Allurar rigakafin cutar rabies

**Alurar riga kafi** Ya kasance shine maganin da ake amfani da shi domin hana ciwon huhu .  Akwai alluran rigakafin rabies da yawa waɗanda ke da aminci da kuma inganci.  Dole ne a yi alluran rigakafi kafin bayyanar cutar ta rabies ko a cikin lokacin latent bayan fallasa don hana cutar.  Bayar da kwayar cutar rabies ga mutane yawanci yana faruwa ta hanyar cizo ko karce daga dabba mai kamuwa da cuta, amma fallasa na iya faruwa ta hanyar saduwa ta kai tsaye da miya daga mutum mai kamuwa da cuta. 

Yawancin lokaci ana ba da allurai ta hanyar allura a cikin fata ko tsoka.  Bayan bayyanar cututtuka, ana amfani da maganin alurar riga kafi tare da rabies immunoglobulin .  Ana ba da shawarar cewa waɗanda ke cikin haɗarin fallasa su a yi musu alluran rigakafi kafin yuwuwar fallasa su.  Alurar riga kafi yana da tasiri a jikin mutane da sauran dabbobi, kuma allurar rigakafin karnuka na da matukar tasiri wajen hana kamuwa da cutar kanjamau ga mutane.  Kariya mai dorewa ga ƙwayar cuta yana tasowa bayan cikakken magani. 

Za a iya amfani da allurar rigakafin rabies lafiya ta kowane rukunin shekaru.  Kimanin kashi 35 zuwa 45 cikin 100 na mutane suna samun ɗan gajeren lokaci na ja da zafi a wurin allurar, kuma kashi 5 zuwa 15 na mutane na iya fuskantar zazzabi, ciwon kai, ko tashin zuciya .  Bayan kamuwa da cutar rabies, babu wani hani game da amfani da shi, saboda kwayar cutar da ba a yi amfani da ita ba ta kusan mutuwa 100%.  

An gabatar da rigakafin cutar rabies na farko a cikin 1885 kuma an biye da ingantaccen sigar a cikin 1908. Fiye da mutane miliyan 29 a duk duniya suna samun allurar cutar rabies na ɗan adam kowace shekara.  Yana cikin Jerin Mahimman Magunguna na Hukumar Lafiya ta Duniya .  

## Amfanin likita

### Kafin bayyana
Hukumar Lafiya ta Duniya (WHO) ta ba da shawarar yin allurar rigakafi ga wadanda ke da hatsarin kamuwa da cutar, kamar yara da ke zaune a wuraren da cutar ta yadu.  Sauran ƙungiyoyin na iya haɗawa da likitocin dabbobi, masu bincike, ko mutanen da ke shirin tafiya zuwa yankuna inda cutar hauka ta zama ruwan dare.  Ana ba da allurai uku na alluran rigakafin tsawon wata ɗaya a ranakun sifili, bakwai, ko dai ashirin da ɗaya ko ashirin da takwas.  

### Bayan ya bayyana
Ga mutanen da ke da yuwuwar kamuwa da cutar, ana ba da shawarar allurai huɗu sama da makonni biyu, da kuma allurar rabies immunoglobulin tare da kashi na farko.  Ana kiran wannan da allurar bayan fallasa.  Ga mutanen da aka yi musu allurar a baya, ana buƙatar kashi ɗaya na allurar rabies.  Duk da haka, allurar rigakafi bayan fallasa ba magani ba ne kuma ba magani ba ne ga ciwon hauka; tana iya hana kamuwa da cutar hanji ne kawai idan aka ba shi kafin kwayar cutar ta kai ga kwakwalwa.  Saboda kwayar cutar rabies tana da ɗan gajeren lokacin shiryawa, allurar rigakafin bayan fallasa suna da tasiri sosai. 

### Ƙarin allurai
Kariyar rigakafin bin tsarin allurai yawanci yana daɗewa, kuma ƙarin allurai yawanci ba a buƙatar sai dai idan mutum yana da babban haɗarin kamuwa da cutar.  Wadanda ke cikin hadarin za su iya yin gwaje-gwaje don auna adadin ƙwayoyin rigakafi na rabies a cikin jini, sa'an nan kuma a sami masu kara kuzari kamar yadda ake bukata.  Bayan gudanar da kashi mai haɓakawa, bincike ɗaya ya gano kashi 97% na mutanen da ke da ƙarfin rigakafi sun nuna matakan kariya na kawar da ƙwayoyin cuta bayan shekaru goma. 

## Tsaro
Alurar riga kafi na rabies ba su da lafiya a kowane rukuni na shekaru.   Kimanin kashi 35 zuwa 45 cikin 100 na mutane suna samun ɗan gajeren lokaci na ja da zafi a wurin allurar, kuma kashi 5 zuwa 15 na mutane na iya fuskantar zazzabi, ciwon kai, ko tashin zuciya .  Saboda takamammen kisa na kwayar cutar, karbar maganin yana da kyau koyaushe. 

Ana amfani da allurar rigakafin da aka yi daga naman jijiyoyi a wasu ƙasashe, galibi a Asiya da Latin Amurka, amma ba su da tasiri kuma suna da illa mai yawa.  Don haka Hukumar Lafiya ta Duniya ba ta ba da shawarar yin amfani da su ba. 

## Nau'ukan
An fara rigakafin cutar diploid cell rabies (HDCV) a cikin 1967. Alurar rigakafin ƙwayoyin cuta na diploid cell rabies sune allurar rigakafin da aka yi ta amfani da nau'in ƙwayar cuta ta Pitman-Moore L503. 

Baya ga waɗannan ci gaban, sabbin alluran rigakafin ƙwayar amfrayo na kaji masu ƙarancin tsada (CCEEV) da kuma tsaftataccen rigakafin ƙwayar cuta ta Vero cell yanzu suna samuwa kuma WHO ta ba da shawarar yin amfani da su.  Tsaftataccen maganin rigakafi na Vero cell rabies yana amfani da nau'in Wistar da aka rage na cutar rabies, kuma yana amfani da layin salula na Vero a matsayin mai masaukinsa. Ana iya amfani da CCEEVs a cikin allurar riga-kafi da bayan fallasa. CCEEVs suna amfani da kwayar cutar rabies mara aiki da aka girma daga ko dai a cikin ƙwai masu ciki ko a cikin al'adun tantanin halitta kuma suna da aminci don amfani ga mutane da dabbobi.  

An ƙaddamar da maganin alurar rigakafi kuma an shirya shi a cikin nau'in HDC WI-38 wanda aka ba wa Hilary Koprowski a Cibiyar Wistar ta Leonard Hayflick, Mataimakin Memba, wanda ya haɓaka wannan nau'in kwayar diploid na mutum na yau da kullum.  

Verorab, wanda Sanofi-Aventis da Speeda suka haɓaka, wanda Liaoning Chengda ya haɓaka shine maganin rigakafin ƙwayar cuta na vero cell (PVRV).   Na farko ya amince da Hukumar Lafiya ta Duniya .  An amince da Verorab don amfani da magani a Ostiraliya da Tarayyar Turai kuma an nuna shi don duka pre-exposure da prophylaxis na bayan faɗuwa daga rabies.  

## Tarihi

Kusan duk cututtukan da suka kamu da cutar rabies sun haifar da mutuwa har sai da masana kimiyyar Faransa guda biyu, Louis Pasteur da Émile Roux, suka fara yin allurar rigakafin rabies na farko a cikin 1885. Joseph Meister mai shekaru tara (1876-1940), wanda wani karen muguwar cuta ya lalata shi, shine mutum na farko da ya sami wannan rigakafin.  An fara maganin ne da allurar subcutaneous a ranar 6 ga Yuli 1885, da ƙarfe 8:00pm, wanda aka biyo baya tare da ƙarin allurai 12 da aka gudanar a cikin kwanaki 10 masu zuwa. An samo allurar ta farko ne daga kashin bayan wani zomo da aka yi wa allurar wanda ya mutu kwanaki 15 a baya. Dukkanin allurai an samo su ta hanyar ragewa, amma daga baya wadanda suka ci gaba da karuwa. 

Alurar rigakafin Pasteur-Roux ta rage samfuran ƙwayoyin cuta da aka girbe ta hanyar ba su damar bushewa na tsawon kwanaki biyar zuwa goma. Har yanzu ana amfani da irin wannan rigakafin da aka samu daga nama na jijiyoyi a wasu ƙasashe, kuma yayin da suke da rahusa fiye da allurar al'adun ƙwayoyin halitta na zamani, ba su da tasiri.  Har ila yau, alluran nama na jijiyoyi suna ɗaukar wani haɗari na rikice-rikicen jijiyoyin jiki. 

## Al'umma da al'adu

### Ilimin tattalin arziki
Lokacin da aka fara bullo da allurar rigakafi ta al’ada ta zamani a farkon shekarun 1980, ana kashe dala 45 a kowane kashi, kuma ana ganin ya yi tsada sosai. Kudin allurar riga-kafin cutar na ci gaba da zama iyaka ga samun riga-kafin cutar kanjamau ga matafiya daga kasashen da suka ci gaba. A cikin 2015, a cikin Amurka, hanya na allurai uku na iya kashe sama , yayin da a Turai tsarin kwas ɗin yana kusa da €100 . Yana yiwuwa kuma mafi inganci don raba kashi ɗaya na alluran intramuscular zuwa allurai na ciki da yawa. Hukumar Lafiya ta Duniya (WHO) ce ke ba da shawarar wannan hanyar a wuraren da aka takura ta hanyar farashi ko kuma tare da batun samar da kayayyaki. Hanyar tana da aminci da inganci kamar na cikin tsoka a cewar WHO. 

## Amfani da dabbobi

An yi amfani da riga-kafin riga- kafi akan mutanen gida da na daji. A yawancin hukunce-hukuncen, ana buƙatar a yi wa karnukan gida, kuliyoyi, ƙwaya, da zomaye. 

Akwai manyan nau'ikan alluran rigakafi guda biyu da ake amfani da su don dabbobin gida da dabbobin gida (ciki har da dabbobi daga nau'in namun daji):

* Kwayar cutar rabies mara aiki (irin wannan fasaha da ake ba mutane) wanda ake gudanarwa ta hanyar allura
* Gyaran ƙwayoyin cuta masu rai da ake gudanarwa ta baki (ta baki): Kwayar cutar rabies mai rai daga nau'ikan da aka rage. Attenuated yana nufin nau'ikan da suka haifar da maye gurbi wanda ke haifar da rauni kuma baya haifar da cuta.

Imrab misali ne na maganin ciwon hauka na dabbobi da ke ɗauke da nau'in Pasteur na cutar rabies da aka kashe. Akwai nau'ikan Imrab iri-iri, gami da Imrab, Imrab 3, da Imrab Large Animal. An amince da Imrab 3 don ferrets kuma, a wasu yankuna, skunks na dabbobi . 

### Karnuka
Baya ga yiwa mutane allurar rigakafi, an kuma bullo da wata hanya ta hanyar yiwa karnuka allurar rigakafin kamuwa da cutar. A cikin 1979, dakin binciken bincike na Van Houweling na Cibiyar Kiwon Lafiya ta Jami'ar Silliman a Dumaguete a Philippines  ya haɓaka kuma ya samar da rigakafin kare wanda ya ba da rigakafi na shekaru uku daga rabies . Haɓaka maganin rigakafin ya haifar da kawar da rabies a yawancin sassan tsibirin Visayas da Mindanao . An yi amfani da shirin da ya yi nasara a Philippines daga baya a matsayin abin koyi daga wasu ƙasashe, irin su Ecuador da jihar Yucatán na Mexico, a yaƙin da suke yi da cutar huhu da aka gudanar tare da haɗin gwiwar Hukumar Lafiya ta Duniya . 

A Tunisiya, an ƙaddamar da wani shiri na yaƙi da cutar baƙar fata don ba masu karnuka allurar rigakafi kyauta don inganta yawan rigakafin da gwamnatinsu ta dauki nauyin yi. Ana kiran maganin da sunan Rabisin ( Mérial ), wanda shine maganin tantanin halitta wanda ake amfani da shi kawai a cikin ƙasa. Yawancin lokaci ana yin alluran rigakafi lokacin da masu su ɗauki karnukansu don dubawa da ziyartar likitan dabbobi. 

An gwada allurar rigakafin ciwon hauka na baka (duba ƙasa don cikakkun bayanai) akan karnukan da ba a san su ba a wasu wuraren da ke da yawan kamuwa da cutar rabies, saboda yana iya yin tasiri fiye da kama su da allura. Duk da haka ba a tura waɗannan don karnuka da yawa ba tukuna. 

### Dabbobin daji
Dabbobin namun daji, da farko jemagu, raccoons, skunks, da foxes, suna aiki a matsayin nau'in tafki don bambance-bambancen kwayar cutar rabies a yankuna daban-daban na Amurka.   Wannan yana haifar da kamuwa da cutar rabies gaba ɗaya tare da barkewar cutar a yawan dabbobi.  Kusan kashi 90 cikin 100 na dukkan cututtukan da aka ruwaito a Amurka sun fito ne daga namun daji. 

#### Alurar riga kafi na baka
Ana rarraba allurar rigakafin cutar ta baka a cikin shimfidar wuri, wanda ke nufin nau'in tafki, a ƙoƙarin samar da tasirin rigakafin garken garken . An yi tunanin yin rigakafin namun daji a cikin shekarun 1960, kuma an yi amfani da ƙwayoyin cuta masu rai na rabies don gwajin gwajin baka na namun daji ta 1970s.  Haɓaka rigakafin baka don namun daji ya fara ne a cikin Amurka tare da gwaje-gwajen dakin gwaje-gwaje ta amfani da rayuwa mai rai, rigakafin Evelyn-Rokitnicki-Abselseth (ERA), wanda aka samo daga nau'in Titin Alabama Dufferin (SAD).  Gwajin filin ORV na farko ta yin amfani da maganin rigakafi mai rai don yin rigakafin foxes ya faru a Switzerland a lokacin 1978.  

A halin yanzu akwai nau'ikan nau'ikan allurar namun daji na baka da ake amfani da su:

* Kwayar cutar da aka canza: Rarraba nau'ikan allurar rigakafi na ƙwayar cutar rabies kamar SAG2 da SAD B19 
* Recombinant vaccinia virus yana bayyana rabies glycoprotein (V-RG): Wannan nau'in kwayar cutar alurar riga kafi ne (asali alurar riga-kafi) wanda aka ƙirƙira don ɓoye kwayar halitta ga rabies glycoprotein.
** An tabbatar da V-RG lafiya a cikin nau'ikan dabbobi sama da 60 da suka haɗa da kuliyoyi da karnuka.   An yi tunanin yin rigakafin namun daji a cikin shekarun 1960, kuma an yi amfani da ƙwayoyin cuta masu rai na rabies don gwajin gwajin baka na masu naman dabbobi a cikin 1970s.
* ONRAB: wani gwaji mai rai recombinant adenovirus alurar rigakafi  

Sauran allurar gwaji na baka a cikin haɓaka sun haɗa da recombinant adenovirus alurar rigakafi. 

An yi amfani da shirye-shiryen rigakafi na baka (ORV) a cikin ƙasashe da yawa a ƙoƙarin da ake yi na shawo kan yaduwar cutar ta rabies da kuma iyakance haɗarin hulɗar ɗan adam da kwayar cutar ta rabies.  An fara shirye-shiryen ORV a Turai a cikin 1980s, Kanada a cikin 1985, da kuma a Amurka a cikin 1990.  ORV wani ma'auni ne na rigakafi don kawar da ciwon hauka a cikin cututtukan daji na namun daji, musamman foxes, raccoons, karnuka raccoon, coyotes da jackals, amma kuma ana iya amfani dashi ga karnuka a kasashe masu tasowa .  Shirye-shiryen ORV yawanci shawagi ne don isar da rigakafin ga dabbobin da aka yi niyya. A cikin Amurka, RABORAL V-RG (Boehringer Ingelheim, Duluth, GA, Amurka) ita ce kawai ORV mai lasisi don sarrafa ƙwayar cutar rabies tun 1997.  Koyaya, ONRAB "Ultralite" (Artemis Technologies Inc., Guelph, Ontario, Canada) Ma'aikatar Aikin Gona ta Amurka (USDA) ta rarraba baits a wasu yankuna na gabashin Amurka a ƙarƙashin izinin gwaji don kai hari kan raccoons tun 2011.  RABORAL V-RG baits yana kunshe da karamin fakiti mai dauke da maganin alurar riga kafi wanda sai a rufe shi a cikin man kifi ko kuma a lullube shi a cikin shingen kifi-polymer.  ONRAB "Ultralite" baits sun ƙunshi fakitin blister tare da matrix na dandano na vanilla, launin abinci mai launin kore, mai kayan lambu da mai mai hydrogenated.  Lokacin da dabba ta ciji cikin koto, fakitin ya fashe kuma ana ba da maganin.  Bincike na yanzu ya nuna cewa idan an sha isassun adadin maganin, rigakafin cutar ya kamata ya wuce sama da shekara guda.  Ta hanyar rigakafi da dabbobin daji ko batattu, shirye-shiryen ORV suna aiki don ƙirƙirar yanki mai ɓoyewa tsakanin ƙwayar cutar rabies da yuwuwar hulɗa da mutane, dabbobi, ko dabbobi.  Ana amfani da fasalin fasalin ƙasa kamar manyan jikunan ruwa da tsaunuka don haɓaka tasiri na buffer **.**  An ƙaddara tasirin kamfen na ORV a takamaiman wurare ta hanyar tarko-da-saki hanyoyin.  Ana yin gwajin titer akan jinin da aka zana daga samfurin dabbobi don auna matakan rigakafin cutar rabies a cikin jini.  Yawancin lokaci jiragen sama suna rarraba bats don rufe manyan yankunan karkara yadda ya kamata. Domin a sanya bat daidai da kuma rage cudanya da mutane da dabbobi, ana rarraba su da hannu a yankunan karkara ko birane.  Matsakaicin rabon koto shine 75 baits/km 2 a yankunan karkara da 150 baits/km 2 a birane da yankunan da suka ci gaba. 

Aiwatar da shirye-shiryen ORV a Amurka ya haifar da kawar da bambance-bambancen ƙwayar cutar coyote rabies a cikin 2003 da kuma bambancin fox mai launin toka a lokacin 2013.   Bugu da ƙari, ORV ya yi nasara wajen hana faɗaɗa yamma na raccoon rabies enzootic gaban bayan Alabama.

## Hanyoyin haɗi na waje

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* Rabies Vaccines at the U.S. National Library of Medicine Medical Subject Headings (MeSH)

## Manazarta