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Bastos V, Pacheco V, Rodrigues ÉDL, Moraes CNS, Nóbile AL, Fonseca DLM, Souza KBS, do Vale FYN, Filgueiras IS, Schimke LF, Giil LM, Moll G, Cabral-Miranda G, Ochs HD, Vasconcelos PFDC, de Melo GD, Bourhy H, Casseb LMN, Cabral-Marques O. Neuroimmunology of rabies: New insights into an ancient disease. J Med Virol 2023; 95:e29042. [PMID: 37885152 DOI: 10.1002/jmv.29042] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 09/28/2023] [Accepted: 09/30/2023] [Indexed: 10/28/2023]
Abstract
Rabies is an ancient neuroinvasive viral (genus Lyssavirus, family Rhabdoviridae) disease affecting approximately 59,000 people worldwide. The central nervous system (CNS) is targeted, and rabies has a case fatality rate of almost 100% in humans and animals. Rabies is entirely preventable through proper vaccination, and thus, the highest incidence is typically observed in developing countries, mainly in Africa and Asia. However, there are still cases in European countries and the United States. Recently, demographic, increasing income levels, and the coronavirus disease 2019 (COVID-19) pandemic have caused a massive raising in the animal population, enhancing the need for preventive measures (e.g., vaccination, surveillance, and animal control programs), postexposure prophylaxis, and a better understanding of rabies pathophysiology to identify therapeutic targets, since there is no effective treatment after the onset of clinical manifestations. Here, we review the neuroimmune biology and mechanisms of rabies. Its pathogenesis involves a complex and poorly understood modulation of immune and brain functions associated with metabolic, synaptic, and neuronal impairments, resulting in fatal outcomes without significant histopathological lesions in the CNS. In this context, the neuroimmunological and neurochemical aspects of excitatory/inhibitory signaling (e.g., GABA/glutamate crosstalk) are likely related to the clinical manifestations of rabies infection. Uncovering new links between immunopathological mechanisms and neurochemical imbalance will be essential to identify novel potential therapeutic targets to reduce rabies morbidity and mortality.
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Affiliation(s)
- Victor Bastos
- Department of Pharmaceutical Sciences, Postgraduate Program of Physiopathology and Toxicology, University of São Paulo, São Paulo, Brazil
- Department of Arbovirology and Hemorrhagic Fevers, PAHO Collaborating Centre for Emerging and Reemerging Arboviruses and other Zoonotic Viruses, Evandro Chagas Institute, Ananindeua, Brazil
| | - Vinicius Pacheco
- Department of Arbovirology and Hemorrhagic Fevers, PAHO Collaborating Centre for Emerging and Reemerging Arboviruses and other Zoonotic Viruses, Evandro Chagas Institute, Ananindeua, Brazil
| | - Érika D L Rodrigues
- Department of Arbovirology and Hemorrhagic Fevers, PAHO Collaborating Centre for Emerging and Reemerging Arboviruses and other Zoonotic Viruses, Evandro Chagas Institute, Ananindeua, Brazil
| | - Cássia N S Moraes
- Department of Arbovirology and Hemorrhagic Fevers, PAHO Collaborating Centre for Emerging and Reemerging Arboviruses and other Zoonotic Viruses, Evandro Chagas Institute, Ananindeua, Brazil
| | - Adriel L Nóbile
- Department of Pharmaceutical Sciences, Postgraduate Program of Physiopathology and Toxicology, University of São Paulo, São Paulo, Brazil
| | - Dennyson Leandro M Fonseca
- Interunit Postgraduate Program on Bioinformatics, Institute of Mathematics and Statistics (IME), University of São Paulo, São Paulo, Brazil
| | - Kamilla B S Souza
- Department of Immunology, University of São Paulo, São Paulo, Brazil
| | - Fernando Y N do Vale
- Department of Pharmaceutical Sciences, Postgraduate Program of Physiopathology and Toxicology, University of São Paulo, São Paulo, Brazil
| | - Igor S Filgueiras
- Department of Immunology, University of São Paulo, São Paulo, Brazil
| | - Lena F Schimke
- Department of Immunology, University of São Paulo, São Paulo, Brazil
| | - Lasse M Giil
- Department of Internal Medicine, Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Guido Moll
- Department of Nephrology and Internal Intensive Care Medicine, Charité University Hospital, Berlin, Germany
| | | | - Hans D Ochs
- School of Medicine and Seattle Children's Research Institute, University of Washington, Seattle, Washington, USA
| | - Pedro F da Costa Vasconcelos
- Department of Arbovirology and Hemorrhagic Fevers, PAHO Collaborating Centre for Emerging and Reemerging Arboviruses and other Zoonotic Viruses, Evandro Chagas Institute, Ananindeua, Brazil
- Department of Pathology, University of the State of Pará, Belem, Brazil
| | - Guilherme D de Melo
- Lyssavirus Epidemiology and Neuropathology Unit, WHO Collaborating Centre for Reference and Research on Rabies, Institut Pasteur, Université Paris Cité, Paris, France
| | - Hervé Bourhy
- Lyssavirus Epidemiology and Neuropathology Unit, WHO Collaborating Centre for Reference and Research on Rabies, Institut Pasteur, Université Paris Cité, Paris, France
| | - Livia M N Casseb
- Department of Arbovirology and Hemorrhagic Fevers, PAHO Collaborating Centre for Emerging and Reemerging Arboviruses and other Zoonotic Viruses, Evandro Chagas Institute, Ananindeua, Brazil
| | - Otavio Cabral-Marques
- Department of Pharmaceutical Sciences, Postgraduate Program of Physiopathology and Toxicology, University of São Paulo, São Paulo, Brazil
- Department of Immunology, University of São Paulo, São Paulo, Brazil
- Network of Immunity in Infection, Malignancy, Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), São Paulo, Brazil
- Department of Medicine, Division of Molecular Medicine, University of São Paulo School of Medicine, São Paulo, Brazil
- Laboratory of Medical Investigation 29, School of Medicine, University of São Paulo, São Paulo, Brazil
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2
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Casazza JA, Thakur B, Perl TM, Hanna JJ, Diaz MI, Ho M, Lanier H, Pickering M, Saleh SN, Shah P, Shah D, Navar AM, Lehmann CU, Medford RJ, Turer RW. Is there an association between peri-diagnostic vaccination and clinical outcomes in COVID-19 patients? ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2023; 3:e150. [PMID: 37771735 PMCID: PMC10523550 DOI: 10.1017/ash.2023.417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 06/24/2023] [Accepted: 06/28/2023] [Indexed: 09/30/2023]
Abstract
Background Peri-diagnostic vaccination contemporaneous with SARS-CoV-2 infection might boost antiviral immunity and improve patient outcomes. We investigated, among previously unvaccinated patients, whether vaccination (with the Pfizer, Moderna, or J&J vaccines) during the week before or after a positive COVID-19 test was associated with altered 30-day patient outcomes. Methods Using a deidentified longitudinal EHR repository, we selected all previously unvaccinated adults who initially tested positive for SARS-CoV-2 between December 11, 2020 (the date of vaccine emergency use approval) and December 19, 2021. We assessed whether vaccination between days -7 and +7 of a positive test affected outcomes. The primary measure was progression to a more severe disease outcome within 30 days of diagnosis using the following hierarchy: hospitalization, intensive care, or death. Results Among 60,031 hospitalized patients, 543 (0.91%) were initially vaccinated at the time of diagnosis and 59,488 (99.09%) remained unvaccinated during the period of interest. Among 316,337 nonhospitalized patients, 2,844 (0.90%) were initially vaccinated and 313,493 (99.1%) remained unvaccinated. In both analyses, individuals receiving vaccines were older, more often located in the northeast, more commonly insured by Medicare, and more burdened by comorbidities. Among previously unvaccinated patients, there was no association between receiving an initial vaccine dose between days -7 and +7 of diagnosis and progression to more severe disease within 30 days compared to patients who did not receive vaccines. Conclusions Immunization during acute SARS-CoV-2 infection does not appear associated with clinical progression during the acute infectious period.
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Affiliation(s)
| | - Bhaskar Thakur
- Clinical Informatics Center, UT Southwestern Medical Center, Dallas, TX, USA
- O’Donnell School of Public Health, UT Southwestern Medical Center, Dallas, TX, USA
| | - Trish M. Perl
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - John J. Hanna
- Clinical Informatics Center, UT Southwestern Medical Center, Dallas, TX, USA
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - Marlon I. Diaz
- Clinical Informatics Center, UT Southwestern Medical Center, Dallas, TX, USA
| | - Milan Ho
- UT Southwestern Medical School, Dallas, TX, USA
| | | | - Madison Pickering
- Clinical Informatics Center, UT Southwestern Medical Center, Dallas, TX, USA
| | - Sameh N. Saleh
- Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Pankil Shah
- Department of Urology, UT Health San Antonio, San Antonio, TX, USA
| | - Dimpy Shah
- Department of Population Health Sciences, UT Health San Antonio, San Antonio, TX, USA
| | - Ann Marie Navar
- O’Donnell School of Public Health, UT Southwestern Medical Center, Dallas, TX, USA
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - Christoph U. Lehmann
- Clinical Informatics Center, UT Southwestern Medical Center, Dallas, TX, USA
- O’Donnell School of Public Health, UT Southwestern Medical Center, Dallas, TX, USA
- Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX, USA
- Lyda Hill Department of Bioinformatics, UT Southwestern Medical Center, Dallas, TX, USA
| | - Richard J. Medford
- Clinical Informatics Center, UT Southwestern Medical Center, Dallas, TX, USA
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
- Chief Medical Informatics and Digital Health Officer, ECU Health, Greenville, NC, USA
| | - Robert W. Turer
- Clinical Informatics Center, UT Southwestern Medical Center, Dallas, TX, USA
- Department of Emergency Medicine, UT Southwestern Medical Center, Dallas, TX, USA
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3
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Li J, Liu Q, Liu J, Wu X, Lei Y, Li S, Zhao D, Li Z, Luo L, Peng S, Ou Y, Yang H, Jin J, Li Y, Peng Y. An mRNA-based rabies vaccine induces strong protective immune responses in mice and dogs. Virol J 2022; 19:184. [PMID: 36371169 PMCID: PMC9652961 DOI: 10.1186/s12985-022-01919-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 11/04/2022] [Indexed: 11/13/2022] Open
Abstract
AbstractRabies is a lethal zoonotic disease that is mainly caused by the rabies virus (RABV). Although effective vaccines have long existed, current vaccines take both time and cost to produce. Messenger RNA (mRNA) technology is an emergent vaccine platform that supports rapid vaccine development on a large scale. Here, an optimized mRNA vaccine construct (LVRNA001) expressing rabies virus glycoprotein (RABV-G) was developed in vitro and then evaluated in vivo for its immunogenicity and protective capacity in mice and dogs. LVRNA001 induced neutralizing antibody production and a strong Th1 cellular immune response in mice. In both mice and dogs, LVRNA001 provided protection against challenge with 50-fold lethal dose 50 (LD50) of RABV. With regards to protective efficiency, an extended dosing interval (14 days) induced greater antibody production than 3- or 7-day intervals in mice. Finally, post-exposure immunization against RABV was performed to evaluate the survival rates of dogs receiving two 25 μg doses of LVRNA001 vs. five doses of inactivated vaccine over the course of three months. Survival rate in the LVRNA001 group was 100%, whereas survival rate in the inactivated vaccine control group was only 33.33%. In conclusion, these results demonstrated that LVRNA001 induced strong protective immune responses in mice and dogs, which provides a new and promising prophylactic strategy for rabies.
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Knobel DL, Jackson AC, Bingham J, Ertl HCJ, Gibson AD, Hughes D, Joubert K, Mani RS, Mohr BJ, Moore SM, Rivett-Carnac H, Tordo N, Yeates JW, Zambelli AB, Rupprecht CE. A One Medicine Mission for an Effective Rabies Therapy. Front Vet Sci 2022; 9:867382. [PMID: 35372555 PMCID: PMC8967983 DOI: 10.3389/fvets.2022.867382] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 02/14/2022] [Indexed: 11/13/2022] Open
Abstract
Despite the disease's long history, little progress has been made toward a treatment for rabies. The prognosis for patient recovery remains dire. For any prospect of survival, patients require aggressive critical care, which physicians in rabies endemic areas may be reluctant or unable to provide given the cost, clinical expertise required, and uncertain outcome. Systematic clinical research into combination therapies is further hampered by sporadic occurrence of cases. In this Perspective, we examine the case for a One Medicine approach to accelerate development of an effective therapy for rabies through the veterinary care and investigational treatment of naturally infected dogs in appropriate circumstances. We review the pathogenesis of rabies virus in humans and dogs, including recent advances in our understanding of the molecular basis for the severe neurological dysfunction. We propose that four categories of disease process need to be managed in patients: viral propagation, neuronal degeneration, inflammation and systemic compromise. Compassionate critical care and investigational treatment of naturally infected dogs receiving supportive therapy that mimics the human clinical scenario could increase opportunities to study combination therapies that address these processes, and to identify biomarkers for prognosis and therapeutic response. We discuss the safety and ethics of this approach, and introduce the Canine Rabies Treatment Initiative, a non-profit organization with the mission to apply a One Medicine approach to the investigation of diagnostic, prognostic, and therapeutic options for rabies in naturally infected dogs, to accelerate transformation of rabies into a treatable disease for all patients.
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Affiliation(s)
- Darryn L. Knobel
- Department of Biomedical Sciences, Ross University School of Veterinary Medicine, Basseterre, Saint Kitts and Nevis
- Department of Veterinary Tropical Diseases, Faculty of Veterinary Science, University of Pretoria, Pretoria, South Africa
- Canine Rabies Treatment Initiative, Salt Rock, South Africa
- *Correspondence: Darryn L. Knobel ;
| | - Alan C. Jackson
- Department of Medicine, Northern Consultation Centre, Thompson General Hospital, Thompson, MB, Canada
- Department of Medicine, Lake of the Woods District Hospital, Kenora, ON, Canada
| | - John Bingham
- Commonwealth Scientific and Industrial Research Organisation (CSIRO) Australian Animal Health Laboratory at the Australian Centre for Disease Preparedness, Geelong, VIC, Australia
| | | | - Andrew D. Gibson
- Division of Genetics and Genomics, Easter Bush Veterinary Centre, The Roslin Institute and the Royal (Dick) School of Veterinary Studies, The University of Edinburgh, Roslin, United Kingdom
| | - Daniela Hughes
- Canine Rabies Treatment Initiative, Salt Rock, South Africa
| | - Kenneth Joubert
- Veterinary Anaesthesia, Analgesia and Critical Care Services, Lonehill, South Africa
| | - Reeta S. Mani
- Department of Neurovirology, WHO Collaborating Centre for Reference and Research in Rabies, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Bert J. Mohr
- Canine Rabies Treatment Initiative, Salt Rock, South Africa
- Centre for Animal Research, Faculty of Health Sciences, University of Cape Town, Observatory, South Africa
| | - Susan M. Moore
- Veterinary Medical Diagnostic Laboratory, University of Missouri, Columbia, MO, United States
| | | | - Noël Tordo
- Institut Pasteur de Guinée, Conakry, Guinea
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5
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de Melo GD, Hellert J, Gupta R, Corti D, Bourhy H. Monoclonal antibodies against rabies: current uses in prophylaxis and in therapy. Curr Opin Virol 2022; 53:101204. [PMID: 35151116 DOI: 10.1016/j.coviro.2022.101204] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 01/11/2022] [Accepted: 01/15/2022] [Indexed: 12/25/2022]
Abstract
Rabies is a severe viral infection that causes an acute encephalomyelitis, which presents a case fatality of nearly 100% after the manifestation of neurological clinical signs. Rabies can be efficiently prevented with post-exposure prophylaxis (PEP), composed of vaccines and anti-rabies immunoglobulins (RIGs); however, no treatment exists for symptomatic rabies. The PEP protocol faces access and implementation obstacles in resource-limited settings, which could be partially overcome by substituting RIGs for monoclonal antibodies (mAbs). mAbs offer lower production costs, consistent supply availability, long-term storage/stability, and an improved safety profile. Here we summarize the key features of the different available mAbs against rabies, focusing on their application in PEP and highlighting their potential in a novel therapeutic approach.
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Affiliation(s)
- Guilherme Dias de Melo
- Institut Pasteur, Université de Paris, Lyssavirus Epidemiology and Neuropathology Unit, Paris, F-75015, France
| | - Jan Hellert
- Centre for Structural Systems Biology, Leibniz-Institut für Experimentelle Virologie (HPI), Notkestrasse 85, Hamburg, 22607, Germany
| | | | - Davide Corti
- Humabs Biomed SA, a Subsidiary of Vir Biotechnology, Bellinzona, Switzerland
| | - Hervé Bourhy
- Institut Pasteur, Université de Paris, Lyssavirus Epidemiology and Neuropathology Unit, Paris, F-75015, France; Institut Pasteur, Université de Paris, National Reference Center for Rabies, Paris, F-75015, France; Institut Pasteur, Université de Paris, WHO Collaborating Centre for Reference and Research on Rabies, Paris, F-75015, France.
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6
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Mastraccio KE, Huaman C, Laing ED, Broder CC, Schaefer BC. Longitudinal Tracing of Lyssavirus Infection in Mice via In Vivo Bioluminescence Imaging. Methods Mol Biol 2022; 2524:369-394. [PMID: 35821488 DOI: 10.1007/978-1-0716-2453-1_30] [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] [Indexed: 06/15/2023]
Abstract
Bioluminescence imaging (BLI) is a technique that can be employed to quantify biological processes in living cells. When used in small animal models such as mice, BLI can provide both longitudinal and positional information regarding the biological process under investigation. Although perhaps best known for its utility in non-invasively quantifying tumor burden over time in experimental animals, BLI has also been applied in many pathogenesis models to track pathogen burden and responses to therapeutic interventions. In this chapter, we present a BLI-based method for tracing anatomical progression of lyssavirus infection in a mouse model. We also include validation methods to ensure that semiquantitative BLI data correlate well with viral load. Due to the longitudinal nature of this approach, lyssavirus pathogenesis and therapeutic intervention studies can be performed with far fewer animals than more traditional approaches, which typically require euthanasia of large animal groups at every data collection time point.
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Affiliation(s)
- Kate E Mastraccio
- Department of Microbiology and Immunology, Uniformed Services University, Bethesda, MD, USA
- David Axelrod Institute, Wadsworth Center, NYS Department of Health, Albany, NY, USA
| | - Celeste Huaman
- Department of Microbiology and Immunology, Uniformed Services University, Bethesda, MD, USA
| | - Eric D Laing
- Department of Microbiology and Immunology, Uniformed Services University, Bethesda, MD, USA
| | - Christopher C Broder
- Department of Microbiology and Immunology, Uniformed Services University, Bethesda, MD, USA
| | - Brian C Schaefer
- Department of Microbiology and Immunology, Uniformed Services University, Bethesda, MD, USA.
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7
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Huang F, Ren M, Pei J, Mei H, Sui B, Wu Q, Chai B, Yang R, Zhou M, Fu ZF, Zhou H, Zhao L. Preexposure and Postexposure Prophylaxis of Rabies With Adeno-Associated Virus Expressing Virus-Neutralizing Antibody in Rodent Models. Front Microbiol 2021; 12:702273. [PMID: 34489891 PMCID: PMC8417364 DOI: 10.3389/fmicb.2021.702273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 07/28/2021] [Indexed: 12/25/2022] Open
Abstract
Rabies, a fatal disease in humans and other mammals, is caused by the rabies virus (RABV), and it poses a public health threat in many parts of the world. Once symptoms of rabies appear, the mortality is near 100%. There is currently no effective treatment for rabies. In our study, two human-derived RABV-neutralizing antibodies (RVNA), CR57 and CR4098, were cloned into adeno-associated virus (AAV) vectors, and recombinant AAVs expressing RVNA were evaluated for postexposure prophylaxis after intrathecal injection into RABV-infected rats. At 4days post-infection with a lethal dose of RABV, 60% of the rats that received an intrathecal injection of AAV-CR57 survived, while 100% of the rats inoculated with AAV-enhanced green fluorescent protein (EGFP) succumbed to rabies. Overall, these results demonstrate that AAV-encoding RVNA can be utilized as a potential human rabies postexposure prophylaxis.
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Affiliation(s)
- Fei Huang
- State Key Laboratory of Agricultural Microbiology, Huazhong Agricultural University, Wuhan, China.,Key Laboratory of Preventive Veterinary Medicine in Hubei Province, College of Veterinary Medicine, Huazhong Agricultural University, Wuhan, China
| | - Meishen Ren
- State Key Laboratory of Agricultural Microbiology, Huazhong Agricultural University, Wuhan, China.,Key Laboratory of Preventive Veterinary Medicine in Hubei Province, College of Veterinary Medicine, Huazhong Agricultural University, Wuhan, China
| | - Jie Pei
- State Key Laboratory of Agricultural Microbiology, Huazhong Agricultural University, Wuhan, China.,Key Laboratory of Preventive Veterinary Medicine in Hubei Province, College of Veterinary Medicine, Huazhong Agricultural University, Wuhan, China
| | - Hong Mei
- State Key Laboratory of Agricultural Microbiology, Huazhong Agricultural University, Wuhan, China.,Key Laboratory of Preventive Veterinary Medicine in Hubei Province, College of Veterinary Medicine, Huazhong Agricultural University, Wuhan, China
| | - Baokun Sui
- State Key Laboratory of Agricultural Microbiology, Huazhong Agricultural University, Wuhan, China.,Key Laboratory of Preventive Veterinary Medicine in Hubei Province, College of Veterinary Medicine, Huazhong Agricultural University, Wuhan, China
| | - Qiong Wu
- State Key Laboratory of Agricultural Microbiology, Huazhong Agricultural University, Wuhan, China.,Key Laboratory of Preventive Veterinary Medicine in Hubei Province, College of Veterinary Medicine, Huazhong Agricultural University, Wuhan, China
| | - Benjie Chai
- State Key Laboratory of Agricultural Microbiology, Huazhong Agricultural University, Wuhan, China.,Key Laboratory of Preventive Veterinary Medicine in Hubei Province, College of Veterinary Medicine, Huazhong Agricultural University, Wuhan, China
| | - Ruicheng Yang
- State Key Laboratory of Agricultural Microbiology, Huazhong Agricultural University, Wuhan, China.,Key Laboratory of Preventive Veterinary Medicine in Hubei Province, College of Veterinary Medicine, Huazhong Agricultural University, Wuhan, China
| | - Ming Zhou
- State Key Laboratory of Agricultural Microbiology, Huazhong Agricultural University, Wuhan, China.,Key Laboratory of Preventive Veterinary Medicine in Hubei Province, College of Veterinary Medicine, Huazhong Agricultural University, Wuhan, China
| | - Zhen F Fu
- State Key Laboratory of Agricultural Microbiology, Huazhong Agricultural University, Wuhan, China.,Key Laboratory of Preventive Veterinary Medicine in Hubei Province, College of Veterinary Medicine, Huazhong Agricultural University, Wuhan, China
| | - Huiping Zhou
- School of Basic Medicine, Hubei University of Science and Technology, Xianning, China
| | - Ling Zhao
- State Key Laboratory of Agricultural Microbiology, Huazhong Agricultural University, Wuhan, China.,Key Laboratory of Preventive Veterinary Medicine in Hubei Province, College of Veterinary Medicine, Huazhong Agricultural University, Wuhan, China
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8
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Cai L, Wang L, Guan X, Wang L, Hu X, Wu Y, Tong Y, Wang P. Epidemiological Analysis of Rabies in Central China from 2013 to 2018. Infect Drug Resist 2021; 14:2753-2762. [PMID: 34305400 PMCID: PMC8297554 DOI: 10.2147/idr.s314881] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 06/02/2021] [Indexed: 11/23/2022] Open
Abstract
Objective The study aimed to timely grasp the epidemiologic status of rabies in Central China from 2013 to 2018 and provide scientific evidence for the implementation of follow-up prevention and control measures. Methods We initiated a retrospective observational and descriptive study of bite-related injuries data and rabies disease data in Hubei province from 2013 to 2018, managed by the Center for Disease Control and Prevention. Results A total of 2,028,691 individuals were exposed to bites from 2013 to 2018, of which 221 were diagnosed with rabies and deceased. Among those cases, the incubation periods of rabies varied from 3 days to 18,406 days, which has been shown to be statistically associated with where the infected person was exposed and whether the wound care has been conducted. Conclusion Epidemiological studies have shown that from 2013 to 2018, the current situation of rabies in Central China is still severe. The case fatality rate keeps virtually 100%. The rural population is still the most vulnerable group to rabies, characterized by a high exposure ratio and low treatment rate as well as poor vaccination compliance. Hoewever, larger populations are warranted to validate our findings.
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Affiliation(s)
- Li Cai
- School of Health Sciences, Wuhan University, Wuhan, 430071, People's Republic of China.,Wuhan Center for Disease Control and Prevention, Wuhan, 430015, People's Republic of China
| | - Lixian Wang
- Xiaonan Center for Disease Control and Prevention, Xiaogan, 432100, People's Republic of China
| | - Xuhua Guan
- Hubei Center for Disease Control and Prevention, Wuhan, Hubei, 430079, People's Republic of China
| | - Lei Wang
- Hubei Center for Disease Control and Prevention, Wuhan, Hubei, 430079, People's Republic of China
| | - Xinyi Hu
- Global Study Institute, University of Geneva, Geneva, Switzerland
| | - Yang Wu
- Hubei Center for Disease Control and Prevention, Wuhan, Hubei, 430079, People's Republic of China
| | - Yeqing Tong
- Hubei Center for Disease Control and Prevention, Wuhan, Hubei, 430079, People's Republic of China
| | - Peigang Wang
- School of Health Sciences, Wuhan University, Wuhan, 430071, People's Republic of China
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9
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Wobessi JNS, Kenmoe S, Mahamat G, Belobo JTE, Emoh CPD, Efietngab AN, Bebey SRK, Ngongang DT, Tchatchouang S, Nzukui ND, Modiyinji AF, Simo REG, Ka'e AC, Tazokong HR, Ngandji AB, Mbaga DS, Kengne-Nde C, Sadeuh-Mba SA, Njouom R. Incidence and seroprevalence of rabies virus in humans, dogs and other animal species in Africa, a systematic review and meta-analysis. One Health 2021; 13:100285. [PMID: 34258372 PMCID: PMC8254041 DOI: 10.1016/j.onehlt.2021.100285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 06/16/2021] [Accepted: 06/24/2021] [Indexed: 12/30/2022] Open
Abstract
Rabies is transmitted to humans mainly by dogs but also by other animal species. Reliable data on the incidence of Rabies virus (RABV) in humans, dogs, and other animal species in Africa, could be essential in the implementation of a global strategic plan to eliminate the RABV by 2030 as adopted by the WHO, OIE, and FAO. We searched the Pubmed, Embase, Scopus, African Journal Online, and African Index Medicus databases for relevant studies that report data on the incidence of RABV in Africa up to February 17, 2020. Information on active and past RABV exposures in various categories of dogs, humans and other animal species were extracted. Incidence and seroprevalence estimates were pooled using a random-effect meta-analysis. We included 73 articles which provided 142 RABV incidence and seroprevalence records in 21 African countries. The estimated incidence of RABV in 222 humans, 15,600 dogs, and 12,865 other animal species was 83.4% (95% CI = 64.6–96.5), 44.1% (95% CI = 35.1–53.4), and 41.4% (95% CI = 29.6–53.8), respectively. The estimated seroprevalence of RABV in 420 humans, 3577 dogs, and 8,55 other animal species was 33.8% (95% CI = 21.9–46.8), 19.8% (95% CI = 13.3–27.3), and 3.6% (95% CI = 0.3–9.2), respectively. The incidence of RABV in general was higher in suspected rabid dogs, other animal species of the Orders Perissodactyla, Artiodactyla and Carnivora. The incidence of RABV was higher for humans in regions of West and East Africa, for dogs in urban areas and in regions of Central and South Africa, and for animals of the order Perissodactyla in urban areas. This meta-analysis demonstrated a high incidence of RABV in Africa. Itis necessary to improve surveillance system to provide reliable data on RABV in Africa, essential for the implementation of an effective control strategy.
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Affiliation(s)
- Jocelyne Noel Sowe Wobessi
- Virology Department, Centre, Pasteur of Cameroon, Yaounde, Cameroon.,Ecole Doctorale Régionale d'Afrique Centrale, Franceville, Gabon
| | - Sebastien Kenmoe
- Virology Department, Centre, Pasteur of Cameroon, Yaounde, Cameroon
| | - Gadji Mahamat
- Department of Microbiology, Faculty of Science, The University of Yaounde I, Yaounde, Cameroon
| | - Jean Thierry Ebogo Belobo
- Medical Research Centre, Institute of Medical Research and Medicinal Plants Studies, Yaoundé, Cameroon
| | | | - Atembeh Noura Efietngab
- Medical Research Centre, Institute of Medical Research and Medicinal Plants Studies, Yaoundé, Cameroon
| | | | - Dimitri Tchami Ngongang
- Department of Microbiology, Faculty of Science, The University of Yaounde I, Yaounde, Cameroon
| | | | - Nathalie Diane Nzukui
- School of Health Sciences-Catholic University of Central Africa, Department of Medical Microbiology, Yaounde, Cameroon
| | - Abdou Fatawou Modiyinji
- Ecole Doctorale Régionale d'Afrique Centrale, Franceville, Gabon.,Department of Animals Biology and Physiology, Faculty of Science, The University of Yaounde I, Yaounde, Cameroon
| | | | - Aude Christelle Ka'e
- Virology Department, Chantal Biya International Reference Centre, Yaounde, Cameroon
| | - Hervé Raoul Tazokong
- Department of Microbiology, Faculty of Science, The University of Yaounde I, Yaounde, Cameroon
| | - Arnol Bowo Ngandji
- Department of Microbiology, Faculty of Science, The University of Yaounde I, Yaounde, Cameroon
| | - Donatien Serge Mbaga
- Department of Microbiology, Faculty of Science, The University of Yaounde I, Yaounde, Cameroon
| | - Cyprien Kengne-Nde
- Epidemiological Surveillance, Evaluation and Research Unit, National AIDS Control Committee, Yaounde, Cameroon
| | | | - Richard Njouom
- Virology Department, Centre, Pasteur of Cameroon, Yaounde, Cameroon
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10
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Rabies: Presentation, case management and therapy. J Neurol Sci 2021; 424:117413. [PMID: 33812240 DOI: 10.1016/j.jns.2021.117413] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 02/26/2021] [Accepted: 03/22/2021] [Indexed: 11/23/2022]
Abstract
Several Lyssaviruses are known to be a causative agent of rabies and rabies like syndrome. There are no proven effective treatment strategies for symptomatic rabies patient. Risk of infection from dog variant of rabies virus is highest with deep bite reaching muscular layer and much higher when compared to scratch. Failure of viral eradication at the central nervous system (CNS) is partly due to inadequate immune response. Favipiravir selectively inhibit viral RNA polymerase and has been shown to reduce rabies replication in neuronal cell and mouse model system. Endocannabinoid system has emerged as an important regulator for CNS integrity, cell fate and may serve as an important novel neuroprotective agent. Cannabinoid may be able to regulate the impaired homeostasis induced by rabies virus by promoting infected cell survival and promote complete autophagy in infected cell.
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11
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Bourhy H, de Melo GD, Tarantola A. [New aspects of rabies control]. BULLETIN DE L'ACADEMIE NATIONALE DE MEDECINE 2020; 204:1000-1009. [PMID: 32981935 PMCID: PMC7500396 DOI: 10.1016/j.banm.2020.09.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 09/10/2020] [Indexed: 12/25/2022]
Abstract
Rabies still causes about 60,000 human deaths per year, mainly in poor populations in Africa and Asia. However, since Louis Pasteur developed the first vaccine 130 years ago, prophylactic measures have been considerably improved and simplified. They now consist of the vaccine combined with purified rabies immunoglobulins of equine or human origin. In general, however, post-exposure prophylaxis protocols are long and expensive. Furthermore, the immunoglobulins used for associated serotherapy are costly and not widely available in developing countries. Approaches have been developed to deal with these two issues that offer hope for a paradigm shift for the benefit of exposed populations. Finally, mass rabies vaccination in dogs, which are the most cost-effective measure for preventing rabies in humans, are difficult to implement and sometimes have moderate effectiveness. The identification and analysis of the epidemiological drivers conditioning the circulation of the virus in dog populations allow a better understanding of the key control points that need to be associated with these campaigns for a better efficacy.
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Affiliation(s)
- H Bourhy
- Unité lyssavirus, épidémiologie et neuropathologie, centre collaborateur de l'Organisation mondiale de la santé de référence et de recherche sur la rage, institut Pasteur, 28, rue du Docteur Roux, 75724 Paris cedex 15, France
| | - G D de Melo
- Unité lyssavirus, épidémiologie et neuropathologie, centre collaborateur de l'Organisation mondiale de la santé de référence et de recherche sur la rage, institut Pasteur, 28, rue du Docteur Roux, 75724 Paris cedex 15, France
| | - A Tarantola
- Unité lyssavirus, épidémiologie et neuropathologie, centre collaborateur de l'Organisation mondiale de la santé de référence et de recherche sur la rage, institut Pasteur, 28, rue du Docteur Roux, 75724 Paris cedex 15, France
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12
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de Melo GD, Sonthonnax F, Lepousez G, Jouvion G, Minola A, Zatta F, Larrous F, Kergoat L, Mazo C, Moigneu C, Aiello R, Salomoni A, Brisebard E, De Benedictis P, Corti D, Bourhy H. A combination of two human monoclonal antibodies cures symptomatic rabies. EMBO Mol Med 2020; 12:e12628. [PMID: 32945125 PMCID: PMC7645379 DOI: 10.15252/emmm.202012628] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 08/26/2020] [Accepted: 08/27/2020] [Indexed: 12/18/2022] Open
Abstract
Rabies is a neglected disease caused by a neurotropic Lyssavirus, transmitted to humans predominantly by the bite of infected dogs. Rabies is preventable with vaccines or proper post-exposure prophylaxis (PEP), but it still causes about 60,000 deaths every year. No cure exists after the onset of clinical signs, and the case-fatality rate approaches 100% even with advanced supportive care. Here, we report that a combination of two potent neutralizing human monoclonal antibodies directed against the viral envelope glycoprotein cures symptomatic rabid mice. Treatment efficacy requires the concomitant administration of antibodies in the periphery and in the central nervous system through intracerebroventricular infusion. After such treatment, recovered mice presented good clinical condition, viral loads were undetectable, and the brain inflammatory profile was almost normal. Our findings provide the unprecedented proof of concept of an antibody-based therapeutic approach for symptomatic rabies.
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Affiliation(s)
| | - Florian Sonthonnax
- Lyssavirus Epidemiology and Neuropathology UnitInstitut PasteurParisFrance
- Sorbonne‐Paris CitéCellule PasteurUniversité Paris‐DiderotParisFrance
| | | | - Grégory Jouvion
- Experimental Neuropathology UnitInstitut PasteurParisFrance
- INSERMPathophysiology of Pediatric Genetic DiseasesSorbonne UniversitéHôpital Armand‐TrousseauUF Génétique MoléculaireAssistance Publique‐Hôpitaux de ParisParisFrance
| | - Andrea Minola
- Humabs BioMed SAa subsidiary of Vir BiotechnologyBellinzonaSwitzerland
| | - Fabrizia Zatta
- Humabs BioMed SAa subsidiary of Vir BiotechnologyBellinzonaSwitzerland
| | - Florence Larrous
- Lyssavirus Epidemiology and Neuropathology UnitInstitut PasteurParisFrance
| | - Lauriane Kergoat
- Lyssavirus Epidemiology and Neuropathology UnitInstitut PasteurParisFrance
| | - Camille Mazo
- Perception and Memory UnitInstitut PasteurParisFrance
| | | | - Roberta Aiello
- Istituto Zooprofilattico Sperimentale delle VeneziePaduaItaly
| | - Angela Salomoni
- Istituto Zooprofilattico Sperimentale delle VeneziePaduaItaly
| | - Elise Brisebard
- Experimental Neuropathology UnitInstitut PasteurParisFrance
- Laboratoire d'HistopathologieVetAgro‐SupUniversité de LyonLyonFrance
| | | | - Davide Corti
- Humabs BioMed SAa subsidiary of Vir BiotechnologyBellinzonaSwitzerland
| | - Hervé Bourhy
- Lyssavirus Epidemiology and Neuropathology UnitInstitut PasteurParisFrance
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13
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Viruses in connectomics: Viral transneuronal tracers and genetically modified recombinants as neuroscience research tools. J Neurosci Methods 2020; 346:108917. [PMID: 32835704 DOI: 10.1016/j.jneumeth.2020.108917] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 08/12/2020] [Accepted: 08/14/2020] [Indexed: 12/25/2022]
Abstract
Connectomic studies have become 'viral', as viral pathogens have been turned into irreplaceable neuroscience research tools. Highly sensitive viral transneuronal tracing technologies are available, based on the use of alpha-herpesviruses and a rhabdovirus (rabies virus), which function as self-amplifying markers by replicating in recipient neurons. These viruses highly differ with regard to host range, cellular receptors, peripheral uptake, replication, transport direction and specificity. Their characteristics, that make them useful for different purposes, will be highlighted and contrasted. Only transneuronal tracing with rabies virus is entirely specific. The neuroscientist toolbox currently include wild-type alpha-herpesviruses and rabies virus strains enabling polysynaptic tracing of neuronal networks across multiple synapses, as well as genetically modified viral tracers for dual transneuronal tracing, and complementary viral tools including defective and chimeric recombinants that function as single step or monosynaptically restricted tracers, or serve for monitoring and manipulating neuronal activity and gene expression. Methodological issues that are crucial for appropriate use of these technologies will be summarized. Among wild-type and genetically engineered viral tools, rabies virus and chimeric recombinants based on rabies virus as virus backbone are the most powerful, because of the ability of rabies virus to propagate exclusively among connected neurons unidirectionally (retrogradely), without affecting neuronal function. Understanding in depth viral properties is essential for neuroscientists who intend to exploit alpha-herpesviruses, rhabdoviruses or derived recombinants as research tools. Key knowledge will be summarized regarding their cellular receptors, intracellular trafficking and strategies to contrast host defense that explain their different pathophysiology and properties as research tools.
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14
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Mastraccio KE, Huaman C, Warrilow D, Smith GA, Craig SB, Weir DL, Laing ED, Smith IL, Broder CC, Schaefer BC. Establishment of a longitudinal pre-clinical model of lyssavirus infection. J Virol Methods 2020; 281:113882. [PMID: 32407866 PMCID: PMC8056983 DOI: 10.1016/j.jviromet.2020.113882] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 04/19/2020] [Accepted: 05/07/2020] [Indexed: 12/12/2022]
Abstract
Traditional mouse models of lyssavirus pathogenesis rely on euthanizing large groups of animals at various time points post-infection, processing infected tissues, and performing histological and molecular analyses to determine anatomical sites of infection. While powerful by some measures, this approach is limited by the inability to monitor disease progression in the same mice over time. In this study, we established a novel non-invasive mouse model of lyssavirus pathogenesis, which consists of longitudinal imaging of a luciferase-expressing Australian bat lyssavirus (ABLV) reporter virus. In vivo bioluminescence imaging (BLI) in mice revealed viral spread from a peripheral site of inoculation into the central nervous system (CNS), with kinetically and spatially distinct foci of replication in the footpad, spinal cord, and hindbrain. Detection of virus within the CNS was associated with onset of clinical disease. Quantification of virus-derived luminescent signal in the brain was found to be a reliable measure of viral replication, when compared to traditional molecular methods. Furthermore, we demonstrate that in vivo imaging of ABLV infection is not restricted to the use of albino strains of mice, but rather strong BLI signal output can be achieved by shaving the hair from the heads and spines of pigmented strains, such as C57BL/6. Overall, our data show that in vivo BLI can be used to rapidly and non-invasively identify sites of lyssavirus replication and to semi-quantitatively determine viral load without the need to sacrifice mice at multiple time points.
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Affiliation(s)
- Kate E Mastraccio
- Uniformed Services University, Department of Microbiology and Immunology, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA.
| | - Celeste Huaman
- Uniformed Services University, Department of Microbiology and Immunology, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA.
| | - David Warrilow
- Queensland Health Forensic and Scientific Services, Archerfield, Australia.
| | - Greg A Smith
- Queensland Health Forensic and Scientific Services, Archerfield, Australia.
| | - Scott B Craig
- Queensland Health Forensic and Scientific Services, Archerfield, Australia.
| | - Dawn L Weir
- Uniformed Services University, Department of Microbiology and Immunology, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA.
| | - Eric D Laing
- Uniformed Services University, Department of Microbiology and Immunology, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA.
| | - Ina L Smith
- Queensland Health Forensic and Scientific Services, Archerfield, Australia; Risk Evaluation and Preparedness Program, Health and Biosecurity, CSIRO, Black Mountain, ACT, Australia.
| | - Christopher C Broder
- Uniformed Services University, Department of Microbiology and Immunology, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA.
| | - Brian C Schaefer
- Uniformed Services University, Department of Microbiology and Immunology, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA.
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15
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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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16
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Yang F, Lin S, Ye F, Yang J, Qi J, Chen Z, Lin X, Wang J, Yue D, Cheng Y, Chen Z, Chen H, You Y, Zhang Z, Yang Y, Yang M, Sun H, Li Y, Cao Y, Yang S, Wei Y, Gao GF, Lu G. Structural Analysis of Rabies Virus Glycoprotein Reveals pH-Dependent Conformational Changes and Interactions with a Neutralizing Antibody. Cell Host Microbe 2020; 27:441-453.e7. [DOI: 10.1016/j.chom.2019.12.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 12/06/2019] [Accepted: 12/30/2019] [Indexed: 12/21/2022]
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17
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Hampson K, Abela-Ridder B, Bharti O, Knopf L, Léchenne M, Mindekem R, Tarantola A, Zinsstag J, Trotter C. Modelling to inform prophylaxis regimens to prevent human rabies. Vaccine 2019; 37 Suppl 1:A166-A173. [PMID: 30528846 PMCID: PMC7612382 DOI: 10.1016/j.vaccine.2018.11.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 10/21/2018] [Accepted: 11/02/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND The Strategic Advisory Group of Experts (SAGE) Working Group on rabies vaccines and immunoglobulins was established in 2016 to develop practical and feasible recommendations for prevention of human rabies. To support the SAGE agenda we developed models to compare the relative costs and potential benefits of rabies prevention strategies. METHODS We examined Post-Exposure Prophylaxis (PEP) regimens, protocols for administration of Rabies Immunoglobulin (RIG) and inclusion of rabies Pre-Exposure Prophylaxis (PrEP) within the Expanded Programme on Immunization (EPI). For different PEP regimens, clinic throughputs and consumables for vaccine administration, we evaluated the cost per patient treated, costs to patients and potential to treat more patients given limited vaccine availability. RESULTS We found that intradermal (ID) vaccination reduces the volume of vaccine used in all settings, is less costly and has potential to mitigate vaccine shortages. Specifically, the abridged 1-week 2-site ID regimen was the most cost-effective PEP regimen, even in settings with low numbers of bite patients presenting to clinics. We found advantages of administering RIG to the wound(s) only, using considerably less product than when the remaining dose is injected intramuscularly distant to the wound(s). We found that PrEP as part of the EPI programme would be substantially more expensive than use of PEP and dog vaccination in prevention of human rabies. CONCLUSIONS These modeling insights inform WHO recommendations for use of human rabies vaccines and biologicals. Specifically, the 1-week 2-site ID regimen is recommended as it is less costly and treats many more patients when vaccine is in short supply. If available, RIG should be administered at the wound only. PrEP is highly unlikely to be an efficient use of resources and should therefore only be considered in extreme circumstances, where the incidence of rabies exposures is extremely high.
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Affiliation(s)
- Katie Hampson
- Institute of Biodiversity, Animal Health & Comparative Medicine, University of Glasgow, Glasgow G12 8QQ, UK.
| | | | - Omesh Bharti
- State Institute of Health and Family Welfare, Himachal Pradesh, India.
| | - Lea Knopf
- Department of the Control of Neglected Tropical Diseases, 1121 Geneva 27, Switzerland.
| | - Monique Léchenne
- Swiss Tropical & Public Health Institute, PO Box, 4002 Basel, Switzerland, University of Basel, Petersplatz 1, 4003 Basel, Switzerland.
| | - Rolande Mindekem
- Centre de Support en Sante International (CSSI), N'Djamena, Chad.
| | - Arnaud Tarantola
- Epidemiology & Public Health Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia.
| | - Jakob Zinsstag
- Swiss Tropical & Public Health Institute, PO Box, 4002 Basel, Switzerland, University of Basel, Petersplatz 1, 4003 Basel, Switzerland.
| | - Caroline Trotter
- Disease Dynamics Unit, Department of Veterinary Medicine, University of Cambridge, Madingley Road, Cambridge CB3 0ES, UK.
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18
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Rupprecht CE, Salahuddin N. Current status of human rabies prevention: remaining barriers to global biologics accessibility and disease elimination. Expert Rev Vaccines 2019; 18:629-640. [PMID: 31159618 DOI: 10.1080/14760584.2019.1627205] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Introduction: Rabies is a serious, neglected tropical disease. Zoonotic agents are RNA viruses (Genus Lyssavirus, Family Rhabdoviridae), global in distribution. As an acute, progressive, incurable encephalitis, rabies has the highest case fatality of any infectious disease. Warm-blooded vertebrates are susceptible hosts. Major mammalian reservoirs include mesocarnivores and bats. Given wildlife perpetuation, rabies is not eradicable, but is preventable and controllable, especially under newly available international guidelines. Areas covered: Literature review over the past 5 years reveals development of sensitive, specific diagnostic tests and safe and highly effective human and veterinary vaccines. Yet, tens of thousands of human fatalities occur annually, usually in Africa and Asia, primarily after canine exposure. Human and domestic animal vaccination, before or after exposure, is the single greatest preventative strategy following a rabid animal bite. Expert opinion: Significant progress occurred during the twenty-first century regarding vaccine development, doses, and schedules. Remaining barriers to widespread rabies vaccination include an inter-related set of economic, cultural, social, educational, ecological and technological factors. A basic understanding of local and regional root causes of cases historically allows for broader accessibility to vaccination in a trans-disciplinary fashion to meet the global elimination of human rabies caused via dogs (GEHRD) by 2030.
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Affiliation(s)
| | - Naseem Salahuddin
- b Infectious Disease Division, Department of Medicine , The Indus Hospital , Karachi , Pakistan
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19
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Rupprecht CE, Kuzmin IV, Yale G, Nagarajan T, Meslin FX. Priorities in applied research to ensure programmatic success in the global elimination of canine rabies. Vaccine 2019; 37 Suppl 1:A77-A84. [PMID: 30685249 DOI: 10.1016/j.vaccine.2019.01.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 12/14/2018] [Accepted: 01/10/2019] [Indexed: 01/19/2023]
Abstract
The elimination of human rabies mediated by dogs is attainable in concept, based upon current sensitive and specific diagnostic methods, existing safe and effective human and veterinary vaccines and a sound virological, pathological and epidemiological understanding of the disease. Globally, all developed countries achieved this goal. Regionally, major progress occurred throughout the Americas. However, less advancement is evident in Africa and Asia. Our objective was to concentrate upon those salient improvements to extant tools and methods over the next five years which could assist and simplify the task for both those developing countries that have already begun the process, as well as other localities in the earlier stages of consideration. We considered several categories of applied research which could be accomplished in the short term, based upon the available scientific evidence and recent recommendations from subject matter experts and key opinion leaders, focused upon perceived major limitations to prior program success. Areas of concentration included: laboratory-based surveillance, pathogen detection and characterization; human rabies prophylaxis; veterinary biologics; implementation of canine vaccination; and oral vaccination of free-ranging community dogs. Further real-time application in these core areas with proven techniques and technology would simplify attaining not only the global goal focused subtly upon human mortality, but the actual elimination of canine rabies as well.
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Affiliation(s)
| | | | - Gowri Yale
- Mission Rabies, Panaji, Goa 403002, India
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