博文
中美狂犬病教授共同治愈恐狂症一例
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据博友Roy1981今天上午给本博主的留言反映，他的恐狂症在中美两国狂犬病教授的共同帮助下，已完全治愈。他在留言中介绍了他的相关情况和主要心得体会，供大家分享。
现将本博主对该留言的回复及该留言原文照录如下，
希望更多的恐狂症患者能从中获得有益的启示：
博主回复(2012-4-22 14:09)：祝贺你走出恐狂症的困境。
你总结得不错。你的英语也不错。
特别值得嘉许的是，你在如今这个信息大爆炸的时代，善于从浩瀚的知识的海洋中快速获取正确、有用知识，这种能力和技巧是值得所有年轻人学习和借鉴的。
[4259]Roy1981 留言 2012-4-22 09:02
各位好！本人前段时间，由于对狂犬病的恐惧而苦恼。先后打了疫苗，查了抗体，咨询了行业专家，包括：严老师和国外的专业人士。现在已摆脱苦恼。总结一下，和大家分享：
1. 严老师的观点和我从国外的专业人士或机构处获得的信息，大都一致。所以，请相信严老师；
2. 推荐两个专业的国外网站。（完全应该由国内的相关从业人员如：CDC学习并在国内正确普及。但很遗憾，他们不少都是Rubbish）
- http://www.who.int/rabies/en/
- http://www.worldrabiesday.org/
推荐两篇文章：
- http://www.who.int/rabies/ExpertConsultationOnRabies.pdf
- http://www.infzm.com/content/62928
3. 对于潜伏期，WHO（世界卫生组织）931报告承认的最长潜伏期为6年(注：WHO近期对狂犬病潜伏期的最新立场是：最长不超过一年。见本博客的文章：WHO最新立场：狂犬病潜伏期最长不超过一年！）。我个人的观点是：这说明目前的世界纪录为6年。没有必要担忧自己会创造新的纪录。这样的可能性有如被陨石击中。担心这，还不如担心食品安全，药品安全和交通安全等；
4. 请相信疫苗的效用。按照WHO推荐的方法接种疫苗，可彻底清除潜伏的病毒。而且，只要在发病前接种，都是有效的。所以，对于超长潜伏期的担忧，不放心的话，也可注射疫苗。可消除所有的担忧，毕竟你有打破世界纪录的权力；
5. 发病前，注射了疫苗，体内的病毒就能被彻底清除，就不会再得狂犬病。也不会因为曾经潜伏过病毒，而导致其他的疾病或者创伤。狂犬病毒只能导致狂犬病。病毒清除了，就不会再得狂犬病，也不会产生其他任何的疾病和创伤。
6. 接种完疫苗后，通常没有必要查抗体。至少WHO标准的接种流程不推荐；
7. 接种完疫苗后，就应该彻底放下。如果还有疑虑，那很大程度上是存在心理疾病，至少，性格上有问题。要么找心理医生治疗；要么视这段经历为一个磨砺自己性格的机会。
以下为我（R）向一国外专业人士Debbie（D）的咨询邮件的部分内容。他被WHO视为专家，为美国堪萨斯州立大学的教授。 (博主注：以下英文的内容在原则上与上述用中文写的总结是一致的。欢迎Roy1981或其他英文好的博友将这些英文译成中文，以方便英文不好的博友。)
R:
1. I was bitten by dogs twice when I was in kinder garden almost 25 years ago without any post-exposure prophylaxis, do you think it is possible for me to get rabies due to these 2 bites? For sure, I am still alive:-)
2. During incubation period, can the rabies virus attack body?
3. If rabies virus is eliminated by vaccination before symptom occurs, there won't be any disease in the future, right?
D:
There are a few questions to ask about your bites before I answer. What country were you bitten in? Where were you bitten and were the wounds washed etc? Would you kindly tell me the circumstances of your bites?
Rabies vaccination will enable your body to produce antibodies to the virus and that process will prevent you from developing rabies. Once a person is vaccinated, they have “immune memory”. Thus if you are exposed after vaccination, you would only need to receive a short booster series of rabies vaccine.
If you have a job or hobby that puts you at increased risk of exposure to rabies, you could consider to have rabies pre-exposure vaccination.
R:
I am located in China. One bite is at shank, while the one at thigh. These two bites happened around 25 years ago. So I have no more detailed memory. In case of any record-breaking long incubation period, I did vaccination recently.
D:
If you have received rabies vaccination recently for post-exposure prophylaxis, can you tell me how many doses of vaccine that you received and on what dates? Once a person received Post-exposure prophylaxis, they have developed an immune response against rabies. It is the best strategy.
R:
I received 5 doses per WHO suggested process on (0, 3, 7, 14, 28). The last dose was on Mar. 17th.
D:
Answers to your first 3 questions.
1. Since you have received the WHO recommended PEP regimen and your last dose was on March 17th, you should not worry about contracting rabies from the previous bites you received 25 years ago. You will have antibodies to the rabies virus.
2. No need to worry about this. Your PEP will have provided you with the immune response to inactivate rabies virus. Normally, when a person does not receive PEP after an exposure, rabies virus will enter the nerves and travel to the Central nervous system eventually reaching the brain. However, as I mentioned, this will not happen in your case since you had the recommended PEP regimen.
3. You have the best protection at this point. If you are re-exposed in the future, you only need to receive a two-dose booster series, one injection is given on day 0 and the second is given on day 3.
R:
There is one thing I did not state clearly. I know that there can not be any symptom during incubation period. Does it mean rabies virus does not attack body during incubation period? I am a little bit afraid that during incubation period, the virus can attack body especially nervous system but without any symptom, which can lead to other diseases (of course not rabies) after rabies virus is inactivated by antibody.
D:
No, the rabies virus will not cause other diseases and any rabies virus that would could have potentially been infiltrated into a wound during a bite will be totally eliminated from the body due to the PEP vaccination. Therefore, there is no rabies virus left and nothing can be caused by it.
R:
Is it necessary to check antibody?
D:
No, it is not necessary to check your antibody. The PEP 5-dose vaccination regimen elicits a very high immune response. Checking antibody levels after PEP is not routinely recommended by WHO.
(博主注: Dr. Debbie (Deborah) Briggs is an adjunct professor in the College of Veterinary Medicine at Kansas State University. She has contributed to the World Health Organization expert consultation on rabies.
Her interests focus on veterinary and human diagnostics, laboratory quality assurance, educational awareness, and emerging infectious diseases.)
附：以上英文的中文译文。谢谢 Roy1981Roy1981的中文也很不错)。
谢谢您的回复及夸奖，严教授。也再次感谢您的专业精神和善意的开导。以下的翻译，敬请各位朋友参考。如有不准确之处，请严教授指出。
我：
1. 我在近25年前读幼儿园的时候被狗咬过两次，且没有采取暴露后的预防措施。您认为我可能由于这两次咬伤而得狂犬病吗？当然，我还活着。:-)
2. 在潜伏期内，狂犬病毒会攻击机体吗？
3. 如果在发病前，狂犬病毒在接种疫苗后被清除，以后就不会再因此患病，对吗？
Debbie：
在回复之前，对于你的咬伤，我有一些问题需要确认。你在哪个国家被咬的？ 身体什么部位被咬？是否清洗伤口？请告诉我咬伤的具体情况。接种狂犬疫苗将使你的身体产生病毒抗体，这样将防止你感染狂犬病。一旦接种疫苗，你将产生“免疫记忆”。这样，如果在接种疫苗后暴露，你只需要采取狂犬疫苗的加强接种。如果你的工作或者爱好让你有较高的暴露危险，你可以考虑采取暴露前接种狂犬疫苗。
我：
我在中国，一次小腿被咬，另一次大腿被咬。由于这两次被咬都发生在约25年前，具体的细节我记得不清楚。以防万一打破潜伏期的世界纪录，我近期接种了疫苗。
Debbie：
如果你近期采取了暴露后预防的疫苗接种，请告诉我你打了几针以及接种的时间。如果采取了暴露后预防的接种，你的机体将产生病毒的免疫应答。这样做最好。
我：
我按照WHO推荐的方案打了5针（0, 3, 7, 14, 28），3月17日打了最后一针。
Debbie：
对于你最初的3个问题，回复如下：
1. 鉴于你已经采取了WHO推荐的PEP（暴露后预防）接种方案，且在3月17日打了最后一针，你不必再担忧由于25年前被咬而感染狂犬病。你的机体将产生狂犬病毒的抗体。
2. 没有必要担心这个。你采取的PEP方案，将使你产生免疫应答，由此灭活（清除）狂犬病毒。通常情况下，当人在暴露后不采取PEP措施，狂犬病毒将进入神经并扩散至中央神经系统并最终到达大脑。但是，如我之前所述，由于你采取了PEP措施，这种情况将不会发生在你的身上。
3. 在这点上，你具备了最好的保护。如果以后你再次暴露，你只需要接受两针加强针。一针暴露当天注射，3天后注射第二针。
我：
我有一个问题没有阐述清楚。我明白在潜伏期内，是没有任何症状的。这是否意味着在潜伏期内，狂犬病毒是不会攻击机体？我有些担心，病毒在潜伏期内会攻击机体，特别是神经系统，只是没有症状而已。但当病毒被抗体清除后，却由此可能导致其他的疾病（当然不是狂犬病）。
Debbie：
不，狂犬病毒不会导致其他的疾病。任何可能在咬伤过程中渗入伤口的狂犬病毒，都会由于PEP接种，而从身体彻底清除。因此，将不会再有狂犬病毒，将不会再有任何问题。
我：
有必要检测抗体吗？
Debbie：
不，没有必要。5针PEP接种方案能引起很高的免疫应答。WHO不推荐在PEP后例行检查抗体。
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