1
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Khan IA, Bashar MDA, Mohsin S, Shrivastava DK. Prevalence of delayed initiation of rabies postexposure prophylaxis and factors influencing it among animal bite victims from Eastern Uttar Pradesh, India. Trans R Soc Trop Med Hyg 2024; 118:399-404. [PMID: 38324406 DOI: 10.1093/trstmh/trae002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 12/06/2023] [Accepted: 01/12/2024] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND In a rabies-endemic country like India, every animal bite is potentially taken as rabid exposure and timely and appropriate postexposure prophylaxis (PEP) is crucial as rabies is an almost 100% fatal disease. METHODS A retrospective record-based study was conducted at an anti-rabies clinic (ARC) in Eastern Uttar Pradesh, India. Data of the animal bite victims attending the ARC for PEP from January to December 2022 were extracted from the records. A semistructured questionnaire was used for collecting information regarding the interval between exposure and the initiation of anti-rabies PEP, age, gender, residence, the bite site on the body, category of exposure and other risk factors associated with the delay in PEP. RESULTS Most of the victims were male (67.6%), from an urban background (61.3%) and aged up to 20 y (43.9%). Out of the 222 victims, 62 (27.9%) had delayed initiation of PEP (>48 h after exposure). Factors found to be significantly associated with delayed initiation of PEP were residence (p=0.01), age (p=0.04) and the type of biting animal (p=0.002). CONCLUSIONS Delayed initiation of PEP is common among animal bite victims in this region of India, although PEP is affordable. Educational programmes and awareness-raising campaigns for timely administration of PEP should be a priority, especially targeting rural residents, those aged<18 y and those bitten by animals other than dogs.
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Affiliation(s)
- Imran Ahmed Khan
- Department of Community Medicine, BRD Medical College, Gorakhpur 273013, Uttar Pradesh, India
| | - M D Abu Bashar
- Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Gorakhpur 273008, Uttar Pradesh, India
| | - Sufiya Mohsin
- Department of Community Medicine, BRD Medical College, Gorakhpur 273013, Uttar Pradesh, India
| | - D K Shrivastava
- Department of Community Medicine, BRD Medical College, Gorakhpur 273013, Uttar Pradesh, India
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Lu R, Lin J, Zhou Y, Chen Q, Fan Z, Wu S, Qin P, Li L. Rabies vaccination adherence and associated factors among rabies-exposed patients in Shenzhen, China: a hospital-based cross-sectional study. Epidemiol Infect 2024; 152:e15. [PMID: 38195536 PMCID: PMC10894897 DOI: 10.1017/s0950268824000049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 12/17/2023] [Accepted: 01/03/2024] [Indexed: 01/11/2024] Open
Abstract
Adherence to post-exposure prophylaxis and post-exposure vaccination (PEV) is an important measure to prevent rabies. The purpose of this study was to explore the adherence to the vaccination protocol and its influencing factors among rabies-exposed patients in Shenzhen, China. A cross-sectional survey was conducted in a tertiary hospital in Shenzhen, China, to obtain epidemiological characteristics of patients; knowledge, attitude, and practice scores of rabies prevention; and medical records. A total of 326 patients requiring full rabies PEV were included in this study, and only 62% (202) completed the full course of vaccination according to the norms of the vaccination guidelines. After multifactor logistic regression, the factors influencing adherence to vaccination were as follows: age 31 to 40 years, time spent to reach the nearest rabies prevention clinic was >60 min, the time of injury was at night to early morning, the place of injury was a school/laboratory, the animal causing injury was a cat, the health status of the animal causing injury could not be determined, and patients with higher practice scores (all p<0.05). Understanding the factors influencing rabies vaccination adherence among rabies-exposed patients in urban areas of China and promote changes in patients' practice toward rabies prevention is essential for rabies elimination by 2030.
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Affiliation(s)
- Ruiqi Lu
- School of Public Health, Shantou University, Shantou, China
- Injury Prevention Research Center, Shantou University Medical College, Shantou, China
| | - Jinsheng Lin
- Emergency Department, Shenzhen Qianhai Shekou Free Trade Zone Hospital, Shenzhen, China
| | - Yang Zhou
- Emergency Department, Shenzhen Qianhai Shekou Free Trade Zone Hospital, Shenzhen, China
| | - Qian Chen
- Emergency Department, Shenzhen Qianhai Shekou Free Trade Zone Hospital, Shenzhen, China
| | - Zaiying Fan
- Emergency Department, Shenzhen Qianhai Shekou Free Trade Zone Hospital, Shenzhen, China
| | - Shuning Wu
- Department of Thyroid and Breast Surgery, Shenzhen Qianhai Shekou Free Trade Zone Hospital, Shenzhen, China
| | - Pei Qin
- Clinical Center for Public Health, Shenzhen Qianhai Shekou Free Trade Zone Hospital, Shenzhen, China
| | - Liping Li
- School of Public Health, Shantou University, Shantou, China
- Injury Prevention Research Center, Shantou University Medical College, Shantou, China
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Iddi S, Mlenga F, Hamasaki K, Mwita S, Konje E. Assessment of knowledge, attitude, and practice of dog owners to rabies disease in Kahama town council, Shinyanga region, Tanzania. PLoS Negl Trop Dis 2023; 17:e0011580. [PMID: 37672544 PMCID: PMC10482259 DOI: 10.1371/journal.pntd.0011580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 08/09/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND Rabies is a fatal zoonotic disease of significant public health importance. Domestic dogs are the main reservoir and transmitter of this disease, particularly in developing countries. Community awareness about rabies is one of the key components of prevention. This study describes the knowledge, attitudes, and practices about rabies disease among dog owners at Kahama town council, Shinyanga Region, Tanzania. METHODOLOGY This was a cross sectional community-based study which was done in May 2021. Structured questionnaires were administered to collect the data among 422 dog owners. The information collected included demographic characteristics of the dog owners, as well as their knowledge, attitude and practice towards rabies. Data were analyzed using SPSS statistical software version 20. RESULTS Out of 422 respondents, 421 (99.76%) knew that rabies can be transmitted by dogs, 384 (91%) knew that rabies can be prevented by vaccination of dogs, 269 (63.74%) knew the symptoms and signs, and 379 (89.81%) believed that it was necessary to vaccinate all owned dogs, but 227 (53.79%) had not vaccinated their dogs. Education level (p = 0.006) and occupation (p = 0.002) were significantly associated with a positive attitude, whereby those with a higher level of education and farmers were more likely to have a positive attitude. Also there was statistically significant association between gender (p = 0.038), marital status (p < 0.001) occupation (p < 0.001), education level (p = 0.006) and the practices of the respondents in the community whereby majority of male, unmarried dog owner who are farmer with primary education level had lower practice score. CONCLUSION This study concludes that respondents had good knowledge, a relatively good attitude, and poor practice towards rabies prevention and control. Rabies awareness with an emphasis on the importance of vaccination as well as vaccination campaigns should, therefore, be intensified, especially among the least educated dog owners.
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Affiliation(s)
- Shabani Iddi
- Department of Physiology, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Farida Mlenga
- Department of Pharmaceutics and Pharmacy Practice, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Kayo Hamasaki
- Department of Pharmaceutics and Pharmacy Practice, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Stanley Mwita
- Department of Pharmaceutics and Pharmacy Practice, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Eveline Konje
- Department of Biostatistics Epidemiology and Behavioral Sciences, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
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Khazaei S, Shirzadi MR, Amiri B, Pourmozafari J, Ayubi E. Epidemiologic Aspects of Animal Bite, Rabies, and Predictors of Delay in Post-exposure Prophylaxis: A National Registry-based Study in Iran. J Res Health Sci 2023; 23:e00583. [PMID: 37571954 PMCID: PMC10422135 DOI: 10.34172/jrhs.2023.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/09/2023] [Accepted: 05/23/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND The increasing trend in animal bites and rabies in recent years makes the disease a public health concern in Iran. The objectives of the current study were to investigate the epidemiologic aspects of the animal bite and determine the associated risk factors of the delay in initiation of post-exposure prophylaxis (PEP) against rabies in Iran. STUDY DESIGN National registry-based cross-sectional study. METHODS This study included all registered cases of animal bites between March 2021 and March 2022 at the Ministry of Health and Medical Education in Iran. We retrieved epidemiologic data on person, time, place, and PEP outcome. RESULTS A total of 260470 animal bite cases (approximately 334 per 100000 populations, and 11 deaths) were registered during the study period. About 77.2% of them were reported in males, 4.3% in children aged less than 5 years, 56.4% occurred in urban areas, 98% in domestic animals, and mostly in north and northeast areas of Iran. Additionally, 2.8% of cases had a delay of more than 48 hours in the initiation of PEP. Significant determinants of the increase in delay were female gender (OR=1.43, 95% CI: 1.36, 1.51, P<0.001), foreign nationality (OR=1.19, 95% CI: 1.01, 1.12, P=0.001), rural residence (OR=1.07, 95% CI: 1.01, 1.12, P=0.010), and the wild animals (OR=1.22, 95% CI: 1.12, 1.34, P<0.001). CONCLUSION The observed frequency of animal bites in a year indicates a serious public health concern and the need for targeted interventions, especially in at-risk areas and vulnerable populations.
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Affiliation(s)
- Salman Khazaei
- Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
- Research Center for Health Sciences, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mohammad Reza Shirzadi
- Center for Communicable Diseases Management, Ministry of Health and Medical Education, Tehran, Iran
| | - Behzad Amiri
- Center for Communicable Diseases Management, Ministry of Health and Medical Education, Tehran, Iran
| | - Jamshid Pourmozafari
- Center for Communicable Diseases Management, Ministry of Health and Medical Education, Tehran, Iran
| | - Erfan Ayubi
- Social Determinants of Health Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
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Kisaka S, Makumbi F, Majalija S, Bahizi G, Thumbi SM. Delays in initiating rabies post-exposure prophylaxis among dog bite victims in Wakiso and Kampala districts, Uganda. AAS Open Res 2022; 4:49. [PMID: 36419540 PMCID: PMC9648361 DOI: 10.12688/aasopenres.13311.3] [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] [Accepted: 11/14/2022] [Indexed: 12/13/2022] Open
Abstract
Background Although rabies in dog bite patients is preventable through timely initiation of post-exposure prophylaxis (PEP), a number of barriers to achieving PEP exist. This study investigated the delays to initiation of PEP among dog bite patients in the emergency departments of two PEP centers in Uganda. Methods A cross-sectional study was conducted among dog-bite patients that presented to two selected rabies PEP centers. A semi-structured questionnaire was used to collect data. Delay to receive PEP was defined as reporting for PEP beyond 24 hours after the bite event. Generalized linear models were used to calculate prevalence ratios and the 95% confidence intervals as a measure of association between delay and patient factors. Results Out of 376 participants, just over half (53.5%) were males. The majority of participants (54.0%) were 15 years or older and 28.5% had no formal education. Just over three-quarters (77.9%) had category II dog bite wounds. Nearly 40% delayed to receive PEP, and median (inter quartile range) lag time between bite event and seeking medical care of 18 (41) hours. Compared to education level of secondary or above, patients with no formal education (adj. PR=4.06, 95% CI: 2.69 - 6.10) or primary education (adj.PR=2.15, 95% CI: 1.37 - 3.35), belonging to the lowest socio-economic tertile as compared to the highest (adj.PR=1.58, 95% CI: 1.10 - 2.28), knowing the owner of the biting dog (adj.PR=1.30, 95% CI: 1.02 - 1.65) and having category II wounds (adj.PR=2.31, 95% CI: 1.43 - 3.71) were all associated with delayed presentation for PEP. Conclusions and recommendations Delays to receive PEP are common and are associated with poor level of education or low socio-economic status, knowledge of who the dog owner is and less severity of bite wounds. Seeking care irrespective of wound severity or knowledge of dog owner should be promoted.
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Affiliation(s)
- Stevens Kisaka
- University of Nairobi Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, 00254, Kenya
- School of Public Health, Makerere University, Kampala, 00256, Uganda
- College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, 00256, Uganda
| | - Fredrick Makumbi
- School of Public Health, Makerere University, Kampala, 00256, Uganda
| | - Samuel Majalija
- College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, 00256, Uganda
| | - Gloria Bahizi
- School of Public Health, Makerere University, Kampala, 00256, Uganda
- Department of National Disease Control, Ministry of Health, Uganda, Kampala, 00256, Uganda
| | - SM Thumbi
- University of Nairobi Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, 00254, Kenya
- Paul G Allen School for Global Animal Health, Washington State University, Washington, 001, USA
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Madjadinan A, Mbaipago N, Sougou NM, Diongue M, Zinsstag J, Heitz-Tokpa K, Lechenne M. "When a dog bites someone": Community and service provider dynamics influencing access to integrated bite case management in Chad. Front Vet Sci 2022; 9:866106. [PMID: 36299635 PMCID: PMC9588941 DOI: 10.3389/fvets.2022.866106] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 09/12/2022] [Indexed: 11/04/2022] Open
Abstract
This study aims to identify factors on the community, the human health and the animal health provider level that determine access to Post Exposure Prophylaxis (PEP) and animal rabies diagnosis in the light of a future integrated bite case management (IBCM) approach for rabies control in Chad. The study was embedded in an overall project conducted from 2016 to 2018, to determine rabies burden and vaccine demand in West and Central Africa. Data collection took place during the projects closing workshops with stakeholders organized between August and September 2018 in the three study zones in Chad covering Logone Occidental and Ouaddaï province and parts of Hadjer Lamis and Chari Baguirmi province. A qualitative approach based on focus group discussion and in-depth interviews was used to get insights on access to care and animal investigation after suspected rabies exposure. A total of 96 participants, including 39 from the community (bite victims, dog owners) and 57 human and animal health providers (health center managers, chief veterinary officers, chief district medical officers, chiefs of livestock sectors) contributed to the study. Based on an existing conceptual framework of access to health care, several points of dissatisfaction were identified, in particular the unaffordability of human rabies vaccine for PEP (affordability) and the distance to travel to a health facility in case of a bite (accessibility). In addition, there are unfavorable attitudes observed highlighted by the importance given to traditional or local rabies care practices to the detriment of PEP (acceptability) and a low level of knowledge among Chadian communities regarding bite prevention, coupled with a very inadequate information and awareness system regarding the disease (adequacy). As for human and veterinary health services, both sectors suffer from insufficient resources for PEP on the human health and rabies diagnosis on the veterinary side impacting negatively on availability and accessibility of both these services. Action to improving provision of rabies health services and increasing knowledge about risk and prevention of the disease among the population need to be undertaken to implement IBCM, improve access to PEP and achieve the goal of eliminating dog mediated human rabies by 2030 in Chad.
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Affiliation(s)
- Alladoumngar Madjadinan
- Centre de Support en Santé Internationale, N'Djamena, Chad,Institute of Health and Development, Dakar, Senegal,Public Health Department, Université Cheik Anta Diop de Dakar, Dakar, Senegal
| | | | - Ndèye Marème Sougou
- Institute of Health and Development, Dakar, Senegal,Public Health Department, Université Cheik Anta Diop de Dakar, Dakar, Senegal
| | | | - Jakob Zinsstag
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland,University of Basel, Basel, Switzerland
| | | | - Monique Lechenne
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland,University of Basel, Basel, Switzerland,*Correspondence: Monique Lechenne
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N'Guessan RD, Heitz-Tokpa K, Amalaman DM, Tetchi SM, Kallo V, Ndjoug Ndour AP, Nicodem G, Koné I, Kreppel K, Bonfoh B. Determinants of Rabies Post-exposure Prophylaxis Drop-Out in the Region of San-Pedro, Côte d'Ivoire. Front Vet Sci 2022; 9:878886. [PMID: 35873685 PMCID: PMC9305495 DOI: 10.3389/fvets.2022.878886] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 05/09/2022] [Indexed: 12/03/2022] Open
Abstract
Abstract Despite the fact that death from rabies is 100% preventable with a course of post-exposure prophylaxis (PEP) treatment, canine rabies still causes about 59,000 human deaths worldwide annually, half of which are occurring in Africa. In Côte d'Ivoire, rabies remains a threat partly due to the high drop-out rate of the life-saving human PEP treatment among people exposed to dog bites. Each year, half of the victims starting treatment, do not complete the course. The current study therefore assessed the determinants for drop-out of the life-saving treatment among people exposed to rabies in the department of San-Pedro in Côte d'Ivoire. Methods A mixed-methods approach was used, including questionnaires, observation, individual interviews and focus group discussions, to gather socio-demographic and economic data from 235 participants about possible reasons for abandoning treatment. The study population consisted of patients and medical and veterinary health professionals who were selected using stratified sampling and purposive selection from a database available at the Rabies Center of San Pedro. Result The drop-out of PEP treatment was related to perception bias and a habit of low attendance of health care and vaccination centers in the population. Quantitative analysis shows differences between rural and urban areas and an association with age when it comes to treatment completion. The dropout rate was most significant among patients who, in case of other illness, did not routinely see a doctor or go to vaccination centers. The rate of abandonment was higher among those who believed that dog-related injuries could be easily treated at home, and who believed that a person with rabies could be cured without completing the preventive treatment. Insufficient provision of health information on rabies and logistic constraints related to the practical organization of treatment, including the long distance to the anti-rabies center and weaknesses in the patient follow-up procedure, did not contribute to the completion of PEP. Conclusion Established determinants for drop-out provide a framework for effective design and implementation of rabies control strategies to accelerate rabies deaths elimination efforts. In particular, access to PEP and community knowledge about rabies need to be improved and integrated in the health system and education system, respectively.
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Affiliation(s)
- Rose Delima N'Guessan
- Sociology Department, Université Peleforo Gon Coulibaly, Korhogo, Côte d'Ivoire
- Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Côte d'Ivoire
| | - Kathrin Heitz-Tokpa
- Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Côte d'Ivoire
- *Correspondence: Kathrin Heitz-Tokpa
| | | | | | - Vessaly Kallo
- Direction des Services Vétérinaires, Abidjan, Côte d'Ivoire
| | - Andrée Prisca Ndjoug Ndour
- Department of Microbiology, Immunology, and Infectious Pathology, Ecole Inter-Etats des Sciences et Médecine Vétérinaires de Dakar, Dakar, Senegal
| | - Govella Nicodem
- Department of Environmental Health and Ecological Sciences, Ifakara Health Institute, Dar es-Salaam, Tanzania
| | - Issiaka Koné
- Department of Sociology, Université Jean Lorougnon Guédé, Daloa, Côte d'Ivoire
| | - Katharina Kreppel
- Department of Life Sciences and Bioengineering, Nelson Mandela African Institution of Science and Technology, Arusha, Tanzania
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Bassirou Bonfoh
- Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Côte d'Ivoire
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Kisaka S, Makumbi F, Majalija S, Bahizi G, Thumbi SM. Delays in initiating rabies post-exposure prophylaxis among dog bite victims in Wakiso and Kampala districts, Uganda. AAS Open Res 2021; 4:49. [PMID: 36419540 PMCID: PMC9648361 DOI: 10.12688/aasopenres.13311.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Although rabies in dog bite patients is preventable through timely initiation of post-exposure prophylaxis (PEP), a number of barriers to achieving PEP exist. This study investigated the delays to initiation of PEP among dog bite patients in the emergency departments of two PEP centers in Uganda. Methods: A cross-sectional study was conducted among dog-bite patients that presented to two selected rabies PEP centers. A semi-structured questionnaire was used to collect data. Delay to receive PEP was defined as reporting for PEP beyond 24 hours after the bite event. Generalized linear models were used to calculate prevalence ratios and the 95% confidence intervals as a measure of association between delay and patient factors. Results: Out of 376 participants, just over half (53.5%) were males. The majority of participants (54.0%) were 15 years or older and 28.5% had no formal education. Just over three-quarters (77.9%) had category II dog bite wounds. Nearly 40% delayed to receive PEP, and median (inter quartile range) lag time between bite event and seeking medical care of 18 (41) hours. Compared to education level of secondary or above, patients with no formal education (adj. PR=4.06, 95% CI: 2.69 - 6.10) or primary education (adj.PR=2.15, 95% CI: 1.37 - 3.35), belonging to the lowest socio-economic tertile as compared to the highest (adj.PR=1.58, 95% CI: 1.10 - 2.28), knowing the owner of the biting dog (adj.PR=1.30, 95% CI: 1.02 - 1.65) and having category II wounds (adj.PR=2.31, 95% CI: 1.43 - 3.71) were all associated with delayed presentation for PEP. Conclusions and recommendations: Delays to receive PEP are common and are associated with poor level of education or low socio-economic status, knowledge of who the dog owner is and less severity of bite wounds. Seeking care irrespective of wound severity or knowledge of dog owner should be promoted.
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Affiliation(s)
- Stevens Kisaka
- University of Nairobi Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, 00254, Kenya
- School of Public Health, Makerere University, Kampala, 00256, Uganda
- College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, 00256, Uganda
| | - Fredrick Makumbi
- School of Public Health, Makerere University, Kampala, 00256, Uganda
| | - Samuel Majalija
- College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, 00256, Uganda
| | - Gloria Bahizi
- School of Public Health, Makerere University, Kampala, 00256, Uganda
- Department of National Disease Control, Ministry of Health, Uganda, Kampala, 00256, Uganda
| | - SM Thumbi
- University of Nairobi Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, 00254, Kenya
- Paul G Allen School for Global Animal Health, Washington State University, Washington, 001, USA
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Kisaka S, Makumbi F, Majalija S, Bahizi G, Thumbi SM. Delays in initiating rabies post-exposure prophylaxis among dog bite victims in Wakiso and Kampala districts, Uganda. AAS Open Res 2021; 4:49. [PMID: 36419540 PMCID: PMC9648361 DOI: 10.12688/aasopenres.13311.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Although rabies in dog bite patients is preventable through timely initiation of post-exposure prophylaxis (PEP), a number of barriers to achieving PEP exist. This study investigated the delays to initiation of PEP among dog bite patients in the emergency departments of two PEP centers in Uganda. Methods: A cross-sectional study was conducted among dog-bite patients that presented to two selected rabies PEP centers. A semi-structured questionnaire was used to collect data. Delay to receive PEP was defined as reporting for PEP beyond 24 hours after the bite event. Generalized linear models were used to calculate prevalence ratios and the 95% confidence intervals as a measure of association between delay and patient factors. Results: Out of 376 participants, just over half (53.5%) were males. The majority of participants (54.0%) were 15 years or older and 28.5% had no formal education. Just over three-quarters (77.9%) had category II dog bite wounds. Nearly 40% delayed to receive PEP, and median (IQR) lag time between bite event and seeking medical care of 18 (41) hours. Compared to education level of secondary or above, patients with no formal education (adj. PR=4.06, 95% CI: 2.69 - 6.10) or primary education (adj.PR=2.15, 95% CI: 1.37 - 3.35), belonging to the lowest socio-economic tertile as compared to the highest (adj.PR=1.58, 95% CI: 1.10 - 2.28), knowing the owner of the biting dog (adj.PR=1.30, 95% CI: 1.02 - 1.65) and having category II wounds (adj.PR=2.31, 95% CI: 1.43 - 3.71) were all associated with delayed presentation for PEP. Conclusions and recommendations: Delays to receive PEP are common and are associated with poor level of education or low socio-economic status, knowledge of who the dog owner is and less severity of bite wounds. Seeking care irrespective of wound severity or knowledge of dog owner should be promoted.
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Affiliation(s)
- Stevens Kisaka
- University of Nairobi Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, 00254, Kenya
- School of Public Health, Makerere University, Kampala, 00256, Uganda
- College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, 00256, Uganda
| | - Fredrick Makumbi
- School of Public Health, Makerere University, Kampala, 00256, Uganda
| | - Samuel Majalija
- College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, 00256, Uganda
| | - Gloria Bahizi
- School of Public Health, Makerere University, Kampala, 00256, Uganda
- Department of National Disease Control, Ministry of Health, Uganda, Kampala, 00256, Uganda
| | - SM Thumbi
- University of Nairobi Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, 00254, Kenya
- Paul G Allen School for Global Animal Health, Washington State University, Washington, 001, USA
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Tiwari HK, Gogoi-Tiwari J, Robertson ID. Eliminating dog-mediated rabies: challenges and strategies. ANIMAL DISEASES 2021. [DOI: 10.1186/s44149-021-00023-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
AbstractRabies is an acute encephalitis caused by a lyssavirus. It is primarily transmitted through bites of infected dogs which results in the worldwide death of an estimated 59000 humans every year. The disease is preventable through the application of post-exposure prophylaxis (PEP) and its elimination has been demonstrated in many countries by applying multiple interventions simultaneously. Nonetheless, rabies is still widespread in many developing countries, primarily due to the poor implementation of intervention strategies that include inadequate dog-bite wound management practices, unavailability/unaffordability of PEP by the communities, failure to control the disease in free-roaming dogs and wildlife, improper dog population management, weak surveillance and diagnostic facilities and a lack of a One Health approach to the disease. In this review, strategies to control dog-mediated rabies through a One Health approach were discussed. We recommend applying multiple interventions against the disease by involving all the concerned stakeholders in selected urban and rural areas of the countries where rabies is endemic. An empirical demonstration of disease freedom in the selected areas through a One Health approach is needed to convince policymakers to invest in rabies prevention and control on the national level. This multifaceted One Health control model will enhance the likelihood of achieving the goal of global rabies eradication by 2030.
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Zhang L, Huang S, Cai L, Zhu Z, Chen J, Lu S, Zhu Z, Zhang M, Fang Y, Hu Q. Safety, immunogenicity of lyophilized purified vero cell cultured rabies vaccine administered in Zagreb and Essen regimen in post-exposure subjects: A post-marketing, parallel control clinical trial. Hum Vaccin Immunother 2021; 17:2547-2553. [PMID: 33631078 PMCID: PMC8475608 DOI: 10.1080/21645515.2021.1880200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 12/18/2020] [Indexed: 10/22/2022] Open
Abstract
To compare the safety and immunogenicity of lyophilized PVRV under Zagreb and Essen regimen.A post-marketing parallel control clinical trial was conducted. Totally 240 subjects were assigned to two groups randomly, immunized with lyophilized PVRV under Zagreb and Essen schedule. Solicited adverse events were observed after each dose and unsolicited adverse events were collected. Serum samples were collected on days 0, 7, 14, 42, 180 and 365 to be used to determine immunogenicity level. No severe adverse events (SAE) were observed. The incidence of adverse events under Zagreb and Essen were similar and there was no significant difference between the two groups and within all age groups. Fever and pain were the most frequently reported systemic and local adverse events (AEs) respectively. There were no differences in the GMT and the positive seroconversion rate between these two groups. All participants in the Zagreb group obtained protective effect on day 14, while 99.16% of the subjects obtained in the Essen group. Both groups showed similar enduring immunity. Immunizations under Zagreb and Essen regimens showed similar safety and immunogenicity. For lyophilized PVRV, Zagreb was non-inferior to Essen to patients of all age groups.
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Affiliation(s)
- Lei Zhang
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shichun Huang
- Department of Academic Research, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Li Cai
- Institute of Infectious Disease, Wuhan Center for Disease Control and Prevention, Wuhan, China
| | - Zhenggang Zhu
- Department of Immunization, Wuhan Center for Disease Control and Prevention, Wuhan, China
| | - Jian Chen
- Institute of Infectious Disease, Wuhan Center for Disease Control and Prevention, Wuhan, China
| | - Sha Lu
- Department of Immunization, Wuhan Center for Disease Control and Prevention, Wuhan, China
| | - Zerong Zhu
- Pathogen Biology Laboratory, Wuhan Center for Disease Control and Prevention, Wuhan, China
| | - Man Zhang
- Department of Immunization, Wuhan Center for Disease Control and Prevention, Wuhan, China
| | - Yuan Fang
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Quan Hu
- Department of Public Health, Wuhan Institute of Dermatology and Venereology, Wuhan, China
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Sarbazi E, Sarbazi M, Ghaffari-fam S, Babazadeh T, Heidari S, Aghakarimi K, Jamali I, Sherini A, Babaie J, Darghahi G. Factors related to delay in initiating post-exposure prophylaxis for rabies prevention among animal bite victims: a cross-sectional study in Northwest of Iran. Bull Emerg Trauma 2020; 8:236-242. [PMID: 33426139 PMCID: PMC7783308 DOI: 10.30476/beat.2020.85134] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 05/05/2020] [Accepted: 06/10/2020] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES The aim of the present study was to identify factors associated with h delayed initiation of post-exposure prophylaxis (PEP) among animal bite victims. METHODS This cross-sectional study assessed biting patterns among 3032 cases that were referred to Tabriz Rabies Center. The delay was described as the initiation of PEP more than 48 hours (h) after possible exposure to the rabies virus. Determinants of delay in initiating PEP were recognized by a decision tree model. RESULTS Totally, 8.5% of the victims who were bitten by an animal had a delay of more than 48 h in the initiation of PEP. The relative frequency of a delay more than 48 h in females was higher than in males (12.9% compared to 8.5%) (p-value= 0.004). Relative frequency of a delay of more of 48 h from carnivorous (dog, jackal, fox) was significantly less than others (p-value< 0.001). Of the decision tree, the overall classification accuracy was 89.5%, with 44.1% sensitivity and 92.3% specificity. The identified variables included gender, biting place (rural, urban), and type of animal. CONCLUSION according to the results of the present study, among the various variables that affect the delayed initiation of PEP, rural residents and being female, in particular, were the major factors associated with a delay in the initiation of PEP for rabies prevention. We found relatively low rates of vaccine completion. Our findings indicat that providing training and patient education are required to ensure the completion of appropriate treatment.
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Affiliation(s)
- Ehsan Sarbazi
- Tabriz Health Services Management Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
- Road Traffic Injury Research Center, Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohamadreza Sarbazi
- PhD student in Applied ELT at Ilam University, Faculty of humanities and foreign languages Ilam, Iran
| | - Saber Ghaffari-fam
- School of Nursing of Miyandoab, Urmia University of Medical Sciences, Urmia, Iran
| | - Towhid Babazadeh
- Department of Public Health, Sarab Faculty of Medical Sciences, Sarab, Iran
| | - Sohrab Heidari
- School of Nursing of Miyandoab, Urmia University of Medical Sciences, Urmia, Iran
| | - Khadijeh Aghakarimi
- School of Nursing of Miyandoab, Urmia University of Medical Sciences, Urmia, Iran
| | - Ismail Jamali
- Tabriz Health Center, Tabriz Rabies Prevention and Treatment Center, Iranian Center of Excellence in Health Management, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ali Sherini
- Tabriz Health Center, Tabriz Rabies Prevention and Treatment Center, Iranian Center of Excellence in Health Management, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Javad Babaie
- Department of Health Services Management, Iranian Center of Excellence in Health Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ghader Darghahi
- MSc of Epidemiology, Research Center of Psychiatry and Behavioral Sciences, Razi Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
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Wani RT, Chowdri IN, Dar H. Factors influencing delay in initiating post-exposure prophylaxis for rabies prevention among animal bite victims: A cross sectional study. J Family Med Prim Care 2020; 9:4751-4755. [PMID: 33209795 PMCID: PMC7652120 DOI: 10.4103/jfmpc.jfmpc_890_20] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 06/14/2020] [Accepted: 07/07/2020] [Indexed: 12/25/2022] Open
Abstract
Background and Aims The aim of this study was to identify the delay and the factors associated with delay in initiating post exposure prophylaxis. Methods A consecutive sampling method was proceeded, and 199 patients attending the anti-rabies clinic with a history of animal bite reported at SMHS Hospital were the subjects of the study. Results Majority of the patients (72.36%) reported a delay within 6 h after exposure, 18.59% within (6-48) h and 9.04% after 48 h of exposure. Conclusion Increasing the number of accessible anti-rabies clinics as well as increasing the awareness among general public about timely post exposure prophylaxis in the community are some of the factors that need to be implemented.
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Affiliation(s)
- Rabbanie Tariq Wani
- Department of Community Medicine, Government Medical College, Srinagar, Kashmir, India
| | - Iqra Nisar Chowdri
- Department of Community Medicine, Government Medical College, Srinagar, Kashmir, India
| | - Hibba Dar
- Department of Pharmacology, Government Medical College, Srinagar, Kashmir, India
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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%).
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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
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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.
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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.
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Gill GS, Singh BB, Dhand NK, Aulakh RS, Sandhu BS, Ward MP, Brookes VJ. Estimation of the incidence of animal rabies in Punjab, India. PLoS One 2019; 14:e0222198. [PMID: 31498815 PMCID: PMC6733466 DOI: 10.1371/journal.pone.0222198] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 08/24/2019] [Indexed: 11/25/2022] Open
Abstract
Background Rabies is a devastating zoonotic disease of mammals that causes encephalitis and death. It is endemic in India, with an estimated annual 20,000 human deaths (one-third of the global rabies burden). The magnitude of animal rabies incidence is unknown. Methods In four sub-districts of Punjab, India, we monitored canine and livestock populations from August 15, 2016 to August 14, 2017. Demographic, clinical and rabies diagnostic laboratory (RDL) data were collected from suspected cases of rabies. The annual incidence rate / 10,000 animal years at risk (95% CI) in each sub-district was estimated for each species. Results During 2016–2017, a total of 41 suspected rabies cases were detected in the four selected sub-districts in Punjab. Laboratory confirmed rabies (LCR) incidence was 2.03/10,000 dog years (0.69, 5.96) and 2.71/10,000 dog years (1.14, 6.43) in stray and pet dogs, respectively. The LCR incidence in farmed buffalo and cattle was 0.19/10,000 buffalo years (0.07, 0.57) and 0.23/10,000 cattle years (0.06, 0.88), respectively. The LCR incidence amongst equine was 4.28/10,000 equine years (0.48, 38.10). Stray cattle rabies incidence in the selected sub-districts was 9.49/10,000 cattle years (3.51, 25.67). If similar enhanced surveillance for rabies was conducted state-wide, we estimate that 98 (34–294) buffalo, 18 (2–156) equine, 56 (15–214) farmed cattle, 96 (35–259) stray cattle, 128 (54–303) pet dogs and 62 (21–182) stray dogs would be expected to be confirmed with rabies in Punjab annually. Conclusion These results indicate that rabies incidence in animals, particularly in dogs and stray cattle, is much higher than previously suspected. We recommend that statewide enhanced disease surveillance should be conducted to obtain more accurate estimates of rabies incidence in Punjab to facilitate better control of this important disease.
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Affiliation(s)
- Gurlal S. Gill
- Guru Angad Dev Veterinary and Animal Sciences University (GADVASU), Ludhiana, Punjab, India
- Punjab Agricultural University (PAU), Ludhiana, Punjab, India
| | - Balbir B. Singh
- Guru Angad Dev Veterinary and Animal Sciences University (GADVASU), Ludhiana, Punjab, India
- Sydney School of Veterinary Science, Faculty of Science, The University of Sydney, Camden, NSW, Australia
- * E-mail:
| | - Navneet K. Dhand
- Sydney School of Veterinary Science, Faculty of Science, The University of Sydney, Camden, NSW, Australia
| | - Rabinder S. Aulakh
- Guru Angad Dev Veterinary and Animal Sciences University (GADVASU), Ludhiana, Punjab, India
| | - Bhupinder S. Sandhu
- Guru Angad Dev Veterinary and Animal Sciences University (GADVASU), Ludhiana, Punjab, India
| | - Michael P. Ward
- Sydney School of Veterinary Science, Faculty of Science, The University of Sydney, Camden, NSW, Australia
| | - Victoria J. Brookes
- Sydney School of Veterinary Science, Faculty of Science, The University of Sydney, Camden, NSW, Australia
- School of Animal and Veterinary Sciences, Faculty of Science, Charles Sturt University, Wagga Wagga, NSW, Australia
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Yan S, Chen Y, Ye W, Chen F, Li L. Characteristics and factors associated with post-exposure prophylaxis (PEP) treatment of dog and cat bites among left-behind children: a cross-sectional study in two cities of China. BMJ Open 2019; 9:e024764. [PMID: 31061023 PMCID: PMC6502015 DOI: 10.1136/bmjopen-2018-024764] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE Animal injury is a significant cause of morbidity and mortality worldwide. Dog bites account for tens of millions of injuries annually and the highest risk is among children. However, children may not receive postexposure prophylaxis (PEP) treatment timely and appropriately after rabies exposure. This study aimed to investigate the characteristics and factors associated with PEP treatment of dog and cat bites among left-behind children. DESIGN A cross-sectional study using questionnaire was conducted in primary and high schools. SETTING Shenzhen and Shantou cities, Guangdong Province, China. PARTICIPANTS A total of 9380 participants were included and 2236 of them were with a history of dog and cat bites. RESULTS 1188 (53.1%) boys and 1048 (46.9%) girls suffered from animal bites. Bitten in holidays was less likely to receive PEP treatment (OR 0.512, 95% CI 0.377 to 0.695) than those bitten in school days. Bitten while being with family (OR 1.418, 95% CI 1.040 to 1.934) and bitten at roadside (OR 1.842, 95% CI 1.297 to 2.171), bitten by unvaccinated animals (OR 1.745, 95% CI 1.246 to 2.443) tended to receive PEP treatment. Compared with unbroken skin, bleeding (OR 1.789, 95% CI 1.165 to 2.745) and laceration (OR 3.834, 95% CI 2.310 to 6.366) were showed as treatment prompting factors. CONCLUSIONS Bitten in holidays was found as a risk factor of receiving PEP treatment of animal bites. Certain measures should be taken to raise left-behind children's awareness of receiving PEP treatment timely and appropriately after dog and cat bites.
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Affiliation(s)
- Shuzhen Yan
- Injury Prevention Research Center, Shantou University Medical College, Shantou, China
| | - Ying Chen
- Injury Prevention Research Center, Shantou University Medical College, Shantou, China
- School of Public Heath, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Wanbao Ye
- Injury Prevention Research Center, Shantou University Medical College, Shantou, China
| | - Fuxiang Chen
- Injury Prevention Research Center, Shantou University Medical College, Shantou, China
| | - Liping Li
- Injury Prevention Research Center, Shantou University Medical College, Shantou, China
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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.
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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
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Tiwari HK, Vanak AT, O’Dea M, Robertson ID. Knowledge, attitudes and practices towards dog-bite related rabies in para-medical staff at rural primary health centres in Baramati, western India. PLoS One 2018; 13:e0207025. [PMID: 30444871 PMCID: PMC6239288 DOI: 10.1371/journal.pone.0207025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 10/22/2018] [Indexed: 12/03/2022] Open
Abstract
The lack of awareness regarding rabies amongst rural primary care health staff and their adverse practices towards the management of dog-bite wounds is a major contributor to the high incidence of rabies infection and subsequent human mortality in India. A Knowledge, Attitudes and Practices survey was carried out involving 54 nursing and non-nursing staff working in 18 rural Primary Health centres and sub-centres around Baramati town of Pune district in Western India. Multivariable logistic regression models were constructed to assess factors that influenced knowledge of rabies and practices towards management of dog-bite related wounds. The more experienced and better-educated workers were found to have a good awareness of rabies (OR 3.4, 95%CI 1.0-12.1) and good practices towards dog-bite wound management (OR 5.6, 95%CI 1.2-27.0). Surprisingly, non-nursing staff were significantly more knowledgeable about rabies (OR 3.5, 95%CI 1.0-12.3), but their practices towards dog-bite wound management were inadequate (OR 0.18, 95%CI 0.04-0.8) compared to the nursing staff. It is recommended that a mandatory training module for primary care health staff be developed and implemented to improve their knowledge regarding rabies and management of dog-bite wounds to reduce the incidence of human rabies in rural India.
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Affiliation(s)
- Harish Kumar Tiwari
- College of Veterinary Medicine, School of Veterinary and Life Sciences, Murdoch University, Western Australia, Australia
- Ashoka Trust for Research on Ecology and Environment (ATREE), Bangalore, India
| | - Abi Tamim Vanak
- Ashoka Trust for Research on Ecology and Environment (ATREE), Bangalore, India
- Wellcome Trust/DBT India-Alliance, Hyderabad, India
- School of Life Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Mark O’Dea
- College of Veterinary Medicine, School of Veterinary and Life Sciences, Murdoch University, Western Australia, Australia
| | - Ian Duncan Robertson
- College of Veterinary Medicine, School of Veterinary and Life Sciences, Murdoch University, Western Australia, Australia
- China-Australia Joint Research and Training Center for Veterinary Epidemiology, Huazhong Agricultural University, Wuhan, Hubei, China
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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.
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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
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Ngugi JN, Maza AK, Omolo OJ, Obonyo M. Epidemiology and surveillance of human animal-bite injuries and rabies post-exposure prophylaxis, in selected counties in Kenya, 2011-2016. BMC Public Health 2018; 18:996. [PMID: 30092769 PMCID: PMC6085719 DOI: 10.1186/s12889-018-5888-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 07/25/2018] [Indexed: 11/29/2022] Open
Abstract
Background Human animal-bite injuries are a serious public health problem due to associated risk for rabies virus exposure. Animal-bite injuries especially dog bites are useful indicators for assessing the risk of rabies virus transmission and need for rabies post exposure prophylaxis (PEP). Understanding the epidemiology and surveillance of animal bites and rabies post-exposure prophylaxis is critical in implementing Kenya’s national rabies elimination strategy. We aimed to describe the incidence of human animal-bite injuries, patient/biting animal characteristics, uptake of rabies PEP and factors associated with animal bite incidents. Methods We reviewed animal bite records from outpatient and anti-rabies vaccine (ARV) registers of 17 health facilities from five counties. An animal bite was defined as an entry of an animal bite of the class mammal including humans in registers in a person of any age from January 2011 to December 2016. We collected demographic and information on PEP uptake. We calculated descriptive statistics, odds ratios (OR) and 95% confidence interval (CI) to examine factors associated with being an animal bite case-patient. We also calculated incidence of animal bites using health facility catchment population for year 2016 as the denominator. Results We analyzed 7307 records. The median age was 22 years (IQR = 31 years); there were 4019 (55%) male and age < 15 years were 2607 (37%). Dogs accounted for 6720 (93%) of bites of which 78% were owned free-roaming dogs. Of the 5674 (88%) cases that received rabies PEP, 2247 (40%) got at least three-doses. The median time from bite to seeking medical care was 2 days (IQR = 4 days). Being bitten on the head/face (OR = 5.8; CI: 3.3–10.2); being bitten by owned free-roaming dog (OR = 1.7; CI: 1.5–1.9) and being male (OR = 1.4; CI: 1.3–1.5) were significantly associated with being an animal-bite case-patient. Being male, being bitten on head/face and being bitten by owned free-roaming dog remained independently associated with being an animal bite case-patient at multivariable logistic regression. Bite-incidence was 289 bites /100,000 persons among all counties. Conclusion Preventing dog bites would most effectively reduce bite injuries by improving public health education among children below 15 years, encouraging early PEP initiation and completion, development and implementation of responsible dog ownership and animal behaviour educational programmes as well as improving human and veterinary health linkages. Electronic supplementary material The online version of this article (10.1186/s12889-018-5888-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jeremiah Ngurimu Ngugi
- Kenya Field epidemiology and Laboratory Training Program, Nairobi, Kenya. .,Department of Veterinary Services, County Government of Taita Taveta, Taveta, Kenya.
| | | | - Owiti Jack Omolo
- Kenya Field epidemiology and Laboratory Training Program, Nairobi, Kenya.,Department of Veterinary Services, County Government of Kilifi, Kilifi, Kenya
| | - Mark Obonyo
- Kenya Field epidemiology and Laboratory Training Program, Nairobi, Kenya.,Ministry of Agriculture, Livestock and Fisheries, Directorate of Veterinary Services, Nairobi, Kenya
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Esmaeilzadeh F, Rajabi A, Vahedi S, Shamsadiny M, Ghelichi Ghojogh M, Hatam N. Epidemiology of Animal Bites and Factors Associated With Delays in Initiating Post-exposure Prophylaxis for Rabies Prevention Among Animal Bite Cases: A Population-based Study. J Prev Med Public Health 2018; 50:210-216. [PMID: 28605885 PMCID: PMC5495689 DOI: 10.3961/jpmph.17.027] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 04/28/2017] [Indexed: 11/29/2022] Open
Abstract
Objectives One way to prevent deaths due to rabies is the timely utilization of post-exposure prophylaxis (PEP). Therefore, in addition to an understanding of the epidemiological distribution of animal bites, it is necessary to explore the factors leading to delays in PEP initiation. Methods This cross-sectional study was conducted in Iran in 2011, and included 7097 cases of animal bites recorded at the Rabies Treatment Center of the Shiraz University of Medical Sciences using the census method. Logistic regression was used to identify factors associated with delays in PEP. Results Among the patients studied, 5387 (75.9%) were males. The prevalence of animal bites in Fars province was 154.4 per 100 000 people. Dogs were the most frequent source of exposure (67.1%), and the most common bitten part of the body was the hands (45.5%). A delay in the initiation of PEP was found among 6.8% of the studied subjects. This delay was more likely in housewives (odds ratio [OR], 4.66; 95% confidence interval [CI], 2.12 to 10.23) and less likely in people with deep wounds (OR, 0.65; 95% CI, 0.43 to 0.97). Conclusions Although all animal bite victims received complete PEP, in some cases, there were delays. Further, the type of animal involved, the depth of the bite, and the patient’s occupation were the major factors associated with a delay in the initiation of PEP for rabies prevention.
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Affiliation(s)
- Firooz Esmaeilzadeh
- Department of Health Economic, School of Nursing and Midwifery, Maragheh University of Medical Sciences, Maragheh, Iran
| | - Abdolhalim Rajabi
- Department of Health Economic, School of Nursing and Midwifery, Maragheh University of Medical Sciences, Maragheh, Iran
| | - Sajad Vahedi
- Department of Health Economic, School of Nursing and Midwifery, Maragheh University of Medical Sciences, Maragheh, Iran
| | - Mohammad Shamsadiny
- Department of Health Economic, School of Nursing and Midwifery, Maragheh University of Medical Sciences, Maragheh, Iran
| | - Mousa Ghelichi Ghojogh
- Department of Health Economic, School of Nursing and Midwifery, Maragheh University of Medical Sciences, Maragheh, Iran
| | - Nahid Hatam
- Department of Health Economic, School of Nursing and Midwifery, Maragheh University of Medical Sciences, Maragheh, Iran
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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.
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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
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Singh R, Singh KP, Cherian S, Saminathan M, Kapoor S, Manjunatha Reddy GB, Panda S, Dhama K. Rabies - epidemiology, pathogenesis, public health concerns and advances in diagnosis and control: a comprehensive review. Vet Q 2017. [PMID: 28643547 DOI: 10.1080/01652176.2017.1343516] [Citation(s) in RCA: 106] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Rabies is a zoonotic, fatal and progressive neurological infection caused by rabies virus of the genus Lyssavirus and family Rhabdoviridae. It affects all warm-blooded animals and the disease is prevalent throughout the world and endemic in many countries except in Islands like Australia and Antarctica. Over 60,000 peoples die every year due to rabies, while approximately 15 million people receive rabies post-exposure prophylaxis (PEP) annually. Bite of rabid animals and saliva of infected host are mainly responsible for transmission and wildlife like raccoons, skunks, bats and foxes are main reservoirs for rabies. The incubation period is highly variable from 2 weeks to 6 years (avg. 2-3 months). Though severe neurologic signs and fatal outcome, neuropathological lesions are relatively mild. Rabies virus exploits various mechanisms to evade the host immune responses. Being a major zoonosis, precise and rapid diagnosis is important for early treatment and effective prevention and control measures. Traditional rapid Seller's staining and histopathological methods are still in use for diagnosis of rabies. Direct immunofluoroscent test (dFAT) is gold standard test and most commonly recommended for diagnosis of rabies in fresh brain tissues of dogs by both OIE and WHO. Mouse inoculation test (MIT) and polymerase chain reaction (PCR) are superior and used for routine diagnosis. Vaccination with live attenuated or inactivated viruses, DNA and recombinant vaccines can be done in endemic areas. This review describes in detail about epidemiology, transmission, pathogenesis, advances in diagnosis, vaccination and therapeutic approaches along with appropriate prevention and control strategies.
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Affiliation(s)
- Rajendra Singh
- a Division of Pathology , ICAR-Indian Veterinary Research Institute , Bareilly , Uttar Pradesh , India
| | - Karam Pal Singh
- b Centre for Animal Disease Research and Diagnosis (CADRAD) , ICAR-Indian Veterinary Research Institute , Bareilly , Uttar Pradesh , India
| | - Susan Cherian
- a Division of Pathology , ICAR-Indian Veterinary Research Institute , Bareilly , Uttar Pradesh , India
| | - Mani Saminathan
- a Division of Pathology , ICAR-Indian Veterinary Research Institute , Bareilly , Uttar Pradesh , India
| | - Sanjay Kapoor
- c Department of Veterinary Microbiology , LLR University of Veterinary and Animal Sciences , Hisar , Haryana , India
| | - G B Manjunatha Reddy
- d ICAR-National Institute of Veterinary Epidemiology and Disease Informatics , Bengaluru , Karnataka , India
| | - Shibani Panda
- a Division of Pathology , ICAR-Indian Veterinary Research Institute , Bareilly , Uttar Pradesh , India
| | - Kuldeep Dhama
- a Division of Pathology , ICAR-Indian Veterinary Research Institute , Bareilly , Uttar Pradesh , India
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Wang J, Luo F, Feng Z, Li L, Bai Y, Ai X, Ma J, Zhang Z, Shi N. Immunogenicity and safety of purified vero cell rabies vaccine (PVRV) produced by Liaoning Cheng Da Co. under Zagreb 2-1-1 or 5-dose Essen regimen in Chinese adults aged 50 and above. Hum Vaccin Immunother 2017; 13:144-150. [PMID: 28045585 DOI: 10.1080/21645515.2016.1230260] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Two kinds of regimens (2-1-1 and 1-1-1-1-1) can be selected after Zagreb regimen(2-1-1)of PVRV was officially approved in Beijing in January 2015. Up to now, the subjects for most studies about the comparison between Zagreb and Essen regimen are under 50 y old, rarely at and above. Aging of the immune system may result in decreasing efficacy of vaccination, especially for adults aged above 65-70 y. This study compared the safety and immunogenicity of the Zagreb and Essen regimen in Chinese adults aged 50 and above with the goal to provide a supplemental data for this age group. METHODS A total of 114 cases were divided into 2 groups randomly, received PVRV under the Zagreb and Essen regimens respectively. Serum samples were collected at D0, D7, D14, D42, D180 and D365 to determine the rabies serum neutralizing antibody by rapid fluorescent focus inhibition test (RFFIT). Safety analyses were made by comparing the AEs in day-3, day-7, and day-(7 + 21) in Zagreb or day-(7 + 28) in Essen by gender and age cohorts. RESULTS 617 blood samples were obtained. Two groups showed similar immunogenicity, the neutralizing antibody titer of all subjects at D14 and D42 showed >0.5 IU/ml. Under the same regimen, Subjects ≥65 y had lower GMC than those who <65 years from D7 to D365 within 2 groups. This difference was significantly shown on D7, D14, D180 in Zagreb group, and on D180 in Essen group (t = 2.38, p = 0.02; t = 3.78, p < 0.001; t = 2.30, p = 0.03; t = 4.42, p < 0.001). Subjects<65 years had higher seroconversion rate compared to ≥65 y on D7, D180 and D365 in both 2 groups, this difference was also significantly shown on D180, D365 in Zagreb group and on D180 in Essen group (χ2 = 20.66, p < 0.001; χ2 = 6.56, p = 0.02; χ2 = 10.96, p = 0.002). Two regimens all showed favorable performances with mildly or common adverse events (AEs). The incidence of local AEs after 3 d in Essen group was higher than Zagreb group (χ2 = 9.69, p = 0.002). The most common local AE was pain, the incidences (8.8%) in Zagreb group was higher than Essen group (8.4%, χ2 = 5.12, p = 0.02). All AEs for Zagreb group and 52.3% of AEs for Essen group occurred during the first 72 hours. During the first 72 hours, subjects aged <65 in Zagreb group (16.26%) had higher incidences of AEs than Essen group (8.57%, χ2 = 4.54, p = 0.03), males in Zagreb group (16.05%) had higher incidence of AEs than Essen group (5.71%, χ2 = 5.34, p = 0.02). The incidences of AEs close in during the first 7 d. CONCLUSION The Zagreb and Essen regimens demonstrated the similar safety and efficacy of PVRV in Chinese adults aged 50 and above. People ≥65 y showed reduced immune response to both regimens. More AEs for the Zagreb regimen were observed within the first 72 hours, especially for male and people < 65 y.
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Affiliation(s)
- Jing Wang
- a ChaoYang Center for Disease Prevention and Control , Beijing , China
| | - FengJi Luo
- a ChaoYang Center for Disease Prevention and Control , Beijing , China
| | - ZiJian Feng
- b China Center for Disease Prevention and Control ; Beijing , China
| | - Li Li
- a ChaoYang Center for Disease Prevention and Control , Beijing , China
| | - YunHua Bai
- a ChaoYang Center for Disease Prevention and Control , Beijing , China
| | - Xing Ai
- c National Institutes for Food and Drug Control , Beijing , China
| | - JianXin Ma
- a ChaoYang Center for Disease Prevention and Control , Beijing , China
| | - Zheng Zhang
- a ChaoYang Center for Disease Prevention and Control , Beijing , China
| | - NianMin Shi
- a ChaoYang Center for Disease Prevention and Control , Beijing , China
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Liu Q, Wang X, Liu B, Gong Y, Mkandawire N, Li W, Fu W, Li L, Gan Y, Shi J, Shi B, Liu J, Cao S, Lu Z. Improper wound treatment and delay of rabies post-exposure prophylaxis of animal bite victims in China: Prevalence and determinants. PLoS Negl Trop Dis 2017; 11:e0005663. [PMID: 28692657 PMCID: PMC5519202 DOI: 10.1371/journal.pntd.0005663] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 07/20/2017] [Accepted: 05/24/2017] [Indexed: 11/18/2022] Open
Abstract
Background Rabies is invariably a fatal disease. Appropriate wound treatment and prompt rabies post-exposure prophylaxis (PEP) are of great importance to rabies prevention. The objective of this study was to investigate the prevalence and influencing factors of improper wound treatment and delay of rabies PEP after an animal bite in Wuhan, China. Methodology This cross-sectional study was conducted among animal bite victims visiting rabies prevention clinics (RPCs). We selected respondents by a multistage sampling technique. A face-to-face interview was conducted to investigate whether the wound was treated properly and the time disparity between injury and attendance to the RPCs. Determinants of improper wound treatment and delay of rabies PEP were identified by a stepwise multivariate logistic regression analysis. Principal findings In total, 1,015 animal bite victims (564 women and 451 men) responded to the questionnaire, and the response rate was 93.98%. Overall, 81.2% of animal bite victims treated their wounds improperly after suspected rabies exposure, and 35.3% of animal bite victims delayed the initiation of PEP. Males (OR = 1.871, 95% CI: 1.318–2.656), residents without college education (OR = 1.698, 95% CI: 1.203–2.396), participants liking to play with animals (OR = 1.554, 95% CI: 1.089–2.216), and people who knew the fatality of rabies (OR = 1.577, 95% CI: 1.096–2.270), were more likely to treat wounds improperly after an animal bite. Patients aged 15–44 years (OR = 2.324, 95% CI: 1.457–3.707), who were bitten or scratched by a domestic animal (OR = 1.696, 95% CI: 1.103–2.608) and people who knew the incubation period of rabies (OR = 1.844, 95% CI: 1.279–2.659) were inclined to delay the initiation of PEP. Conclusions Our investigation shows that improper wound treatment and delayed PEP is common among animal bite victims, although RPCs is in close proximity and PEP is affordable. The lack of knowledge and poor awareness might be the main reason for improper PEP. Educational programs and awareness raising campaigns should be a priority to prevent rabies, especially targeting males, the less educated and those aged 15–44 years. Although the incidence of animal bites is increasing in China, residents’ knowledge about appropriate wound treatment and prompt PEP is insufficient. A face-to-face interview was conducted to investigate whether the wound was treated properly and to determine the time disparity between injury and consultation to the RPCs among animal bite victims. We discovered that a minority of people treated wounds appropriately, and more than one-third of participants delayed the initiation of PEP. A stepwise multivariable logistic regression analysis was used to identify the influencing factors of improper wound treatment and the delay of rabies PEP. Males (OR = 1.871, 95% CI: 1.318–2.656), residents without college education (OR = 1.698, 95% CI: 1.203–2.396), respondents liking to play with animals (OR = 1.554, 95% CI: 1.089–2.216), and people who knew the fatality of rabies (OR = 1.577, 95% CI: 1.096–2.270), were likely to treat wounds improperly after an animal bite. Participants aged 15–44 years (OR = 2.324, 95% CI: 1.457–3.707), residents bitten or scratched by a domestic animal (OR = 1.696, 95% CI: 1.103–2.608), and people who knew the incubation period of rabies (OR = 1.844, 95% CI: 1.279–2.659) tended to delay the initiation of PEP. The results also showed that knowledge of rabies among residents is insufficient. These findings highlight the urgent need for public educational and awareness-raising programs that would improve appropriate wound treatment and prompt PEP to prevent rabies-related deaths.
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Affiliation(s)
- Qiaoyan Liu
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xiaojun Wang
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Bing Liu
- Center of Health Administration and Development Studies, Hubei University of Medicine, Shiyan, Hubei, China
| | - Yanhong Gong
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Naomie Mkandawire
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Wenzhen Li
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Wenning Fu
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Liqing Li
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- School of Economics and Management, Jiangxi Science and Technology Normal University, Nanchang, Jiangxi, China
| | - Yong Gan
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jun Shi
- Department of Orthopedics, Shiyan Traditional Chinese Medicine Hospital, Shiyan, Hubei, China
| | - Bin Shi
- Xinhua Street Community health center of Jianghan District, Wuhan, Hubei, China
| | - Junan Liu
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- * E-mail: (ZL); (CS); (JL)
| | - Shiyi Cao
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- * E-mail: (ZL); (CS); (JL)
| | - Zuxun Lu
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- * E-mail: (ZL); (CS); (JL)
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Sharma S, Agarwal A, Khan AM, Ingle GK. Prevalence of Dog Bites in Rural and Urban Slums of Delhi: A Community-based Study. Ann Med Health Sci Res 2016; 6:115-9. [PMID: 27213095 PMCID: PMC4866364 DOI: 10.4103/2141-9248.181836] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Background: Rabies is a fatal disease of the central nervous system caused by the bites of warm-blooded animals. One of the important methods of controlling rabies is by interventions to limit the number of dog bites, the most common source of transmission of rabies to humans in the community. Community-based data on dog bites are rare from India. Aim: The aim of this study is to determine the prevalence of dog bites and knowledge and practices relating to its management and prevention in an urban and a rural slum of North West Delhi, India. Subjects and Methods: A cross-sectional house to house survey of 500 households covering a population of 2887 individuals was conducted. The families were selected by systematic random sampling. A pretested and a prevalidated questionnaire was used. Chi-square test was applied for comparing proportions related to the categorical variables and t-test was used for comparing means. Results: The dog bite incidence rate for the study population for the last year was 25.2/1000 population with higher rates in urban (30.1/1000) than rural (19.6/1000) slum. Two-fifths of the dog bite patients did not wash the wound with soap and water. The practice of washing the wound with soap and water was significantly higher in urban than rural slum. One-fifth of the patients did not receive anti-rabies vaccine. There was lower coverage in rural than urban slum. A majority (79.0%) of the patients did not receive anti-rabies serum. Conclusion: A high prevalence of dog bites coupled with poor knowledge and dog bite management practices is a worrisome trend which policy makers should take into account to make India rabies free.
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Affiliation(s)
- S Sharma
- Department of Community Medicine, Maulana Azad Medical College, New Delhi, India
| | - A Agarwal
- Department of Pediatrics, Maulana Azad Medical College, New Delhi, India
| | - A M Khan
- Department of Community Medicine, University College of Medical Sciences, New Delhi, India
| | - G K Ingle
- Department of Community Medicine, Maulana Azad Medical College, New Delhi, India
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28
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Wilde H, Lumlertdacha B, Meslin FX, Ghai S, Hemachudha T. Worldwide rabies deaths prevention--A focus on the current inadequacies in postexposure prophylaxis of animal bite victims. Vaccine 2015; 34:187-189. [PMID: 26626211 DOI: 10.1016/j.vaccine.2015.11.036] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 11/13/2015] [Accepted: 11/16/2015] [Indexed: 11/28/2022]
Abstract
The World Health Organization reports that over 60,000 humans die of rabies annually, worldwide. Most occur in remote regions of developing countries. Almost all victims received no postexposure rabies prophylaxis (PEP). There are no facilities or health personnel able to provide it in many areas where the disease is prevalent. A first approach to correct this problem would be by extending provision of modern PEP to areas where human rabies is most prevalent.
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Affiliation(s)
- Henry Wilde
- WHO Collaborating Centre for Research and Training on Viral Zoonoses, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
| | - Boonlert Lumlertdacha
- WHO Collaborating Centre for Research on Rabies Pathogenesis and Prevention, Queen Saovabha Memorial Institute, The Thai Red Cross Society, Bangkok, Thailand
| | | | - Siriporn Ghai
- WHO Collaborating Centre for Research and Training on Viral Zoonoses, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Thiravat Hemachudha
- WHO Collaborating Centre for Research and Training on Viral Zoonoses, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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29
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Barkhouse DA, Faber M, Hooper DC. Pre- and post-exposure safety and efficacy of attenuated rabies virus vaccines are enhanced by their expression of IFNγ. Virology 2015; 474:174-80. [PMID: 25463615 PMCID: PMC4258908 DOI: 10.1016/j.virol.2014.10.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 10/08/2014] [Accepted: 10/24/2014] [Indexed: 12/25/2022]
Abstract
Consistent with evidence of a strong correlation between interferon gamma (IFNγ) production and rabies virus (RABV) clearance from the CNS, we recently demonstrated that engineering a pathogenic RABV to express IFNγ highly attenuates the virus. Reasoning that IFNγ expression by RABV vaccines would enhance their safety and efficacy, we reverse-engineered two proven vaccine vectors, GAS and GASGAS, to express murine IFNγ. Mortality and morbidity were monitored during suckling mice infection, immunize/challenge experiments and mixed intracranial infections. We demonstrate that GASγ and GASγGAS are significantly attenuated in suckling mice compared to the GASGAS vaccine. GASγ better protects mice from lethal DRV4 RABV infection in both pre- and post-exposure experiments compared to GASGAS. Finally, GASγGAS reduces post-infection neurological sequelae, compared to control, during mixed intracranial infection with DRV4. These data show IFNγ expression by a vaccine vector can enhance its safety while increasing its efficacy as pre- and post-exposure treatment.
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Affiliation(s)
- Darryll A Barkhouse
- Department of Cancer Biology, 1020 Locust St., Jefferson Alumni Hall, Room 454, Philadelphia, PA 19107, USA; Center for Neurovirology 1020 Locust St., Jefferson Alumni Hall, Room 454, Philadelphia, PA 19107, USA
| | - Milosz Faber
- Center for Neurovirology 1020 Locust St., Jefferson Alumni Hall, Room 454, Philadelphia, PA 19107, USA; Department of Microbiology and Immunology 1020 Locust St., Jefferson Alumni Hall, Room 465, Philadelphia, PA 19107, USA
| | - D Craig Hooper
- Department of Cancer Biology, 1020 Locust St., Jefferson Alumni Hall, Room 454, Philadelphia, PA 19107, USA; Department of Neurological Surgery, 1020 Locust St., Jefferson Alumni Hall, Room 454, Philadelphia, PA 19107, USA; Center for Neurovirology 1020 Locust St., Jefferson Alumni Hall, Room 454, Philadelphia, PA 19107, USA.
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