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Fasse J, Trawinski H, Hardt M, Lübbert C. [Postexposure prophylaxis after bite of a broad-winged bat with evidence of European bat lyssavirus 1 (EBLV-1)]. INNERE MEDIZIN (HEIDELBERG, GERMANY) 2024; 65:608-611. [PMID: 38100072 PMCID: PMC11136739 DOI: 10.1007/s00108-023-01638-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/28/2023] [Indexed: 05/31/2024]
Abstract
Germany has been considered free of terrestrial rabies since 2008 as a result of intensive vaccination and surveillance efforts but reservoirs of the lyssaviruses EBLV‑1 and EBLV‑2 persist in bat colonies and thus pose a potential risk of infection. We report on a patient who suffered a bat bite in an urban setting in which European bat lyssavirus 1 (EBLV-1) was detected in the euthanized bat. We performed active and passive postexposure prophylaxis (PEP). This case study illustrates the ongoing risk of rabies infection due to close bat contacts in Germany and is intended to sensitize primary care physicians to take such exposure events seriously and to perform a regular PEP including administration of rabies immunoglobulin.
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Affiliation(s)
- Jannik Fasse
- Bereich Infektiologie und Tropenmedizin, Medizinische Klinik I (Hämatologie, Zelltherapie, Hämostaseologie und Infektiologie), Universitätsklinikum Leipzig, Liebigstraße 20, Haus 4, 04103, Leipzig, Deutschland.
- Interdisziplinäres Zentrum für Infektionsmedizin (ZINF), Universitätsklinikum Leipzig, Leipzig, Deutschland.
| | - Henning Trawinski
- Bereich Infektiologie und Tropenmedizin, Medizinische Klinik I (Hämatologie, Zelltherapie, Hämostaseologie und Infektiologie), Universitätsklinikum Leipzig, Liebigstraße 20, Haus 4, 04103, Leipzig, Deutschland
- Interdisziplinäres Zentrum für Infektionsmedizin (ZINF), Universitätsklinikum Leipzig, Leipzig, Deutschland
| | - Michael Hardt
- Standort Leipzig, Landesuntersuchungsanstalt für das Gesundheits- und Veterinärwesen Sachsen (LUA), Leipzig, Deutschland
| | - Christoph Lübbert
- Bereich Infektiologie und Tropenmedizin, Medizinische Klinik I (Hämatologie, Zelltherapie, Hämostaseologie und Infektiologie), Universitätsklinikum Leipzig, Liebigstraße 20, Haus 4, 04103, Leipzig, Deutschland
- Interdisziplinäres Zentrum für Infektionsmedizin (ZINF), Universitätsklinikum Leipzig, Leipzig, Deutschland
- Klinik für Infektiologie und Tropenmedizin, Klinikum St. Georg gGmbH Leipzig, Leipzig, Deutschland
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Jokelainen P, Virtala AMK, Raulo S, Kantele A, Vapalahti O, Kinnunen PM. Veterinarians and zoonotic pathogens, infections and diseases - questionnaire study and case series, Finland. Infect Dis (Lond) 2024; 56:384-392. [PMID: 38344824 DOI: 10.1080/23744235.2024.2313662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 01/29/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Veterinarians are at risk for numerous zoonotic infections. In this paper, we summarise descriptions of zoonotic infections from a questionnaire study and a series of work-related zoonotic cases, aiming to add to the knowledge on occupational zoonotic risks of veterinarians. METHODS We collected data on zoonotic infections contracted by veterinarians in Finland in two studies:1) using a questionnaire in 2009, and 2) inviting veterinarians who had encountered an occupational zoonosis to report it in structured interviews in 2019. RESULTS AND CONCLUSIONS In the questionnaire study in 2009, of 306 veterinarians several reported zoonotic bacterial skin infections (12%), dermatophytosis (ringworm; 4.2%), virus infections (3.9%), bacterial gastroenteritis (3.3%), other bacterial zoonoses (2.3%), and parasitic infections/infestations (2.3%). In the 2019 interviews, 16 occupational zoonosis cases were reported. Of them, seven were selected to the case series. The selected cases included Capnocytophaga canimorsus sepsis following a dog bite, cryptosporidiosis after a contact with calves, cutaneous listeriosis following calving assistance, Salmonella gastroenteritis contracted at laboratory, Trichophyton dermatophytosis after equine contact, Bacillus anthracis exposure at necropsy, and exposure to rabies through a horse bite. In four of the seven cases, the veterinarian disagreed or strongly disagreed with having had good knowledge of the zoonosis before the incident. The results from the questionnaire study and the case series illustrate the variety of zoonotic pathogens that veterinarians may encounter. There is a need to improve the occupational health of veterinarians and to increase awareness in the occupational health sector. We encourage addressing this need using a One Health approach.
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Affiliation(s)
- Pikka Jokelainen
- Infectious Disease Preparedness, Statens Serum Institut, Copenhagen, Denmark
- Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
| | | | - Saara Raulo
- Zoonosis Centre, Finnish Food Authority, Helsinki, Finland
| | - Anu Kantele
- Meilahti Infectious Diseases and Vaccine Research Center MeIVac, Department of Infectious Diseases, University of Helsinki, Helsinki, Finland
- Helsinki University Hospital, Helsinki, Finland
| | - Olli Vapalahti
- Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
- Helsinki University Hospital, Helsinki, Finland
| | - Paula M Kinnunen
- Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
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Banović P, Mijatović D, Simin V, Vranješ N, Meletis E, Kostoulas P, Obregon D, Cabezas-Cruz A. Real-world evidence of rabies post-exposure prophylaxis in Serbia: Nation-wide observational study (2017-2019). Travel Med Infect Dis 2024; 58:102697. [PMID: 38369074 DOI: 10.1016/j.tmaid.2024.102697] [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: 11/02/2023] [Revised: 02/04/2024] [Accepted: 02/12/2024] [Indexed: 02/20/2024]
Abstract
BACKGROUND Rabies remains a deadly zoonotic disease, primarily prevalent in Eastern European countries, with a significant global burden in Asia and Africa. Post-exposure prophylaxis (PEP) is critical to prevent clinical rabies. Serbia, a country with a relatively low animal rabies incidence, has been implementing a 4-dose Essen PEP regimen for 13 years. This real-world study aimed to assess the effectiveness of the 4-dose Essen regimen, considering demographic and clinical factors, after WHO Category III exposure. METHOD The study included 601 patients who received the 4-dose Essen PEP and 79 who received an additional 5th dose. RESULTS Age emerged as a critical factor influencing seroconversion rates after the 4-dose regimen, with older individuals exhibiting lower RVNA titers. Logistic regression indicated a 3.18% decrease in seroconversion odds for each added year of age. The Cox proportional hazards mixed model highlighted age-related risks, with age groups 45-60 and 75-92 at the highest risk of non-seroconversion. Human Rabies Immune Globulin (HRIG) administration was associated with lower RVNA values after the 4-dose regimen, suggesting interference with vaccine immunogenicity among people who received larger doses of HRIG. CONCLUSIONS This study provides valuable real-world evidence for rabies PEP in a non-homogeneous population with potential comorbidities. The results underscore the importance of optimizing PEP strategies, particularly in older individuals, and reconsidering HRIG dosing to improve seroconversion rates.
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Affiliation(s)
- Pavle Banović
- Department for Prevention of Rabies and Other Infectious Diseases, Pasteur Institute Novi Sad, Novi Sad 21000, Serbia; Department of Microbiology with Parasitology and Immunology, Faculty of Medicine, University of Novi Sad, Novi Sad 21000, Serbia.
| | - Dragana Mijatović
- Department for Research & Monitoring of Rabies & Other Zoonoses, Pasteur Institute Novi Sad, 21000 Novi Sad, Serbia
| | - Verica Simin
- Department of Microbiology, Pasteur Institute Novi Sad, 21000 Novi Sad, Serbia
| | - Nenad Vranješ
- Department for Research & Monitoring of Rabies & Other Zoonoses, Pasteur Institute Novi Sad, 21000 Novi Sad, Serbia
| | - Eleftherios Meletis
- Faculty of Public and One Health, School of Health Sciences, University of Thessaly, 24410 Karditsa, Greece
| | - Polychronis Kostoulas
- Faculty of Public and One Health, School of Health Sciences, University of Thessaly, 24410 Karditsa, Greece
| | - Dasiel Obregon
- School of Environmental Sciences University of Guelph, Guelph, Ontario N1G 2W1, Canada
| | - Alejandro Cabezas-Cruz
- ANSES, INRAE, Ecole Nationale Vétérinaire d'Alfort, UMR BIPAR, Laboratoire de Santé Animale, Maisons-Alfort F-94700, France
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Steffen R, Chen LH, Leggat PA. Travel vaccines-priorities determined by incidence and impact. J Travel Med 2023; 30:taad085. [PMID: 37341307 DOI: 10.1093/jtm/taad085] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/05/2023] [Accepted: 06/06/2023] [Indexed: 06/22/2023]
Abstract
BACKGROUND Infectious disease epidemiology is continuously shifting. While travel has been disrupted by the COVID-19 pandemic and travel-related epidemiological research experienced a pause, further shifts in vaccine-preventable diseases (VPDs) relevant for travellers have occurred. METHODS We conducted a literature search on the epidemiology of travel-related VPD and synthesized data for each disease with a focus on symptomatic cases and on the impact of the respective infection among travellers, considering the hospitalization rate, disease sequela and case fatality rate. We present new data and revised best estimates on the burden of VPD relevant for decisions on priorities in travel vaccines. RESULTS COVID-19 has emerged to be a top travel-related risk and influenza remains high in the ranking with an estimated incidence at 1% per month of travel. Dengue is another commonly encountered infection among international travellers with estimated monthly incidence of 0.5-0.8% among non-immune exposed travellers; the hospitalized proportion was 10 and 22%, respectively, according to two recent publications. With recent yellow fever outbreaks particularly in Brazil, its estimated monthly incidence has risen to >0.1%. Meanwhile, improvements in hygiene and sanitation have led to some decrease in foodborne illnesses; however, hepatitis A monthly incidence remains substantial in most developing regions (0.001-0.01%) and typhoid remains particularly high in South Asia (>0.01%). Mpox, a newly emerged disease that demonstrated worldwide spread through mass gathering and travel, cannot be quantified regarding its travel-related risk. CONCLUSION The data summarized may provide a tool for travel health professionals to prioritize preventive strategies for their clients against VPD. Updated assessments on incidence and impact are ever more important since new vaccines with travel indications (e.g. dengue) have been licensed or are undergoing regulatory review.
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Affiliation(s)
- Robert Steffen
- Epidemiology, Biostatistics and Prevention Institute, Department of Public and Global Health, Division of Infectious Diseases, World Health Organization Collaborating Centre for Travelers' Health, University of Zurich, Zurich 8001, Switzerland
- Division of Epidemiology, Human Genetics & Environmental Sciences, University of Texas School of Public Health, Houston, TX 77030, USA
| | - Lin H Chen
- Division of Infectious Diseases and Travel Medicine, Mount Auburn Hospital, Cambridge, MA 02138, USA
- Faculty of Medicine, Harvard Medical School, Boston, MA 02115, USA
| | - Peter A Leggat
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland 4810, Australia
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2193, South Africa
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Yuan F, Iso T, Rizk E, Saldana RB, Tran AT, Nguyen NAA, Boyareddigari PR, Espino D, Swan JT. Implementation of Clinical Decision Support on Emergency Department Delivery of Human Rabies Immune Globulin. JAMA Netw Open 2022; 5:e2216631. [PMID: 35727583 PMCID: PMC9214583 DOI: 10.1001/jamanetworkopen.2022.16631] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Fatal human rabies infections can be prevented through appropriate rabies postexposure prophylaxis (PEP). Errors in patient selection and administration of human rabies immune globulin in the emergency department (ED) setting were identified in a previous study of rabies PEP administration. OBJECTIVE To test the a priori hypothesis that implementation of a rabies PEP bundle in the ED would improve full adherence to 6 human rabies immune globulin quality indicators compared with preimplementation controls. DESIGN, SETTING, AND PARTICIPANTS This quality improvement study was conducted in 15 EDs in a US multihospital health system. Patients who received human rabies immune globulin or rabies vaccine in the ED from January 2015 to June 2018 were included in the preimplementation control group and from December 2019 to November 2020 were included in the postimplementation intervention group. Data were analyzed in January 2021. EXPOSURE The PEP bundle was implemented in December 2019 and consisted of electronic health record enhancements, including clinical decision support, ED staff education, and patient education. MAIN OUTCOMES AND MEASURES Full adherence to 6 human rabies immune globulin quality indicators: patient selection, dose, timing, infiltration into wounds, administration distant from rabies vaccine site, and administration that avoids the buttock. RESULTS The study included 324 patients; 254 patients were in preimplementation group (mean [SD] age, 39 [21] years; 135 [53%] women) and 70 in the postimplementation group (mean [SD] age, 38 [19] years; 33 [47%] women). Most patients presented to EDs embedded in a community hospital (231 patients [71%]). Full adherence increased from 37% in the preimplementation group to 61% postimplementation (absolute increase, 24%; 95% CI, 11% to 37%; P < .001). Adherence improved for quality indicators for infiltration into wounds (137 of 254 patients [54%] to 50 of 70 patients [71%]; P = .009), administration distant from rabies vaccine site (180 of 254 [71%] to 58 of 70 [83%]; P = .04), and administration that avoids the buttock (168 of 254 [66%] to 58 of 70 [83%]; P = .007). No instances of sciatic nerve injury or compartment syndrome were observed. CONCLUSIONS AND RELEVANCE In this quality improvement study, implementation of a rabies PEP bundle was associated with improved patient selection and delivery of human rabies immune globulin in EDs across a multihospital health system. Although the bundle included ED staff education and patient discharge education, the observed improvement was likely driven by clinical decision support from the rabies PEP ED order set. Future research should evaluate implementation of this clinical decision support at other health systems.
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Affiliation(s)
- Fangzheng Yuan
- Department of Pharmacy, Houston Methodist, Houston, Texas
- Department of Surgery, Houston Methodist, Houston, Texas
| | - Tomona Iso
- Department of Pharmacy, Houston Methodist, Houston, Texas
- Department of Surgery, Houston Methodist, Houston, Texas
| | - Elsie Rizk
- Department of Pharmacy, Houston Methodist, Houston, Texas
- Department of Surgery, Houston Methodist, Houston, Texas
| | - R. Benjamin Saldana
- Department of Emergency Medicine, Houston Methodist Hospital, Houston, Texas
| | - Anh Thu Tran
- Department of Pharmacy, Houston Methodist, Houston, Texas
- Department of Surgery, Houston Methodist, Houston, Texas
| | - Ngoc-anh A. Nguyen
- Department of Emergency Medicine, Houston Methodist Hospital, Houston, Texas
| | | | - Daniela Espino
- Department of Pharmacy, Houston Methodist, Houston, Texas
- Department of Emergency Medicine, Houston Methodist Hospital, Houston, Texas
| | - Joshua T. Swan
- Department of Pharmacy, Houston Methodist, Houston, Texas
- Department of Surgery, Houston Methodist, Houston, Texas
- Center for Outcomes Research, Houston Methodist, Houston, Texas
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Whitehouse ER, Person MK, Brown CM, Slavinski S, Rao AK, Blanton JD. Evaluating Surveillance for and Estimating Administration of Rabies Postexposure Prophylaxis in the United States, 2012-2018. PLoS Negl Trop Dis 2021; 15:e0009878. [PMID: 34695115 PMCID: PMC8568135 DOI: 10.1371/journal.pntd.0009878] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 11/04/2021] [Accepted: 10/05/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND An evaluation of postexposure prophylaxis (PEP) surveillance has not been conducted in over 10 years in the United States. An accurate assessment would be important to understand current rabies trends and inform public health preparedness and response to human rabies. METHODOLOGY/PRINCIPLE FINDINGS To understand PEP surveillance, we sent a survey to public health leads for rabies in 50 U.S. states, Puerto Rico, Washington DC, Philadelphia, and New York City. Of leads from 54 jurisdictions, 39 (72%) responded to the survey; 12 reported having PEP-specific surveillance, five had animal bite surveillance that included data about PEP, four had animal bite surveillance without data about PEP, and 18 (46%) had neither. Although 12 jurisdictions provided data about PEP use, poor data quality and lack of national representativeness prevented use of this data to derive a national-level PEP estimate. We used national-level and state specific data from the Healthcare Cost & Utilization Project (HCUP) to estimate the number of people who received PEP based on emergency department (ED) visits. The estimated annual average of initial ED visits for PEP administration during 2012-2017 in the United States was 46,814 (SE: 1,697), costing upwards of 165 million USD. State-level ED data for initial visits for administration of PEP for rabies exposure using HCUP data was compared to state-level surveillance data from Maryland, Vermont, and Georgia between 2012-2017. In all states, state-level surveillance data was consistently lower than estimates of initial ED visits, suggesting even states with robust PEP surveillance may not adequately capture individuals who receive PEP. CONCLUSIONS Our findings suggest that making PEP a nationally reportable condition may not be feasible. Other methods of tracking administration of PEP such as syndromic surveillance or identification of sentinel states should be considered to obtain an accurate assessment.
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Affiliation(s)
- Erin R. Whitehouse
- Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- * E-mail:
| | - Marissa K. Person
- Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Catherine M. Brown
- Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health, Boston, Massachusetts, United States of America
| | - Sally Slavinski
- New York City Department of Health and Mental Hygiene, New York, New York, United States of America
| | - Agam K. Rao
- Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Jesse D. Blanton
- Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Makovska IF, Krupinina TM, Nedosekov VV, Tsarenko TM, Novohatniy YA, Fahrion AS. Current issues and gaps in the implementation of rabies prevention in Ukraine in recent decades. REGULATORY MECHANISMS IN BIOSYSTEMS 2021. [DOI: 10.15421/022134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Ukraine remains the only country in Europe where rabies is widespread among animals and humans. Annually there are about 1,600 rabies cases in animals in Ukraine and sporadic cases in humans have been registered despite the conducting of preventive measures. Therefore, the aim of the study was to inspect the failures in rabies prevention, indicate the top reasons for human cases and highlights the risk of animal attacks in view of their species and geographical distribution in Ukraine during 1996–2020. The following archival state materials were used for analysis: from the Ministry of Health of Ukraine and from the annual reports of oblast departments of the State Service of Ukraine for Food Safety and Consumer Protection. In general, more than 84,000 people (187.4 per 100,000 of the population) were affected by bites or harmful contact with animals every year, among them, 2,155 people were victims of rabid animals. Post-exposure prophylaxis (PEP) was prescribed annually, on average, for 21,434 patients (25.5% of all victims). Most people were attacked by cats and dogs that had owners (71.5%). The frequency of the proportion of the risk of attacks by rabid dogs on humans was (1:124), from cats (1:25), wild animals (1:7), and farm animals (1:2), but the largest general proportion of animal attacks on people was from dogs – 838,635 attacks (77.7%). Thus, due to the permanently higher level of contact with people, attacks by dogs remains more dangerous. Geographically attacks on humans by domestic carnivores were observed most commonly in the east part of Ukraine due to the high urbanization of the region and the high density of the human population. A large number of attacks by foxes was observed in the west part of Ukraine due to the larger area of forests and fields. During the last 25 years, there have been 63 human rabies cases. The main sources of rabies were dogs (24 cases) and cats (22 cases). The main causes of development of rabies were: failure to receive the PEP due to the absence of a visit to a hospital after an attack of an animal (n = 38), failures in prescribing PEP (n = 15), failure of PEP (n = 10). In conclusion, the gaps in the control measures against rabies are the lack of agreed coordination of inter-sectoral links, the lack of significant efforts to raise public awareness and the lack of funding for prophylaxis programmes for humans and animals. Our future research will be aimed at modelling the transmission of rabies from the pet population to humans.
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