1
|
Mogano K, Sabeta CT, Suzuki T, Makita K, Chirima GJ. Patterns of Animal Rabies Prevalence in Northern South Africa between 1998 and 2022. Trop Med Infect Dis 2024; 9:27. [PMID: 38276638 PMCID: PMC10819520 DOI: 10.3390/tropicalmed9010027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/16/2024] [Accepted: 01/16/2024] [Indexed: 01/27/2024] Open
Abstract
Rabies is endemic in South Africa and rabies cycles are maintained in both domestic and wildlife species. The significant number of canine rabies cases reported by the World Organization for Animal Health Reference Laboratory for Rabies at Onderstepoort suggests the need for increased research and mass dog vaccinations on specific targeted foci in the country. This study aimed to investigate the spatiotemporal distribution of animal rabies cases from 1998 to 2017 in northern South Africa and environmental factors associated with highly enzootic municipalities. A descriptive analysis was used to investigate temporal patterns. The Getis-Ord Gi statistical tool was used to exhibit low and high clusters. Logistic regression was used to examine the association between the predictor variables and highly enzootic municipalities. A total of 9580 specimens were submitted for rabies diagnosis between 1998 and 2022. The highest positive case rates were from companion animals (1733 cases, 59.71%), followed by livestock (635 cases, 21.88%) and wildlife (621 cases, 21.39%). Rabies cases were reported throughout the year, with the majority occurring in the mid-dry season. Hot spots were frequently in the northern and eastern parts of Limpopo and Mpumalanga. Thicket bush and grassland were associated with rabies between 1998 and 2002. However, between 2008 and 2012, cultivated commercial crops and waterbodies were associated with rabies occurrence. In the last period, plantations and woodlands were associated with animal rabies. Of the total number of municipalities, five consistently and repeatedly had the highest rabies prevalence rates. These findings suggest that authorities should prioritize resources for those municipalities for rabies elimination and management.
Collapse
Affiliation(s)
- Kgaogelo Mogano
- Agricultural Research Council, GeoInformatics Division, Natural Resources and Engineering, 600 Belvedere St., Pretoria 0083, South Africa
- Department of Geography, Geoinformatics and Meteorology, University of Pretoria, Pretoria 0028, South Africa
| | - Claude Taurai Sabeta
- Veterinary Tropical Diseases Department, University of Pretoria, Pretoria 0110, South Africa
- World Organisation for Animal Health (WOAH) Rabies Reference Laboratory, Agricultural Research Council (Onderstepoort Veterinary Research), Onderstepoort, Pretoria 0110, South Africa
| | - Toru Suzuki
- Department of Environmental and Symbiotic Sciences, Rakuno Gakuen University, Ebetsu 069-8501, Japan
| | - Kohei Makita
- Department of Veterinary Medicine, Rakuno Gakuen University, Ebetsu 069-8501, Japan
| | - George Johannes Chirima
- Agricultural Research Council, GeoInformatics Division, Natural Resources and Engineering, 600 Belvedere St., Pretoria 0083, South Africa
- Department of Geography, Geoinformatics and Meteorology, University of Pretoria, Pretoria 0028, South Africa
| |
Collapse
|
2
|
Kisaka S, Makumbi FE, Majalija S, Kagaha A, Thumbi SM. "As long as the patient tells you it was a dog that bit him, why do you need to know more?" A qualitative study of how healthcare workers apply clinical guidelines to treat dog bite injuries in selected hospitals in Uganda. PLoS One 2021; 16:e0254650. [PMID: 34260651 PMCID: PMC8279313 DOI: 10.1371/journal.pone.0254650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 06/30/2021] [Indexed: 11/19/2022] Open
Abstract
Dog-mediated rabies is on the increase in Uganda despite the availability of post-exposure prophylaxis (PEP). PEP procedures are expounded in the Uganda Clinical Guidelines (UCG) of 2016. We assessed adherence by health workers to UCG while managing dog bites in two PEP centers and obtained insights into motivations of their practices. Using qualitative methods, we observed the health worker-patient encounters, reviewed medical records, and interviewed 14 health workers that were involved in managing dog bite injuries. We used deductive thematic analysis to identify codes in themes developed from UCG. We found that much of the history of the bites was taken, but it was neither verified nor written down on the patient's file. Classification of wounds was inaccurate and ancillary laboratory assessments like culture and sensitivity tests were not conducted in all cases. Although antibiotics were given for both treatment and prophylactic purposes, the prescription was based on availability and affordability, not UCG recommendations. Rabies immunoglobulin (RIG) was not administered to deserving patients due to unavailability and high costs to the patient. Anti-rabies vaccine (ARV) was prescribed indiscriminately and some health workers attributed this to pressure from patients. Health education regarding prevention of dog bites was not given to patients due to time constraints on the side of the providers as a result of high caseloads at the emergency departments. Challenges to adherence to guidelines were identified as frequent ARV stock outs; inadequate cooperation among health facilities; and insufficient knowledge and skills on how injuries and rabies should be managed. We conclude that clinical management of dog bites is not fully in line with UCG. We argue that adoption of an integrated bite case management and cost-saving strategies as well as continuing medical education programs on rabies control and management could improve the clinical management of dog bites.
Collapse
Affiliation(s)
- Stevens Kisaka
- University of Nairobi Institute of Tropical and Infectious Diseases, Nairobi, Kenya
- School of Public Health, Makerere University, Kampala, Uganda
- College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, Uganda
| | | | - Samuel Majalija
- College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, Uganda
| | - Alexander Kagaha
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - S. M. Thumbi
- University of Nairobi Institute of Tropical and Infectious Diseases, Nairobi, Kenya
- Rabies Free Africa, Washington State University, Pullman, Washington, United States of America
- Paul G Allen School for Global Animal Health, Washington State University, Pullman, Washington, United States of America
| |
Collapse
|
3
|
Lhendup K, Dorji T. Probable rabies in a child in a Bhutanese town bordering India, 2020. SAGE Open Med Case Rep 2021; 9:2050313X211019786. [PMID: 34104446 PMCID: PMC8170276 DOI: 10.1177/2050313x211019786] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 04/28/2021] [Indexed: 11/17/2022] Open
Abstract
Rabies is a neglected tropical disease that causes mortality and high economic burden in many developing countries. Rabies is a vaccine-preventable disease if timely post-exposure prophylaxis is available after animal exposure. The control of rabies requires limiting the transmission of the virus in the animal reservoir, effective public health measures to control outbreaks and increasing accessibility and uptake of rabies post-exposure prophylaxis. Bhutan is a small Himalayan country where rabies is endemic. In this article, we describe the death of a 3-year-old female child due to probable rabies in a Bhutanese village located along the border with India. The child had a furious form of rabies with encephalitic syndrome developing 57 days after a category III dog bite on the chest. The child was managed at a district hospital with the available resources. This is the first rabies death in Bhutan in the last 5 years and the 18th since 2006. This case report focuses on the efforts required to increase the timely uptake of post-exposure prophylaxis in a free healthcare system in Bhutan.
Collapse
Affiliation(s)
| | - Thinley Dorji
- Department of Internal Medicine, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan.,Kidu Mobile Medical Unit, His Majesty's People's Project, Thimphu, Bhutan
| |
Collapse
|
4
|
Rana MS, Siddiqi UR, Ghosh S, Jahan AA, Islam MK, Ali Shah MR, Ullah SM, Ali SE, Ahmed BN, Shamsuzzaman AKM. Epidemiological study of human rabies cases in Bangladesh through verbal autopsy. Heliyon 2020; 6:e05521. [PMID: 33251369 PMCID: PMC7679256 DOI: 10.1016/j.heliyon.2020.e05521] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 09/28/2020] [Accepted: 11/11/2020] [Indexed: 11/22/2022] Open
Abstract
Identification of risk factors is crucial to find ways to reduce rabies deaths. We investigated the hospital records of rabies deceased through contact tracing of the relatives of the victims using enhanced verbal autopsies (VA) to identify why the people had to die from rabies in recent years in Bangladesh. Patients whose deaths were confirmed by physicians based on the history of animal exposure and clinical signs were taken into account for VA. Socio-demographic profile of the deceased, animal exposure, nature of the wound, and history of post-exposure prophylaxis (PEP) data were obtained and analysed. The study found 256 cases in which the cause of death was attributed to rabies, most of the victims were male (71.88%), resided in the rural community (80.47%), dependent (49.22%), and children below the age of 15 years (47.27%). Dogs were the single most responsible (81.64%); however, cats (12.11%), jackals (3.91%) and mongoose (2.34%) were also found accountable for rabies incidence (P < 0.05). Significantly, limbs were the most common (67.97%) site of exposure, and the shortest incubation period was identified in the case of bites to head and face (P < 0.05). The majority (86.72%) of the deceased did not receive any PEP; whereas, 66.80% sought treatment from traditional healers. Among the deceased (13.28%, n = 34) who had received PEP, only 8.82% of them completed the full course of the vaccination regimen (P < 0.01); however, none of them had history of taking rabies immunoglobulin (RIG). The study recommends extensive public health awareness programs in the rural community and establishing methods to improve healthcare-seeking behaviours, including receiving PEP instead of visiting traditional healers. Moreover, the availability and accessibility of PEP in the government hospital facilities are desirable, and laboratory-based surveillance with compatible rapid data reporting may be incorporated in the existing policy.
Collapse
Affiliation(s)
- Md Sohel Rana
- Communicable Disease Control, Directorate General of Health Services, Ministry of Health and Family Welfare, Bangladesh
- Department of Livestock Services, Ministry of Fisheries and Livestock, Bangladesh
| | - Umme Ruman Siddiqi
- Communicable Disease Control, Directorate General of Health Services, Ministry of Health and Family Welfare, Bangladesh
| | - Sumon Ghosh
- Communicable Disease Control, Directorate General of Health Services, Ministry of Health and Family Welfare, Bangladesh
- International Centre for Diarrhoeal Disease Research, Mohakhali, Dhaka 1212, Bangladesh
| | - Afsana Akter Jahan
- Communicable Disease Control, Directorate General of Health Services, Ministry of Health and Family Welfare, Bangladesh
| | - Md Kamrul Islam
- Communicable Disease Control, Directorate General of Health Services, Ministry of Health and Family Welfare, Bangladesh
| | - Md Rashed Ali Shah
- Communicable Disease Control, Directorate General of Health Services, Ministry of Health and Family Welfare, Bangladesh
| | - Sayed Mohammed Ullah
- Communicable Disease Control, Directorate General of Health Services, Ministry of Health and Family Welfare, Bangladesh
| | - S.M. Emran Ali
- Infectious Disease Hospital, Mohakhali, Dhaka 1212, Bangladesh
| | - Be-Nazir Ahmed
- Communicable Disease Control, Directorate General of Health Services, Ministry of Health and Family Welfare, Bangladesh
| | | |
Collapse
|
5
|
Kisaka S, Makumbi FE, Majalija S, Bangirana A, Thumbi SM. Epidemiology and preclinical management of dog bites among humans in Wakiso and Kampala districts, Uganda: Implications for prevention of dog bites and rabies. PLoS One 2020; 15:e0239090. [PMID: 32956373 PMCID: PMC7505423 DOI: 10.1371/journal.pone.0239090] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 08/29/2020] [Indexed: 11/19/2022] Open
Abstract
In rabies endemic areas, appropriate management of dog bites is critical in human rabies prevention. Victims must immediately wash bite wound for 15 minutes with water, soap, and a disinfectant before seeking medical care. This study investigated the epidemiology of dog bites and the determinants of compliance to these pre-clinical guidelines requirements among dog bite victims from high rabies-burden areas of Wakiso and Kampala, Uganda. An explanatory sequential mixed-methods study design was used. Quantitative data were collected from 376 dog-bite patients at two healthcare facilities. Qualitative data were also collected through 13 in-depth interviews with patients, healthcare workers, herbalists, and veterinarians. Qualitative data were analyzed using a deductive thematic approach. Generalized linear models were used to determine factors associated with compliance. Nearly half (190, 51%) of the patients were from Wakiso District and 293 (77.9%) had grade II wounds. Most of the wounds (171, 45.5%) were on the legs. Two-thirds of the bites occurred in public places. Only 70 (19%) of the bite patients had complied with pre-clinical guidelines. Nearly half of the patients had applied substances that were not recommended e.g. herbs (47/193), antiseptics (46/193), "black stone" (25/193), and unknown creams (10/193). Factors negatively associated with compliance included: being aged 15 years or older, adjPR = 0.70 (0.47-0.92) and knowing the dog owner, adjPR = 0.65 (0.36-0.93). However, attainment of secondary or higher education, adjPR = 1.76 (1.24-3.79), being in employment, adjPR = 1.48 (1.09-2.31), perception that the dog was sick, adjPR = 1.47 (1.02-2.72) and knowledge about the dog's subsequent victim(s) adjPR = 0.35 (0.17-0.70) were positively associated with compliance. High occurrence of dog bites in public places by free-roaming dogs suggests the need for deliberate promotion of responsible dog ownership. Additionally, targeted health education may be required to improve the low compliance to pre-clinical guidelines.
Collapse
Affiliation(s)
- Stevens Kisaka
- University of Nairobi Institute of Tropical and Infectious Diseases, Nairobi, Kenya
- School of Public Health, Makerere University, Kampala, Uganda
- College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, Uganda
| | | | - Samuel Majalija
- College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, Uganda
| | - Alexander Bangirana
- Department of Emergency Medicine, Mulago National Referral Hospital, Kampala, Uganda
| | - S. M. Thumbi
- University of Nairobi Institute of Tropical and Infectious Diseases, Nairobi, Kenya
- Rabies Free Africa, Washington State University, Pullman, Washington, United States of America
- Paul G Allen School for Global Animal Health, Washington State University, Pullman, Washington, United States of America
| |
Collapse
|
6
|
De la Puente-León M, Levy MZ, Toledo AM, Recuenco S, Shinnick J, Castillo-Neyra R. Spatial Inequality Hides the Burden of Dog Bites and the Risk of Dog-Mediated Human Rabies. Am J Trop Med Hyg 2020; 103:1247-1257. [PMID: 32662391 PMCID: PMC7470517 DOI: 10.4269/ajtmh.20-0180] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 05/25/2020] [Indexed: 12/21/2022] Open
Abstract
Since its reintroduction in 2015, rabies has been established as an enzootic disease among the dog population of Arequipa, Peru. Given the unknown rate of dog bites, the risk of human rabies transmission is concerning. Our objective was to estimate the rate of dog bites in the city and to identify factors associated with seeking health care in a medical facility for wound care and rabies prevention follow-up. To this end, we conducted a door-to-door survey with 4,370 adults in 21 urban and 21 peri-urban communities. We then analyzed associations between seeking health care following dog bites and various socioeconomic factors, stratifying by urban and peri-urban localities. We found a high annual rate of dog bites in peri-urban communities (12.4%), which was 2.6 times higher than that in urban areas (4.8%). Among those who were bitten, the percentage of people who sought medical treatment was almost twice as high in urban areas (39.1%) as in peri-urban areas (21.4%).
Collapse
Affiliation(s)
- Micaela De la Puente-León
- Zoonotic Disease Research Laboratory, One Health Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Arequipa, Perú
| | - Michael Z. Levy
- Zoonotic Disease Research Laboratory, One Health Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Arequipa, Perú
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Amparo M. Toledo
- Zoonotic Disease Research Laboratory, One Health Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Arequipa, Perú
| | - Sergio Recuenco
- Centro de Investigaciones Tecnológicas, Biomédicas y Medioambientales, Universidad Nacional Mayor de San Marcos, Lima, Perú
| | - Julianna Shinnick
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ricardo Castillo-Neyra
- Zoonotic Disease Research Laboratory, One Health Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Arequipa, Perú
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania
| |
Collapse
|
7
|
Rinchen S, Tenzin T, Hall D, Cork S. A Qualitative Risk Assessment of Rabies Reintroduction Into the Rabies Low-Risk Zone of Bhutan. Front Vet Sci 2020; 7:366. [PMID: 32766290 PMCID: PMC7381201 DOI: 10.3389/fvets.2020.00366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 05/27/2020] [Indexed: 10/26/2022] Open
Abstract
In Bhutan, dog-mediated rabies has been successfully eliminated from most regions of the country but remains endemic in the Southern region and sporadic incursions are also reported in the East. Elimination of rabies from the southern part of Bhutan is challenged by the porous border with the neighboring states of India which facilitates free and unregulated movement of animals. Around 17 outbreaks of rabies are reported annually in dogs and other domestic animals, posing continuous public health risks and economic losses. Furthermore, due to anthropogenic factors, such as increasing human settlements along highways, increased animal transportation, and the complex and changing human-pet relationship, there is potential to reintroduce rabies from rabies high-risk zone to rabies low-risk zone. This study was undertaken to estimate the risk of rabies re-introduction to the rabies low-risk zone by performing a qualitative risk assessment. The assessment was conducted for three risk pathways (stray dog-pathway, pet dog-pathway and cattle-pathway) under two scenarios: (1) no risk mitigation measures in place and (2) current risk mitigation measures in place. The current control measures include Government led programs, such as mass dog vaccination and dog population management, regulation of the movment of animals through pre-travel check-up and health certification, regular awareness education and rabies surveillance in the rabies endemic areas. The probability of an event occurring was assigned using the data from the available literature. Where gaps in knowledge existed, expert opinion, elicited through modified Delphi method, was used. Under the scenario in which no risk mitigation measures were in place, the risk of rabies re-introduction was estimated to be medium for the stray-dog pathway with a low level of uncertainty, low for pet-dog pathway with a low level of uncertainty, and very low for the cattle-pathway with a medium level of uncertainty. When current risk-mitigation measures were included, the risk of rabies reintroduction was estimated to be very low for the stray-dog pathway with a medium level of uncertainty, low for the pet dog-pathway with a low level of uncertainty, and extremely low for the cattle-pathway with a medium level of uncertainty. The risk of rabies re-introduction through all the pathways was greater than negligible. These findings highlight the importance of maintaining and enhancing current risk mitigation measures to prevent re-introduction of rabies into rabies low-risk zone.
Collapse
Affiliation(s)
- Sangay Rinchen
- Department of Livestock, National Centre for Animal Health, Ministry of Agriculture and Forests, Thimphu, Bhutan
| | - Tenzin Tenzin
- Department of Livestock, National Centre for Animal Health, Ministry of Agriculture and Forests, Thimphu, Bhutan
| | - David Hall
- Department of Ecosystem and Public Health, Faculty of Veterinary Medicine, University of Calgary, Calgary, AB, Canada
| | - Susan Cork
- Department of Ecosystem and Public Health, Faculty of Veterinary Medicine, University of Calgary, Calgary, AB, Canada
| |
Collapse
|
8
|
Abstract
Background: Animal bite due to the risk of rabies is a major public health problem. Rabies is of great importance because of fatalities and economic damage. Objective: This study was conducted to investigate the epidemiological patterns of animal bite in Najaf Abad during the years of 2012 to 2017. Methods: This is a cross-sectional study. All records (4,104) were registered in the registration offices of animal bites during the years of 2012 to 2017 at the rabies treatment centres of Najafabad by census method. Demographic characteristics, animal type and sometime clinical patterns of the wounded were examined. Results: The mean age of the injured was 31.28 ± 15.28 years. Of the 4,104 injured, 3648 (88%) were male and the rest of them were women. In terms of residential area, 3645 people (88%) were in urban areas and the rest were in rural areas in the place of occurrence of bites. Most cases of animal biting occurred in dogs (70.9%) and then cat (24.3%). The most affected part was 51% with shoulder and hand. In this study, the incidence of animal bites is estimated as 100,000 people per year in Najaf Abad in in 2012 it was 206.4, with an increasing trend to 212.9 in 2019 (P < 0.001). Conclusion: The results of the study showed that most cases of animal bites were related to dogs, urban areas and male sex variables. The incidence of animal bites was also increasing. Due to the importance of this disease and its financial losses, it is recommended that prevention methods should be used to control stray dogs, vaccination of domesticated dogs and to raise awareness of the people.
Collapse
|
9
|
Penjor K, Marquetoux N, Dorji C, Penjor K, Dorjee S, Dorjee C, Jolly PD, Morris RS, McKenzie JS. Evaluation of post-exposure prophylaxis practices to improve the cost-effectiveness of rabies control in human cases potentially exposed to rabies in southern Bhutan. BMC Infect Dis 2020; 20:203. [PMID: 32143641 PMCID: PMC7060656 DOI: 10.1186/s12879-020-4926-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 02/27/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Rabies is endemic in southern Bhutan, associated with 1-2 human deaths and high post exposure prophylaxis (PEP) costs annually. Evaluation of clinicians' management of human cases potentially exposed to rabies could contribute to improving PEP prescribing practices to both reduce unnecessary costs associated with PEP and reach the target of zero human deaths due to rabies by 2023. METHODS A cross-sectional survey of 50 clinicians' management of human cases potentially exposed to rabies was conducted in 13 health centers in high-rabies-risk areas of Bhutan during February-March 2016. RESULTS Data were collected on clinicians' management of 273 human cases potentially exposed to rabies. The 50 clinicians comprised health assistants or clinical officers (55%) and medical doctors (45%) with a respective median of 19, 21 and 2 years' experience. There was poor agreement between clinicians' rabies risk assessment compared with an independent assessment for each case based on criteria in the National Rabies Management Guidelines (NRMG). Of the 194 cases for which clinicians recorded a rabies risk category, only 53% were correctly classified when compared with the NRMG. Clinicians were more likely to underestimate the risk of exposure to rabies and appeared to prescribe PEP independently of their risk classification.. Male health assistants performed the most accurate risk assessments while female health assistants performed the least accurate. Clinicians in Basic Health Units performed less accurate risk assessments compared with those in hospitals. CONCLUSIONS This study highlights important discrepancies between clinicians' management of human cases potentially exposed to rabies and recommendations in the NRMG. In particular, clinicians were not accurately assessing rabies risk in potentially exposed cases and were not basing their PEP treatment on the basis of their risk assessment. This has significant implications for achieving the national goal of eliminating dog-mediated human rabies by 2030 and may result in unnecessary costs associated with PEP. Recommendations to improve clinician's management of human cases potentially exposed to rabies include: reviewing and updating the NRMG, providing clinicians with regular and appropriately targeted training about rabies risk assessment and PEP prescription, and regularly reviewing clinicians' practices.
Collapse
Affiliation(s)
- Kinley Penjor
- School of Veterinary Science, Massey University, Auckland, New Zealand. .,Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu, Bhutan. .,Sarpang District Hospital, Department of Medical Services, Ministry of Health, Thimphu, Bhutan. .,Present address: Vector-Borne Disease Control Program, Department of Public Health, Ministry of Health, Gelephu, Bhutan.
| | - Nelly Marquetoux
- School of Veterinary Science, Massey University, Auckland, New Zealand
| | - Chendu Dorji
- School of Veterinary Science, Massey University, Auckland, New Zealand.,Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu, Bhutan.,Regional Livestock Development Centre Tsimasham, Department of Livetsock, Ministry of Agriculture and Forest, Thimphu, Bhutan
| | - Kinley Penjor
- School of Veterinary Science, Massey University, Auckland, New Zealand.,Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu, Bhutan.,Bhutan Agriculture and Food Regulatory Authority, Ministry of Agriculture and Forest, Thimphu, Bhutan
| | - Sithar Dorjee
- School of Veterinary Science, Massey University, Auckland, New Zealand.,Bhutan Agriculture and Food Regulatory Authority, Ministry of Agriculture and Forest, Thimphu, Bhutan
| | - Chencho Dorjee
- Faculty of Nursing and Public Health, Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu, Bhutan
| | - P D Jolly
- School of Veterinary Science, Massey University, Auckland, New Zealand
| | - R S Morris
- Morvet Ltd, Consultancy services in health risk management and food safety policy and programs, Masterton, New Zealand
| | - J S McKenzie
- School of Veterinary Science, Massey University, Auckland, New Zealand
| |
Collapse
|
10
|
Ghosh S, Rana MS, Islam MK, Chowdhury S, Haider N, Kafi MAH, Ullah SM, Shah MRA, Jahan AA, Mursalin HS, Marma ASP, Ali SME, Hossain S, Bhowmik R, Debnath NC, Shamsuzzaman AKM, Ahmed BN, Siddiqi UR, Jhora ST. Trends and clinico-epidemiological features of human rabies cases in Bangladesh 2006-2018. Sci Rep 2020; 10:2410. [PMID: 32051481 PMCID: PMC7016137 DOI: 10.1038/s41598-020-59109-w] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 01/24/2020] [Indexed: 11/23/2022] Open
Abstract
Vaccinating dogs against rabies is an effective means of reducing human rabies. We subjected 1327 clinically diagnosed human rabies death and mass dog vaccination (MDV) data during 2006-2018 to quantify the impacts of MDV on human rabies incidence in Bangladesh and a subset of rabies death data (422) for clinico-epidemiological analysis. A positive and increasing trend of MDV (p = 0.01 and tau = 0.71) and a negative and declining trend (p < 0.001 and tau = -0.88) of human rabies cases (Correlation coefficient: -0.82) have been observed. Among 422 deaths, the majority (78%) of the victims sought treatment from traditional healers, and 12% received post-exposure prophylaxis (PEP). The mean incubation period of rabies in cases with exposure sites on the head & neck (35 days) was shorter than the upper limb (mean = 64 days, p = 0.02) and lower limb (mean = 89 days, p < 0.01). MDV has been found to be effective for reducing human rabies cases in Bangladesh. Creating awareness among the animal bite victims to stop reliance on traditional healers rather seeking PEP, addressing the role of traditional healers through awareness education programme with respect to the treatment of dog bites, ensuring availability of PEP, and continuing to scale up MDV may help to prevent human rabies deaths.
Collapse
Affiliation(s)
- Sumon Ghosh
- Disease Control Unit, Communicable Disease Control, Directorate General of Health Services, Ministry of Health and Family Welfare, Dhaka, Bangladesh.
| | - Md Sohel Rana
- Disease Control Unit, Communicable Disease Control, Directorate General of Health Services, Ministry of Health and Family Welfare, Dhaka, Bangladesh
- Department of Livestock Services, Ministry of Fisheries and Livestock, Dhaka, Bangladesh
| | - Md Kamrul Islam
- Disease Control Unit, Communicable Disease Control, Directorate General of Health Services, Ministry of Health and Family Welfare, Dhaka, Bangladesh
| | - Sukanta Chowdhury
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Najmul Haider
- Technical University of Denmark, Section for Epidemiology, National Veterinary Institutes, Copenhagen, Denmark
- Department of Pathobiology and Population Sciences, Royal Veterinary College, University of London, London, UK
| | | | - Sayed Mohammed Ullah
- Disease Control Unit, Communicable Disease Control, Directorate General of Health Services, Ministry of Health and Family Welfare, Dhaka, Bangladesh
| | - Md Rashed Ali Shah
- Disease Control Unit, Communicable Disease Control, Directorate General of Health Services, Ministry of Health and Family Welfare, Dhaka, Bangladesh
| | - Afsana Akter Jahan
- Disease Control Unit, Communicable Disease Control, Directorate General of Health Services, Ministry of Health and Family Welfare, Dhaka, Bangladesh
- Faculty of Veterinary and Animal Sciences, Gono University, Savar, Dhaka, Bangladesh
| | - Hasan Sayedul Mursalin
- Disease Control Unit, Communicable Disease Control, Directorate General of Health Services, Ministry of Health and Family Welfare, Dhaka, Bangladesh
| | - Aung Swi Prue Marma
- Disease Control Unit, Communicable Disease Control, Directorate General of Health Services, Ministry of Health and Family Welfare, Dhaka, Bangladesh
| | - S M Emran Ali
- Infectious Disease Hospital, Directorate General of Health Services, Ministry of Health and Family Welfare, Dhaka, Bangladesh
| | | | - Rajub Bhowmik
- John Jay College of the City University of New York, 445 W 59th St-10019, New York, USA
| | - Nitish C Debnath
- Food and Agriculture Organization of the United Nation, Dhaka, Bangladesh
| | - Abul Khair Mohammad Shamsuzzaman
- Disease Control Unit, Communicable Disease Control, Directorate General of Health Services, Ministry of Health and Family Welfare, Dhaka, Bangladesh
| | - Be-Nazir Ahmed
- Disease Control Unit, Communicable Disease Control, Directorate General of Health Services, Ministry of Health and Family Welfare, Dhaka, Bangladesh
| | - Umme Ruman Siddiqi
- Disease Control Unit, Communicable Disease Control, Directorate General of Health Services, Ministry of Health and Family Welfare, Dhaka, Bangladesh
| | - Sanya Tahmina Jhora
- Disease Control Unit, Communicable Disease Control, Directorate General of Health Services, Ministry of Health and Family Welfare, Dhaka, Bangladesh
| |
Collapse
|
11
|
Mbaipago N, Mindekem R, Oussiguere A, Moyengar R, Naïssengar K, Madjadinan A, Zinsstag J, Léchenne M. Rabies knowledge and practices among human and veterinary health workers in Chad. Acta Trop 2020; 202:105180. [PMID: 31542375 DOI: 10.1016/j.actatropica.2019.105180] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 09/03/2019] [Accepted: 09/18/2019] [Indexed: 12/01/2022]
Abstract
To prevent human rabies deaths close communication between the veterinary and human health sector is needed for timely and adequate treatment after a bite exposure. Good practice treatment and efficient One Health communication depends heavily on the knowledge and practices (KP) of both human health and veterinary workers. We have evaluated the level of KP of both these sectors during a one-day joint training program to kick start a large scale rabies burden and vaccine demand study in selected regions of Chad. Participants were evaluated through a questionnaire before and after training to get insight into the basic knowledge of rabies and the improvement of this knowledge after the training session. In addition to 20 questions on rabies derived from the educational platform of the Global Alliance for Rabies Control, the questionnaires included a pre-training knowledge self-evaluation and a post-training evaluation of the course. Overall 247 workshop participants with varied level of educational background responded to at least one questionnaire. Around 75% of respondents were from the human health sector and 20% from the veterinary sector. Knowledge level did not differ significantly between the two sectors nor between rural or urban working backgrounds. Respondents with a university degree scored significantly higher in pre-and post-training questionnaire compared to respondents with high school level degree or lower. Knowledge was also dependent on study region and sex of the respondent. In general, the importance of a One Health approaches, such as vaccination of dogs to prevent human rabies, is well understood in both sectors. Regarding treatment, many participants did not know the adequate number of doses required for a full course of PEP, but through the training, this knowledge improved. Detailed knowledge of atypical transmission routes and pathophysiology (neurotropism of the virus) was generally lacking and did not significantly improve through the training. The study revealed considerable deficiencies and challenges in the knowledge level of both veterinary and human health workers in Chad. Rabies control programs need to anticipate these challenges to implementation and provide sufficient time and funds for training workshops and follow-up.
Collapse
Affiliation(s)
| | - Rolande Mindekem
- Centre de Support en Santé International, BP 972, Moursal, N'Djamena, Chad
| | - Assandi Oussiguere
- Institut de Recherche en Elevage pour le Développement, BP 433, Farcha, N'Djamena, Chad
| | - Ronelngar Moyengar
- Centre de Support en Santé International, BP 972, Moursal, N'Djamena, Chad
| | | | | | - Jakob Zinsstag
- Swiss Tropical and Public Health Institute, P.O. Box, CH-4002 Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Monique Léchenne
- Swiss Tropical and Public Health Institute, P.O. Box, CH-4002 Basel, Switzerland; University of Basel, Basel, Switzerland; Environment and Sustainability Institute, University of Exeter, Penryn Campus, UK.
| |
Collapse
|
12
|
Li AJ, Sreenivasan N, Siddiqi UR, Tahmina S, Penjor K, Sovann L, Gunesekera A, Blanton JD, Knopf L, Hyde TB. Descriptive assessment of rabies post-exposure prophylaxis procurement, distribution, monitoring, and reporting in four Asian countries: Bangladesh, Bhutan, Cambodia, and Sri Lanka, 2017-2018. Vaccine 2019; 37 Suppl 1:A14-A19. [PMID: 30314908 PMCID: PMC6702106 DOI: 10.1016/j.vaccine.2018.10.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 08/21/2018] [Accepted: 10/03/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND There are approximately 35,000 human deaths from rabies in Asia annually. Rabies can be prevented through timely post-exposure prophylaxis (PEP) consisting of wound washing, rabies vaccine, and in some cases, rabies immunoglobulin (RIG). However, access to rabies PEP often remains limited to urban areas and is cost-prohibitive. There is little information on procurement, distribution, monitoring, and reporting of rabies PEP. METHODS We interviewed key informants in the public sector from various levels in Bangladesh, Bhutan, Cambodia, and Sri Lanka between March 2017 and May 2018 using a descriptive assessment tool to obtain information on procurement, distribution, monitoring, and reporting of rabies PEP. These four countries in Asia were chosen to showcase a range of rabies PEP systems. National rabies focal points were interviewed in each country and focal points helped identify additional key informants at lower levels. RESULTS A total of 22 key informants were interviewed at various levels (central level to health facility level) including national rabies focal points in each country. Each country has a unique system for managing rabies PEP procurement, distribution, monitoring, and reporting. There are varying levels of PEP access for those with potential rabies exposures. Rabies PEP is available in select health facilities throughout the country in Bangladesh, Bhutan, and Sri Lanka. In Cambodia, rabies PEP is limited to two urban centers. The availability of RIG in all four countries is limited. In these four countries, most aspects of the rabies PEP distribution system operate independently of systems for other vaccines. However, in Bhutan, rabies PEP and Expanded Programme on Immunization (EPI) vaccines share cold chain space in some locations at the lowest level. All countries have a monitoring system in place, but there is limited reporting of data, particularly to the central level. CONCLUSION Systems to procure, deliver, monitor, and report on rabies PEP are variable across countries. Sharing information on practices more widely among countries can help programs to increase access to this life-saving treatment.
Collapse
Affiliation(s)
- Anyie J Li
- PHI/CDC Global Health Fellowship and ASPPH/CDC Allan Rosenfield Global Health Fellowship, Atlanta, USA.
| | | | - Umme Ruman Siddiqi
- Disease Control Unit, Communicable Disease Control, Directorate General of Health Services, Dhaka, Bangladesh
| | - Sanya Tahmina
- Disease Control Unit, Communicable Disease Control, Directorate General of Health Services, Dhaka, Bangladesh
| | - Kinley Penjor
- Dewathang Military Hospital, Department of Medical Services, Ministry of Health, Thimphu, Bhutan
| | - Ly Sovann
- Communicable Disease Control Department, Ministry of Health, Phnom Penh, Cambodia
| | | | | | - Lea Knopf
- World Health Organization, Geneva, Switzerland
| | - Terri B Hyde
- Centers for Disease Control and Prevention, Atlanta, USA
| |
Collapse
|
13
|
Rajeev M, Edosoa G, Hanitriniaina C, Andriamandimby SF, Guis H, Ramiandrasoa R, Ratovoson R, Randrianasolo L, Andriamananjara M, Heraud JM, Baril L, Metcalf CJE, Hampson K. Healthcare utilization, provisioning of post-exposure prophylaxis, and estimation of human rabies burden in Madagascar. Vaccine 2019; 37 Suppl 1:A35-A44. [PMID: 30509692 PMCID: PMC7612383 DOI: 10.1016/j.vaccine.2018.11.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 08/15/2018] [Accepted: 11/02/2018] [Indexed: 11/18/2022]
Abstract
In Madagascar, dog-mediated rabies has been endemic for over a century, however there is little data on its incidence or impact. We collected data over a 16-month period on provisioning of post-exposure prophylaxis (PEP) at a focal clinic in the Moramanga District and determined the rabies status of biting animals using clinical and laboratory diagnosis. We find that animal rabies cases are widespread, and clinic-based triage and investigation are effective ways to increase detection of rabies exposures and to rule out non-cases. A high proportion of rabies-exposed persons from Moramanga sought (84%) and completed PEP (90% of those that initiated PEP), likely reflecting the access and free provisioning of PEP in the district. Current clinic vial sharing practices demonstrate the potential for intradermal administration of PEP in endemic African settings, reducing vaccine use by 50% in comparison to intramuscular administration. A high proportion of PEP demand was attributed to rabies cases, with approximately 20% of PEP administered to probable rabies exposures and an additional 20% to low-to-no risk contacts with confirmed/probable animal or human cases. Using a simplified decision tree and our data on rabies exposure status and health-seeking behavior, we estimated an annual incidence of 42-110 rabies exposures and 1-3 deaths per 100,000 persons annually. Extrapolating to Madagascar, we estimate an annual burden of 282-745 human rabies deaths with current PEP provisioning averting 1499-3958 deaths each year. Data from other clinics and districts are needed to improve these estimates, particularly given that PEP availability is currently limited to only 31 clinics in the country. A combined strategy of mass dog vaccination, enhanced surveillance, and expanded access to PEP along with more judicious guidelines for administration could effectively reduce and eventually eliminate the burden of rabies in Madagascar.
Collapse
Affiliation(s)
- Malavika Rajeev
- Department of Ecology and Evolutionary Biology, Princeton University, Princeton, United States.
| | - Glenn Edosoa
- Service de Lutte contre les Maladies Épidémiques et Négligées, Ministère de la Santé Publique, Antananarivo, Madagascar
| | - Chantal Hanitriniaina
- Mention Zoologie et Biodiversité Animale, Faculté des Sciences, Université d'Antananarivo, Antananarivo, Madagascar
| | | | - Helene Guis
- Epidemiology and Clinical Research Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar; CIRAD, UMR ASTRE, Antananarivo, Madagascar; ASTRE, Univ Montpellier, CIRAD, INRA, Montpellier, France
| | - Ravo Ramiandrasoa
- Vaccination Center, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - Rila Ratovoson
- Epidemiology and Clinical Research Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - Laurence Randrianasolo
- Epidemiology and Clinical Research Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - Mamitiana Andriamananjara
- Direction des Services Vétérinaires, Ministère chargé de l'Agriculture et de l'Élevage, Antananarivo, Madagascar
| | | | - Laurence Baril
- Epidemiology and Clinical Research Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - C Jessica E Metcalf
- Department of Ecology and Evolutionary Biology, Princeton University, Princeton, United States
| | - Katie Hampson
- Boyd Orr Centre for Population and Ecosystem Health, Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, UK
| |
Collapse
|
14
|
Rinchen S, Tenzin T, Hall D, van der Meer F, Sharma B, Dukpa K, Cork S. A community-based knowledge, attitude, and practice survey on rabies among cattle owners in selected areas of Bhutan. PLoS Negl Trop Dis 2019; 13:e0007305. [PMID: 30933984 PMCID: PMC6459539 DOI: 10.1371/journal.pntd.0007305] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 04/11/2019] [Accepted: 03/15/2019] [Indexed: 11/19/2022] Open
Abstract
Rabies remains a disease of significant zoonotic and economic concern in rabies endemic areas of Bhutan. Rabies outbreaks in livestock threaten the livelihoods of subsistence farming communities and pose a potential public health threat. As a part of identifying approaches to prevent rabies in cattle, a Knowledge, Attitude, and Practice (KAP) survey was conducted among cattle owners in selected rural areas of the southern rabies high-risk zone and low-risk zone in eastern Bhutan. Between March and April 2017, 562 cattle owners (281 in the east and 281 in the south) were interviewed using a questionnaire. Eighty-eight percent of the participants had heard of rabies but only 39% of the participants who had heard of rabies had adequate knowledge about rabies. Multivariable logistic regression analysis showed that residing in the south [OR = 9.25 (95% CI: 6.01-14.53)] and having seen a rabies case [OR = 2.46 (95% CI: 1.6-3.82)] were significantly associated with having adequate knowledge about rabies. Based on our scoring criteria, 65% of the total participants who had heard of rabies had a favorable attitude towards rabies control and prevention programs. The participants residing in the east were two times more likely to have a favourable attitude than their counterparts in the south [OR = 2.08 (95% CI: 1.43-3.05)]. More than 70% of the participants reported engaging in farm activities such as examining the oral cavity of sick cattle and assisting cattle during parturition. Only 25% of the participants reported using personal protective equipment while undertaking these activities. Despite a high level of rabies awareness, we observed that there is a lack of comprehensive knowledge about rabies regarding susceptible hosts, transmission routes, the health outcome of rabies infection in humans, and appropriate health-seeking behaviours. This study highlights the need to strengthen rabies education programs in rural communities to address the knowledge gaps that have been identified.
Collapse
Affiliation(s)
- Sangay Rinchen
- Regional Livestock Development Centre, Department of Livestock, Tsimasham, Chukha Bhutan
- Department of Ecosystem and Public Health, Faculty of Veterinary Medicine, University of Calgary, Alberta, Canada
| | - Tenzin Tenzin
- National Centre for Animal Health, Department of Livestock, Serbithang, Thimphu, Bhutan
| | - David Hall
- Department of Ecosystem and Public Health, Faculty of Veterinary Medicine, University of Calgary, Alberta, Canada
| | - Frank van der Meer
- Department of Ecosystem and Public Health, Faculty of Veterinary Medicine, University of Calgary, Alberta, Canada
| | - Basant Sharma
- Regional Livestock Development Centre, Department of Livestock, Tsimasham, Chukha Bhutan
| | - Kinzang Dukpa
- National Centre for Animal Health, Department of Livestock, Serbithang, Thimphu, Bhutan
| | - Susan Cork
- Department of Ecosystem and Public Health, Faculty of Veterinary Medicine, University of Calgary, Alberta, Canada
| |
Collapse
|
15
|
Penjor K, Tenzin T, Jamtsho RK. Determinants of health seeking behavior of animal bite victims in rabies endemic South Bhutan: a community-based contact-tracing survey. BMC Public Health 2019; 19:237. [PMID: 30813935 PMCID: PMC6391763 DOI: 10.1186/s12889-019-6559-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 02/18/2019] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND Dog bites are the main source of rabies infection and death in humans, contributing up to 99% of all cases. We conducted a contact-tracing study to evaluate the health seeking and treatment compliance behaviors of people following potential exposure to rabies in rabies endemic south Bhutan. METHODS Using information from the rabies post exposure prophylaxis (PEP) register, animal-exposed victims who had visited five hospitals in south Bhutan between January and March 2017 were traced and further data were collected from them using a structured questionnaire. A snowballing technique was used to identify victims who did not seek PEP.The survey was conducted between April and June 2017. Logistic regression was performed to assess factors associated with PEP-seeking and compliance behavior by the victims. RESULTS Amongst 630 who reported to hospitals, 70% (444) of people could be traced and additional 8% (39) who did not seek PEP was identified through contact tracing. Therefore, a total of 483 people were interviewed. Seventy one percent (344/483) of exposure were due to animal bites of which 80% (365/455) were considered to be provoked incidents. Common reasons for not seeking health care included assumptions that risks of infection were minor if bitten by an owned or vaccinated dog. The victims who are male (OR: 0.36; 95% CI: 0.16-0.77) and educated (OR: 0.41; 95% CI: 0.17-0.96) were less likely to seek PEP, while those that experienced unprovoked bite (OR: 5.10; 95% CI: 1.20-21.77) were more likely to seek PEP in the hospitals. Overall, 82% of the victims sought PEP from the hospitals within 24 h after exposure. Eighty three percent completed the PEP course prescribed by the physician. The respondents living in urban areas (OR: 2.67; 95% CI: 1.34-5.30) were more likely to complete the prescribed PEP course than rural dwellers. CONCLUSIONS There is high risk of rabies infection in southern Bhutan. It is critical to bridge knowledge gaps and dispel existing myths which will help to improve PEP seeking and compliance behavior of people exposed to rabies infection from animals. A risk-based advocacy program is necessary to prevent dog-mediated human rabies deaths.
Collapse
Affiliation(s)
- Kinley Penjor
- Dewathang Military Hospital, Department of Medical services, Ministry of Health, Thimphu, Bhutan.
| | - Tenzin Tenzin
- Disease Prevention and Control Unit, National Centre for Animal Health, Department of Livestock, Thimphu, Bhutan
| | - Rinzin Kinga Jamtsho
- Zoonosis Program, Department of Public Health, Ministry of Health, Thimphu, Bhutan
| |
Collapse
|
16
|
Tran CH, Afriyie DO, Pham TN, Otsu S, Urabe M, Dang AD, Tran HGT, Nguyen HV, Le HT, Nguyen HTT. Rabies post-exposure prophylaxis initiation and adherence among patients in Vietnam, 2014-2016. Vaccine 2019; 37 Suppl 1:A54-A63. [PMID: 30723063 DOI: 10.1016/j.vaccine.2019.01.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 10/27/2018] [Accepted: 01/16/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Adhering to post-exposure prophylaxis (PEP): wound treatment, vaccine, and rabies immunoglobulin (RIG) is a crucial step in preventing rabies mortality. When PEP is widely available, a lack of adherence to the recommended treatment guidelines can also lead to death. Our objective was to understand characteristics associated with adherence to the vaccine regimen and RIG in Vietnam. METHODS We obtained individual-level data on PEP adherence from registries at 10 sites located in five provinces. From these registries, we extracted epidemiologic characteristics of patients including the timing of PEP initiation and completion. We used descriptive analyses and logistic regression to examine patient characteristics associated with initiation and completion of RIG and vaccine. Based on reported rabies mortality, the government defined provincial rabies burden as medium-burden (<5 and >2 deaths) and high-burden (≥5 deaths). RESULTS During 2014-2016, 15,646 patients received PEP in our study. Among 14,296 vaccinated patients, only 41.4% (5847) completed their five-dose intramuscular (IM) injections and 81.6% (133) of patients completed their eight-dose intradermal (ID) injections. Approximately 26% of patients received RIG. Patient characteristics associated with vaccine completion were females (44%), <15 years of age (44%), category 1 exposure (68%, bite location on leg (46%), bite from bat (56%), bite from a healthy animal (45%), high-burden province (86%), and district preventive center (49%). Disparities were revealed among provinces, with high-burden provinces having highest (86%) and lowest (7%) vaccine completion rates. CONCLUSIONS AND RELEVANCE Vietnam has made tremendous progress towards reducing the burden of rabies. However, despite the wide availability of PEP, we found relatively low rates of vaccine completion. Our findings suggest provider training and patient education is needed to ensure appropriate treatment is completed. Moreover, our data suggest changes to information reported through the national surveillance system for monitoring good clinical practice for rabies prevention and control.
Collapse
Affiliation(s)
- Cuc H Tran
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA, United States; Poxvirus and Rabies Branch, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA, United States.
| | - Doris O Afriyie
- U.S. Centers for Disease Control and Prevention Country Office in Vietnam, 2 Ngo Quyen, Hanoi, Viet Nam
| | - Thach N Pham
- National Institute of Hygiene and Epidemiology, Ministry of Health, 1 Yersin Street, Hanoi, Viet Nam
| | - Satoko Otsu
- World Health Organization, Representative Office for Vietnam, 304 Kim Ma Street, Hanoi, Viet Nam
| | - Maho Urabe
- World Health Organization, Representative Office for Vietnam, 304 Kim Ma Street, Hanoi, Viet Nam
| | - Anh D Dang
- National Institute of Hygiene and Epidemiology, Ministry of Health, 1 Yersin Street, Hanoi, Viet Nam
| | - Huong G T Tran
- International Cooperation Department, Ministry of Health, 138A Giang Vo, Hanoi, Viet Nam
| | - Hoang V Nguyen
- National Institute of Hygiene and Epidemiology, Ministry of Health, 1 Yersin Street, Hanoi, Viet Nam
| | - Ha T Le
- Hanoi Medical University, No 1 Ton That Tung, Hanoi, Viet Nam
| | - Huong T T Nguyen
- National Institute of Hygiene and Epidemiology, Ministry of Health, 1 Yersin Street, Hanoi, Viet Nam
| |
Collapse
|
17
|
Tran CH, Kligerman M, Andrecy LL, Etheart MD, Adrien P, Blanton JD, Millien M, Wallace RM. Rabies vaccine initiation and adherence among animal-bite patients in Haiti, 2015. PLoS Negl Trop Dis 2018; 12:e0006955. [PMID: 30422986 PMCID: PMC6258545 DOI: 10.1371/journal.pntd.0006955] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 11/27/2018] [Accepted: 10/29/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Approximately 59,000 people die from rabies worldwide annually. Haiti is one of the last remaining countries in the Western Hemisphere with endemic canine rabies. Canine-mediated rabies deaths are preventable with post-exposure prophylaxis (PEP): wound treatment, immunoglobulin, and vaccination. In countries where PEP is available, variability in healthcare seeking behaviors and lack of adherence to recommended treatment guidelines could also contribute to these deaths. Yet, few studies have addressed these issues. METHODS We examined animal-bite reporting and assessed adherence to treatment guidelines at nine healthcare facilities in Haiti. We analyzed individual-level, de-identified patient data (demographic characteristics, geographic location, healthcare facility type, vaccine administration, and bite injury information) using descriptive analyses and logistic regression to examine factors associated with receiving PEP. FINDINGS During the 6 month study period, we found 2.5 times more animal-bite case-patients than reported by the national surveillance system (690 versus 274). Of the 690 animal-bite patients identified, 498 (72%) sought care at six PEP providing facilities. Of the case-patients that sought care, 110 (22%) received at least one rabies vaccine. Of the 110 patients, 60 (55%) received all five doses. Delays were observed for three events: when patients presented to a facility after an animal-bite (3.0 days, range: 0-34 days), when patients received their fourth dose (16.1 days, range: 13-52 days), and when patients received their fifth dose (29 days, range: 26-52). When comparing vaccination status and patient characteristics, we found a significant association for bite location (p < .001), severity rank score (p < .001), geographic location (p < .001), and healthcare facility type (p = .002) with vaccination. CONCLUSION High levels of underreporting identified here are of concern since vaccine distribution may, in part, be based on the number of animal-bite cases reported. Given that the Haitian government provides PEP to the population for free and we found animal-bite victims are seeking care in a timely manner─ reducing rabies deaths is an achievable goal.
Collapse
Affiliation(s)
- Cuc H. Tran
- Epidemic Intelligence Service, Division of Scientific Education and Professional Development, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- * E-mail:
| | - Maxwell Kligerman
- Stanford University, Department of Otolaryngology, Head and Neck Surgery, Palo Alto, California, United States of America
- Family Health Ministries, Durham, NC, United States of America
| | - Lesly L. Andrecy
- Ministère de la Santé Publique et de la Population, Direction d’Epidemiologie de Laboratoire et de Recherche, Port-au-Prince, Haiti
| | - Melissa D. Etheart
- US Centers for Disease Control and Prevention, Port-au-Prince Prince, Haiti
| | - Paul Adrien
- Ministère de la Santé Publique et de la Population, Direction d’Epidemiologie de Laboratoire et de Recherche, Port-au-Prince, Haiti
| | - Jesse D. Blanton
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Max Millien
- Ministère de l'Agriculture, des Ressources Naturelles et du Développement Rural, Port-au-Prince, Haiti
| | - Ryan M. Wallace
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| |
Collapse
|
18
|
Wei XK, Xiong Y, Li XN, Zheng M, Pan Y, He XX, Liang JJ, Liu C, Zhong YZ, Zou LB, Zheng LF, Guo JG, Li CT, Huang SB, Gan JZ, Meng ZM, Yang J, Tang HB, Liu Q, Luo TR. Vaccination demonstration zone successfully controls rabies in Guangxi Province, China. BMC Infect Dis 2018; 18:386. [PMID: 30097026 PMCID: PMC6086044 DOI: 10.1186/s12879-018-3301-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 08/01/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Guangxi is the province most seriously affected by rabies virus (RABV) in China. Those most affected by RABV each year are people in rural areas, where dogs are the main cause of human infection with the virus. METHODS In this study, we established a rabies vaccination demonstration program that included eradication, core, and peripheral areas. This program was implemented for 9 years and comprised three stages: 12 counties in the first stage (2008-2010), 21 counties in the second stage (2011-2013), and then extending to all counties of Guangxi Province in the third stage (2014-2016). The program included a dog vaccination campaign, surveillance of clinically healthy dogs who may be potential RABV carriers, monitoring anti-RABV antibody titers in vaccinated dogs, and compiling and reporting statistics of human rabies cases. RESULTS The target effectiveness was achieved in the eradication, core, and peripheral areas in all three stages. The vaccination demonstration program successfully promoted RABV vaccination of domestic dogs throughout Guangxi Province by drawing upon the experience gained at key points. Compared with a vaccination coverage rate of 39.42-46.85% in Guangxi Province overall during 2003-2007, this rate gradually increased to 48.98-52.67% in 2008-2010, 60.24-69.67% in 2011-2013, and 70.09-71.53% in 2014-2016, thereby meeting World Health Organization requirements. The total cases of human rabies in the province decreased from 602 in 2004 to 41 cases in 2017. CONCLUSIONS The present pilot vaccination program obviously increased the rabies vaccination and seroconversion rates, and effectively reduced the spread of rabies from dogs to humans as well as the number of human rabies cases, thus successfully controlling rabies in Guangxi.
Collapse
Affiliation(s)
- Xian-Kai Wei
- State Key Laboratory for Conservation and Utilization of Subtropical Agro-Bioresourses, Guangxi University, 100# Daxue Road, Nanning, 530004, Guangxi, China.,Laboratory of Veterinary Microbiology and Animal Infectious Diseases, College of Animal Sciences and Veterinary Medicine, Guangxi University, 100# Daxue Road, Nanning, 530004, Guangxi, China.,Guangxi Center for Animal Disease Control and Prevention, Nanning, 530001, Guangxi, China
| | - Yi Xiong
- Guangxi Center for Animal Disease Control and Prevention, Nanning, 530001, Guangxi, China
| | - Xiao-Ning Li
- State Key Laboratory for Conservation and Utilization of Subtropical Agro-Bioresourses, Guangxi University, 100# Daxue Road, Nanning, 530004, Guangxi, China.,Laboratory of Veterinary Microbiology and Animal Infectious Diseases, College of Animal Sciences and Veterinary Medicine, Guangxi University, 100# Daxue Road, Nanning, 530004, Guangxi, China
| | - Min Zheng
- Guangxi Center for Animal Disease Control and Prevention, Nanning, 530001, Guangxi, China
| | - Yan Pan
- State Key Laboratory for Conservation and Utilization of Subtropical Agro-Bioresourses, Guangxi University, 100# Daxue Road, Nanning, 530004, Guangxi, China.,Laboratory of Veterinary Microbiology and Animal Infectious Diseases, College of Animal Sciences and Veterinary Medicine, Guangxi University, 100# Daxue Road, Nanning, 530004, Guangxi, China
| | - Xiao-Xia He
- Laboratory of Veterinary Microbiology and Animal Infectious Diseases, College of Animal Sciences and Veterinary Medicine, Guangxi University, 100# Daxue Road, Nanning, 530004, Guangxi, China
| | - Jing-Jing Liang
- State Key Laboratory for Conservation and Utilization of Subtropical Agro-Bioresourses, Guangxi University, 100# Daxue Road, Nanning, 530004, Guangxi, China.,Laboratory of Veterinary Microbiology and Animal Infectious Diseases, College of Animal Sciences and Veterinary Medicine, Guangxi University, 100# Daxue Road, Nanning, 530004, Guangxi, China
| | - Cheng Liu
- Laboratory of Veterinary Microbiology and Animal Infectious Diseases, College of Animal Sciences and Veterinary Medicine, Guangxi University, 100# Daxue Road, Nanning, 530004, Guangxi, China
| | - Yi-Zhi Zhong
- Laboratory of Veterinary Microbiology and Animal Infectious Diseases, College of Animal Sciences and Veterinary Medicine, Guangxi University, 100# Daxue Road, Nanning, 530004, Guangxi, China
| | - Lian-Bin Zou
- Guangxi Center for Animal Disease Control and Prevention, Nanning, 530001, Guangxi, China
| | - Lie-Feng Zheng
- Guangxi Center for Animal Disease Control and Prevention, Nanning, 530001, Guangxi, China
| | - Jian-Gang Guo
- Guangxi Center for Animal Disease Control and Prevention, Nanning, 530001, Guangxi, China
| | - Chang-Ting Li
- Guangxi Veterinary Research Institute, Nanning, 530001, Guangxi, China
| | - Sheng-Bin Huang
- Guangxi Center for Animal Disease Control and Prevention, Nanning, 530001, Guangxi, China
| | - Jia-Zhong Gan
- Yulin Center for Animal Disease Control and Prevention, Yulin, 537000, Guangxi, China
| | - Zhen-Mu Meng
- Baise Center for Animal Disease Control and Prevention, Baise, 533000, Guangxi, China
| | - Jian Yang
- Laboratory of Veterinary Microbiology and Animal Infectious Diseases, College of Animal Sciences and Veterinary Medicine, Guangxi University, 100# Daxue Road, Nanning, 530004, Guangxi, China
| | - Hai-Bo Tang
- State Key Laboratory for Conservation and Utilization of Subtropical Agro-Bioresourses, Guangxi University, 100# Daxue Road, Nanning, 530004, Guangxi, China.,Laboratory of Veterinary Microbiology and Animal Infectious Diseases, College of Animal Sciences and Veterinary Medicine, Guangxi University, 100# Daxue Road, Nanning, 530004, Guangxi, China
| | - Qi Liu
- Laboratory of Veterinary Microbiology and Animal Infectious Diseases, College of Animal Sciences and Veterinary Medicine, Guangxi University, 100# Daxue Road, Nanning, 530004, Guangxi, China. .,Guangxi Center for Animal Disease Control and Prevention, Nanning, 530001, Guangxi, China.
| | - Ting Rong Luo
- State Key Laboratory for Conservation and Utilization of Subtropical Agro-Bioresourses, Guangxi University, 100# Daxue Road, Nanning, 530004, Guangxi, China. .,Laboratory of Veterinary Microbiology and Animal Infectious Diseases, College of Animal Sciences and Veterinary Medicine, Guangxi University, 100# Daxue Road, Nanning, 530004, Guangxi, China.
| |
Collapse
|
19
|
Etheart MD, Kligerman M, Augustin PD, Blanton JD, Monroe B, Fleurinord L, Millien M, Crowdis K, Fenelon N, Wallace RM. Effect of counselling on health-care-seeking behaviours and rabies vaccination adherence after dog bites in Haiti, 2014-15: a retrospective follow-up survey. LANCET GLOBAL HEALTH 2018; 5:e1017-e1025. [PMID: 28911750 DOI: 10.1016/s2214-109x(17)30321-2] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 06/24/2017] [Accepted: 07/26/2017] [Indexed: 12/25/2022]
Abstract
BACKGROUND Haiti has an integrated bite case management (IBCM) programme to counsel animal-bite victims on the risk of rabies and appropriate treatment, as well as the Haiti Animal Rabies Surveillance Program (HARSP) to examine the animals. We assessed the usefulness of the IBCM programme to promote best practices for rabies prophylaxis after exposure in a low-income rabies-endemic setting. METHODS We did a retrospective follow-up survey of randomly selected bite victims who were counselled by Haiti's IBCM programme between May 15, 2014, and Sept 15, 2015. We classified participants by HARSP decisions of confirmed, probable, suspected, or non-rabies exposures. We compared health-care outcomes in people who sought medical care before IBCM counselling with those in people who sought care after counselling. We used decision trees to estimate the probability of actions taken in the health-care system, and thereby human deaths. FINDINGS During the study period, 1478 dog bites were reported to HARSP for assessment. 37 (3%) were confirmed exposures, 76 (5%) probable exposures, 189 (13%) suspected exposures, and 1176 (80%) non-rabies exposures. 115 of these cases were followed up in the survey. IBCM counselling was associated with a 1·2 times increase in frequency of bite victims seeking medical care and of 2·4 times increase in vaccination uptake. We estimated that there would be four human rabies deaths among the 1478 people assessed by IBCM during the survey period, and 11 in the absence of this programme, which would equate to a 65% decrease in rabies deaths. Among three people dead at the time of the follow-up survey, one was deemed to be due to rabies after a probable rabies exposure. INTERPRETATION Adherence to medical providers' recommendations might be improved through counselling provided by IBCM programmes. FUNDING None.
Collapse
Affiliation(s)
- Melissa Dominique Etheart
- Waterborne Disease Prevention Branch, Centers for Disease Control and Prevention in Haiti, Port-au-Prince, Haiti.
| | | | | | - Jesse D Blanton
- Poxvirus and Rabies Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Benjamin Monroe
- Poxvirus and Rabies Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ludder Fleurinord
- Ministry of Agriculture, Natural Resources and Rural Development, Port-au-Prince, Haiti
| | - Max Millien
- Ministry of Agriculture, Natural Resources and Rural Development, Port-au-Prince, Haiti
| | | | | | - Ryan MacLaren Wallace
- Poxvirus and Rabies Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| |
Collapse
|
20
|
Qi L, Su K, Shen T, Tang W, Xiao B, Long J, Zhao H, Chen X, Xia Y, Xiong Y, Xiao D, Feng L, Li Q. Epidemiological characteristics and post-exposure prophylaxis of human rabies in Chongqing, China, 2007-2016. BMC Infect Dis 2018; 18:6. [PMID: 29295708 PMCID: PMC5751830 DOI: 10.1186/s12879-017-2830-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 11/12/2017] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND According to the global framework of eliminating human rabies, China is responding to achieve the target of zero human death from dog-mediated rabies by 2030. Chongqing is the largest municipality directly under central government in China. We described the epidemiological characteristics and post-exposure prophylaxis (PEP) of human rabies in this area, in order to provide a reliable epidemiology basis for further control and prevention of human rabies. METHODS The most updated epidemiological data for human rabies cases from 2007 to 2016 in Chongqing were collected from the National Disease Reporting Information System. A standardized questionnaire was applied to the human rabies cases or family members of cases as proxy to investigate the PEP situation. RESULTS A total of 809 fatal human rabies cases were reported in Chongqing from 2007 to 2016. There was a trend of gradual annual decline about number of cases from 2007 to 2013, followed by stable levels until 2016. Rabies was mostly reported in summer and autumn; a majority of cases were noted in farmers (71.8%), especially in males (65.3%). The cases aged 35-74 and 5-14 years old accounted for 83.8% of all the cases. We collected information of 548 human rabies cases' rabies exposure and PEP situation. Of those, 95.8% of human rabies cases were victims of dog bites or scratch, and 53.3% of these dogs were identified as stray dogs. Only 4.0% of the domestic dogs were reported to have been vaccinated previously. After exposure, 87.8% of the 548 human rabies cases did not seek any medical services. Further investigation showed that none of the 548 cases received timely and properly standardized PEP. CONCLUSION Human rabies remains a major public health problem in Chongqing, China. Dogs are the main reservoir and source of human rabies infection. Unsuccessful control of canine rabies and inadequate PEP of cases might be the main factors leading to the serious human rabies epidemic in this area. An integrated "One Health" approach should be encouraged and strengthened in this area; with combined effort it would be possible to achieve the elimination of human rabies in the expected date.
Collapse
Affiliation(s)
- Li Qi
- Chongqing Municipal Center for Disease Control and Prevention, No.8, Changjiang 2nd Road, Yuzhong District, Chongqing, China
- Chinese Field Epidemiology Training Program, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Kun Su
- Chongqing Municipal Center for Disease Control and Prevention, No.8, Changjiang 2nd Road, Yuzhong District, Chongqing, China
- Department of Military Epidemiology, College of Military Prevention, Third Military Medical University, Chongqing, China
| | - Tao Shen
- Chinese Field Epidemiology Training Program, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Wenge Tang
- Chongqing Municipal Center for Disease Control and Prevention, No.8, Changjiang 2nd Road, Yuzhong District, Chongqing, China
| | - Bangzhong Xiao
- Chongqing Municipal Center for Disease Control and Prevention, No.8, Changjiang 2nd Road, Yuzhong District, Chongqing, China
| | - Jiang Long
- Chongqing Municipal Center for Disease Control and Prevention, No.8, Changjiang 2nd Road, Yuzhong District, Chongqing, China
| | - Han Zhao
- Chongqing Municipal Center for Disease Control and Prevention, No.8, Changjiang 2nd Road, Yuzhong District, Chongqing, China
| | - Xi Chen
- Chongqing Municipal Center for Disease Control and Prevention, No.8, Changjiang 2nd Road, Yuzhong District, Chongqing, China
| | - Yu Xia
- Chongqing Municipal Center for Disease Control and Prevention, No.8, Changjiang 2nd Road, Yuzhong District, Chongqing, China
| | - Yu Xiong
- Chongqing Municipal Center for Disease Control and Prevention, No.8, Changjiang 2nd Road, Yuzhong District, Chongqing, China
| | - Dayong Xiao
- Chongqing Municipal Center for Disease Control and Prevention, No.8, Changjiang 2nd Road, Yuzhong District, Chongqing, China
| | - Liangui Feng
- Chongqing Medical and Pharmaceutical College, Chongqing, China
| | - Qin Li
- Chongqing Municipal Center for Disease Control and Prevention, No.8, Changjiang 2nd Road, Yuzhong District, Chongqing, China
| |
Collapse
|
21
|
Tenzin T, Namgyal J, Letho S. Community-based survey during rabies outbreaks in Rangjung town, Trashigang, eastern Bhutan, 2016. BMC Infect Dis 2017; 17:281. [PMID: 28415972 PMCID: PMC5393039 DOI: 10.1186/s12879-017-2393-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 04/11/2017] [Indexed: 12/25/2022] Open
Abstract
Background Rabies is a highly fatal disease transmitted through the bite of a rabid animal. Human deaths can be prevented by prompt administering of rabies vaccine and rabies immunoglobulin following the exposure. An assessment of community knowledge, awareness and practices on rabies is important during outbreak to understand their preparedness and target educational messages and response activities by the rapid response team. Methods A rabies outbreak has occurred in Rangjung town, eastern Bhutan on 4 October 2016. A rapid response team was activated to investigate outbreak and to establish a control program. A community-based questionnaire survey was conducted from 20 to 21 October 2016 to assess the community knowledge of rabies to guide outbreak preparedness and also target educational messages and response activities by the RRT. Results A total of 67 respondents were interviewed, of which 61% were female and 39% male. All the respondents have heard of rabies (100%), have knowledge on source of rabies (dog) and its mode of transmission in animals and humans. Most (61%) respondents were aware and also indicated that they would wash the animal bite wound with soap and water and seek medical care on the same day of exposure (100%). Majority (94%) of the respondents have indicated that they would report to the government agencies if they see any suspected rabid dogs in the community and suggested various control measures for dog population management and rabies in Rangjung including neutering procedure and mass dog vaccination. Although only few (10%) of the respondents households owned dogs and cats, but 50% of them have indicated that their dogs were allowed to roam outside the home premises posing risk of contracting rabies through rabid dog bites. Conclusions Although this study indicates a high level of knowledge and awareness on rabies among the community, there exists some knowledge gaps about rabies and therefore, an awareness education should be focused on the source of rabies and rabies virus transmission route to reduce public concern on nonexposure events thereby reducing the cost on unnecessary postexposure treatment. Electronic supplementary material The online version of this article (doi:10.1186/s12879-017-2393-x) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Tenzin Tenzin
- Disease Prevention and Control Unit, National Centre for Animal Health, Department of Livestock, Thimphu, Bhutan.
| | - Jamyang Namgyal
- District Veterinary Hospital, Department of Livestock, Trashigang, Bhutan
| | - Sangay Letho
- Regional Livestock Development Centre, Department of Livestock, Khangma, Trashigang, Bhutan
| |
Collapse
|
22
|
Tenzin T, McKenzie JS, Vanderstichel R, Rai BD, Rinzin K, Tshering Y, Pem R, Tshering C, Dahal N, Dukpa K, Dorjee S, Wangchuk S, Jolly PD, Morris R, Ward MP. Comparison of mark-resight methods to estimate abundance and rabies vaccination coverage of free-roaming dogs in two urban areas of south Bhutan. Prev Vet Med 2015; 118:436-48. [PMID: 25650307 DOI: 10.1016/j.prevetmed.2015.01.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 12/12/2014] [Accepted: 01/08/2015] [Indexed: 11/29/2022]
Abstract
In Bhutan, Capture-Neuter-Vaccinate-Release (CNVR) programs have been implemented to manage the dog population and control rabies, but no detailed evaluation has been done to assess their coverage and impact. We compared estimates of the dog population using three analytical methods: Lincoln-Petersen index, the Chapman estimate, and the logit-normal mixed effects model, and a varying number of count periods at different times of the day to recommend a protocol for applying the mark-resight framework to estimate free-roaming dog population abundance. We assessed the coverage of the CNVR program by estimating the proportion of dogs that were ear-notched and visually scored the health and skin condition of free-roaming dogs in Gelephu and Phuentsholing towns in south Bhutan, bordering India, in September-October 2012. The estimated free-roaming dog population in Gelephu using the Lincoln-Petersen index and Chapman estimates ranged from 612 to 672 and 614 to 671, respectively, while the logit-normal mixed effects model estimate based on the combined two count events was 641 (95% CI: 603-682). In Phuentsholing the Lincoln-Petersen index and Chapman estimates ranged from 525 to 583 and 524 to 582, respectively, while the logit-normal mixed effects model estimate based on the combined four count events was 555 (95% CI: 526-587). The total number of dogs counted was significantly associated with the time of day (AM versus PM; P=0.007), with a 17% improvement in dog sightings during the morning counting events. We recommend to conduct a morning marking followed by one count event the next morning and estimate population size by applying the Lincoln-Peterson corrected Chapman method or conduct two morning count events and apply the logit-normal mixed model to estimate population size. The estimated proportion of vaccinated free-roaming dogs was 56% (95% CI: 52-61%) and 58% (95% CI: 53-62%) in Gelephu and Phuentsholing, respectively. Given coverage in many neighbourhoods was below the recommended threshold of 70%, we recommend conducting an annual "mass dog vaccination only" campaign in southern Bhutan to create an immune buffer in this high rabies-risk area. The male-to-female dog ratio was 1.34:1 in Gelephu and 1.27:1 in Pheuntsholing. Population size estimates using mark-resight surveys has provided useful baseline data for understanding the population dynamics of dogs at the study sites. Mark-resight surveys provide useful information for designing and managing the logistics of dog vaccination or CNVR programs, assessing vaccination coverage, and for evaluating the impact of neutering programs on the size and structure of dog populations over time.
Collapse
Affiliation(s)
- Tenzin Tenzin
- National Centre for Animal Health, Department of Livestock, Thimphu, Bhutan.
| | - Joanna S McKenzie
- Institute of Veterinary, Animal and Biomedical Sciences, Massey University, New Zealand
| | - Raphaël Vanderstichel
- Department of Health Management, Atlantic Veterinary College, University of Prince Edward Island, Charlottetown, PEI, Canada
| | - Bir Doj Rai
- Regional Livestock Development Centre, Department of Livestock, Wangdue, Bhutan
| | - Karma Rinzin
- National Centre for Animal Health, Department of Livestock, Thimphu, Bhutan; College of Veterinary Medicine, School of Veterinary and Life Sciences, Murdoch University, Perth, Australia
| | - Yeshey Tshering
- National Centre for Animal Health, Department of Livestock, Thimphu, Bhutan
| | - Rinzin Pem
- Regional Livestock Development Centre, Department of Livestock, Wangdue, Bhutan
| | - Chenga Tshering
- Regional Livestock Development Centre, Department of Livestock, Zhemgang, Bhutan
| | - Narapati Dahal
- National Centre for Animal Health, Department of Livestock, Thimphu, Bhutan
| | - Kinzang Dukpa
- National Centre for Animal Health, Department of Livestock, Thimphu, Bhutan
| | - Sithar Dorjee
- Department of Health Management, Atlantic Veterinary College, University of Prince Edward Island, Charlottetown, PEI, Canada; Bhutan Agriculture and Food Regulatory Authority, Thimphu, Bhutan
| | - Sonam Wangchuk
- Department of Public Health, Ministry of Health, Thimphu, Bhutan
| | - Peter D Jolly
- Institute of Veterinary, Animal and Biomedical Sciences, Massey University, New Zealand
| | | | - Michael P Ward
- Faculty of Veterinary Science, University of Sydney, Camden, Australia
| |
Collapse
|
23
|
Raymond TN, Roland ME, Françoise KMM, Francis Z, Livo EF, Clovis STH. Do open garbage dumps play a role in canine rabies transmission in Biyem-Assi health district in Cameroon? Infect Ecol Epidemiol 2015; 5:26055. [PMID: 25595689 PMCID: PMC4297275 DOI: 10.3402/iee.v5.26055] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Revised: 11/30/2014] [Accepted: 12/01/2014] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Rabies is a neglected enzootic disease which represents a serious public health problem. In Cameroon, efforts to prevent human deaths caused by rabies are often thwarted by the lack of community awareness. The community knowledge, as well as attitudes and perception on rabies, is therefore important for both prevention of human deaths and control in animals. METHODS A cross-sectional study was carried out to evaluate the level of community knowledge as well as the role of open garbage dumps (OGDs) in the epidemiology of human rabies. Overall 420 heads of household were interviewed in the Biyem-Assi health district of Yaoundé. OGDs were identified through a systematic check, and household wastes they contained were characterized. RESULTS Although 66.9% of respondents have knowledge on stray dogs, only 35% of respondents knew the role of OGDs in the increase of stray dog population. Overall OGDs consisted of fermentable wastes. Nutrition places for stray dogs were wild garbage dumps (68.1%), markets (18.3%), and houses (13.6%). The feeding behavior of stray dogs correlated significantly with the human rabies transmission (χ (2)=154.12, df=4, p<0.05). CONCLUSION Most participants knew that rabies could be transmitted by a dog bite as well as the measures to be taken in this type of situation. Increased knowledge of respondents on rabies showed OGDs and stray dogs as significant risk factors for canine rabies in Biyem-Assi health district.
Collapse
Affiliation(s)
- Tabue N Raymond
- Ministry of Public Health, Yaoundé, Cameroon; National Reference Unit for Vector Control, The Biotechnology Center, University of Yaoundé, Yaoundé, Cameroon;
| | - Madgan E Roland
- School of Health Technicians and Sanitary Engineering of Yaoundé, Yaoundé, Cameroon
| | | | - Zeukeng Francis
- National Reference Unit for Vector Control, The Biotechnology Center, University of Yaoundé, Yaoundé, Cameroon
| | - Esemu F Livo
- National Reference Unit for Vector Control, The Biotechnology Center, University of Yaoundé, Yaoundé, Cameroon
| | - Seumen T H Clovis
- National Reference Unit for Vector Control, The Biotechnology Center, University of Yaoundé, Yaoundé, Cameroon
| |
Collapse
|
24
|
Dhand NK, Rai BD, Tenzin S, Tsheten K, Ugyen P, Singye K, Ward MP. Community-based study on knowledge, attitudes and perception of rabies in Gelephu, south-central Bhutan. Int Health 2013; 4:210-9. [PMID: 24029402 DOI: 10.1016/j.inhe.2012.03.005] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Community knowledge, attitudes and practices are important both for prevention of human deaths due to rabies and for control of the disease in animals. This study was a cross-sectional survey investigating the level of community knowledge as well as attitudes and perceptions about rabies in Gelephu, south-central Bhutan, a region endemic for rabies. A total of 615 household respondents were interviewed, of which 224 (36%) were male and 391 (64%) were female. The majority of respondents had a high level of knowledge, attitudes and perception of rabies and had a positive attitude towards the prevention and control of rabies. Multivariate logistic regression modelling showed that better knowledge of rabies was predicted by gender, educational level and dog ownership status of respondents, whilst health-seeking behaviour of animal bite injuries was predicted by dog ownership status, presence of children in the household and occupation of the respondents. The majority of respondents believed that stray dogs are a problem in the community and felt that it was important to control the dog population in Gelephu. These findings also indicate that there exists a knowledge gap about rabies in the community that could be improved by creating an awareness education programme.
Collapse
|
25
|
Gozdas HT, Karabay O. Safety of purified chick embryo cell rabies vaccine (Vaxirab N) after pre-exposure prophylaxis against rabies in children: is only adverse event profile enough? Hum Vaccin Immunother 2013; 10:317-8. [PMID: 24113798 PMCID: PMC4185915 DOI: 10.4161/hv.26716] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Accepted: 10/06/2013] [Indexed: 11/19/2022] Open
Affiliation(s)
- Hasan Tahsin Gozdas
- Department of Infectious Diseases and Clinical Microbiology; Sakarya University Faculty of Medicine; Sakarya, Turkey
| | - Oguz Karabay
- Department of Infectious Diseases and Clinical Microbiology; Sakarya University Faculty of Medicine; Sakarya, Turkey
| |
Collapse
|
26
|
Ward MP. Review of rabies epidemiology and control in South, South East and East Asia: past, present and prospects for elimination. Zoonoses Public Health 2013. [PMID: 23180493 DOI: 10.1111/j.1863-2378.2012.01489.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Rabies is a serious public health problem in Asia. It causes substantial animal welfare, economic and human health impacts, with approximately 39,000 human deaths each year. Domestic dogs are the main reservoir and source of rabies in Asia. Common constraints for the control of rabies in the countries of Asia include inadequate resources; lack of political commitment to control programs; lack of consensus on strategy; weak intersectoral coordination and inadequate management structure; insensitive surveillance systems; limited accessibility to modern rabies vaccine and supply problems; lack of public awareness and public cooperation; and the existence of myths and religious issues. In this review, we summarize the epidemiology of rabies in both human and animals in each South and South East Asian country, the past and current approaches to control and the prospect for rabies elimination. We conclude that defining the cost of rabies to society and communicating this to decisionmakers might be the key to achieving such an advance.
Collapse
|
27
|
Anthropogenic and environmental risk factors for rabies occurrence in Bhutan. Prev Vet Med 2012; 107:21-6. [PMID: 22673581 DOI: 10.1016/j.prevetmed.2012.05.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2011] [Revised: 04/27/2012] [Accepted: 05/04/2012] [Indexed: 11/27/2022]
Abstract
Anthropogenic and environmental factors were assessed as predictors of sub-districts in Bhutan that reported rabies in domestic animals during the period 1996-2009. Rabies surveillance data were retrieved from the Veterinary Information System database. Anthropogenic and environmental information were obtained from public data sources. Using the total number of rabies cases reported in domestic animals, the 205 sub-districts of Bhutan were categorized as those sub-districts that reported rabies and those that did not report rabies (n=146). Logistic regression models were fit to the data and odds ratios and 95% confidence intervals were estimated. Sub-districts that share a border with India (OR 10.43; 95% CI: 4.42-24.64; P<0.001); sub-districts connected by major roads (OR 3.09; 95% CI: 1.24-7.68; P=0.015); and greater human population density (OR 3.26; 95% CI: 1.48-7.21, P=0.003) were significantly associated with a sub-district reporting animal rabies in Bhutan during 1996-2009. Results suggest that human population characteristics play an important role in rabies occurrence.
Collapse
|
28
|
Tenzin, Wangdi K, Ward MP. Human and animal rabies prevention and control cost in Bhutan, 2001-2008: the cost-benefit of dog rabies elimination. Vaccine 2012; 31:260-70. [PMID: 22634297 DOI: 10.1016/j.vaccine.2012.05.023] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2012] [Revised: 05/10/2012] [Accepted: 05/11/2012] [Indexed: 11/15/2022]
Abstract
The objective of this study was to estimate the cost of various interventions and to quantify the economic impacts of rabies in Bhutan. Cost-benefit of dog rabies elimination versus human post exposure treatment cost was also assessed. The average direct medical cost of human post-exposure treatment (using rabies vaccine only) was estimated to be Nu. 1615 (US$ 35.65) per 5-dose Essen regimen per patient. The cost would increase to Nu. 2497 (US$ 55.13) and Nu. 19,633 (US$ 433.41) per patient when one dose of either equine rabies immunoglobulin (ERIG) or human rabies immunoglobulin (HRIG) is administered, respectively. The societal cost (direct medical and indirect patient expenses) per patient was estimated to be Nu. 2019 (US$ 45), Nu. 2901 (US$ 64) and Nu. 20,037 (US$ 442) using vaccine only, vaccine with ERIG and vaccine with HRIG, respectively. The average cost per dog vaccination and sterilization were estimated to be Nu. 75 (US$ 1.66) and Nu. 288 (US$ 6.36), respectively. The total direct cost of rabies and various interventions between 2001 and 2008 was estimated to be Nu. 46.95 million (US$ 1.03 million). The direct cost for intensified human PET was estimated to be Nu. 5.85 million (US$ 0.11 million) per year with a cumulated estimated costs of Nu. 35.10 million (US$ 0.70 million) while the cost of mass dog vaccination with at least 70% coverage is estimated to be approximately Nu. 10.31 million (US$ 0.21 million) at the end of 6 years. The combined cost of mass dog vaccination and human PET was estimated to be greater than the cost of human PET alone during the first 2 years of the campaign, and then would be lower than human PET cost alone after the 5th year of the campaign. The total cumulated cost of the combined strategy was estimated to be Nu. 34.14 million (US$ 0.73 million) and would be lower than the cumulated cost of human PET alone (Nu. 35.10 million, US$ 0.77 million) at the end of 6 years. Rabies represents a substantial economic impact to the Bhutanese society. Well-planned and implemented mass dog vaccination would result in elimination of rabies reservoirs in the domestic dog population and would eliminate human rabies cases. It would also reduce the recurrent expenditure on human post-exposure treatment.
Collapse
Affiliation(s)
- Tenzin
- University of Sydney, Camden, NSW 2570, Australia
| | | | | |
Collapse
|
29
|
Dog bites in humans and estimating human rabies mortality in rabies endemic areas of Bhutan. PLoS Negl Trop Dis 2011; 5:e1391. [PMID: 22132247 PMCID: PMC3222627 DOI: 10.1371/journal.pntd.0001391] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2011] [Accepted: 09/26/2011] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Dog bites in humans are a public health problem worldwide. The issues of increasing stray dog populations, rabies outbreaks, and the risk of dogs biting humans have been frequently reported by the media in Bhutan. This study aimed to estimate the bite incidence and identify the risk factors for dog bites in humans, and to estimate human deaths from rabies in rabies endemic south Bhutan. METHODS A hospital-based questionnaire survey was conducted during 2009-2010 among dog bites victims who visited three hospitals in Bhutan for anti-rabies vaccine injection. Decision tree modeling was used to estimate human deaths from rabies following dog bite injuries in two rabies endemic areas of south Bhutan. RESULTS Three hundred and twenty four dog bite victims were interviewed. The annual incidence of dog bites differed between the hospital catchment areas: 869.8 (95% CI: 722.8-1022.5), 293.8 (240-358.2) and 284.8 (251.2-323) per 100,000 people in Gelephu, Phuentsholing and Thimphu, respectively. Males (62%) were more at risk than females (P<0.001). Children aged 5-9 years were bitten more than other age groups. The majority of victims (71%) were bitten by stray dogs. No direct fatal injury was reported. In two hospital areas (Gelephu and Phuentsholing) in south Bhutan the annual incidence of death from rabies was 3.14 (95% CI: 1.57-6.29) per 100,000 population. The decision tree model predicted an equivalent annual incidence of 4.67 (95% CI: 2.53-7.53) deaths/100,000 population at risk. In the absence of post exposure prophylaxis, the model predicted 19.24 (95% CI: 13.69-25.14) deaths/year in these two areas. CONCLUSIONS Increased educational awareness of people about the risk of dog bites and rabies is necessary, particularly for children in rabies endemic areas of Bhutan.
Collapse
|