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Septelici D, Carbone G, Cipri A, Esposito S. Management Strategies for Common Animal Bites in Pediatrics: A Narrative Review on the Latest Progress. Microorganisms 2024; 12:924. [PMID: 38792754 PMCID: PMC11124134 DOI: 10.3390/microorganisms12050924] [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: 03/23/2024] [Revised: 04/28/2024] [Accepted: 04/30/2024] [Indexed: 05/26/2024] Open
Abstract
Animal bites are a common reason for children to visit primary care and emergency departments. Dog bites are the most prevalent, followed by cat bites at 20-30%. Other animals such as bats, monkeys, snakes, and rats collectively contribute less than 1% of cases. Hospitalization is necessary in only 4% of animal bite incidents. The main aim of this narrative review is to summarize the main protocols currently followed in pediatrics in cases involving the most common bites from different animal species. Analysis of the literature showed that the management of common animal bites in children presents a multifaceted challenge requiring a comprehensive understanding of the epidemiology, clinical presentation, and treatment modalities associated with each specific species. Effective wound management is paramount in reducing the risk of infection and promoting optimal healing outcomes. Additionally, tetanus vaccination status should be assessed and updated as necessary, and prophylactic antibiotics may be indicated in certain cases to prevent secondary infections. Furthermore, the role of rabies prophylaxis cannot be overstated, particularly in regions where rabies is endemic or following bites from high-risk animals. In addition to medical management, psychosocial support for both the child and their caregivers is integral to the overall care continuum. Future studies exploring the efficacy of novel treatment modalities, such as topical antimicrobial agents or advanced wound dressings, may offer new insights into optimizing wound healing and reducing the risk of complications.
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Affiliation(s)
| | | | | | - Susanna Esposito
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (D.S.); (G.C.); (A.C.)
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2
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Ferreira-Machado E, Conselheiro JA, Bernardes da Silva BE, Matsumoto PSS, Castagna CL, Nitsche A, de Lima CS, Presotto D, Nunes da Silva MCR, Ervedosa TB, Navas-Suárez PE, de Jesus ÍP, de Carvalho J, Ressio RA, dos Santos Cirqueira C, Barone GT, del Castillo Saad L, Brandão PE, Catão-Dias JL, Guerra JM, de Azevedo Fernandes NCC. Naturally Acquired Rabies in White-Eared Opossum, Brazil. Emerg Infect Dis 2023; 29:2541-2545. [PMID: 37987590 PMCID: PMC10683831 DOI: 10.3201/eid2912.230373] [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] [Indexed: 11/22/2023] Open
Abstract
Opossums are considered resistant to rabies. Nonhematophagous bats are reservoirs of rabies in urban areas of South America. We analyzed bats and opossums tested for rabies during 2021 in a highly urbanized city in Brazil to understand spillover in an urban setting. Wildlife surveillance is necessary to prevent rabies in humans and domestic animals.
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3
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Willoughby R. Aging and Rabies Prophylaxis. Clin Infect Dis 2023; 77:931. [PMID: 37200494 DOI: 10.1093/cid/ciad293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 05/12/2023] [Indexed: 05/20/2023] Open
Affiliation(s)
- Rodney Willoughby
- Medical College of Wisconsin-Children's Hospital of Wisconsin, Wauwatosa, Wisconsin, USA
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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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5
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Tierradentro-García LO, Cortés-Albornoz MC, Talero-Gutiérrez C. Of love and other demons: depicting human rabies in Colombia. Heliyon 2022; 8:e09703. [PMID: 35734566 PMCID: PMC9207665 DOI: 10.1016/j.heliyon.2022.e09703] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 07/08/2021] [Accepted: 06/06/2022] [Indexed: 11/18/2022] Open
Abstract
Human rabies has been described by various cultures in many countries around the world. Gabriel García Márquez's novel Of love and other demons recounts the story of a girl who, in colonial Colombia in the 18th century, was bitten by a rabid dog. This paper aims to review the general status of the disease in Colombia and interweave it with García Márquez's book. Developed countries have successfully controlled dog-mediated rabies virus transmission, whereas in some countries in Latin America wildlife and canine rabies are still an issue. Our approach suggests that although the measures that have been taken to mitigate dog-transmitted rabies have worked well in most parts of the world, greater efforts are required to control sylvatic rabies transmitted by bats or other mammals, as occurs in Colombia. Since developing countries are the most affected by the disease at present, transdisciplinary commitment between human and veterinary sectors is necessary to fight against rabies virus transmission.
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Affiliation(s)
- Luis Octavio Tierradentro-García
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Neuroscience Research Group (NeURos), Escuela de Medicina y Ciencias de La Salud, Universidad Del Rosario, Bogotá D.C., Colombia
- Centro de Neurociencia Neurovitae-UR, Escuela de Medicina y Ciencias de La Salud, Universidad Del Rosario, Bogotá D.C., Colombia
- Corresponding author.
| | - María Camila Cortés-Albornoz
- Neuroscience Research Group (NeURos), Escuela de Medicina y Ciencias de La Salud, Universidad Del Rosario, Bogotá D.C., Colombia
- Centro de Neurociencia Neurovitae-UR, Escuela de Medicina y Ciencias de La Salud, Universidad Del Rosario, Bogotá D.C., Colombia
| | - Claudia Talero-Gutiérrez
- Neuroscience Research Group (NeURos), Escuela de Medicina y Ciencias de La Salud, Universidad Del Rosario, Bogotá D.C., Colombia
- Centro de Neurociencia Neurovitae-UR, Escuela de Medicina y Ciencias de La Salud, Universidad Del Rosario, Bogotá D.C., Colombia
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Appolinário CM, Daly JM, Emes RD, Marchi FA, Ribeiro BLD, Megid J. Gene Expression Profile Induced by Two Different Variants of Street Rabies Virus in Mice. Viruses 2022; 14:v14040692. [PMID: 35458422 PMCID: PMC9031335 DOI: 10.3390/v14040692] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 03/20/2022] [Accepted: 03/24/2022] [Indexed: 12/10/2022] Open
Abstract
Pathogenicity and pathology of rabies virus (RABV) varies according to the variant, but the mechanisms are not completely known. In this study, gene expression profile in brains of mice experimentally infected with RABV isolated from a human case of dog rabies (V2) or vampire bat-acquired rabies (V3) were analyzed. In total, 138 array probes associated with 120 genes were expressed differentially between mice inoculated with V2 and sham-inoculated control mice at day 10 post-inoculation. A single probe corresponding to an unannotated gene was identified in V3 versus control mice. Gene ontology (GO) analysis revealed that all of the genes upregulated in mice inoculated with V2 RABV were involved in the biological process of immune defense against pathogens. Although both variants are considered pathogenic, inoculation by the same conditions generated different gene expression results, which is likely due to differences in pathogenesis between the dog and bat RABV variants. This study demonstrated the global gene expression in experimental infection due to V3 wild-type RABV, from the vampire bat Desmodus rotundus, an important source of infection for humans, domestic animals and wildlife in Latin America.
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Affiliation(s)
- Camila M. Appolinário
- Faculdade de Medicina Veterinária e Zootecnia, Universidade Estadual Paulista, Julio de Mesquita Filho, Distrito de Rubião Júnior, s/n, CEP, Botucatu 18618-970, SP, Brazil;
- Correspondence: (C.M.A.); (J.M.)
| | - Janet M. Daly
- School of Veterinary Medicine and Science, University of Nottingham, Sutton Bonington Campus, Loughborough LE12 5RD, UK; (J.M.D.); (R.D.E.)
| | - Richard D. Emes
- School of Veterinary Medicine and Science, University of Nottingham, Sutton Bonington Campus, Loughborough LE12 5RD, UK; (J.M.D.); (R.D.E.)
| | | | - Bruna Leticia Devidé Ribeiro
- Faculdade de Medicina Veterinária e Zootecnia, Universidade Estadual Paulista, Julio de Mesquita Filho, Distrito de Rubião Júnior, s/n, CEP, Botucatu 18618-970, SP, Brazil;
| | - Jane Megid
- Faculdade de Medicina Veterinária e Zootecnia, Universidade Estadual Paulista, Julio de Mesquita Filho, Distrito de Rubião Júnior, s/n, CEP, Botucatu 18618-970, SP, Brazil;
- Correspondence: (C.M.A.); (J.M.)
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7
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Frederickson JJ, Monroe AK, Hall GA, Weant KA. Characterization of Emergency Department Rabies Post-Exposure Prophylaxis Procedures with an Infectious Diseases Clinic Referral Process. Hosp Pharm 2022; 57:38-44. [PMID: 35521016 PMCID: PMC9065527 DOI: 10.1177/0018578720973889] [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: 02/03/2023]
Abstract
Purpose: Rabies post-exposure prophylaxis (rPEP) in the emergency department (ED) is associated with high costs, complicated administration protocols, and a time-sensitive vaccination series that often requires ED follow-up visits for subsequent vaccine administration. This study sought to characterize the number of redirected vaccine administrations in those patients referred to ID Clinic, guideline compliance, and opportunities for improvement. Methods: Retrospective chart review of adult and pediatric patients presenting to the ED from 2016 to 2019 and prescribed rabies immunoglobulin. Results: Of the 89 patients included, 66.3% were referred to ID Clinic. Those referred to clinic had significantly fewer average visits to the ED for repeat vaccination (P < .001). Of the 177 vaccinations prescribed for patients referred, 105 were administered in clinic. Overall, having insurance significantly increased the odds of completing the prescribed vaccination series (Odds Ratio (OR) = 4.34, 95% Confidence Interval (CI) = 1.34 to 15.52). Among those patients referred to clinic, having insurance significantly increased the odds of receiving any follow-up doses in clinic (OR = 6.00, 95% CI = 1.48 to 25.98), receiving all of their prescribed follow-up doses in clinic (OR = 10.00, 95% CI = 1.72 to 190.80), and completing the entirety of their vaccination series (OR = 5.89, 95% CI = 1.50 to 26.21). Conclusions: The use of an ID Clinic referral process for rPEP resulted in a significant reduction in the average number of visits to the ED for repeat vaccination, hence avoiding 105 ED visits. Insurance status was a significant factor in both the utilization of the ID Clinic referral system and overall completion of the vaccination series. Future research should explore workflows inclusive of both ED care and outpatient follow-up, care plans for the uninsured, and mechanisms to limit the number of patients that fail to complete the recommended vaccination series.
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Affiliation(s)
| | - Alexandra K. Monroe
- Department of Emergency Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Gregory A. Hall
- Department of Emergency Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Kyle A. Weant
- Department of Clinical Pharmacy and Outcomes Sciences, College of Pharmacy, University of South Carolina, Columbia, SC, USA
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8
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Scott TP, Nel LH. Lyssaviruses and the Fatal Encephalitic Disease Rabies. Front Immunol 2021; 12:786953. [PMID: 34925368 PMCID: PMC8678592 DOI: 10.3389/fimmu.2021.786953] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 11/17/2021] [Indexed: 12/12/2022] Open
Abstract
Lyssaviruses cause the disease rabies, which is a fatal encephalitic disease resulting in approximately 59,000 human deaths annually. The prototype species, rabies lyssavirus, is the most prevalent of all lyssaviruses and poses the greatest public health threat. In Africa, six confirmed and one putative species of lyssavirus have been identified. Rabies lyssavirus remains endemic throughout mainland Africa, where the domestic dog is the primary reservoir - resulting in the highest per capita death rate from rabies globally. Rabies is typically transmitted through the injection of virus-laden saliva through a bite or scratch from an infected animal. Due to the inhibition of specific immune responses by multifunctional viral proteins, the virus usually replicates at low levels in the muscle tissue and subsequently enters the peripheral nervous system at the neuromuscular junction. Pathogenic rabies lyssavirus strains inhibit innate immune signaling and induce cellular apoptosis as the virus progresses to the central nervous system and brain using viral protein facilitated retrograde axonal transport. Rabies manifests in two different forms - the encephalitic and the paralytic form - with differing clinical manifestations and survival times. Disease symptoms are thought to be due mitochondrial dysfunction, rather than neuronal apoptosis. While much is known about rabies, there remain many gaps in knowledge about the neuropathology of the disease. It should be emphasized however, that rabies is vaccine preventable and dog-mediated human rabies has been eliminated in various countries. The global elimination of dog-mediated human rabies in the foreseeable future is therefore an entirely feasible goal.
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Affiliation(s)
| | - Louis Hendrik Nel
- Global Alliance for Rabies Control, Manhattan, KS, United States
- Department of Biochemistry, Genetics and Microbiology, Faculty of Natural and Agricultural Sciences, University of Pretoria, Pretoria, South Africa
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Riccardi N, Giacomelli A, Antonello RM, Gobbi F, Angheben A. Rabies in Europe: An epidemiological and clinical update. Eur J Intern Med 2021; 88:15-20. [PMID: 33934971 DOI: 10.1016/j.ejim.2021.04.010] [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: 01/24/2021] [Revised: 03/30/2021] [Accepted: 04/09/2021] [Indexed: 11/16/2022]
Abstract
Rabies is a vaccine preventable zoonotic disease with a significant mortality burden worldwide. Several years of vaccination campaigns in wildlife animals have now achieved the control of rabies in Western Europe through a vaccination belt in front of endemic Eastern European countries. Nevertheless, rabies could be imported both by travellers from areas without an active public control of the disease or by animals coming from areas where the virus circulates in wildlife fauna. The knowledge of the current world epidemiology combined with a high index of clinical suspicion are needed to reach a diagnosis of rabies, especially in case of atypical presentation or without a history of animal exposure. The pre-travel counselling to people visiting highly endemic areas is essential to give information on how to reduce exposure to potential sources of infection and to select those subjects who could benefit from pre-travel vaccination. Rabies is almost invariably fatal, but the prompt administration of a vaccine course combined with anti-rabies immunoglobulins significantly reduces the probability to develop life-threatening consequences. In this review, we give a brief epidemiological and clinical update about rabies in Europe.
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Affiliation(s)
- Niccolò Riccardi
- Department of Infectious, Tropical Diseases & Microbiology (DITM), IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy.
| | - Andrea Giacomelli
- III Infectious Diseases Unit, ASST Fatebenefratelli Sacco, Milano, Italy
| | - Roberta Maria Antonello
- Clinical Department of Medical, Surgical and Health Sciences, Trieste University Hospital, Trieste, Italy.
| | - Federico Gobbi
- Department of Infectious, Tropical Diseases & Microbiology (DITM), IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy.
| | - Andrea Angheben
- Department of Infectious, Tropical Diseases & Microbiology (DITM), IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy.
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Bello MB, Yusoff K, Ideris A, Hair-Bejo M, Jibril AH, Peeters BPH, Omar AR. Exploring the Prospects of Engineered Newcastle Disease Virus in Modern Vaccinology. Viruses 2020; 12:v12040451. [PMID: 32316317 PMCID: PMC7232247 DOI: 10.3390/v12040451] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 03/13/2020] [Accepted: 03/15/2020] [Indexed: 12/12/2022] Open
Abstract
Many traditional vaccines have proven to be incapable of controlling newly emerging infectious diseases. They have also achieved limited success in the fight against a variety of human cancers. Thus, innovative vaccine strategies are highly needed to overcome the global burden of these diseases. Advances in molecular biology and reverse genetics have completely restructured the concept of vaccinology, leading to the emergence of state-of-the-art technologies for vaccine design, development and delivery. Among these modern vaccine technologies are the recombinant viral vectored vaccines, which are known for their incredible specificity in antigen delivery as well as the induction of robust immune responses in the vaccinated hosts. Although a number of viruses have been used as vaccine vectors, genetically engineered Newcastle disease virus (NDV) possesses some useful attributes that make it a preferable candidate for vectoring vaccine antigens. Here, we review the molecular biology of NDV and discuss the reverse genetics approaches used to engineer the virus into an efficient vaccine vector. We then discuss the prospects of the engineered virus as an efficient vehicle of vaccines against cancer and several infectious diseases of man and animals.
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Affiliation(s)
- Muhammad Bashir Bello
- Department of Veterinary Microbiology, Faculty of Veterinary Medicine, Usmanu Danfodiyo University PMB, Sokoto 2346, Nigeria;
- Laboratory of Vaccines and Immunotherapeutics, Institute of Bioscience, Universiti Putra Malaysia, Serdang, Selangor 43400, Malaysia; (K.Y.); (A.I.); (M.H.-B.)
| | - Khatijah Yusoff
- Laboratory of Vaccines and Immunotherapeutics, Institute of Bioscience, Universiti Putra Malaysia, Serdang, Selangor 43400, Malaysia; (K.Y.); (A.I.); (M.H.-B.)
- Department of Microbiology, Faculty of Biotechnology and Biomolecular Sciences, Universiti Putra Malaysia, Serdang, Selangor 43400, Malaysia
| | - Aini Ideris
- Laboratory of Vaccines and Immunotherapeutics, Institute of Bioscience, Universiti Putra Malaysia, Serdang, Selangor 43400, Malaysia; (K.Y.); (A.I.); (M.H.-B.)
- Department of Veterinary Clinical Studies, Faculty of Veterinary Medicine, Universiti Putra Malaysia Serdang, Selangor 43400, Malaysia
| | - Mohd Hair-Bejo
- Laboratory of Vaccines and Immunotherapeutics, Institute of Bioscience, Universiti Putra Malaysia, Serdang, Selangor 43400, Malaysia; (K.Y.); (A.I.); (M.H.-B.)
- Department of Veterinary Pathology and Microbiology, Faculty of Veterinary Medicine, Universiti Putra Malaysia Serdang, Selangor 43400, Malaysia
| | - Abdurrahman Hassan Jibril
- Department of Veterinary Public Health and Preventive Medicine, Faculty of Veterinary Medicine, Usmanu Danfodiyo University PMB, Sokoto 2346, Nigeria;
| | - Ben P. H. Peeters
- Department of Virology, Wageningen Bioveterinary Research, POB 65, NL8200 Lelystad, The Netherlands;
| | - Abdul Rahman Omar
- Laboratory of Vaccines and Immunotherapeutics, Institute of Bioscience, Universiti Putra Malaysia, Serdang, Selangor 43400, Malaysia; (K.Y.); (A.I.); (M.H.-B.)
- Department of Veterinary Pathology and Microbiology, Faculty of Veterinary Medicine, Universiti Putra Malaysia Serdang, Selangor 43400, Malaysia
- Correspondence: ; Tel.:+603-89472111
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Hadebe JM, Sibiya MN. Experiences of people affected by rabies in Ethekwini district in the province of Kwazulu-Natal, South Africa. Afr Health Sci 2020; 20:150-157. [PMID: 33402903 PMCID: PMC7750068 DOI: 10.4314/ahs.v20i1.20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background South Africa is one of the countries in Africa adversely affected by rabies, a notifiable disease which can be fatal. Fatalities can be prevented if health care is sought timeously and people are educated about the disease. The Province of Kwa-Zulu-Natal, in particular, has had rabies outbreaks in the past which have led to loss of many lives and devastation of entire families. Objective The aim of the study was to explore the experiences of people affected by rabies in the eThekwini district of Kwa-Zulu-Natal, South Africa. Methods The study was guided by a qualitative, exploratory, descriptive design. The sample was purposively selected, and a semi-structured interview was used to collect data from people affected by rabies in the eThekwini district. Data saturation was reached after 12 participants were interviewed. Data was analysed by using Tesch's eight steps of thematic analysis. Results The themes included family stability and support structures, exposure to risk factors and risky practices, factors that hindered participants from seeking health care assistance, limited knowledge about rabies and the effects of rabies. Conclusion It was evident that participants experienced many challenges during their rabies exposure. Individuals, who were directly affected by rabies through contact with rabid animals, were expected to take responsibility for their own lives.
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Condori RE, Niezgoda M, Lopez G, Matos CA, Mateo ED, Gigante C, Hartloge C, Filpo AP, Haim J, Satheshkumar PS, Petersen B, Wallace R, Olson V, Li Y. Using the LN34 Pan-Lyssavirus Real-Time RT-PCR Assay for Rabies Diagnosis and Rapid Genetic Typing from Formalin-Fixed Human Brain Tissue. Viruses 2020; 12:v12010120. [PMID: 31963651 PMCID: PMC7019996 DOI: 10.3390/v12010120] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 01/10/2020] [Accepted: 01/15/2020] [Indexed: 11/16/2022] Open
Abstract
Human rabies post mortem diagnostic samples are often preserved in formalin. While immunohistochemistry (IHC) has been routinely used for rabies antigen detection in formalin-fixed tissue, the formalin fixation process causes nucleic acid fragmentation that may affect PCR amplification. This study reports the diagnosis of rabies in an individual from the Dominican Republic using both IHC and the LN34 pan-lyssavirus real-time RT-PCR assay on formalin-fixed brain tissue. The LN34 assay generates a 165 bp amplicon and demonstrated higher sensitivity than traditional PCR. Multiple efforts to amplify nucleic acid fragments larger than 300 bp using conventional PCR were unsuccessful, probably due to RNA fragmentation. Sequences generated from the LN34 amplicon linked the case to the rabies virus (RABV) strain circulating in the Ouest Department of Haiti to the border region between Haiti and the Dominican Republic. Direct sequencing of the LN34 amplicon allowed rapid and low-cost rabies genetic typing.
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Affiliation(s)
- Rene Edgar Condori
- Pox and Rabies Branch, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Michael Niezgoda
- Pox and Rabies Branch, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Griselda Lopez
- Laboratorio de Salud Pública “Dr. Defillo”, 10105 Santo Domingo, Dominican Republic
| | | | - Elinna Diaz Mateo
- Centro de Prevención y Control de Enfermedades Transmitidas por Vectores y Zoonosis (CECOVEZ), 10308 Santo Domingo, Dominican Republic
| | - Crystal Gigante
- Pox and Rabies Branch, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
- Oak Ridge Institute for Science and Education, Oak Ridge, TN 37830, USA
| | - Claire Hartloge
- Pox and Rabies Branch, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
- Oak Ridge Institute for Science and Education, Oak Ridge, TN 37830, USA
| | | | - Joseph Haim
- Ministère de l’Agriculture, des Resources Naturelles et du Développement Rural, Department of Animal Health, HT 6110, Republic of Haiti
| | | | - Brett Petersen
- Pox and Rabies Branch, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Ryan Wallace
- Pox and Rabies Branch, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Victoria Olson
- Pox and Rabies Branch, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Yu Li
- Pox and Rabies Branch, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
- Correspondence:
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13
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Mandja BAM, Bompangue D, Handschumacher P, Gonzalez JP, Salem G, Muyembe JJ, Mauny F. The score of integrated disease surveillance and response adequacy (SIA): a pragmatic score for comparing weekly reported diseases based on a systematic review. BMC Public Health 2019; 19:624. [PMID: 31118016 PMCID: PMC6532185 DOI: 10.1186/s12889-019-6954-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 05/08/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Integrated Disease Surveillance and Response (IDSR) strategy implemented by the World Health Organization (WHO) in Africa has produced a large amount of data on participating countries, and in particular on the Democratic Republic of Congo (DRC). These data are increasingly considered as unevaluable and, therefore, as requiring a rigorous process of validation before they can be used for research or public health purposes. The aim of this study was to propose a method to assess the level of adequacy of IDSR morbidity data in reflecting actual morbidity. METHODS A systematic search of English- and French-language articles was performed in Scopus, Medline, Science Direct, Springer Link, Cochrane, Cairn, Persée, and Erudit databases. Other types of documents were identified through manual searches. Selected articles focused on the determinants of the discrepancies (differences) between reported morbidity and actual morbidity. An adequacy score was constructed using some of the identified determinants. This score was applied to the 15 weekly reported diseases monitored by IDSR surveillance in the DRC. A classification was established using the Jenks method and a sensitivity analysis was performed. Twenty-three classes of determinants were identified in 35 IDSR technical guides and reports of outbreak investigations and in 71 out of 2254 researched articles. For each of the 15 weekly reported diseases, the SIA was composed of 12 items grouped in 6 dimensions. RESULTS The SIA classified the 15 weekly reported diseases into 3 categories or types: high score or good adequacy (value > = 14), moderate score or fair adequacy (value > = 8 and < 14), and low score or low or non-adequacy (value < 8). Regardless of the criteria used in the sensitivity analysis, there was no notable variation in SIA values or categories for any of the 15 weekly reported diseases. CONCLUSION In a context of sparse health information in low- and middle-income countries, this study developed a score to help classify IDSR morbidity data as usable, usable after adjustment, or unusable. This score can serve to prioritize, optimize, and interpret data analyses for epidemiological research or public health purposes.
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Affiliation(s)
- Bien-Aimé Makasa Mandja
- Service de Microbiologie, Faculté de Médecine, Université de Kinshasa, Kinshasa, Democratic Republic of Congo.
- Laboratoire Chrono-Environnement, UMR 6249 CNRS, Université de Bourgogne Franche-Comté, Besançon, France.
| | - Didier Bompangue
- Service de Microbiologie, Faculté de Médecine, Université de Kinshasa, Kinshasa, Democratic Republic of Congo
- Laboratoire Chrono-Environnement, UMR 6249 CNRS, Université de Bourgogne Franche-Comté, Besançon, France
| | | | - Jean-Paul Gonzalez
- Department of Microbiology and Immunology, Division of Biomedical Graduate Research Organization, Georgetown University School of Medicine, 4000 Reservoir Road, Washington, D.C., NW, 20057, USA
| | | | - Jean-Jacques Muyembe
- Service de Microbiologie, Faculté de Médecine, Université de Kinshasa, Kinshasa, Democratic Republic of Congo
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of Congo
| | - Frédéric Mauny
- Laboratoire Chrono-Environnement, UMR 6249 CNRS, Université de Bourgogne Franche-Comté, Besançon, France
- Centre Hospitalier Universitaire de Besançon, uMETh, Besançon, France
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14
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Metlin АЕ, Botvinkin АD, Elakov АL, Gruzdev КN. [Сases of human convalescence from rabies and lifetime diagnostics of lyssavirus encephalitis.]. Vopr Virusol 2019; 64:42-48. [PMID: 30893529 DOI: 10.18821/0507-4088-2019-64-1-42-48] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Accepted: 04/26/2018] [Indexed: 12/25/2022]
Abstract
Notwithstanding the availability of effective vaccines, 40 - 60 thousand rabies cases in humans are reported every year. Almost always the disease is fatal because therapeutic treatment of lyssavirus encephalitis has not been developed. Since 1970 the number of reports on rare cases of convalescence including those using experimental treatment protocols has been gradually increasing 20 cases of convalescence, "partial" convalescence or long-term survival of humans (1970-2015) were selected as they were complaint with laboratory criteria of active lyssavirus infection. Children and teenagers were predominant in the analyzed group (85%). The cases were irregularly spread between the continents: Asia - 6 cases, North America - 6 cases, Africa - 2 cases and Europe - 1 case. India and the USA were on the top of the list of countries by the number of described cases. More than 60% humans were infected from dogs, three cases got infection from bats and 2 cases were allegedly associated with an unknown lyssavirus and an unidentified infection source. 70% cases were vaccinated and 10% cases were treated with gamma globulin before the disease onset. Serological tests for detection of antibodies to lyssaviruses in cerebrospinal fluid of infected humans were typically used for diagnostic laboratory verification. Less than 30% IFA and PCR positives were obtained. Lyssaviruses were never detected. Only 4 convalescent patients were treated using experimental protocols. 80% cases demonstrated severe neurological consequences, four (may be more) patients died afterwards within the period from two months to four years. Different perspectives on prospects of Milwaukee protocol use and other therapeutic techniques are given.
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Affiliation(s)
- А Е Metlin
- Federal Center for Animal Health, Vladimir, 600901, Russian Federation
| | - А D Botvinkin
- Irkutstky State Medical University, Irkutsk, 600901, Russian Federation
| | - А L Elakov
- D.I. Ivanovsky Institute of Virology, «National Research Centre of Epidemiology and Microbiology named after honorary academician N.F. Gamaleya», Moscow, 123098, Russian Federation
| | - К N Gruzdev
- Federal Center for Animal Health, Vladimir, 600901, Russian Federation
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15
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[Rabies and Bornavirus encephalitis : Fatal emerging viral encephalitis-a potential problem for organ recipients]. DER NERVENARZT 2018; 89:1332-1337. [PMID: 30276429 DOI: 10.1007/s00115-018-0620-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
A severe, often fatal encephalitis needs to be extensively and carefully clarified, especially when it occurs in a patient weeks or months after an organ transplantation. If the donor was viremic at the time of the organ removal or living viruses were present in the organ tissue, many viruses can be transferred to the organ recipient. This has been repeatedly reported in recent years and decades. In this overview rabies is discussed as a particularly important form of viral encephalitis, which is transferred via organs and always has a fatal outcome, because patients carry a high risk of infection for all caregivers. Bornavirus has been known in veterinary medicine for many decades and in human medicine has been discussed as possibly being associated with psychiatric diseases. Very recently Bornavirus has been identified as the causative pathogen of fatal encephalitis in organ recipients. The aim of this article is to raise awareness for rabies and Bornavirus disease in intensive care medicine and neurology for organ donors and those taking care of organ recipients. Prevention by knowledge can be lifesaving.
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16
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Seetahal JFR, Vokaty A, Vigilato MAN, Carrington CVF, Pradel J, Louison B, Sauers AV, Roopnarine R, Arrebato JCG, Millien MF, James C, Rupprecht CE. Rabies in the Caribbean: A Situational Analysis and Historic Review. Trop Med Infect Dis 2018; 3:E89. [PMID: 30274485 PMCID: PMC6160905 DOI: 10.3390/tropicalmed3030089] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 08/14/2018] [Accepted: 08/15/2018] [Indexed: 12/25/2022] Open
Abstract
Rabies virus is the only Lyssavirus species found in the Americas. In discussions about rabies, Latin America and the Caribbean are often grouped together. Our study aimed to independently analyse the rabies situation in the Caribbean and examine changes in rabies spatiotemporal epidemiology. A questionnaire was administered to the 33 member countries and territories of the Caribbean Animal Health Network (CaribVET) to collect current data, which was collated with a literature review. Rabies was endemic in ten Caribbean localities, with the dog, mongoose, and vampire bat identified as enzootic reservoirs. The majority of animal cases occurred in Puerto Rico, the Dominican Republic, and Haiti, while human cases only consistently occurred in the latter two areas. Rabies vaccination was conducted for high-risk animal populations with variable coverage, and rabies diagnostic capacities varied widely throughout the region. Illegal importation and natural migration of animals may facilitate the introduction of rabies virus variants into virus-naïve areas. Passive surveillance, together with enhanced methods and serological screening techniques, can therefore be of value. The insularity of the Caribbean makes it ideal for conducting pilot studies on reservoir host population management. Best practice guidelines developed for these reservoir hosts can be individually modified to the epidemiological status and available resources within each locality.
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Affiliation(s)
- Janine F R Seetahal
- Department of Preclinical Sciences, Faculty of Medical Sciences, The University of the West Indies, St. Augustine, Trinidad and Tobago.
| | - Alexandra Vokaty
- Pan American Health Organization (PAHO/WHO), Trinidad and Tobago Country Office, St. Clair, Trinidad and Tobago.
| | - Marco A N Vigilato
- Zoonosis Group, Pan American Foot-and-Mouth Disease Center (PANAFTOSA), Pan American Health Organization (PAHO/WHO), Rio de Janeiro, Brazil.
| | - Christine V F Carrington
- Department of Preclinical Sciences, Faculty of Medical Sciences, The University of the West Indies, St. Augustine, Trinidad and Tobago.
| | - Jennifer Pradel
- CIRAD, UMR ASTRE, Petit-Bourg, Guadeloupe F-97170, France.
- ASTRE, CIRAD, INRA, Univ Montpellier, Montpellier F-34398, France.
| | - Bowen Louison
- Veterinary and Livestock Division, Ministry of Agriculture, Ministerial Complex, Tanteen, St. George's, Grenada.
| | - Astrid Van Sauers
- Ministry of Agriculture, Animal husbandry and Health and Fisheries, Paramaribo, Suriname.
| | | | | | - Max F Millien
- Ministry of Agriculture, Natural Resources and Rural Development, Port-au-Prince, Haiti.
| | - Colin James
- National Health Surveillance Unit, Ministry of Health, Georgetown, Guyana.
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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: 110] [Impact Index Per Article: 15.7] [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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18
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Begeman L, GeurtsvanKessel C, Finke S, Freuling CM, Koopmans M, Müller T, Ruigrok TJH, Kuiken T. Comparative pathogenesis of rabies in bats and carnivores, and implications for spillover to humans. THE LANCET. INFECTIOUS DISEASES 2017; 18:e147-e159. [PMID: 29100899 DOI: 10.1016/s1473-3099(17)30574-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 08/23/2017] [Accepted: 09/11/2017] [Indexed: 12/15/2022]
Abstract
Bat-acquired rabies is becoming increasingly common, and its diagnosis could be missed partly because its clinical presentation differs from that of dog-acquired rabies. We reviewed the scientific literature to compare the pathogenesis of rabies in bats and carnivores-including dogs-and related this pathogenesis to differences in the clinical presentation of bat-acquired and dog-acquired rabies in human beings. For bat-acquired rabies, we found that the histological site of exposure is usually limited to the skin, the anatomical site of exposure is more commonly the face, and the virus might be more adapted for entry via the skin than for dog-acquired rabies. These factors could help to explain several differences in clinical presentation between individuals with bat-acquired and those with dog-acquired rabies. A better understanding of these differences should improve the recording of a patient's history, enable drawing up of a more sophisticated list of clinical characteristics, and therefore obtain an earlier diagnosis of rabies after contact with a bat or carnivore that has rabies.
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Affiliation(s)
- Lineke Begeman
- Department of Viroscience, Postgraduate School Molecular Medicine, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - Corine GeurtsvanKessel
- Department of Viroscience, Postgraduate School Molecular Medicine, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - Stefan Finke
- Friedrich-Loeffler-Institut, Federal Research Institute for Animal Health, Institute of Molecular Virology and Cell Biology, WHO Collaborating Centre for Rabies Surveillance and Research, OIE Reference Laboratory for Rabies, Greifswald, Insel Riems, Germany
| | - Conrad M Freuling
- Friedrich-Loeffler-Institut, Federal Research Institute for Animal Health, Institute of Molecular Virology and Cell Biology, WHO Collaborating Centre for Rabies Surveillance and Research, OIE Reference Laboratory for Rabies, Greifswald, Insel Riems, Germany
| | - Marion Koopmans
- Department of Viroscience, Postgraduate School Molecular Medicine, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - Thomas Müller
- Friedrich-Loeffler-Institut, Federal Research Institute for Animal Health, Institute of Molecular Virology and Cell Biology, WHO Collaborating Centre for Rabies Surveillance and Research, OIE Reference Laboratory for Rabies, Greifswald, Insel Riems, Germany
| | - Tom J H Ruigrok
- Department of Neuroscience, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - Thijs Kuiken
- Department of Viroscience, Postgraduate School Molecular Medicine, Erasmus University Medical Centre, Rotterdam, Netherlands.
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19
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Lyssavirus phosphoproteins increase mitochondrial complex I activity and levels of reactive oxygen species. J Neurovirol 2017; 23:756-762. [DOI: 10.1007/s13365-017-0550-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 06/19/2017] [Accepted: 06/20/2017] [Indexed: 12/25/2022]
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20
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Huang XY, Li XL, Wu SY, Gu YL, Lv XJ, Klena JD, Xu BL. Bites from the same dog, different outcomes for two patients: a case report. Infect Dis Poverty 2017; 6:107. [PMID: 28676127 PMCID: PMC5497382 DOI: 10.1186/s40249-017-0321-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 05/31/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Rabies is a serious reemerging zoonosis in China. At present human rabies cases are primarily diagnosed based on clinical presentation. CASE PRESENTATION In August 2012, a woman and her son were attacked by a stray dog in Henan, China. The son received rabies postexposure prophylaxis (wound treatment followed by vaccine, no immunoglobulin), however, the mother did not. Rabies infection was subsequently laboratory confirmed in the mother and she died in December; her son is alive and healthy after 2 years of follow-up. CONCLUSION This report documents that the timely utilization of postexposure prophylaxis is a required measure in preventing rabies after exposure to an animal bite.
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Affiliation(s)
- Xue-Yong Huang
- Henan Center for Disease Control and Prevention, Zhengzhou, China.,Henan Key Laboratory of Pathogenic Microorganisms, Zhengzhou, China.,Henan Collaborative Innovation Center of Molecular Diagnosis and Laboratory Medicine, Xinxiang, China
| | - Xing-Le Li
- Henan Center for Disease Control and Prevention, Zhengzhou, China.,Henan Key Laboratory of Pathogenic Microorganisms, Zhengzhou, China
| | - Shu-Yu Wu
- International Emerging Infections Program, United States Centers for Disease Control and Prevention, Beijing, China.,Global Disease Detection Branch, Division of Global Health Protection, Center for Global Health, United States Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Yu-Lei Gu
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xin-Jun Lv
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - John David Klena
- International Emerging Infections Program, United States Centers for Disease Control and Prevention, Beijing, China.,Global Disease Detection Branch, Division of Global Health Protection, Center for Global Health, United States Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Bian-Li Xu
- Henan Center for Disease Control and Prevention, Zhengzhou, China. .,Henan Key Laboratory of Pathogenic Microorganisms, Zhengzhou, China.
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21
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Clavijo A, Freire de Carvalho MH, Orciari LA, Velasco-Villa A, Ellison JA, Greenberg L, Yager PA, Green DB, Vigilato MA, Cosivi O, Del Rio-Vilas VJ. An inter- laboratory proficiency testing exercise for rabies diagnosis in Latin America and the Caribbean. PLoS Negl Trop Dis 2017; 11:e0005427. [PMID: 28369139 PMCID: PMC5391118 DOI: 10.1371/journal.pntd.0005427] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 04/13/2017] [Accepted: 02/21/2017] [Indexed: 12/02/2022] Open
Abstract
The direct fluorescent antibody test (DFA), is performed in all rabies reference laboratories across Latin America and the Caribbean (LAC). Despite DFA being a critical capacity in the control of rabies, there is not a standardized protocol in the region. We describe the results of the first inter-laboratory proficiency exercise of national rabies laboratories in LAC countries as part of the regional efforts towards dog-maintained rabies elimination in the American region. Twenty three laboratories affiliated to the Ministries of Health and Ministries of Agriculture participated in this exercise. In addition, the laboratories completed an online questionnaire to assess laboratory practices. Answers to the online questionnaire indicated large variability in the laboratories throughput, equipment used, protocols availability, quality control standards and biosafety requirements. Our results will inform actions to improve and harmonize laboratory rabies capacities across LAC in support for the regional efforts towards elimination of dog-maintained rabies.
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Affiliation(s)
- Alfonso Clavijo
- Pan American Foot-and-Mouth Disease Center, Pan American Health Organization, Rio de Janeiro, Brazil
| | | | - Lillian A. Orciari
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Andres Velasco-Villa
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - James A. Ellison
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Lauren Greenberg
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Pamela A. Yager
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Douglas B. Green
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Marco A. Vigilato
- Pan American Foot-and-Mouth Disease Center, Pan American Health Organization, Rio de Janeiro, Brazil
| | - Ottorino Cosivi
- Pan American Foot-and-Mouth Disease Center, Pan American Health Organization, Rio de Janeiro, Brazil
| | - Victor J. Del Rio-Vilas
- Pan American Foot-and-Mouth Disease Center, Pan American Health Organization, Rio de Janeiro, Brazil
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22
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Abstract
Rabies is a zoonotic disease that is usually transmitted to humans by animal bites. Dogs are the most important vector worldwide. There are encephalitic and paralytic forms of the disease. There are differences in the clinical features of the disease acquired from dogs and bats. Neuroimaging is non-specific. Confirmatory diagnostic laboratory tests for rabies include detection of neutralizing anti-rabies virus antibodies in serum or cerebrospinal fluid and rabies virus antigen or RNA in tissues or fluids. Rabies is preventable after recognized exposures with wound cleansing and administration of rabies vaccine and rabies immune globulin. Rabies is virtually always fatal after clinical disease develops, and there have only been rare survivors. The Milwaukee protocol, which includes therapeutic coma, has been shown to be ineffective and should no longer be used. The development of novel therapeutic approaches may depend on a better understanding of basic mechanisms underlying the disease.
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Hsu CH, Brown CM, Murphy JM, Haskell MG, Williams C, Feldman K, Mitchell K, Blanton JD, Petersen BW, Wallace RM. Perceptions and Practices of Mass Bat Exposure Events in the Setting of Rabies Among U.S. Public Health Agencies. Zoonoses Public Health 2016; 64:127-136. [PMID: 27389926 PMCID: PMC5525325 DOI: 10.1111/zph.12289] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Indexed: 12/25/2022]
Abstract
Current guidelines in the setting of exposures to potentially rabid bats established by the Advisory Committee on Immunization Practices (ACIP) address post-exposure prophylaxis (PEP) administration in situations where a person may not be aware that a bite or direct contact has occurred and the bat is not available for diagnostic testing. These include instances when a bat is discovered in a room where a person awakens from sleep, is a child without an adult witness, has a mental disability or is intoxicated. The current ACIP guidelines, however, do not address PEP in the setting of multiple persons exposed to a bat or a bat colony, otherwise known as mass bat exposure (MBE) events. Due to a dearth of recommendations for response to these events, the reported reactions by public health agencies have varied widely. To address this perceived limitation, a survey of 45 state public health agencies was conducted to characterize prior experiences with MBE and practices to mitigate the public health risks. In general, most states (69% of the respondents) felt current ACIP guidelines were unclear in MBE scenarios. Thirty-three of the 45 states reported prior experience with MBE, receiving an average of 16.9 MBE calls per year and an investment of 106.7 person-hours annually on MBE investigations. PEP criteria, investigation methods and the experts recruited in MBE investigations varied between states. These dissimilarities could reflect differences in experience, scenario and resources. The lack of consistency in state responses to potential mass exposures to a highly fatal disease along with the large contingent of states dissatisfied with current ACIP guidance warrants the development of national guidelines in MBE settings.
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Affiliation(s)
- C H Hsu
- Centers for Disease Control and Prevention, Poxvirus and Rabies Branch, Atlanta, GA, USA.,Epidemic Intelligence Service, Atlanta, GA, USA
| | - C M Brown
- Massachusetts Department of Public Health State Laboratory Institute, Jamaica Plain, MA, USA
| | - J M Murphy
- Virginia Department of Health, Office of Epidemiology, Richmond, VA, USA
| | - M G Haskell
- Division of Public Health, Communicable Disease Branch, North Carolina Department of Health and Human Services, Raleigh, NC, USA
| | - C Williams
- Division of Public Health, Communicable Disease Branch, North Carolina Department of Health and Human Services, Raleigh, NC, USA
| | - K Feldman
- Center for Zoonotic and Vector-borne Diseases, Maryland Department of Health and Mental Hygiene, Baltimore, MD, USA
| | - K Mitchell
- Center for Zoonotic and Vector-borne Diseases, Maryland Department of Health and Mental Hygiene, Baltimore, MD, USA
| | - J D Blanton
- Centers for Disease Control and Prevention, Poxvirus and Rabies Branch, Atlanta, GA, USA
| | - B W Petersen
- Centers for Disease Control and Prevention, Poxvirus and Rabies Branch, Atlanta, GA, USA
| | - R M Wallace
- Centers for Disease Control and Prevention, Poxvirus and Rabies Branch, Atlanta, GA, USA
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24
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Weyer J, Msimang-Dermaux V, Paweska JT, le Roux K, Govender P, Coertse J, Markotter W, Nel LH, Blumberg LH. A case of human survival of rabies, South Africa. S Afr J Infect Dis 2016. [DOI: 10.1080/23120053.2016.1128151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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25
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Regunath H, Chinnakotla B, Rojas-Moreno C, Salzer W, Hughes NJ, Sangha H. A Case of Fatal Serotonin Syndrome-Like Human Rabies Caused by Tricolored Bat-Associated Rabies Virus. Am J Trop Med Hyg 2016; 94:1376-9. [PMID: 27001756 PMCID: PMC4889760 DOI: 10.4269/ajtmh.15-0852] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 02/17/2016] [Indexed: 12/25/2022] Open
Abstract
Human rabies is a fatal disease, transmitted by saliva of infected animals, and the diagnosis requires a high index of suspicion. Very few cases are reported annually in the United States. We present a case of human rabies without a clear exposure history that masqueraded as serotonin syndrome.
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Affiliation(s)
- Hariharan Regunath
- Division of Pulmonary, Critical Care and Environmental Medicine, Department of Medicine, University of Missouri, Columbia, Missouri; Division of Infectious Diseases, Department of Medicine, University of Missouri, Columbia, Missouri; Department of Medicine, University of Florida, Gainesville, Florida
| | - Bhavana Chinnakotla
- Division of Pulmonary, Critical Care and Environmental Medicine, Department of Medicine, University of Missouri, Columbia, Missouri; Division of Infectious Diseases, Department of Medicine, University of Missouri, Columbia, Missouri; Department of Medicine, University of Florida, Gainesville, Florida
| | - Christian Rojas-Moreno
- Division of Pulmonary, Critical Care and Environmental Medicine, Department of Medicine, University of Missouri, Columbia, Missouri; Division of Infectious Diseases, Department of Medicine, University of Missouri, Columbia, Missouri; Department of Medicine, University of Florida, Gainesville, Florida
| | - William Salzer
- Division of Pulmonary, Critical Care and Environmental Medicine, Department of Medicine, University of Missouri, Columbia, Missouri; Division of Infectious Diseases, Department of Medicine, University of Missouri, Columbia, Missouri; Department of Medicine, University of Florida, Gainesville, Florida
| | - Natalie J Hughes
- Division of Pulmonary, Critical Care and Environmental Medicine, Department of Medicine, University of Missouri, Columbia, Missouri; Division of Infectious Diseases, Department of Medicine, University of Missouri, Columbia, Missouri; Department of Medicine, University of Florida, Gainesville, Florida
| | - Harbaksh Sangha
- Division of Pulmonary, Critical Care and Environmental Medicine, Department of Medicine, University of Missouri, Columbia, Missouri; Division of Infectious Diseases, Department of Medicine, University of Missouri, Columbia, Missouri; Department of Medicine, University of Florida, Gainesville, Florida
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Neurotropic virus infections as the cause of immediate and delayed neuropathology. Acta Neuropathol 2016; 131:159-184. [PMID: 26659576 PMCID: PMC4713712 DOI: 10.1007/s00401-015-1511-3] [Citation(s) in RCA: 199] [Impact Index Per Article: 24.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 10/24/2015] [Accepted: 11/17/2015] [Indexed: 12/30/2022]
Abstract
A wide range of viruses from different virus families in different geographical areas, may cause immediate or delayed neuropathological changes and neurological manifestations in humans and animals. Infection by neurotropic viruses as well as the resulting immune response can irreversibly disrupt the complex structural and functional architecture of the central nervous system, frequently leaving the patient or affected animal with a poor or fatal prognosis. Mechanisms that govern neuropathogenesis and immunopathogenesis of viral infections are highlighted, using examples of well-studied virus infections that are associated with these alterations in different populations throughout the world. A better understanding of the molecular, epidemiological and biological characteristics of these infections and in particular of mechanisms that underlie their clinical manifestations may be expected to provide tools for the development of more effective intervention strategies and treatment regimens.
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Appolinário CM, Allendorf SD, Peres MG, Ribeiro BD, Fonseca CR, Vicente AF, Antunes JMADP, Megid J. Profile of Cytokines and Chemokines Triggered by Wild-Type Strains of Rabies Virus in Mice. Am J Trop Med Hyg 2015; 94:378-83. [PMID: 26711511 DOI: 10.4269/ajtmh.15-0361] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 11/02/2015] [Indexed: 12/25/2022] Open
Abstract
Rabies is a lethal infectious disease that causes 55,000 human deaths per year and is transmitted by various mammalian species, such as dogs and bats. The host immune response is essential for avoiding viral progression and promoting viral clearance. Cytokines and chemokines are crucial in the development of an immediate antiviral response; the rabies virus (RABV) attempts to evade this immune response. The virus's capacity for evasion is correlated with its pathogenicity and the host's inflammatory response, with highly pathogenic strains being the most efficient at hijacking the host's defense mechanisms and thereby decreasing inflammation. The purpose of this study was to evaluate the expression of a set of cytokine and chemokine genes that are related to the immune response in the brains of mice inoculated intramuscularly or intracerebrally with two wild-type strains of RABV, one from dog and the other from vampire bat. The results demonstrated that the gene expression profile is intrinsic to the specific rabies variant. The prompt production of cytokines and chemokines seems to be more important than their levels of expression for surviving a rabies infection.
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Affiliation(s)
- Camila Michele Appolinário
- Department of Veterinary Hygiene and Public Health, School of Veterinary Medicine and Animal Science, UNESP-Universidade Estadual Paulista, Botucatu, São Paulo, Brazil
| | - Susan Dora Allendorf
- Department of Veterinary Hygiene and Public Health, School of Veterinary Medicine and Animal Science, UNESP-Universidade Estadual Paulista, Botucatu, São Paulo, Brazil
| | - Marina Gea Peres
- Department of Veterinary Hygiene and Public Health, School of Veterinary Medicine and Animal Science, UNESP-Universidade Estadual Paulista, Botucatu, São Paulo, Brazil
| | - Bruna Devidé Ribeiro
- Department of Veterinary Hygiene and Public Health, School of Veterinary Medicine and Animal Science, UNESP-Universidade Estadual Paulista, Botucatu, São Paulo, Brazil
| | - Clóvis R Fonseca
- Department of Veterinary Hygiene and Public Health, School of Veterinary Medicine and Animal Science, UNESP-Universidade Estadual Paulista, Botucatu, São Paulo, Brazil
| | - Acácia Ferreira Vicente
- Department of Veterinary Hygiene and Public Health, School of Veterinary Medicine and Animal Science, UNESP-Universidade Estadual Paulista, Botucatu, São Paulo, Brazil
| | - João Marcelo A de Paula Antunes
- Department of Veterinary Hygiene and Public Health, School of Veterinary Medicine and Animal Science, UNESP-Universidade Estadual Paulista, Botucatu, São Paulo, Brazil
| | - Jane Megid
- Department of Veterinary Hygiene and Public Health, School of Veterinary Medicine and Animal Science, UNESP-Universidade Estadual Paulista, Botucatu, São Paulo, Brazil
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Appolinário C, Allendorf SD, Vicente AF, Ribeiro BD, Fonseca CRD, Antunes JM, Peres MG, Kotait I, Carrieri ML, Megid J. Fluorescent antibody test, quantitative polymerase chain reaction pattern and clinical aspects of rabies virus strains isolated from main reservoirs in Brazil. Braz J Infect Dis 2015; 19:479-85. [PMID: 26303004 PMCID: PMC9427647 DOI: 10.1016/j.bjid.2015.06.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 06/17/2015] [Accepted: 06/18/2015] [Indexed: 12/25/2022] Open
Abstract
Rabies virus (RABV) isolated from different mammals seems to have unique characteristics that influence the outcome of infection. RABV circulates in nature and is maintained by reservoirs that are responsible for the persistence of the disease for almost 4000 years. Considering the different pattern of pathogenicity of RABV strains in naturally and experimentally infected animals, the aim of this study was to analyze the characteristics of RABV variants isolated from the main Brazilian reservoirs, being related to a dog (variant 2), Desmodus rotundus (variant 3), crab eating fox, marmoset, and Myotis spp. Viral replication in brain tissue of experimentally infected mouse was evaluated by two laboratory techniques and the results were compared to clinical evolution from five RABV variants. The presence of the RABV was investigated in brain samples by fluorescent antibody test (FAT) and real time polymerase chain reaction (qRT-PCR) for quantification of rabies virus nucleoprotein gene (N gene). Virus replication is not correlated with clinical signs and evolution. The pattern of FAT is associated with RABV replication levels. Virus isolates from crab eating fox and marmoset had a longer evolution period and higher survival rate suggesting that the evolution period may contribute to the outcome. RABV virus variants had independent characteristics that determine the clinical evolution and survival of the infected mice.
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Affiliation(s)
- Camila Appolinário
- Departamento de Higiene Veterinária e Saúde Pública, Faculdade de Medicina Veterinária e Zootecnia, Universidade Estadual Paulista (UNESP), Botucatu, SP, Brazil
| | - Susan Dora Allendorf
- Departamento de Higiene Veterinária e Saúde Pública, Faculdade de Medicina Veterinária e Zootecnia, Universidade Estadual Paulista (UNESP), Botucatu, SP, Brazil
| | - Acácia Ferreira Vicente
- Departamento de Higiene Veterinária e Saúde Pública, Faculdade de Medicina Veterinária e Zootecnia, Universidade Estadual Paulista (UNESP), Botucatu, SP, Brazil
| | - Bruna Devidé Ribeiro
- Departamento de Higiene Veterinária e Saúde Pública, Faculdade de Medicina Veterinária e Zootecnia, Universidade Estadual Paulista (UNESP), Botucatu, SP, Brazil
| | - Clóvis Reinaldo da Fonseca
- Departamento de Higiene Veterinária e Saúde Pública, Faculdade de Medicina Veterinária e Zootecnia, Universidade Estadual Paulista (UNESP), Botucatu, SP, Brazil
| | - João Marcelo Antunes
- Departamento de Higiene Veterinária e Saúde Pública, Faculdade de Medicina Veterinária e Zootecnia, Universidade Estadual Paulista (UNESP), Botucatu, SP, Brazil
| | - Marina Gea Peres
- Departamento de Higiene Veterinária e Saúde Pública, Faculdade de Medicina Veterinária e Zootecnia, Universidade Estadual Paulista (UNESP), Botucatu, SP, Brazil
| | | | | | - Jane Megid
- Departamento de Higiene Veterinária e Saúde Pública, Faculdade de Medicina Veterinária e Zootecnia, Universidade Estadual Paulista (UNESP), Botucatu, SP, Brazil.
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Ortiz-Prado E, Ponce-Zea J, Ramirez D, Stewart-Ibarra AM, Armijos L, Yockteng J, Cardenas WB. Rabies Epidemiology and Control in Ecuador. Glob J Health Sci 2015; 8:113-21. [PMID: 26493436 PMCID: PMC4804063 DOI: 10.5539/gjhs.v8n3p113] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Accepted: 05/29/2015] [Indexed: 11/13/2022] Open
Abstract
Objective: Describe the epidemiology and the control effort for rabies in Ecuador. Methods: This observational study included data from the Ecuadorian National Institute of Census and Statistics (INEC), and mortality and morbidity data reported by the Ministry of Public Health and the National Institute for Social Security. We conducted a phylogeny analyses to compare the N gene from the Challenge Virus Standard (CVS) vaccine strain used in Ecuador with published Cosmopolitan, Asian and Sylvatic strains. Descriptive and inferential statistics were used to determine the significance of the data. Results: In 1996 Ecuador suffered the highest rate of rabies per capita in the Americas, with an incidence rate of 0.56 cases per 100 000 people per year. Human and canine rabies showed a sharp decline until 2012. Between 1994 and 2014, we found a correlation of 0.925 (p<0.01) between annual cases of dog and human rabies. In 2011, there was an epidemic of sylvatic rabies transmitted to people by vampire bats (Desmodus rotundus) in the Amazon region, specifically in Morona Santiago, leading to 11 fatalities. Phylogenetic analyses of the CVS vaccine N gene showed an association with urban canine rabies strains (the Cosmopolitan lineage and Asian strains), whereas sylvatic rabies, like those reported in the Amazon region, were found to be grouped in a different clade represented mainly by bat-derived strains. Conclusions: This study presents the first compilation of epidemiological data on rabies in Ecuador. The incidence of human and canine rabies, also known as urban rabies, has clearly decreased due to massive canine vaccination campaigns. Phylogenetic analysis of the prevailing vaccine used in the country showed a clear separation from bat-derived rabies, the source of recent rabies outbreaks. Efforts are ongoing to develop rabies vaccines that are highly specific to the rabies virus genotype circulating in the region, including sylvatic rabies. These efforts include the implementation of reverse genetics to generate recombinant virus coding for the prevailing glycoprotein gene.
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Affiliation(s)
- Esteban Ortiz-Prado
- Universidad de las Americas, Quito, Ecuador, Research and development Department, ENFARMA EP..
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Muyila DI, Aloni MN, Lose-Ekanga MJ, Nzita JM, Kalala-Mbikay A, Bongo HL, Esako MN, Malonga-Biapi JP, Mputu-Dibwe B, Aloni ML, Ekila MB. Human rabies: a descriptive observation of 21 children in Kinshasa, the Democratic Republic of Congo. Pathog Glob Health 2015; 108:317-22. [PMID: 25417907 DOI: 10.1179/2047773214y.0000000161] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVES Human rabies has recently emerged as a significant public health threat in Kinshasa, Democratic Republic of Congo (DRC). However, there is little epidemiological information on human rabies especially in children. METHODS We performed at Pediatrics Department of General Reference hospital of Kinshasa between December 2008 and July 2009, a retrospective study to assess the incidence and to describe their clinical aspects and outcome. RESULTS A total of 21 cases were observed, rather three cases per month. There were 12 boys (57·1%) and 9 girls (42·9%). Biting animal was found to be dog in all cases (100%). The dog was not immunized in all of cases. On admission, all patients (100%) showed furious rabies manifestations. Only two (9·5%) had their wounds treated and received an anti-rabies vaccine (ARV) after the bite incident. Two (9·5%) patients received rabies immunoglobulin (RIG). The case-fatality rate was 100%. CONCLUSIONS The disease emerges as a new major public health problem because of a lack of knowledge regarding rabies risk, the poor management of dog bites. Preventative vaccination for rabies should be recommended in the population of Kinshasa, area at high risk to contract rabies, particularly in children.
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