Экстренная профилактика клещевого энцефалита у детей: ретроспективный анализ и случаи из практики

Abstract

The purpose — to conduct a retrospective analysis of the effectiveness of anti-tick borne immunoglobulin (IgG) and technologically processed antibodies to interferon gamma (ТOАIG) (аnaferon for children) for the emergency prevention of tick-borne encephalitis (TBE) in children. Material and methods. The analysis of medical documentation of patients with TBE who received various emergency prevention: anti-tick-borne IgG in the dose of 0.1 ml/kg i/m once (n = 626) or ТОАIG during 21 days (n = 354) or anti-tick-borne IgG together with ТОАIG (n = 56). The comparison group consisted of 351 patients with TBE who were admitted to the clinic and had not received any prevention. In groups of children who received various emergency prevention regimens, blood was examined by PCR method for the TBE virus at 1, 2 and 6 months after a tick bite. Results. Both the children affected by ticks and among those who got ill were predominantly 7 to 17 years old, 76.1 and 93%, respectively. Among the patients with TBE, 77.6% had not received any prevention, and 22.4% had different emergency prevention tactics. When prescribing anti-tick-borne IgG to children affected by ticks infected with the TBE virus, infection developed in 27.3% of cases (n = 93); when taking ТОАIG — in 1.7% (n = 3), and when using anti-tick-borne IgG and ТОАIG together — in 8.9% of cases (n = 5). The implementation of ТОАIG resulted in only 3 cases of asymptomatic acute (inapparent) infection identified by PCR results. After the introduction of anti-tick-borne IgG to 93 children, a half of them developed manifest forms of TBE, including 16.1% — meningeal forms and 5.4% — forms with focal neurological symptoms and brain edema. When anti-tick-borne IgG was used together with ТОАIG, fever form was observed in 40% (n = 2) and inapparant form in 60% (n = 3) of cases. The article presents 4 cases of severe focal cerebrospinal forms of tick-borne encephalitis associated with the ineffectiveness of the anti-tick-borne IgG for preventive purposes. Conclusions. The maximum effectiveness (98.3%) for emergency prevention was shown by an immunomodulator ТОАIG (anaferon for children), while 21.5% of children (20 cases out of 93) developed clinical forms of tick-borne neuroinfection with CNS damage syndromes and the number of non-patients was 72.7%.