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© 1987 Oxford University Press

research-article

The Diagnostic Properties of Laboratory Tests for Rabies

C SITTHI-AMORN*, V JIRATANAVATTANA, J KEOYOO and N SONPUNYA

Clinical Epidemiology Unit. Faculty of Medicine, Khon Kaen University

* Reprint requests to: Chitr Sitthi-Amorn. Department of Medicine. Chulalongkorn Hospital. Bankok. Thailand.

We have prospectively followed 915 victims bitten by 664 dogs between January 1984 and December 1985 to assess death and severe neurological disability. These dogs were brought either by the owner or bite victims to Ta Pra Diagnostic Centre for detection of rabies. Each patient was followed every three months by mail for at least one year after the bite. In addition, intensive follow-up in the community was undertaken on 235 patients who failed to respond to mail follow-up, all 23 who reported events as well as 523 of the 720 mail-responders. Hospital records were examined for all patients requiring treatment. All patients with non-fatal events were also examined at the university hospital.

Blind independent comparison of the three diagnostic tests (Sellers stain, fluorescent antibody test and mouse inoculation test for the presence or absence of rabies in animal brains were performed to assess the accuracy of local routine diagnostic test methods. In case of disagreement between test methods, the result on mouse inoculation was considered definitive for the presence or absence of rabies. Test results were mailed to all victims.

Seven hundred and twenty out of 955 subjects responded to the mail follow-up giving a response rate of 75.4%. Intensive follow-ups were successful in all subjects who responded. Of 235 subjects who did not respond to the mail follow-up, only 195 (83%) were located. The remaining 40 bite victims who did not respond to mail follow-up and could not be located were all bitten by animals who did not have rabies.

Nine of 20 unvaccinated victims, bitten by confirmed rabid animals, died, a mortality rate of 45%. Those who were bitten by animals not found to have rabies and were not vaccinated remained healthy. Neurological complications were found in three of 427 Sample vaccines, a complication rate of 1: 142. No serious complications occured among those who received human diploid cell vaccine.

Received 1 November 1986


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