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Whitehouse ER, Mandra A, Bonwitt J, Beasley EA, Taliano J, Rao AK. Human rabies despite post-exposure prophylaxis: a systematic review of fatal breakthrough infections after zoonotic exposures. THE LANCET INFECTIOUS DISEASES 2022; 23:e167-e174. [PMID: 36535276 DOI: 10.1016/s1473-3099(22)00641-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 08/05/2022] [Accepted: 09/06/2022] [Indexed: 12/23/2022]
Abstract
Post-exposure prophylaxis (PEP) for rabies is widely administered and highly effective. Nevertheless, sporadic breakthrough infections (ie, rabies in people who have started PEP) have been reported. We conducted a systematic review of articles published between Jan 1, 1980 and June 1, 2022 to characterise breakthrough infections. After reviewing 3380 articles from across all continents, we identified 52 articles, which included a total of 122 breakthrough infections. We classified breakthrough infections on the basis of adherence to core practices (ie, wound cleaning and vaccine administration). Of 86 breakthrough infections with data, median time from exposure to symptom onset was 20 days (IQR 16-24). Most (89 [77%] of 115) participants received PEP within 2 days of an exposure. Severe wounds (defined as those involving multiple wound sites or bites to the head, face, or neck) were common (80 [69%] of 116 [with data]). Deviations from core practices were reported in 68 (56%) of 122 cases. Other possible causes for breakthrough infections included errors in the administration of rabies immunoglobulin, delays in seeking health care, and comorbidities or immunosuppression. Cold-chain integrity assessments and potency testing of PEP biologics were only rarely assessed (8 [7%] of 122 cases), neither of which were found to be a cause of breakthrough infections. Timely and appropriate administration of PEP is crucial to prevent rabies, and although people with high-risk exposures or immunosuppression can develop rabies despite adherence to core practices, this occurrence remains exceedingly rare.
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Cottingham E, Johnstone T, Hartley CA, Devlin JM. Use of feline herpesvirus as a vaccine vector offers alternative applications for feline health. Vet Microbiol 2021; 261:109210. [PMID: 34416538 DOI: 10.1016/j.vetmic.2021.109210] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 08/15/2021] [Indexed: 12/26/2022]
Abstract
Herpesviruses are attractive vaccine vector candidates due to their large double stranded DNA genome and latency characteristics. Within the scope of veterinary vaccines, herpesvirus-vectored vaccines have been well studied and commercially available vectored vaccines are used to help prevent diseases in different animal species. Felid alphaherpesvirus 1 (FHV-1) has been characterised as a vector candidate to protect against a range of feline pathogens. In this review we highlight the methods used to construct FHV-1 based vaccines and their outcomes, while also proposing alternative uses for FHV-1 as a viral vector.
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Affiliation(s)
- Ellen Cottingham
- The Asia Pacific Centre for Animal Health, Melbourne Veterinary School, The University of Melbourne, Parkville, Victoria, 3010, Australia.
| | - Thurid Johnstone
- U-Vet Animal Hospital, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Werribee, Victoria, 3030, Australia
| | - Carol A Hartley
- The Asia Pacific Centre for Animal Health, Melbourne Veterinary School, The University of Melbourne, Parkville, Victoria, 3010, Australia
| | - Joanne M Devlin
- The Asia Pacific Centre for Animal Health, Melbourne Veterinary School, The University of Melbourne, Parkville, Victoria, 3010, Australia
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Jiang Y, Dou X, Yan C, Wan L, Liu H, Li M, Wang R, Li G, Zhao L, Liu Z, Zhao X, Wan K. Epidemiological characteristics and trends of notifiable infectious diseases in China from 1986 to 2016. J Glob Health 2021; 10:020803. [PMID: 33214900 PMCID: PMC7649044 DOI: 10.7189/jogh.10.020803] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background Since the 1980s, China has undergone significant social change and the incidence of infectious diseases has also changed considerably. Here, we report the epidemiological features and changes in notifiable infectious diseases in China from 1986 to 2016 to explore the factors contributing to the successful control of infectious diseases and the challenges faced in the prevention and control of infectious diseases. Methods The data of notifiable infectious diseases in China from 1986 to 2016 were collected from the monthly analysis report of the National Infectious Disease Surveillance System. Joinpoint regression models were used to examine incidence and mortality trends from 1986 to 2016. IBM SPSS Statistics version 22.0, Excel 2010 and R x64 3.5.2 were used for data analysis. Results A total of 132 858 005 cases of notifiable infectious diseases were reported over these 31 years, with an average yearly incidence of 342.14/100 000. There were 284 694 deaths with an average yearly mortality rate of 0.73/100 000. The overall incidence and overall mortality of notifiable infectious diseases both showed a "U" distribution (ie, a decrease, stable, an increase, stable again). The top five diseases in terms of incidence were hand, foot and mouth disease, viral hepatitis, tuberculosis, other infectious causes of diarrhea and dysentery, accounting for 78.0% of all reported cases. The top five causes of death were HIV/AIDS, rabies, tuberculosis, viral hepatitis and epidemic encephalitis B, which accounted for 76.07% of all mortalities. The diseases with the top five fatality rates were rabies, H5N1, H7N9, HIV/AIDS and plague, with rates of 91.06%, 66.07%, 38.51%, 25.19% and 10.31%, respectively. Conclusions This analysis will benefit the future monitoring of infectious diseases and public health measures in China.
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Affiliation(s)
- Yi Jiang
- State Key Laboratory for Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xiangfeng Dou
- Beijing Center for Diseases Prevention and Control, Beijing, China
| | - Chenqi Yan
- State Key Laboratory for Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Chinese Center for Disease Control and Prevention, Beijing, China.,Foshan Women and Children Hospital, Guangdong Province, China
| | - Li Wan
- State Key Laboratory for Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Chinese Center for Disease Control and Prevention, Beijing, China.,Department of Physiology, Xiangya School of Medicine, Central South University, Changsha, China
| | - Haican Liu
- State Key Laboratory for Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Machao Li
- State Key Laboratory for Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Ruibai Wang
- State Key Laboratory for Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Guilian Li
- State Key Laboratory for Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Lili Zhao
- State Key Laboratory for Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zhiguang Liu
- State Key Laboratory for Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xiuqin Zhao
- State Key Laboratory for Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Kanglin Wan
- State Key Laboratory for Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Chinese Center for Disease Control and Prevention, Beijing, China
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Ma C, Hao X, Deng H, Wu R, Liu J, Yang Y, Li S, Han Y, Wei M, Zhang J, Wang J, Li H, Tian H, Xu B, Yu P, Wu X. Re-emerging of rabies in Shaanxi province, China, from 2009 to 2015. J Med Virol 2017; 89:1511-1519. [PMID: 28112421 DOI: 10.1002/jmv.24769] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 11/16/2016] [Accepted: 12/28/2016] [Indexed: 11/10/2022]
Abstract
To explore the epidemiological, phylogeographic, and migration characteristics of human rabies in Shaanxi province, China from 2009 to 2015. The collected data were described and the sequenced glycoprotein (G) and nucleoprotein (N) genes were implemented to estimate the evolutionary rates and phylogeographic patterns using BEAST v.1.8.2. A total of 269 rabies cases were reported and 70.26% of the cases were male and 61.71% were between the ages of 19-59. The majority of the cases were farmers (83.27%). The estimated evolutionary rate of the N genes was 2.4 × 10-4 substitutions/site/year and the G genes was 3.4 × 10-4 . The time of the most recent common ancestor (TMRCA) was estimated around 1990. We detected viral migration paths from Sichuan, Guizhou, and Hunan to Hanzhong prefecture of Shaanxi and then spreaded to Xi'an and other prefectures. The main population affected by rabies virus was male adult farmers. The evolution rate of rabies viruses in Shaanxi was similar with the prior results reported by others and the ancestor virus should be circulating in neighboring province Sichuan around 1990 and then transmitted to Shaanxi. Promptly standard wound treatment and timely post-exposure prophylaxis should be compulsory for the dog-bitten victims.
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Affiliation(s)
- Chaofeng Ma
- Xi'an Center for Disease Control and Prevention, Xi'an, China
| | - Xiaoyun Hao
- Xi'an Medical Emergency Center, Xi'an, China
| | | | - Rui Wu
- Xi'an Center for Disease Control and Prevention, Xi'an, China
| | - Jifeng Liu
- Xi'an Center for Disease Control and Prevention, Xi'an, China
| | - Yang Yang
- Xi'an Center for Disease Control and Prevention, Xi'an, China
| | - Shen Li
- Shaanxi Center for Disease Control and Prevention, Xi'an, China
| | - Yifei Han
- Hanzhong Center for Disease Control and Prevention, Xi'an, China
| | - Mingmin Wei
- Weinan Center for Disease Control and Prevention, Xi'an, China
| | - Junjun Zhang
- Xianyang Center for Disease Control and Prevention, Xi'an, China
| | - Jingjun Wang
- Shaanxi Center for Disease Control and Prevention, Xi'an, China
| | - Hengxin Li
- Xi'an Center for Disease Control and Prevention, Xi'an, China
| | - Huaiyu Tian
- College of Global Change and Earth System Science, Beijing Normal University, Beijing, China
| | - Bing Xu
- College of Global Change and Earth System Science, Beijing Normal University, Beijing, China
| | - Pengbo Yu
- Shaanxi Center for Disease Control and Prevention, Xi'an, China
| | - Xiaokang Wu
- The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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Abstract
OBJECTIVES To explore the epidemiological characteristics of human rabies in Zhejiang Province, China. METHODS Descriptive and statistical analyses were performed using data collected through interview with human rabies cases or their relatives during 2007 to 2014. A standardized questionnaire was used to collect the data. RESULTS Two hundred and one cases of human rabies were diagnosed in Zhejiang Province between 2007 and 2014, with a gradually declining annual incidence. Of the rabies cases identified, 61.2% were aged 40-65 years, and the male to female ratio was 2.30:1; 63.7% of cases occurred in the summer and autumn. The two most reported occupations were farmer (69.2%) and rural laborer (15.4%). Wenzhou, Jinhua, and Huzhou were the three cities with the most reported cases. The majority of cases (92.8%) were attributed to canines, and 71.0% of animal vectors were household animals. Less than half of the cases (41.4%) sought wound treatment after exposure. Post-exposure passive immunization was given to 9.7% and active immunization to 2.3%. Cases with a wound on the head/face only had a significantly shorter incubation than those with wounds at other sites (p<0.05); cases with a wound on the hand only had a significantly shorter incubation than those with a wound on the lower limb below the knee only (p<0.001). Non-resident cases were significantly younger (p<0.001) and had a shorter disease duration (p=0.015) than locally resident cases. CONCLUSIONS The majority of rabies cases occurred among 40-65-year-old male residents of northern, mid-west, and southeast Zhejiang Province. Further health education is needed to increase the coverage of post-exposure prophylaxis (PEP) in people exposed to possible rabid animals and rabies vaccine use in household animals.
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Ribadeau Dumas F, N'Diaye DS, Paireau J, Gautret P, Bourhy H, Le Pen C, Yazdanpanah Y. Cost-effectiveness of rabies post-exposure prophylaxis in the context of very low rabies risk: A decision-tree model based on the experience of France. Vaccine 2015; 33:2367-78. [PMID: 25797366 DOI: 10.1016/j.vaccine.2015.02.075] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 02/14/2015] [Accepted: 02/28/2015] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Benefit-risk of different anti-rabies post-exposure prophylaxis (PEP) strategies after scratches or bites from dogs with unknown rabies status is unknown in very low rabies risk settings. DESIGN AND SETTING A cost-effectiveness analysis in metropolitan France using a decision-tree model and input data from 2001 to 2011. POPULATION A cohort of 2807 patients, based on the mean annual number of patients exposed to category CII (minor scratches) or CIII (transdermal bite) dog attacks in metropolitan France between 2001 and 2011. INTERVENTIONS Five PEP strategies: (A) no PEP for CII and CIII; (B) vaccine only for CIII; (C) vaccine for CII and CIII; (D) vaccine+ rabies immunoglobulin (RIG) only for CIII; and (E) vaccine for CII and vaccine+ RIG for CIII. MAIN OUTCOMES MEASURES The number of deaths related to rabies and to traffic accidents on the way to anti-rabies centers (ARC), effectiveness in terms of years of life gained by reducing rabies cases and avoiding traffic accidents, costs, and incremental cost-effectiveness ratios (ICER) associated with each strategy. RESULTS Strategy E led to the fewest rabies cases (3.6 × 10(-8)) and the highest costs (€ 1,606,000) but also to 1.7 × 10(-3) lethal traffic accidents. Strategy A was associated with the most rabies cases (4.8 × 10(-6)), but the risk of traffic accidents and costs were null; therefore, strategy A was the most effective and the least costly. The sensitivity analysis showed that, when the probability that a given dog is rabid a given day (PA) was > 1.4 × 10(-6), strategy D was more effective than strategy A; strategy B became cost-effective (i.e. ICER vs strategy A < 3 × French Gross Domestic Product per capita) when PA was > 1 .4 × 10(-4). CONCLUSIONS In the metropolitan France's very low rabies prevalence context, PEP with rabies vaccine, administered alone or with RIG, is associated with significant and unnecessary costs and unfavourable benefit-risk ratios regardless to exposure category.
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Affiliation(s)
- Florence Ribadeau Dumas
- Université Paris Dauphine, LEDa/LEGOS, F-75016, Paris, France; Institut Pasteur, Unité Dynamique des lyssavirus et adaptation à l'hôte, National Reference Center for Rabies, F-75015 Paris, France; Institut Pasteur, CAR/CMIP/CINP, F-75015, Paris, France.
| | - Dieynaba S N'Diaye
- IAME, UMR 1137, INSERM, F-75018 Paris, France; UPMC Univ Paris 06, ED393, F-75005, Paris, France; Univ Paris Diderot, Sorbonne Paris Cité, F-75018 Paris, France
| | - Juliette Paireau
- Univ Pierre et Marie Curie, Cellule Pasteur UPMC, F-75015, Paris, France; Institut Pasteur, Unité d'Epidémiologie des Maladies Emergentes, F-75015, Paris, France
| | - Philippe Gautret
- Assistance Publique Hôpitaux de Marseille, CHU Nord, Pôle Infectieux, Institut Hospitalo-Universitaire Méditerranée Infection, F-13015 Marseille, France; Aix Marseille Université, Unité de Recherche en Maladies Infectieuses et Tropicales Emergentes (URMITE), UM63, CNRS 7278, IRD 198, Inserm 1095, Faculté de Médecine, F-13005 Marseille, France
| | - Hervé Bourhy
- Institut Pasteur, Unité Dynamique des lyssavirus et adaptation à l'hôte, National Reference Center for Rabies, F-75015 Paris, France
| | - Claude Le Pen
- Université Paris Dauphine, LEDa/LEGOS, F-75016, Paris, France
| | - Yazdan Yazdanpanah
- IAME, UMR 1137, INSERM, F-75018 Paris, France; AP-HP, Hôpital Bichat, Service de Maladies Infectieuses, F-75018 Paris, France; Univ Paris Diderot, Sorbonne Paris Cité, F-75018 Paris, France
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Zagreb regimen, an abbreviated intramuscular schedule for rabies vaccination. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2014; 22:1-5. [PMID: 25392012 DOI: 10.1128/cvi.00531-14] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The Zagreb regimen, an abbreviated intramuscular schedule for rabies vaccination, was developed by I. Vodopija and colleagues of the Zagreb Institute of Public Health in Croatia in the 1980s. It was recommended by WHO as one of the intramuscular (IM) schedules for rabies vaccination in 2010. We reviewed the literature on the immunogenicity, safety, economic burden, and compliance of the Zagreb 2-1-1 regimen. Compared to Essen, another IM schedule recommended by WHO, Zagreb has higher compliance, lower medical cost, and better immunogenicity at an early stage.
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Stahl JP, Gautret P, Ribadeau-Dumas F, Strady C, Le Moal G, Souala F, Maslin J, Fremont B, Bourhy H. Update on human rabies in a dog- and fox-rabies-free country. Med Mal Infect 2014; 44:292-301. [DOI: 10.1016/j.medmal.2014.05.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 04/29/2014] [Accepted: 05/22/2014] [Indexed: 01/11/2023]
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Burgos-Cáceres S. Canine Rabies: A Looming Threat to Public Health. Animals (Basel) 2011; 1:326-42. [PMID: 26486619 PMCID: PMC4513477 DOI: 10.3390/ani1040326] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2011] [Revised: 09/13/2011] [Accepted: 09/22/2011] [Indexed: 12/14/2022] Open
Abstract
Rabies is an acute, fatal viral disease that infects domestic and wild animals and is transmissible to humans. Worldwide, rabies kills over 55,000 people every year. The domestic dog plays a pivotal role in rabies transmission. Domestic dogs are not only part of our daily lives but also of our immediate surroundings, and this is reflected in the rise in pet dog ownership in developed and developing countries. This is important given that more frequent exposures and interactions at the animal-human interface increases the likelihood of contracting zoonotic diseases of companion animals. Despite existing vaccines and post-exposure prophylactic treatment, rabies remains a neglected disease that is poorly controlled throughout much of the developing world, particularly Africa and Asia, where most human rabies deaths occur. It is believed that with sustained international commitments, global elimination of rabies from domestic dog populations, the most dangerous vector to humans, is a realistic goal.
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Affiliation(s)
- Sigfrido Burgos-Cáceres
- Food and Agriculture Organization of the United Nations, Viale delle Terme di Caracalla, Building C, Room 506, Rome, 00100, Italy.
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