIC Research Nurse, Murdoch Children’s Research Institute) and Georgina Lewis (SAEFVIC Clinical Manager, Murdoch Children’s Research Institute)

Ngày: tháng 7 năm 2020

Tài liệu trong phần này được cập nhật khi có thông tin mới và có vắc-xin. Nhân viên của Trung Tâm Giáo Dục Vắc-xin Melbourne (MVEC) thường xuyên xem xét độ chính xác của các tài liệu.

Quý vị không nên coi thông tin trong trang web này là tư vấn y tế chuyên nghiệp, cụ thể cho sức khỏe cá nhân của quý vị hay của gia đình quý vị. Đối với các lo ngại về y tế, bao gồm các quyết định về chủng ngừa, thuốc men và các phương pháp điều trị khác, quý vị luôn phải tham khảo ý kiến của chuyên viên chăm sóc sức khỏe.


Rituximab và khuyến nghị tiêm chủng

Rituximab is becoming a frequently used treatment option for many patients with complex medical needs, including in oncology and rheumatology. It is an immune suppressive medication which greatly impacts the production and functionality of immune cells, including the near complete depletion of B-cells. Once treatment with rituximab has been completed, recovery of immune cell function can take 3-12 months, and even longer in some cases. It may be used as a once-only dose or as a long term therapy.

Due to the effects on lymphocytes, patients on rituximab therapy are considered immune suppressed and are at a greater risk of vaccine preventable diseases. However, recommendations for immunisation of these patients is complicated by the inability to produce an immune response to vaccines without functioning B- and T-cells.

Many patients on rituximab are also receiving concomitant immunoglobulin therapy. As this is a blood product, it further complicates the immunisation recommendations involving live-attenuated vaccines.

Prior to commencing treatment

Where possible please ensure patients are up to date for their age with the current immunisation schedule. Ideally inactivated vaccines should be completed at least 1 week prior, and any live-attenuated vaccines should be completed a minimum of 4 weeks prior to commencing treatment. The same principle also applies to COVID-19 vaccines.

During treatment

Due to lack of immune cell function, all future immunisations should be withheld whilst on rituximab. An immunisation medical exemption form should be completed where appropriate to ensure that the patient is not considered overdue [see resources].

The exception to this, may be for influenza and COVID-19 vaccines. Some studies have indicated that a partial immune response to the influenza vaccine in patients receiving rituximab therapy may occur. For this reason MVEC recommends that patients continue to be immunised against influenza whilst on therapy and receive 2 doses of the age-appropriate vaccine annually, minimum of 4 weeks apart (regardless of age or vaccine history).

Due to the potential risk for severe COVID-19 disease and its complications in this population, which may outweigh the lack of vaccine response, COVID-19 vaccination whilst on rituximab could be considered.

COVID-19 vaccination and rituximab

Studies are still ongoing to determine optimum timing and vaccine efficacy in patients on rituximab. However, based on evidence from other vaccines, the assumption is that there is a diminished response to COVID-19 vaccination.

Therefore, important principles to consider for this group of patients include:

  • it is not recommended to delay initiation or disrupt optimum timing of rituximab if being used for cancer treatment
  • due to its immunosuppressive effects, patients on rituximab are at higher risk of severe COVID-19 disease and poor COVID-19 disease outcomes.

As such, COVID-19 vaccination could be performed as close to the end of a rituximab cycle as possible, or prior to the initiation of therapy. There is no current data to inform optimum timing of two-dose COVID-19 vaccination regimes and intervals.

tham khảo MVEC: immunosuppression and vaccines

Immunisation of household contacts

All close contacts should ensure that they are up to date with the routine immunisation schedule, including MMR, varicella and pertussis vaccines. Annual Influenza vaccination is strongly recommended. COVID-19 vaccination is encouraged.

huyết thanh học

There is no need to check serology pre- or post-rituximab therapy. There is currently no established immune correlate of protection for COVID-19.

Patients should be aware of their immune suppression and avoid potential exposures to vaccine preventable diseases. The need to continue preventative measures such as social distancingmask wearing and hand hygiene should be discussed. Medical advice should be sought if exposure does occur [see resources for post-exposure immunoglobulin recommendations].

Post treatment

Post the completion of rituximab therapy, immunoglobulin and B-cell levels should be checked every 3 months. Once both levels have returned to normal AND ≥ 6 months post treatment has lapsed (whichever is later), immunisation with both inactivated and live-attenuated vaccines can recommence. For patients who have received immunoglobulin alongside their rituximab, specific intervals are recommended between the administration of live-attenuated vaccines and blood products/immunoglobulin [refer to MVEC: Vắc xin sống giảm độc lực và globulin miễn dịch hoặc sản phẩm máu]. Any previous vaccine history (routine vaccines) should be disregarded due to the loss of immune memory. There is currently no recommendation for additional booster doses of COVID-19 vaccines.

Vui lòng tham khảo trước MVEC: Post rituximab therapy immunisation guideline for re-immunisation recommendations.

Tài liệu

Các tác giả: Rachael McGuire (SAEFVIC Research Nurse, Murdoch Children’s Research Institute), Daryl Cheng (Senior Research Fellow, Murdoch Children’s Research Institute) and Theresa Cole (Consultant, Allergy and Immunology, The Royal Children’s Hospital)

Đượcxem xét bởi: Theresa Cole (Consultant, Allergy and Immunology, The Royal Children’s Hospital)

Ngày: Tháng Tư 6, 2023

Tài liệu trong phần này được cập nhật khi có thông tin mới và vắc xin. Nhân viên của Trung tâm Giáo dục Vắc xin Melbourne (MVEC) thường xuyên xem xét độ chính xác của các tài liệu. Bạn không nên coi thông tin trong trang web này là lời khuyên y tế cụ thể, chuyên nghiệp cho sức khỏe cá nhân của bạn hoặc cho sức khỏe cá nhân của gia đình bạn. Đối với các mối quan tâm về y tế, bao gồm các quyết định về tiêm chủng, thuốc men và các phương pháp điều trị khác, bạn luôn phải tham khảo ý kiến của chuyên gia chăm sóc sức khỏe.


Rotavirus

Cúm là gì?

Rotaviruses belong to the genus Rotavirus (in the family Reoviridae) which comprises eight species, referred to as A, B, C, D, E, F, G and H. Group A rotaviruses are responsible for most rotavirus infections in humans, although people have also been infected with groups B and C. Like in influenza viruses, the structure of rotaviruses enables them to mutate rapidly to produce new strains.

Rotavirus infections are the leading cause of dehydrating gastroenteritis in young children.

Cần để ý những gì

Rotavirus disease can present with a spectrum of symptoms, from asymptomatic or mild infection to severe disease. Clinical signs can include:

  • sốt
  • vomiting
  • abdominal pain
  • watery diarrhoea.

Severe cases, if left untreated, can result in significant dehydration leading to electrolyte imbalance, hypotensive shock and death.

The incubation period for developing disease is usually between 24 and 72 hours. The diarrhoea usually lasts from 3 to 7 days.

Bệnh lây truyền qua đường nào

Rotaviruses are mainly transmitted through the faecal–oral route, through close person-to-person contact, contaminated food and water, and via fomites (e.g. toys and other surfaces contaminated by faeces). Rotaviruses are also transmitted through respiratory droplets (e.g. through coughing, sneezing, talking). Spread is common in families, hospitals and childcare settings.

Viral replication occurs in the villous epithelium of the small intestine.  The virus can be transmitted during the acute illness. Excretion for more than 30 days has been reported to occur.

Asymptomatic infected individuals can transmit the virus unknowingly.

Dịch tễ học

Worldwide, rotaviruses are the most common cause of dehydrating diarrhoea among children under 5 years of age. Despite the availability of a vaccine, rotavirus continues to result in over 200,000 deaths per year. Deaths due to rotavirus are rare in Australia due to access to health care services.  

Rotavirus vaccines were added to the Australian National Immunisation Program (NIP) in 2007. Since then, there has been an estimated 64% decrease in hospitalisations for children aged under 3 years, and case numbers have fallen. In 2022, notification rates were lowest in Tasmania (at 11 per 100,000) and highest in the Northern Territory and Queensland (at 47 per 100,000). 

Compared with their non-Indigenous peers, Aboriginal and Torres Strait Islander infants and children are hospitalised with rotavirus gastroenteritis about 3 to 5 times more often, and are younger at age of hospitalisation. 

Without vaccination, most children will experience at least one rotavirus infection before the age of 3 years. Repeated infections can occur.  

In temperate areas of Australia infections are more common in the winter months. However, in the tropical/arid regions of Australia there is no seasonal pattern.  

Phòng ngừa

Rotavirus spread can be mitigated through: 

  • effective hand hygiene measures 
  • effective decontamination of fomites 
  • vaccination.

Vắc-xin

Vaccination is approximately 88% effective in preventing rotavirus infection. There are 2 vaccines registered for use in Australia: 

  • Rotarix  
  • Rotateq. 

Both rotavirus vaccines are live-attenuated vaccines requiring oral administration (by mouth). A 2-dose course of Rotarix is currently provided on the NIP at 6 weeks and 4 months of age.  

There is limited data on the safety and efficacy of rotavirus vaccination when given outside of specific age groups. For this reason, rotavirus vaccines must be administered within the recommended timeframe, with particular attention paid to the upper age limits. If adherence to the recommended timeframes for administration is not possible, vaccination should be withheld indefinitely.  

Infants who receive a first dose of either vaccine should complete the entire course of vaccination using the same oral rotavirus vaccine. However, if an infant inadvertently received one of each, give a 3rd dose of either rotavirus vaccine. The upper age limits and minimum intervals between doses must still be met.

WordPress Tables Plugin

* Preterm infants are recommended to receive vaccines based on chronological age, not corrected age.
^Dose 2 is ideally administered before turning 28 weeks to allow for dose 3 to be given 4 weeks later (before the infant turns 33 weeks). If dose 2 is administered later than 28 weeks, a 4 week interval is not possible, and dose 3 must not be administered.
shaded boxes indicate live-attenuated vaccines.
Rotateq is not routinely used in Australia.

Considerations

If an infant spits out a small amount of the dose of vaccine, it is still considered a valid dose and does not need repeating. If they spit out most of the dose of vaccine within minutes of receiving it, a repeat dose should be administered at the same visit.

Infants who have an enteral feeding tube (e.g. orogastric, nasogastric, gastrostomy, or jejunal tube) can receive rotavirus vaccines via their tube. Rotavirus vaccines should never be injected.

Rotavirus vaccination is not required for a child to be considered up to date with their routine vaccines. It is not bắt buộc for the purposes of the No Jab No Pay or No Jab No Play legislation.

Tác dụng phụ của vắc-xin

Several large studies have showed that vaccinated infants had no increase in vomiting, diarrhoea or fever compared with unvaccinated infants. However, anecdotally, infants may be more fussy or gassy within the first 7 days following vaccination. Supportive therapies such as paracetamol and additional fluids (breastmilk/formula) can help manage symptoms.  

Good hand hygiene practices are particularly important when handling soiled nappies during this period to minimise the risk of transmission as the virus can shed in stools for 7 to 10 days following immunisation. 

Some Australian and international studies have shown a very small increase in risk of intussusception post rotavirus vaccine. The baseline risk of intussusception for Australian infants is around 80 cases per 100,000 infants. A 2013 study found 6 additional cases of intussusception for every 100,000 infants vaccinated. This equates to 14 more cases per year in Australia.

Intussusception is a rare condition where the bowel slides or telescopes inside itself causing a blockage. Infants with intussusception may show signs of lethargy, intermittent pain or distress, associated with episodes of pallor. They may pull up their legs, vomit and/or have diarrhoea. Jelly-like or bloody stools is a late sign. Immunisation providers should inform parents and carers to be alert for symptoms and the very rare risk of intussusception.

Precautions and contraindications

There is a theoretical risk of vaccine-associated gastroenteritis if vaccines are administered to infants with immunocompromise. However, for some infants with less severe immunocompromise (including those with HIV who are asymptomatic and have adequate CD4+ count) the benefits of vaccine-induced protection may outweigh this risk. Further clarification on the degree of immunocompromise may be sought from dịch vụ tiêm chủng chuyên khoa 

Infants living in households with persons who have an immunodeficiency disorder or impaired immune status can still be vaccinated. Counselling on hand hygiene and disposing of soiled nappies to minimise the risk of vaccine virus transmission is recommended.  

Infants with severe combined immunodeficiency (SCID) must not receive rotavirus vaccines due to the risk of vaccine-associated gastroenteritis.  

Infants born to mothers who received bDMARDs (biological disease-modifying anti-rheumatic drugs) during pregnancy can receive rotavirus vaccines. Refer to MVEC: Immunosuppression in pregnancy để biết thêm thông tin.  

Rotavirus vaccines must not be given to any infant with a previous history of intussusception or a congenital bowel abnormality which predisposes them to intussusception.

Phối hợp với các loại vắc-xin khác

Rotavirus vaccines can be safety administered with other vaccines including other live-attenuated vaccines, such as BCG.

Các tác giả: Georgie Lewis (Giám đốc lâm sàng SAEFVIC, Viện nghiên cứu trẻ em Murdoch) và Rachael McGuire (Y tá nghiên cứu SAEFVIC, Viện nghiên cứu trẻ em Murdoch)

Đượcxem xét bởi: Rachael McGuire (MVEC Education Nurse Coordinator) and Katie Butler (MVEC Education Nurse Coordinator)

Ngày: May 2024

Tài liệu trong phần này được cập nhật khi có thông tin mới và có vắc-xin. Nhân viên của Trung Tâm Giáo Dục Vắc-xin Melbourne (MVEC) thường xuyên xem xét độ chính xác của các tài liệu.

Quý vị không nên coi thông tin tại trang mạng này là lời khuyên y tế chuyên nghiệp, cụ thể cho sức khỏe của riêng mình hoặc sức khỏe riêng của gia đình quý vị. Đối với những mối lo ngại về y tế, bao gồm các quyết định về chủng ngừa, thuốc men và các phương pháp điều trị khác, quý vị phải luôn hỏi ý kiến chuyên gia y tế.


bệnh dại

Cúm là gì?

rabies an acute viral encephalomyelitis (inflammatory disease of the brain and/or spinal cord) caused by infection with the rabies virus, a type of lyssavirus. Other lyssaviruses include Australian bat lyssavirus (ABLV) and the European bat lyssavirus (EBLV).

Rabies is transmitted to humans via bites or scratches from animals infected with the virus. Infection with các rabies virus, and other lyssaviruses, resultS in Một progressive inflammation of the brain and spinal cord. Without vaccination effective post-exposure management, rabiesalmost always fatal. 

Cần để ý những gì

The incubation period of rabies is generally between 3 and 12 weeks, but the onset of symptoms has occurred as early as days after exposure or as long as 19 years later.   

Early signs of infection involve non-specific symptoms, such as loss of appetite, cough, fever, headache, discomfort and fatigue, nausea and vomiting, and sore throat. There also may be discomfort, paraesthesia (prickling or itching sensation) and fasciculations (muscle twitching) at the site of the scratch or bite.  A person may show signs of anxiety, confusion and agitation. These initial symptoms last 1 to 4 days. Following this, symptoms progress to: 

  • delirium and bizarre behaviour 
  • disorientation
  • hallucinations 
  • hypersalivation, hyperthermia and hyperventilation (signs of autonomic instability) 
  • hydrophobia (fear of water) 
  • paralysis 
  • insomnia.

The disease progresses rapidly. Once clinical signs have developed, the person’s neurological status will deteriorate over a period of up to 12 days, resulting in death. There is no specific treatment for rabies.

Bệnh lây truyền qua đường nào

Rabies is a zoonotic disease (spread between animals and humans). Dog species (including wolves, coyotes, foxes and jackals) are the main source of infection for humans. Skunks, raccoons, monkeys and bats can also harbour infection.  

Human exposure occurs primarily through the scratch or deep bite of an infected animal. Transmission can also occur if saliva of an infected animal comes into direct contact with a person’s mucosal surface (nose, eyes or mouth).  

The virus travels from the site of the injury to the brain by moving along nerve pathways.

Dịch tễ học

Rabies is found in animals on all continents of the globe except Antarctica. Australia is currently rabies free. However, ABLV has been known to occur in fruit bats and insectivorous bats.  It is difficult to determine the disease burden in animals, due to the impracticalities of testing wild and domestic animals. 

Each year, rabies infection causes approximately 59,000 human deaths worldwide, 95% of these occurring in Africa and Asia. The burden of disease in humans is higher in rural, low-income populations. Children are more likely to be infected due to their size and proximity to the ground, being less likely to appreciate an animal’s temperament, and their tendency to make sudden movements or loud noises which are intimidating to animals. 

Phòng ngừa

According to the World Health Organization, vaccinating dogs in rabies-prone regions is the most cost-effective strategy for preventing rabies in people.

People who will be travelling to, or living in, rabies-prone regions should take preventative measures. These include:

  • avoiding close contact with wild and domestic animals (this is especially important for children)
  • not feeding, patting or playing with animals
  • getting vaccinated.

Vaccination

Vaccines can be administered either before potential exposure (pre-exposure prophylaxis), or after exposure has occurred (as part of post-exposure prophylaxis). 

Pre-exposure vaccination requires fewer vaccine doses and eliminates the need for immunoglobulin if exposed (except for those who are severely immunocompromised). Immunoglobulin may be expensive and difficult to source in developing countries.  

There are 2 rabies vaccines available in Australia: 

  • Verorab 
  • Rabipur 

Both Verorab and Rabipur are inactivated vaccines and can be administered via the intramuscular (IM) route or the intradermal (ID) route 

It is preferable but not essential to use the same brand of vaccine for the entire course. If using the same brand is not possible, vaccination should not be delayed, and the alternate brand should be used. 

  • Pre-exposure prophylaxis

    Vaccination is recommended for: 

    • people who work with bats 
    • laboratory workers who work with live lyssaviruses 
    • people travelling to, working in or moving to rabies-prone regions, based on a risk assessment with a travel medicine adviser. 

    Table 1: Pre-exposure prophylaxis schedule

    WordPress Tables Plugin

    *intradermal route is not recommended for individuals with immunocompromise, can only be administered by providers with specialist training and should not be administered to patients taking antimalarials at the time of vaccination or within 1 month of vaccination.
    ^intradermal accelerated schedules should not be used in people > 50 years of age due to a lack of evidence for seroconversion.
    #If exposure risk continues > 1 year after vaccination, refer booster dose recommendations in the table below.  

  • Phòng ngừa sau phơi nhiễm

    There are important steps to take after a potential exposure to the rabies virus. These include:  

    • timely wound management 
    • medical review (including risk assessment) 
    • administration of rabies vaccine (regardless of pre-exposure vaccine history). 

    Human rabies immunoglobulin is also administered in some cases. Rabies immunoglobulin provides short-term protection against the immediate development of rabies. Vaccination provides longer-term protection against the development of disease.  

    Those who have previously been vaccinated against rabies still require postexposure treatment. 

    The Australian Immunisation Handbook includes 2 different post exposure prophylaxis management algorithms. For detailed guidance, refer to:  

    If post-exposure prophylaxis is commenced overseas (with clear documentation of an appropriate vaccine course), Australian clinicians can complete treatment in accordance with the post-exposure prophylaxis guidance in the Handbook. If there is unclear documentation or in other scenarios, consult the Sổ tay tiêm chủng or an Infectious Diseases specialist.

Boosters and serology 

Recommendations for vaccine boosters and serology (blood testing to check antibody levels) vary on a case-by-case basis. Individuals should seek personalised advice from their healthcare provider (e.g. immunisation provider, travel medicine adviser or other specialist consultant). 

It is especially important for individuals in the following groups to speak with their health provider for specific advice on boosters and serology: 

  • immunocompromised individuals 
  • laboratory workers who work with live lyssaviruses 
  • people with ongoing exposure to bats or potentially rabid mammals. 

Table 2: Immunisation Handbook Serology recommendations

WordPress Tables Plugin

* Or, receive a booster dose every 3 years without checking serology.

A single IM booster dose is recommended for people with significant ongoing exposure risk: 

  • when serology is < 0.5 IU/mL   
  • 12 months after dose 1 of primary course of vaccination (whether pre- or post-exposure) then every 3 years after first booster (may check serology first).

Các biện pháp phòng ngừa

People with anaphylaxis to egg should receive Verorab instead of Rabipur. 

People with latex allergy should receive Rabipur instead of Verorab 

Phối hợp với các loại vắc-xin khác

Verorab and Rabipur can be co-administered with other vaccines, using separate injection sites.  

Tetanus vaccination status should also be considered after a bite or scratch from an animal, see MVEC: Tetanus. 

Tác dụng phụ của vắc-xin

Common side effects following rabies vaccination include nausea, headache, injection site pain and myalgia (muscle aches). 

Due to the seriousness of disease, post exposure vaccination should never be delayed, even in those who have experienced an unpleasant side effect or who have a history of allergic reactions. A specialist immunisation service should be contacted for specific advice. 

Tài liệu

Tác giả: Rachael McGuire (Y tá nghiên cứu SAEFVIC, Viện nghiên cứu trẻ em Murdoch)

Đượcxem xét bởi: Katie Butler (MVEC Education Nurse Coordinator) and Rachael McGuire (Điều phối viên y tá giáo dục MVEC)

Ngày: February 2024

Tài liệu trong phần này được cập nhật khi có thông tin mới và có vắc-xin. Nhân viên của Trung Tâm Giáo Dục Vắc-xin Melbourne (MVEC) thường xuyên xem xét độ chính xác của các tài liệu.

Quý vị không nên coi thông tin trong trang web này là tư vấn y tế chuyên nghiệp, cụ thể cho sức khỏe cá nhân của quý vị hay của gia đình quý vị. Đối với các lo ngại về y tế, bao gồm các quyết định về chủng ngừa, thuốc men và các phương pháp điều trị khác, quý vị luôn phải tham khảo ý kiến của chuyên viên chăm sóc sức khỏe.