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Saito N, Inton KL, Mauhay JD, Solante RM, Guzman FD, Yamada K, Kamiya Y, Saito-Obata M, Quiambao BP, Yahiro T, Kimitsuki K, Nishizono A. Puppies as the primary causal animal for human rabies cases: three-year prospective study of human rabies in the Philippines. Front Microbiol 2024; 15:1425766. [PMID: 39040907 PMCID: PMC11260713 DOI: 10.3389/fmicb.2024.1425766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 06/24/2024] [Indexed: 07/24/2024] Open
Abstract
Introduction While rabies remains a global concern, detailed studies on human rabies, particularly regarding causal animals and the reasons for not receiving postexposure prophylaxis (PEP), are lacking. Methods We conducted a 3-year prospective study (October 2019-September 2022) at the Philippines' largest rabies referral center. We interviewed patients with suspected rabies and their families. We used LN34 qRT-PCR and rapid fluorescent focus inhibition test on saliva samples. We also compared our findings with two retrospective studies at the same hospital. Results We enrolled 151 patients, including 131 with potential rabies exposure. Similar to retrospective studies, the participants were predominantly males (75.5%), adults (76.8%), low-income individuals (91.4%), and rural dwellers (62.3%). The causal animals were mainly dogs (97.0%), with similar incubation periods, clinical symptoms, and a high proportion not receiving vaccines or immunoglobulins (93.2%). Most causal animals were owned by either the patients' households or their neighbors (60.2%), with a significant proportion being puppies (58.8%). Most patients had knowledge of rabies; however, reasons for not seeking PEP included misconceptions about minor bites not causing rabies (51.3%), beliefs in traditional healers (33.9%), and economic constraints (22.6%). Despite completing the WHO regimen, two PEP failures were observed. LN34 qRT-PCR detected 98 positive cases (sensitivity, 64.9%; 95% CI 56.7-72.5). These strains belong to the Southeast Asia 4 subclade. Discussion In conclusion, this study highlights the role of puppies as primary causal animals and the presence of misconceptions that preclude patients from acquiring PEP.
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Affiliation(s)
- Nobuo Saito
- Research Center for Global and Local Infectious Diseases, Oita University, Yufu, Japan
- Department of Microbiology, Faculty of Medicine, Oita University, Yufu, Japan
- Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Karren L. Inton
- Department of Microbiology, Faculty of Medicine, Oita University, Yufu, Japan
| | - Jaira D. Mauhay
- Department of Microbiology, Faculty of Medicine, Oita University, Yufu, Japan
| | | | | | - Kentaro Yamada
- Laboratory of Veterinary Public Health, Department of Veterinary Medical Science, Faculty of Agriculture, University of Miyazaki, Miyazaki, Japan
| | - Yasuhiko Kamiya
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | | | | | - Takaaki Yahiro
- Research Center for Global and Local Infectious Diseases, Oita University, Yufu, Japan
- Department of Microbiology, Faculty of Medicine, Oita University, Yufu, Japan
| | - Kazunori Kimitsuki
- Research Center for Global and Local Infectious Diseases, Oita University, Yufu, Japan
- Department of Microbiology, Faculty of Medicine, Oita University, Yufu, Japan
| | - Akira Nishizono
- Research Center for Global and Local Infectious Diseases, Oita University, Yufu, Japan
- Department of Microbiology, Faculty of Medicine, Oita University, Yufu, Japan
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Zhao J, Luo M, Tan X, Zhu Z, Zhang M, Liu J, Lin W, Yang Y, Li X, Zeng W, Gong D, Rong Z, Huang Z, Zheng W, Guo H, Zeng S, Sun L, Xiao J. Spatial accessibility and inequality analysis of rabies-exposed patients to rabies post-exposure prophylaxis clinics in Guangzhou City, China. Int J Equity Health 2024; 23:122. [PMID: 38877457 PMCID: PMC11179278 DOI: 10.1186/s12939-024-02207-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 05/29/2024] [Indexed: 06/16/2024] Open
Abstract
BACKGROUND The incidence of rabies exposure is high and increasing in China, leading to an urgent demand of rabies post-exposure prophylaxis (PEP) clinics for the injured. However, the spatial accessibility and inequality of rabies-exposed patients to rabies PEP clinics is less known in China. METHODS Based on rabies exposure data, PEP clinic data, and resident travel origin-destination (OD) matrix data in Guangzhou City, China, we first described the incidence of rabies exposure in Guangzhou from 2020 to 2022. Then, the Gaussian two-step floating catchment area method (2SFCA) was used to analyze the spatial accessibility of rabies-exposed patients to rabies PEP clinics in Guangzhou, and the Gini coefficient and Moran's I statistics were utilized to evaluate the inequality and clustering of accessibility scores. RESULTS From 2020 to 2022, a total of 524,160 cases of rabies exposure were reported in Guangzhou, and the incidence showed a significant increasing trend, with an average annual incidence of 932.0/100,000. Spatial accessibility analysis revealed that the overall spatial accessibility scores for three scenarios (threshold of driving duration [d0] = 30 min, 45 min, and 60 min) were 0.30 (95% CI: 0.07, 0.87), 0.28 (95% CI: 0.11, 0.53) and 0.28 (95% CI: 0.14, 0.44), respectively. Conghua, Huangpu, Zengcheng and Nansha districts had the higher accessibility scores, while Haizhu, Liwan, and Yuexiu districts exhibited lower spatial accessibility scores. The Gini coefficient and Moran's I statistics showed that there were certain inequality and clustering in the accessibility to rabies PEP clinics in Guangzhou. CONCLUSIONS This study clarifies the heterogeneity of spatial accessibility to rabies PEP clinics, and provide valuable insights for resource allocation to achieve the WHO target of zero human dog-mediated rabies deaths by 2030.
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Affiliation(s)
- Jianguo Zhao
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, 511430, China
| | - Min Luo
- Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, 511430, China
| | - Xiaohua Tan
- Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, 511430, China
| | - Zhihua Zhu
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, 511430, China
| | - Meng Zhang
- Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, 511430, China
| | - Jun Liu
- Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, 511430, China
| | - Wenqing Lin
- Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, 511430, China
| | - Yuwei Yang
- Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, 511430, China
| | - Xing Li
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, 511430, China
| | - Weilin Zeng
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, 511430, China
| | - Dexin Gong
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, 511430, China
| | - Zuhua Rong
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, 511430, China
| | - Zitong Huang
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, 511430, China
- School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Wenyuan Zheng
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, 511430, China
- Department of Public Health and Preventive Medicine, School of Medicine, Ji'nan University, Guangzhou, 510632, China
| | - Huijie Guo
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, 511430, China
| | - Siqing Zeng
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, 511430, China
| | - Limei Sun
- Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, 511430, China.
| | - Jianpeng Xiao
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, 511430, China.
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Shen T, Welburn SC, Sun L, Yang GJ. Progress towards dog-mediated rabies elimination in PR China: a scoping review. Infect Dis Poverty 2023; 12:30. [PMID: 37024944 PMCID: PMC10077633 DOI: 10.1186/s40249-023-01082-3] [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] [Received: 10/01/2022] [Accepted: 03/14/2023] [Indexed: 04/08/2023] Open
Abstract
BACKGROUND Rabies continues to be a serious threat to global public health endangering people's health and public health safety. In the People's Republic of China, multi-sectoral and comprehensive prevention and control strategies have aimed to extensively curb human rabies transmission. Here, we examine the current state of rabies infection in China, explore strategic interventions put in place in response to WHO's ambition of "Zero rabies deaths by 2030" and critically assess the constraints and feasibility of dog-mediated rabies elimination in China. METHODS This study analyzed and evaluated the process towards dog-mediated rabies elimination in China from five perspectives: namely, human, dog, policy, challenge, and prospects. Evidence-based data on progress of dog-mediated rabies elimination in China was derived from a number of sources; a literature search was undertaken using PubMed, Web of Science and CNKI databases, distribution data for human rabies cases as derived from the Data-center of the China Public Health Science and policy and document data were obtained from official websites of the relevant China ministries and commissions. RESULTS The incidence of human rabies cases in China have shown a downward trend year-on-year since 2007. Implementation of a government-led, multi-sectoral "One Health" approach to combating rabies has driven down the total number of rabies deaths nationwide to around 200 in 2020. The number of provincial-level administrative divisions (PLADs) reporting human cases of rabies has also decreased to 21 in 2020, 13 of which reported less than 10 cases. Furthermore, the number of outpatient visits seeking rabies post-exposure prophylaxis has risen dramatically over the past two decades, with demand being 15 times higher than it was initially. There remain however, significant gaps in rabies elimination outcomes across the different regions of China. To date the target of achieving a canine rabies vaccination rate of > 75% has not been met. The challenges of rabies immunization of dogs and dog management in underdeveloped cities and rural areas need to be addressed together with more effective animal surveillance and rabies risk from and too wildlife and livestock. CONCLUSIONS The Chinese government-led, multi-sectoral "One Health" approach to combating rabies and has made significant progress over the past decade. Development and adoption of more cost-effective One Health strategies can achieve more nationally beneficial rabies elimination outcomes. The ambitious target of "Zero rabies deaths by 2030" can be met through establishment of long-lasting herd immunity in dogs by means of dog mass vaccination campaigns, dog population management, epidemiological surveillance and the application of large-scale oral rabies vaccine to eliminate rabies in wild animals coupled with deployment of cost-effective human post-exposure prophylaxis, and community education.
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Affiliation(s)
- Tianren Shen
- Zhejiang University-University of Edinburgh Joint Institute, Zhejiang University, International Campus, 718 East Haizhou Road, Haining, 314400, People's Republic of China
- Infection Medicine, Deanery of Biomedical Sciences, Edinburgh Medical School, College of Medicine and Veterinary Medicine, The University of Edinburgh, 1 George Square, Edinburgh, EH8 9JZ, Scotland, UK
| | - Susan Christina Welburn
- Zhejiang University-University of Edinburgh Joint Institute, Zhejiang University, International Campus, 718 East Haizhou Road, Haining, 314400, People's Republic of China
- Infection Medicine, Deanery of Biomedical Sciences, Edinburgh Medical School, College of Medicine and Veterinary Medicine, The University of Edinburgh, 1 George Square, Edinburgh, EH8 9JZ, Scotland, UK
| | - Long Sun
- Department of Infectious Diseases, The First Affiliated Hospital of Hainan Medical University, Hainan Medical University, Haikou, Hainan, People's Republic of China
| | - Guo-Jing Yang
- Key Laboratory of Tropical Translational Medicine of Ministry of Education, The School of Tropical Medicine, The First Affiliated Hospital, Hainan Medical University, Haikou, 571199, Hainan, People's Republic of China.
- Infection Medicine, Deanery of Biomedical Sciences, Edinburgh Medical School, College of Medicine and Veterinary Medicine, The University of Edinburgh, 1 George Square, Edinburgh, EH8 9JZ, Scotland, UK.
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Furthner E, Fabian R, Kipar A, Schuler G, Janett F, Nudelmann N, Kutter APN, Reichler IM. Epididymectomy as a novel surgical procedure; application in the domestic cat. Theriogenology 2023; 200:168-178. [PMID: 36806926 DOI: 10.1016/j.theriogenology.2023.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 02/09/2023] [Accepted: 02/09/2023] [Indexed: 02/12/2023]
Abstract
Feline overpopulation raises issues concerning health, ecology, economy, and ethics. Procedures to limit overpopulation should carefully address animal welfare, efficiency, costs, and feasibility. Vasectomy in unowned cats is suggested as preferable to standard neutering as it maintains male sexual behaviour which may induce ovulation and pseudopregnancy in intact females and may prevent immigration of other males. Vasectomy is not performed routinely because it is fastidious, time consuming and requires more material than standard neutering. We describe epididymectomy as an alternative. In a first experiment, we analysed semen, testosterone, behaviour and pain in six experimental cats before and after epididymectomy, and after castration two months later. Excised tissues were analysed histologically. Testosterone concentrations did not differ significantly between intact and epididymectomised animals but were significantly different after castration. Sexual behaviour and testicular spermatogenesis persisted after epididymectomy, but with a marked drop in the semen count after 7 days. The Glasgow pain scores did not differ significantly after epididymectomy and castration. In a subsequent experiment, 20 privately owned cats were epididymectomised and castrated immediately afterwards, to analyse the learning curve and perioperative complications. The time required for an epididymectomy was significantly shorter than for castration. The study confirms that epididymectomy is quicker and less invasive than castration, it is associated with minimal risks and post-operative pain while easy to learn and inexpensive. Further field studies are required to test its efficiency for feline feral population control or in other species such as in bears, lions or deer, where infertility is required and castration not wanted.
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Affiliation(s)
- Etienne Furthner
- Clinic of Reproductive Medicine, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland; Centre d'Etude en Reproduction des Carnivores, Ecole Nationale Vétérinaire d'Alfort, Maisons-Alfort, France.
| | - Rosalie Fabian
- Institute of Veterinary Pathology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Anja Kipar
- Institute of Veterinary Pathology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Gerhard Schuler
- Clinic for Obstetrics, Gynaecology and Andrology of Large and Small Animals, Faculty of Veterinary Medicine, Justus-Liebig-University Giessen, Giessen, Germany
| | - Fredi Janett
- Section of Andrology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Nicolas Nudelmann
- Centre d'Etude en Reproduction des Carnivores, Ecole Nationale Vétérinaire d'Alfort, Maisons-Alfort, France
| | - Annette P N Kutter
- Section of Anaesthesiology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Iris M Reichler
- Clinic of Reproductive Medicine, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
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Mohammad Basir MF, Mohd Hairon S, Tengku Ismail TA, Che' Muda CM, Abdul Halim HI. The Determinants of Non-compliance on Rabies Vaccination in North-West Peninsular Malaysia. J Epidemiol Glob Health 2023; 13:1-10. [PMID: 36622636 PMCID: PMC9828360 DOI: 10.1007/s44197-022-00080-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 11/25/2022] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Rabies post-exposure vaccination (Rabies PEV) remains the most fundamental prevention of human Rabies if administered in a timely and appropriate manner. The study was aimed to determine the proportion and determinants of non-compliance on Rabies PEV among dog bite patients in Perlis, Malaysia from July 2015 to June 2020. METHODS A retrospective cohort study was conducted using Perlis Rabid Potential Animal Bite Registry data. Independent variables and compliance status were obtained from the registry. Logistic regression analysis was utilized on 507 dog bite patients. RESULTS Most of dog bite patients were age group of 46-60 years old (23.1%), male (61.3%), Chinese (49.5%), seeking treatment less than 24 h after the exposure (78.3%), category two of exposure (76.3%) and bitten on lower extremities (57.8%) by an owned dog (58.4%). Only 19.5% were non-compliance to Rabies PEV. Siamese had significantly two-timed (AOR: 2.00; 95% CI 1.06, 3.76) odd higher to become non-compliance. Being bitten during 3rd (AOR: 0.27; 95% CI 0.12, 0.59), 4th (AOR: 0.24; 95% CI 0.11, 0.52) and 5th (AOR: 0.20; 95% CI 0.09, 0.44) year of the outbreak had significantly lower odds to non-comply with Rabies PEV. CONCLUSION 19.5% of dog bite patients still did not comply with the Rabies PEV series. Siamese would likely to non-comply whereas bitten on the 3rd, 4th and 5th years of outbreak less tendency to non-comply. Continuous health promotion to the public in the various languages despite outbreak status are ongoing to improve the perception of risk and benefit toward compliance of Rabies PEV.
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Affiliation(s)
- Mohammad Fazrul Mohammad Basir
- Department of Community Medicine, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, 16150, Kubang Kerian, Kelantan, Malaysia
| | - Suhaily Mohd Hairon
- Department of Community Medicine, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, 16150, Kubang Kerian, Kelantan, Malaysia.
| | - Tengku Alina Tengku Ismail
- Department of Community Medicine, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, 16150, Kubang Kerian, Kelantan, Malaysia
| | - Che Muzaini Che' Muda
- Communicable Disease Control Unit, Perlis State Health Department, Ministry of Health Malaysia, 01000, Kangar, Perlis, Malaysia
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Ji C, Feng J, Li S, Yang H, Wang H, Geng X, Wang H, Liu Z, Zhang T, He Y, Liu W. Factors Associated with Dog Rabies Immunization in Changsha, China: Results of a Cross-Sectional Cluster Survey, 2015-2021. Viruses 2022; 15:138. [PMID: 36680178 PMCID: PMC9863250 DOI: 10.3390/v15010138] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 12/27/2022] [Accepted: 12/27/2022] [Indexed: 01/04/2023] Open
Abstract
The objective of this study was to examine longitudinal trends in the prevalence of dogs that are successfully immunized against rabies virus (as measured by sufficient serum antibodies) in Changsha, an urban center of China. The secondary objective was to investigate the factors affecting the seroprevalence of rabies virus antibodies in dogs. In this study, 4515 canine serum samples were collected from 57 pet hospitals (immunization points) during the period of 2015-2021 in five major urban areas of Kaifu, Furong, Tianxin, Yuhua, and Yuelu in Changsha, China. The enzyme-linked immunosorbent assay (ELISA) method was used to analyze the level and trend of rabies virus antibodies in serum and further evaluate the potential factors affecting the immunization effect from five factors: sex, age, time interval after most recent vaccination and sample collection, number of vaccinations, and vaccine manufacturer. The results showed that the seroconversion from the urban dog in Changsha steadily increased from 46.13% to 73.38% during 2015-2017. The seropositivity prevalence remained above the international standard (70%) from 2018 to 2020 and up to 90.99% in 2021. Further analysis showed that the seroconversion of rabies virus among dogs was significantly affected by the age, the number of vaccinations, time interval after the most recent vaccination and sample collection, and vaccine manufacturer, while sex had less influence. The overall rabies vaccination situation in urban areas of Changsha generally meets international standards, with only a few areas showing low levels of antibodies in dogs after vaccination and risk of infectiousness. Therefore, it is recommended that the first vaccination should be given when the dog is about three months old and regularly repeated every year after that. At the same time, antibody concentrations in dogs, especially in newborn puppies and older dogs, need to be tested promptly after vaccination at the required time to ensure that they are at a high level of immune protection, which can strengthen the supervision of rabies.
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Affiliation(s)
- Chunxiao Ji
- College of Veterinary Medicine, Hunan Agricultural University, Changsha 410128, China
| | - Jia Feng
- Changsha Animal Disease Control Center, Changsha 410013, China
| | - Siying Li
- College of Bioscience and Biotechnology, Hunan Agricultural University, Changsha 410128, China
| | - Hui Yang
- Changsha Animal Disease Control Center, Changsha 410013, China
| | - Hui Wang
- Changsha Animal Disease Control Center, Changsha 410013, China
| | - Xiangchang Geng
- Changsha Animal Disease Control Center, Changsha 410013, China
| | - Hongliang Wang
- Changsha Animal Disease Control Center, Changsha 410013, China
| | - Zengzai Liu
- Changsha Animal Disease Control Center, Changsha 410013, China
| | - Tao Zhang
- Changsha Animal Disease Control Center, Changsha 410013, China
| | - Yu He
- Changsha Animal Disease Control Center, Changsha 410013, China
| | - Wei Liu
- College of Veterinary Medicine, Hunan Agricultural University, Changsha 410128, China
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Investigate Non-EPI Vaccination Recommendation Practice from a Socio-Ecological Perspective: A Mixed-Methods Study in China. Vaccines (Basel) 2022; 10:vaccines10122105. [PMID: 36560515 PMCID: PMC9788484 DOI: 10.3390/vaccines10122105] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 12/03/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022] Open
Abstract
The uptake of non-EPI vaccines, such as influenza and pneumonia vaccines, are very low in China compared to other countries. In China, immunization services are provided by dedicated vaccination service providers (VSPs), and their recommendation is the key to improve vaccine uptake. This study explores VSP recommendation practices for non-EPI vaccines from a socio-ecological perspective. A mixed-methods study, combining a questionnaire survey and key informant interviews, was conducted in Anhui, Shaanxi, and Guangdong provinces. 555 VSPs completed the valid questionnaire, and 49 VSPs participated in in-depth interviews. Among the surveyed VSPs, 51.54% stated that they always or often recommended non-EPI vaccines in work, and the remaining half reported that they sometimes or never recommended non-EPI vaccines. Most VSPs interviewed communicated about non-EPI vaccines with the public in an informed style, not a presumptive one, and provided the public with all the decision-making latitude. The infrequent recommendation of non-EPI vaccines was widely prevalent among Chinese VSPs regardless of their individual characteristics, and was mainly driven by the interpersonal relationship, institutional arrangement, and public policy. Firstly, the VSPs were concerned about conflicts arising from the recommendation of self-paid vaccines and the risk of adverse reactions following vaccination. Secondly, high workloads left them insufficient time to communicate about non-EPI vaccines. Thirdly, there was no performance assessment or financial incentive for VSPs to recommend non-EPI vaccination, and their main responsibility was around EPI vaccination. Therefore, multi-level socio-ecological systems around non-EPI vaccination should be improved to optimize the communication between VSPs and the public, which include a better system of legal redress to resolve potential misunderstandings between the VSPs and the public, more effective workload management through whole-process health information system and strengthening public health workforce, and the introduction of performance assessment and appropriate incentives on non-EPI vaccination.
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Whitehouse ER, Mandra A, Bonwitt J, Beasley EA, Taliano J, Rao AK. Human rabies despite post-exposure prophylaxis: a systematic review of fatal breakthrough infections after zoonotic exposures. THE LANCET INFECTIOUS DISEASES 2022; 23:e167-e174. [PMID: 36535276 DOI: 10.1016/s1473-3099(22)00641-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 08/05/2022] [Accepted: 09/06/2022] [Indexed: 12/23/2022]
Abstract
Post-exposure prophylaxis (PEP) for rabies is widely administered and highly effective. Nevertheless, sporadic breakthrough infections (ie, rabies in people who have started PEP) have been reported. We conducted a systematic review of articles published between Jan 1, 1980 and June 1, 2022 to characterise breakthrough infections. After reviewing 3380 articles from across all continents, we identified 52 articles, which included a total of 122 breakthrough infections. We classified breakthrough infections on the basis of adherence to core practices (ie, wound cleaning and vaccine administration). Of 86 breakthrough infections with data, median time from exposure to symptom onset was 20 days (IQR 16-24). Most (89 [77%] of 115) participants received PEP within 2 days of an exposure. Severe wounds (defined as those involving multiple wound sites or bites to the head, face, or neck) were common (80 [69%] of 116 [with data]). Deviations from core practices were reported in 68 (56%) of 122 cases. Other possible causes for breakthrough infections included errors in the administration of rabies immunoglobulin, delays in seeking health care, and comorbidities or immunosuppression. Cold-chain integrity assessments and potency testing of PEP biologics were only rarely assessed (8 [7%] of 122 cases), neither of which were found to be a cause of breakthrough infections. Timely and appropriate administration of PEP is crucial to prevent rabies, and although people with high-risk exposures or immunosuppression can develop rabies despite adherence to core practices, this occurrence remains exceedingly rare.
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Guzman FD, Iwamoto Y, Saito N, Salva EP, Dimaano EM, Nishizono A, Suzuki M, Oloko O, Ariyoshi K, Smith C, Parry CM, Solante RM. Clinical, epidemiological, and spatial features of human rabies cases in Metro Manila, the Philippines from 2006 to 2015. PLoS Negl Trop Dis 2022; 16:e0010595. [PMID: 35852994 PMCID: PMC9295989 DOI: 10.1371/journal.pntd.0010595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 06/18/2022] [Indexed: 11/18/2022] Open
Abstract
Rabies remains a public health problem in the Philippines despite the widespread provision of rabies vaccines and rabies immunoglobulin (RIG) as post-exposure prophylaxis (PEP). Detailed descriptions of recent human rabies cases in the Philippines are scarce. This study aimed to describe the clinical, epidemiological, and spatial features of human rabies cases between January 1, 2006, and December 31, 2015. We conducted a retrospective hospital-based case record review of all patients admitted to one referral hospital in Manila who received a clinical diagnosis of rabies. During the 10-year study period there were 575 patients (average 57.5 cases per year, range 57 to 119) with a final diagnosis of rabies. Most patients were male (n = 404, 70.3%) and aged ≥ 20 years (n = 433, 75.3%). Patients mostly came from the National Capital Region (n = 160, 28.0%) and the adjacent Regions III (n = 197, 34.4%) and IV-A (n = 168, 29.4%). Case mapping and heatmaps showed that human rabies cases were continuously observed in similar areas throughout the study period. Most patients had hydrophobia (n = 444, 95.5%) and/or aerophobia (n = 432, 93.3%). The leading causative animals were dogs (n = 421, 96.3%) and cats (n = 16, 3.7%). Among 437 patients with animal exposure history, only 42 (9.6%) had been administered at least one rabies vaccine. Two patients (0.5%), young children bitten on their face, had received and a full course of rabies vaccine. Human rabies patients were continuously admitted to the hospital, with no notable decline over the study period. The geographical area in which human rabies cases commonly occurred also did not change. Few patients received PEP and there were two suspected cases of PEP failure. The retrospective design of this study was a limitation; thus, prospective studies are required. Rabies remains a public health problem in the Philippines despite improvements in the availability of rabies vaccines and rabies immunoglobulin (RIG) as post-exposure prophylaxis (PEP). The incidence of rabies is highest in Metro Manila and surrounding areas. We reviewed the records of all human rabies patients admitted to the national infectious disease hospital in Manila between 2006 and 2015. This hospital treats most cases in this area. During the 10-year study period, human rabies cases were continuously admitted to the hospital, with no notable decline in numbers by year. Most patients were adult men bitten by domestic dogs. The geographical areas in which cases commonly occurred during the 10-year period also did not change over time. Only 9.6% of patients had received at least one dose of a rabies vaccine as PEP. Although the risk of PEP failure is reported to be almost zero, we identified two suspected cases of PEP failure. The retrospective design of this study was a limitation, and the exact details of PEP were not reliably available. As human rabies death is a significant public health concern, the circumstances of each case should be prospectively investigated. Further research is required to understand how to reduce the number of rabies cases.
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Affiliation(s)
| | - Yuta Iwamoto
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Nobuo Saito
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
- Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
- Department of Microbiology, Faculty of Medicine, Oita University, Yufu, Japan
- * E-mail:
| | | | | | - Akira Nishizono
- Department of Microbiology, Faculty of Medicine, Oita University, Yufu, Japan
| | - Motoi Suzuki
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
- Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Tokyo, Japan
| | - Oladeji Oloko
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Koya Ariyoshi
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
- Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Chris Smith
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
- Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Christopher M. Parry
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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Liu Y, Li L, Lyu J, Su C. Epidemiological Study of Outpatients in Rabies Post-Exposure Prophylaxis Clinics - Tianjin Municipality, China, 2020. China CDC Wkly 2021; 3:822-824. [PMID: 34595000 PMCID: PMC8477052 DOI: 10.46234/ccdcw2021.201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 09/02/2021] [Indexed: 11/14/2022] Open
Abstract
What is already known on this topic? Rabies remains a serious public health problem in China. The only way to prevent the fatal disease was through timely and adequate post-exposure prophylaxis (PEP). What is added by this report? Among all the 126,133 cases visited Tianjin PEP clinics during 2020, more than 90% of the patients were injured by domestic dogs or cats, and about 70% of the animals received vaccination. Most outpatients have knowledge of rabies and show high compatibility with PEP. What are the implications for public health practice? To better control rabies, we need to pay more attention to people who lack knowledge of rabies and help them gain awareness of PEP.
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Affiliation(s)
- Yifang Liu
- Tianjin Centers for Disease Control and Prevention, Tianjin, China
| | - Lin Li
- Tianjin Centers for Disease Control and Prevention, Tianjin, China
| | - Jie Lyu
- Tianjin Centers for Disease Control and Prevention, Tianjin, China
| | - Cheng Su
- Tianjin Centers for Disease Control and Prevention, Tianjin, China
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11
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Li Y, Rainey JJ, Yang H, Tran CH, Huai Y, Liu R, Zhu H, Wang Z, Mu D, Yin W, Guo C, Shiferaw M, Chen Q, Hu S, Li Z. Assessing clinicians' Post-Exposure Prophylaxis recommendations for rabies virus exposures in Hunan Province, China. PLoS Negl Trop Dis 2021; 15:e0009564. [PMID: 34228714 PMCID: PMC8284641 DOI: 10.1371/journal.pntd.0009564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 07/16/2021] [Accepted: 06/14/2021] [Indexed: 11/05/2022] Open
Abstract
Background Timely and appropriate administration of post-exposure prophylaxis (PEP) is an essential component of human rabies prevention programs. We evaluated patient care at rabies clinics in a high-risk county in Hunan Province, China to inform strategies needed to achieve dog-mediated human rabies elimination by 2030. Methods We collected information on PEP, staff capacity, and service availability at the 17 rabies clinics in the high-risk county during onsite visits and key staff interviews. Additionally, we conducted observational assessments at five of these clinics, identified through purposive sampling to capture real-time information on patient care during a four-week period. Wound categories assigned by trained observers were considered accurate per national guidelines for comparison purposes. We used the kappa statistic and an alpha level of 0.05 to assess agreement between observers and clinic staff. Results In 2015, the 17 clinics provided PEP to 5,261 patients. Although rabies vaccines were available at all 17 clinics, rabies immune globulin (RIG) was only available at the single urban clinic in the county. During the assessment period in 2016, 196 patients sought care for possible rabies virus exposures. According to observers, 88 (44%) patients had category III wounds, 104 (53%) had category II wounds and 4 (2%) had category I wounds. Observers and PEP clinic staff agreed on approximately half of the assigned wound categories (kappa = 0.55, p-value< 0.001). Agreement for the urban county-level CDC clinic (kappa = 0.93, p-value<0.001) was higher than for the township clinics (kappa = 0.16, p-value = 0.007). Using observer assigned wound categories, 142 (73%) patients received rabies vaccinations and RIG as outlined in the national guidelines. Conclusion Rabies PEP services were available at each town of the project county; however, gaps between clinical practice and national rabies guidelines on the use of PEP were identified. We used these findings to develop and implement a training to rabies clinic staff on wound categorization, wound care, and appropriate use of PEP. Additional risk-based approaches for evaluating human rabies virus exposures may be needed as China progresses towards elimination. Members of the United Nations agreed on a goal of eliminating dog-mediated rabies by 2030. To achieve this goal, China and other endemic rabies countries will need to increase dog rabies vaccination coverage as well as ensure proper administration of rabies post-exposure prophylaxis (PEP) for patients with animal wounds. PEP includes wound washing, timely vaccination, and rabies immune globulin (RIG) according to the type and severity of patients’ wounds. The authors conducted an observational assessment of PEP clinics in a high-risk county in Hunan Province. Most patients at these clinics received PEP according to the national guidelines; however, certain patients received PEP, when not warranted, and others did not receive RIG, as recommended for severe animal wounds. Wound type categorization and corresponding use of PEP were most accurate at the single urban clinic and least accurate at the rural clinics in the project county. RIG was only available at the single urban clinic. These findings highlight the importance of improving the use of PEP and access to RIG, particularly in rural areas, and exploring the use of risk-based approaches for evaluating human rabies virus exposures. These steps can contribute to eliminating dog-mediated rabies in the project county as well as elsewhere in China.
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Affiliation(s)
- Yu Li
- Division of Infectious Disease, Key Laboratory of Surveillance and Early-Warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jeanette J. Rainey
- Division of Global Health Protection, United States Centers for Disease Control and Prevention, Beijing, China
| | - Hao Yang
- Hunan Province Center for Disease Control and Prevention, Changsha, China
| | - Cuc H. Tran
- Division of High Consequence Pathogens and Pathology, United States Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Yang Huai
- Division of Global Health Protection, United States Centers for Disease Control and Prevention, Beijing, China
| | - Rongqiang Liu
- Shuangfeng Center for Disease Control and Prevention, Shuangfeng, China
| | - Hongwei Zhu
- Shuangfeng Center for Disease Control and Prevention, Shuangfeng, China
| | - Zhengliang Wang
- Shuangfeng Center for Disease Control and Prevention, Shuangfeng, China
| | - Di Mu
- Division of Infectious Disease, Key Laboratory of Surveillance and Early-Warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Wenwu Yin
- Division of Infectious Disease, Key Laboratory of Surveillance and Early-Warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Chun Guo
- School of Public Health, Huazhong University of Science and Technology, Wuhan, China
| | - Miriam Shiferaw
- Division of High Consequence Pathogens and Pathology, United States Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Qiulan Chen
- Division of Infectious Disease, Key Laboratory of Surveillance and Early-Warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
- * E-mail: (QC); (SH)
| | - Shixiong Hu
- Hunan Province Center for Disease Control and Prevention, Changsha, China
- * E-mail: (QC); (SH)
| | - Zhongjie Li
- Division of Infectious Disease, Key Laboratory of Surveillance and Early-Warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
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12
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Wang X, Yang F, Huang L, Chen R, Shan Y, Jia Y, Li F. Evaluation of rabies immunoglobulin administration status in China: a retrospective, cross-sectional study at a tertiary hospital in Beijing. Jpn J Infect Dis 2021; 75:76-82. [PMID: 34193661 DOI: 10.7883/yoken.jjid.2021.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This retrospective cross-sectional study included patients with category Ⅲ exposure to the rabies virus at a single center between January and December 2019. Exposure characteristics and clinical data were compared and statistically analyzed among groups willing and unwilling to receive RIG injection, and determinants of its administration were identified by stepwise multivariate logistic regression analyses. In total, 1,757 patients with category Ⅲ exposure were enrolled: 845 males (48.1%) and 912 females (51.9%; median age: 28 [9-50] years). Among them, 1,297 (73.8%) received RIG injection (median age: 28 [8-50] years) and 460 (26.2%) refused to receive the injection (median age: 25 [15-48] years). Patients aged 16-25 years (odds ratio [OR]=3.006, 95% confidence interval [CI]=1.957-4.619), 26-45years (OR=2.940, 95% CI=2.011-4.298), 46-55 years (OR=3.647, 95% CI=2.233-5.959) and over 56 years (OR=6.660, 95% CI=4.009-11.062); those with injuries caused by cats (OR=1.937, 95% CI=1.476- 2.542); and people with scratch (OR=3.319, 95% CI= 2.510-4.390), minor (OR=35.281, 95% CI=18.524-64.198), and moderate (OR=12.711, 95% CI=7.221-22.375) injuries were more likely to refuse injection. The RIG administration level in the settings studied herein is insufficient. Educational and awareness programs should be considered for rabies prevention, especially those targeted at people not injured by dogs, people with minor injuries, and the elderly.
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Affiliation(s)
- Xuefei Wang
- Emergency Department, The Sixth Medical Center of the People's Liberation Army (PLA) General Hospital, China
| | - Fen Yang
- Department of Neurology, Air Force Medicine Center, China
| | - Lisong Huang
- Emergency Department, The Sixth Medical Center of the People's Liberation Army (PLA) General Hospital, China
| | - Ruifeng Chen
- Emergency Department, The Sixth Medical Center of the People's Liberation Army (PLA) General Hospital, China
| | - Yi Shan
- Emergency Department, The Sixth Medical Center of the People's Liberation Army (PLA) General Hospital, China
| | - Yiqing Jia
- Emergency Department, The Sixth Medical Center of the People's Liberation Army (PLA) General Hospital, China
| | - Fei Li
- Emergency Department, The Sixth Medical Center of the People's Liberation Army (PLA) General Hospital, China
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13
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Bastos V, Mota R, Guimarães M, Richard Y, Lima AL, Casseb A, Barata GC, Andrade J, Casseb LMN. Challenges of Rabies Surveillance in the Eastern Amazon: The Need of a One Health Approach to Predict Rabies Spillover. Front Public Health 2021; 9:624574. [PMID: 34249829 PMCID: PMC8267869 DOI: 10.3389/fpubh.2021.624574] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 05/21/2021] [Indexed: 11/18/2022] Open
Abstract
Brazil has been promoting essential improvements in health indicators by implementing free-access health programs, which successfully reduced the prevalence of neglected zoonosis in urban areas, such as rabies. Despite constant efforts from the authorities to monitor and control the disease, sylvatic rabies is a current issue in Amazon's communities. The inequalities among Amazon areas challenge the expansion of high-tech services and limit the implementation of active laboratory surveillance to effectively avoid outbreaks in human and non-human hosts, which also reproduces a panorama of vulnerability in risk communities. Because rabies is a preventable disease, the prevalence in the particular context of the Amazon area highlights the failure of surveillance strategies to predict spillovers and indicates the need to adapt the public policies to a “One Health” approach. Therefore, this work assesses the distribution of free care resources and facilities among Pará's regions in the oriental Amazon; and discusses the challenges of implanting One Health in the particular context of the territory. We indicate a much-needed strengthening of the sylvatic and urban surveillance networks to achieve the “Zero by 30” goal, which is inextricable from multilateral efforts to combat the progressive biome's degradation.
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Affiliation(s)
- Victor Bastos
- Federal University of Pará, Institute of Biological Sciences, Belém, Brazil.,Department of Arbovirology and Hemorrhagic Fevers, Evandro Chagas Institute, Ananindeua, Brazil
| | - Roberta Mota
- Federal University of Pará, Institute of Biological Sciences, Belém, Brazil.,Department of Arbovirology and Hemorrhagic Fevers, Evandro Chagas Institute, Ananindeua, Brazil
| | - Mylenna Guimarães
- Department of Arbovirology and Hemorrhagic Fevers, Evandro Chagas Institute, Ananindeua, Brazil
| | - Yuri Richard
- Federal University of Pará, Institute of Biological Sciences, Belém, Brazil
| | - André Luis Lima
- Federal Rural University of the Amazon, Institute of Animal Health and Production, Belém, Brazil
| | - Alexandre Casseb
- Federal Rural University of the Amazon, Institute of Animal Health and Production, Belém, Brazil
| | | | - Jorge Andrade
- Pará State Health Secretary, Health Surveillance Directorate, Belém, Brazil
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14
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Du Z, Huang W, Zhang Y, Zhang P, Liu Z, Chen Q, Wang C. Assessment of the content, usability, and benefits of the WeChat-based programme for dog bite victims in China: A prospective observation study. Medicine (Baltimore) 2020; 99:e23657. [PMID: 33327351 PMCID: PMC7738026 DOI: 10.1097/md.0000000000023657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
WeChat in China has been used for public health education and the prevention of diseases. This study introduced a WeChat-based program for rabies prevention and evaluated the users' satisfaction with the program using the technology acceptance model.An online satisfaction questionnaire was used to survey 315 users who had followed the WeChat official account in China, and their satisfaction scores were assessed and analyzed.The users were generally satisfied with the WeChat-based program as an educational and instructional tool with the mean satisfaction score for each item ranging from 3.9 to 4.6 out of a maximum of 5.0 and the total mean satisfaction score of 41.5 out of a maximum of 50.0 (SD = 4.3). Urban users showed more satisfaction than rural users (P = .03). Users who were satisfied also reported that they intended to recommend WeChat to others (P = .00).Findings from the present study indicated that WeChat was considered a useful educational and instructional tool for dog-bite victims among young and urban population. This model of a WeChat-based program for rabies prevention should be expanded to other areas in China.
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Affiliation(s)
- Zhe Du
- Trauma Center, National Center for Trauma Medicine, Key Laboratory of Trauma and Neural Regeneration, Peking University People's Hospital
| | - Wei Huang
- Trauma Center, National Center for Trauma Medicine, Key Laboratory of Trauma and Neural Regeneration, Peking University People's Hospital
| | - Yajun Zhang
- Trauma Center, National Center for Trauma Medicine, Key Laboratory of Trauma and Neural Regeneration, Peking University People's Hospital
| | - Peng Zhang
- Trauma Center, National Center for Trauma Medicine, Key Laboratory of Trauma and Neural Regeneration, Peking University People's Hospital
| | - Zhongdi Liu
- Trauma Center, National Center for Trauma Medicine, Key Laboratory of Trauma and Neural Regeneration, Peking University People's Hospital
| | - Qingjun Chen
- Department of Emergency, Beijing Hepingli Hospital, Beijing, China
| | - Chuanlin Wang
- Trauma Center, National Center for Trauma Medicine, Key Laboratory of Trauma and Neural Regeneration, Peking University People's Hospital
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15
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Kisaka S, Makumbi FE, Majalija S, Bangirana A, Thumbi SM. Epidemiology and preclinical management of dog bites among humans in Wakiso and Kampala districts, Uganda: Implications for prevention of dog bites and rabies. PLoS One 2020; 15:e0239090. [PMID: 32956373 PMCID: PMC7505423 DOI: 10.1371/journal.pone.0239090] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 08/29/2020] [Indexed: 11/19/2022] Open
Abstract
In rabies endemic areas, appropriate management of dog bites is critical in human rabies prevention. Victims must immediately wash bite wound for 15 minutes with water, soap, and a disinfectant before seeking medical care. This study investigated the epidemiology of dog bites and the determinants of compliance to these pre-clinical guidelines requirements among dog bite victims from high rabies-burden areas of Wakiso and Kampala, Uganda. An explanatory sequential mixed-methods study design was used. Quantitative data were collected from 376 dog-bite patients at two healthcare facilities. Qualitative data were also collected through 13 in-depth interviews with patients, healthcare workers, herbalists, and veterinarians. Qualitative data were analyzed using a deductive thematic approach. Generalized linear models were used to determine factors associated with compliance. Nearly half (190, 51%) of the patients were from Wakiso District and 293 (77.9%) had grade II wounds. Most of the wounds (171, 45.5%) were on the legs. Two-thirds of the bites occurred in public places. Only 70 (19%) of the bite patients had complied with pre-clinical guidelines. Nearly half of the patients had applied substances that were not recommended e.g. herbs (47/193), antiseptics (46/193), "black stone" (25/193), and unknown creams (10/193). Factors negatively associated with compliance included: being aged 15 years or older, adjPR = 0.70 (0.47-0.92) and knowing the dog owner, adjPR = 0.65 (0.36-0.93). However, attainment of secondary or higher education, adjPR = 1.76 (1.24-3.79), being in employment, adjPR = 1.48 (1.09-2.31), perception that the dog was sick, adjPR = 1.47 (1.02-2.72) and knowledge about the dog's subsequent victim(s) adjPR = 0.35 (0.17-0.70) were positively associated with compliance. High occurrence of dog bites in public places by free-roaming dogs suggests the need for deliberate promotion of responsible dog ownership. Additionally, targeted health education may be required to improve the low compliance to pre-clinical guidelines.
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Affiliation(s)
- Stevens Kisaka
- University of Nairobi Institute of Tropical and Infectious Diseases, Nairobi, Kenya
- School of Public Health, Makerere University, Kampala, Uganda
- College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, Uganda
| | | | - Samuel Majalija
- College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, Uganda
| | - Alexander Bangirana
- Department of Emergency Medicine, Mulago National Referral Hospital, Kampala, Uganda
| | - S. M. Thumbi
- University of Nairobi Institute of Tropical and Infectious Diseases, Nairobi, Kenya
- Rabies Free Africa, Washington State University, Pullman, Washington, United States of America
- Paul G Allen School for Global Animal Health, Washington State University, Pullman, Washington, United States of America
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16
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Modern biologics for rabies prophylaxis and the elimination of human cases mediated by dogs. Expert Opin Biol Ther 2020; 20:1347-1359. [PMID: 32370562 DOI: 10.1080/14712598.2020.1766021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Introduction: Rabies is a major viral zoonosis and neglected tropical disease, with a global distribution. Humans, domestic animals, and wild mammals are susceptible to infection. Etiological agents reside in the Order Mononegavirales, Family Rhabdoviridae, Genus Lyssavirus. This acute, progressive encephalitis causes the highest case fatality of any conventional infectious disease. Tens of millions of humans become exposed annually to the bites of infected mammals, predominantly in Asia and Africa. Despite the existence of effective vaccines and immune globulins, tens of thousands of people, typically children in the developing world, succumb. Areas covered: Concentrating upon both historical and major published references from the peer-reviewed literature over the past 5 years, we describe current biologics for rabies prevention, newly recommended principles for prophylaxis, and relevant future products in the developmental pipeline. Expert opinion: Modern human rabies biologics are pure, potent, safe, and efficacious, when used in a timely and appropriate manner. Few individuals survive after clinical signs. Anti-viral compounds are not licensed. Experimental therapy, while obviously desirable, is highly controversial. Education on bite prevention and integrated risk management are critical. Access to affordable care, dose-sparing, and shortened regimens of human rabies biologics remain key.
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17
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Du Z, Chen Q, Lyu X, Wang T, Wang C. Analyzing the distribution of rabies clinics and achievements of standardized rabies clinics implementation in mainland China. BMC Health Serv Res 2019; 19:955. [PMID: 31829178 PMCID: PMC6907271 DOI: 10.1186/s12913-019-4730-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 11/08/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND For rabies prevention and treatment, the Chinese government has been establishing standardized rabies clinics since 2016. This study aimed to investigate the distribution of rabies clinics and the achievements of newly-implemented standardized rabies clinics in mainland China, for the purpose of providing further rabies control strategies. METHODS The number of rabies clinics, including per million inhabitants in each region, was determined. We sampled 1200 clinics from 8 provinces by multi-stage stratified sampling, and a questionnaire survey was carried out to record each clinic's achievements. Data collected from 1185 questionnaires were analyzed. RESULTS We found that rabies clinics were mostly located in the southwest, central, and eastern regions of China; these accounted for 67.1% of all clinics. The eastern and south regions showed the lowest number of rabies clinics per million inhabitants (0.15 and 0.12, respectively). The total standard-reaching rate of rabies clinics in mainland China was only 11.0%, with significant differences in the rate among regions (X2 = 33.004, p < 0.001). Specifically, the qualified rates of supporting facilities and functional areas were 13.9% (X2 = 34.003, p < 0.001) and 56.1% (X2 = 9.943, p = 0.019), respectively. Vaccines with 2 different substrates and professional flushing equipment were provided by 40.5% (X2 = 27.935, p = 0.001) and 37.7% (X2 = 54.922, p = 0.001) of clinics, respectively. CONCLUSION Regional differences do exist in the distribution of rabies clinics in mainland China, with relative low number per million population in south and eastern China. There are few standardized rabies clinics in mainland China. Efforts are needed to establish supporting facilities, especially for wound treatment and vaccination. Future research should focus on the improvement of rabies clinics standardization.
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Affiliation(s)
- Zhe Du
- Trauma Center, Peking University People's Hospital, No.11 South Xizhimen Street, Beijing, 100044, China
| | - Qingjun Chen
- Department of Emergency, Beijing Hepingli Hospital, Beijing, China
| | - Xinjun Lyu
- China Center for Disease Control and Prevention, Institute for Viral Disease Prevention and Control, Beijing, China
| | - Tianbing Wang
- Trauma Center, Peking University People's Hospital, No.11 South Xizhimen Street, Beijing, 100044, China.
| | - Chuanlin Wang
- Trauma Center, Peking University People's Hospital, No.11 South Xizhimen Street, Beijing, 100044, China. .,Department of Emergency, Peking University People's Hospital, Beijing, China.
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18
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Zhang J, Klepac P, Read JM, Rosello A, Wang X, Lai S, Li M, Song Y, Wei Q, Jiang H, Yang J, Lynn H, Flasche S, Jit M, Yu H. Patterns of human social contact and contact with animals in Shanghai, China. Sci Rep 2019; 9:15141. [PMID: 31641189 PMCID: PMC6805924 DOI: 10.1038/s41598-019-51609-8] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 09/29/2019] [Indexed: 12/17/2022] Open
Abstract
East Asia is as a principal hotspot for emerging zoonotic infections. Understanding the likely pathways for their emergence and spread requires knowledge on human-human and human-animal contacts, but such studies are rare. We used self-completed and interviewer-completed contact diaries to quantify patterns of these contacts for 965 individuals in 2017/2018 in a high-income densely-populated area of China, Shanghai City. Interviewer-completed diaries recorded more social contacts (19.3 vs. 18.0) and longer social contact duration (35.0 vs. 29.1 hours) than self-reporting. Strong age-assortativity was observed in all age groups especially among young participants (aged 7-20) and middle aged participants (25-55 years). 17.7% of participants reported touching animals (15.3% (pets), 0.0% (poultry) and 0.1% (livestock)). Human-human contact was very frequent but contact with animals (especially poultry) was rare although associated with frequent human-human contact. Hence, this densely populated area is more likely to act as an accelerator for human-human spread but less likely to be at the source of a zoonosis outbreak. We also propose that telephone interview at the end of reporting day is a potential improvement of the design of future contact surveys.
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Affiliation(s)
- Juanjuan Zhang
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Petra Klepac
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Public Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Jonathan M Read
- Centre for Health Informatics, Computation and Statistics, Lancaster Medical School, Lancaster University, Lancashire, UK
| | - Alicia Rosello
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Public Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Xiling Wang
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Shengjie Lai
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
- WorldPop, School of Geography and Environmental Science, University of Southampton, Southampton, UK
- Flowminder Foundation, Stockholm, Sweden
| | - Meng Li
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Yujian Song
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Qingzhen Wei
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Hao Jiang
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Juan Yang
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Henry Lynn
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Stefan Flasche
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Public Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Mark Jit
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Public Health, London School of Hygiene and Tropical Medicine, London, UK
- Modelling and Economics Unit, Public Health England, London, UK
- School of Public Health, University of Hong Kong, Hong Kong, China
| | - Hongjie Yu
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China.
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19
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Epidemiological and phylogenetic analysis of rabies virus isolated from humans in Henan province, China. Arch Virol 2019; 164:2811-2817. [DOI: 10.1007/s00705-019-04388-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 08/01/2019] [Indexed: 12/14/2022]
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