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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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Nyasulu PS, Weyer J, Tschopp R, Mihret A, Aseffa A, Nuvor SV, Tamuzi JL, Nyakarahuka L, Helegbe GK, Ntinginya NE, Gebreyesus MT, Doumbia S, Busse R, Drosten C. Rabies mortality and morbidity associated with animal bites in Africa: a case for integrated rabies disease surveillance, prevention and control: a scoping review. BMJ Open 2021; 11:e048551. [PMID: 34857556 PMCID: PMC8640643 DOI: 10.1136/bmjopen-2020-048551] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 09/08/2021] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE The objective of this scoping review was to map the current situation and available evidence and gaps on rabies morbidity, mortality, integrated rabies surveillance programmes, and existing prevention and control strategies in Africa. METHODS We conducted a systematic scoping review following the Joanna Briggs methodology and Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews checklist. Medline, Embase, CINAHL (EBSCOHost), Scopus, Web of Science and rabies web conferences were used to search for peer-reviewed publications between January 1946 and May 2020. Two researchers reviewed the studies and extracted data based on author (year) and region, study design and data collection duration, participants/comparators, interventions, control conditions/exposures and outcomes (rabies mortality and morbidity) and key findings/gaps/challenges. The results were reported narratively using Arksey and O'Malley's methodological framework. RESULTS Electronic search yielded 2775 records, of which 43 studies were included. A total of 543 714 bite victims were censored through the included studies. Most of the victims were less than 15 years of age. The studies included rabies morbidity (21) and mortality (15) fluctuating in space and time across Africa depending on countries' rabies prevention and control practices (16). Others were surveillance (nine studies); surveillance and prevention (five studies); management and control (seven studies); and surveillance, prevention and control (six studies). We found challenges in rabies reporting, existing dog vaccination programmes and post-exposure prophylaxis availability or compliance. CONCLUSION This study found challenges for dog rabies control and elimination in Africa and the need for a policy to drive the goal of zero dog-transmitted rabies to humans by 2030.This is an open-access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build on this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated and the use is non-commercial (see http://creativecommons.org/licenses/by-nc/4.0/).
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Affiliation(s)
- Peter Suwirakwenda Nyasulu
- Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jacqueline Weyer
- Centre for Emerging Zoonosis and Parasitic Diseases, National Institute of Communicable Diseases, Johannesburg, South Africa
- Department of Microbiology and Infectious Diseases, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Rea Tschopp
- Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Adane Mihret
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Abraham Aseffa
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Samuel Victor Nuvor
- Department of Microbiology and Immunology, School of Medical Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Jacques Lukenze Tamuzi
- Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Luke Nyakarahuka
- Department of Biosecurity, Ecosystems and Veterinary Public Health, College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, Uganda
| | - Gideon Kofi Helegbe
- Department of Biochemistry and Molecular Medicine, School of Medicine, University for Development Studies, Tamale, Ghana
| | - Nyanda Elias Ntinginya
- Mbeya Medical Research Centre, National Institute of Medical Research, Mbeya, Tanzania, United Republic of
| | | | - Seydou Doumbia
- Faculty of Medicine and Odontostomatology & University Clinical Research Center, University of Sciences, Techniques and Technology of Bamako, Bamako, Mali
| | - Reinhard Busse
- Department of Health Care Management, Technical University Berlin, Berlin, Germany
| | - Christian Drosten
- Institute of Virology, Charité-University Medicine Berlin, Berlin, Germany
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Dog rabies control in West and Central Africa: A review. Acta Trop 2021; 224:105459. [PMID: 32404295 DOI: 10.1016/j.actatropica.2020.105459] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 03/16/2020] [Accepted: 03/24/2020] [Indexed: 02/06/2023]
Abstract
Rabies is a neglected but preventable zoonotic disease that predominantly affects the most vulnerable populations living in remote rural areas of resource-limited countries. To date, every country on the African mainland is considered endemic for dog-mediated rabies with an estimated 21'500 human rabies deaths occurring each year. In 2018, the United Against Rabies collaboration launched the Global Strategic Plan to end human deaths from dog-mediated rabies by 2030. The epidemiology of rabies from most Western and Central African countries remains poorly defined, making it difficult to assess the overall rabies situation and progress towards the 2030 goal. In this review, we attempt to provide an overview of the current rabies situation in 22 West and Central African countries based on published scientific literature and information obtained from rabies focal points. To this end, information was collected on i) established surveillance, ii) diagnostic capacity, iii) post-exposure prophylaxis (PEP) availability and coverage, iv) dog population estimates, v) dog vaccination campaigns, vi) animal and human health communication (One Health), vii) molecular studies, viii) Knowledge, Attitude and Practices (KAP), ix) cost estimates and x) national control strategies. Although rabies is a notifiable disease in the majority of the studied countries, national surveillance systems do not adequately capture the disease. A general lack of rabies diagnostic capacity has an additional negative impact on rabies surveillance and attempts to estimate rabies burden. Recurrent shortages of human rabies vaccine are reported by all of the countries, with vaccine availability usually limited to major urban centers but no country has yet adopted the new WHO-recommended 1-week intradermal vaccination regimen. Most countries carry out subsidized mass dog vaccination campaigns on World Rabies Day. Such activities are indispensable to keep rabies in the public consciousness but are not of the scale and intensity that is required to eliminate rabies from the dog population. Countries will need to scale up the intensity of their campaigns, if they are to progress towards the 2030 goal. But more than half of the countries do not yet have reliable figures on their dog populations. Only two countries reached stage 2 on the Stepwise Approach towards Rabies Elimination ladder - indicating that their national governments have truly prioritized rabies elimination and are thus providing the necessary support and political buy-in required to achieve success. In summary, the sub-region of West and Central Africa seems to be divided into countries which have accepted the challenge to eliminate rabies with governments committed to pushing forward rabies elimination, while other countries have achieved some progress, but elimination efforts remain stuck due to lacking government commitment and financial constraints. The possibility to meet the 2030 goal without international solidarity is low, because more than two-thirds of the countries rank in the low human development group (HDI ≤ 152). Leading countries should act as role models, sharing their experiences and capacities so that no country is left behind. Unified and with international support it is possible to reach the common goal of zero human rabies deaths by 2030.
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Kazadi Kawaya E, Marcotty T, Mfumu-Kazadi LM, Marcotty D, Van Gucht S, Kirschvink N. Evaluation of dog vaccination schemes against rabies in Kinshasa, Democratic Republic of the Congo. Prev Vet Med 2021; 198:105531. [PMID: 34773832 DOI: 10.1016/j.prevetmed.2021.105531] [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: 04/12/2021] [Revised: 10/30/2021] [Accepted: 11/02/2021] [Indexed: 11/15/2022]
Abstract
The traditional rabies control strategy based on annual mass vaccination of dogs appears to be costly and cumbersome. Given the existence of different risk zones for rabies transmission, the present study aimed at proposing risk-based vaccination schemes by considering canine population dynamics as well as vaccine efficacy and duration of immunity (DOI). The capital of the Democratic Republic of the Congo (RDC), Kinshasa, was chosen as study site. The turnover rate of dogs was used to assess their population dynamics in two low-roaming (<25 % of dogs are roaming) and in two high-roaming zones (>75 % of dogs are roaming). The sero-conversion rate was assessed in response to primo-vaccination in three age groups: 24 puppies (≤3months), 37 juveniles (4-12 months) and 22 adult dogs. The DOI was evaluated serologically by revaccinating dogs previously vaccinated since 1-2 years (n = 31), 2-3 years (n = 12) or 3-7.5 years (n = 4). Rapid Fluorescent Focus Inhibition Test was used to quantify antibodies. These data were used to implement vaccination outcome models.The turnover rate was twice as high in high-roaming zones (36 %) as that in lowroaming zones (17 %). Irrespective of roaming level, 75 % of dogs were less than 3 years old. The vaccine was equally effective in puppies (96 %), juvenile (97 %) and adult dogs (100 %, p = 0.24). The vaccine was effective in 93 % (11/12) of puppies without pre-vaccinal protective titers (≥0.5 IU/mL). The anamnestic response was strong within 5-8 days upon the booster vaccination, in 96 % (45/47) of dogs reported vaccinated 1-7.5 years before. This suggests that the vaccine provided a long-term protection (≥3 years) which is likely to occur in 75 % of dogs in Kinshasa.Hypothesizing a vaccination stop, the vaccination outcome model allowed to estimate the time point after which vaccination coverage would drop below 40 % in function of dog population turnover rate. The systematic vaccination of puppies as well as annual vaccination of dogs aged between 3 and 15 months or annual vaccination of all unvaccinated dogs aged more than 3 months of age appeared as valuable alternative to systematic annual mass vaccination.In conclusion, this study developed a vaccination outcome model pointing out the impact of dog population dynamics and of effective duration of immunity. It appears as a promising tool for designing cost-effective rabies vaccination campaigns.
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Affiliation(s)
- Eric Kazadi Kawaya
- Faculty of Veterinary Medicine, University of Kinshasa, BP 127, Kinshasa, Congo.
| | - Tanguy Marcotty
- Faculty of Sciences, Namur Research Institute for Life Sciences (NARILIS), Department of Veterinary Medicine, Unit of Integrated Veterinary Research, University of Namur, Rue de Bruxelles, 61-5000, Namur, Belgium
| | | | - Damien Marcotty
- Catholic University of Louvain, Louvain School of Engineering, Rue Archimède1, 1348, Louvain-la-Neuve, Belgium
| | - Steven Van Gucht
- National Reference Laboratory of Rabies, Sciensano, Rue Juliette Wytsmanstraat, 14-1050, Brussels, Belgium
| | - Nathalie Kirschvink
- Faculty of Sciences, Namur Research Institute for Life Sciences (NARILIS), Department of Veterinary Medicine, Unit of Integrated Veterinary Research, University of Namur, Rue de Bruxelles, 61-5000, Namur, Belgium
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Molecular characterization of rabies viruses from two western provinces of the Democratic Republic of the Congo (2008-2017). Virus Genes 2020; 56:651-656. [PMID: 32696325 DOI: 10.1007/s11262-020-01784-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 07/16/2020] [Indexed: 10/23/2022]
Abstract
Although rabies is enzootic in the Democratic Republic of the Congo, there is very little molecular epidemiological information about the viruses circulating in animals. In this study, a fragment of the rabies virus (RABV) nucleoprotein gene was amplified and sequenced from 21 animal brain samples collected in two western provinces of the country between 2008 and 2017. The samples tested were from cat (n = 1), dog (n = 17), goat (n = 2), and sheep (n = 1). Phylogenetic analysis revealed that the sequences generated were highly similar to each other and belonged to lineage Africa 1b clustering with a single sample identified in a canine in the Republic of Congo in 2014. This is the first molecular epidemiological study of RABV in the DRC and the data generated will assist authorities in the development of effective control strategies for rabies in the country.
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Kazadi Kawaya E, Marcotty T, Mulumba Mfumu-Kazadi L, Van Gucht S, Kirschvink N. Factors of maintenance of rabies transmission in dogs in Kinshasa, Democratic Republic of the Congo. Prev Vet Med 2020; 176:104928. [PMID: 32113177 DOI: 10.1016/j.prevetmed.2020.104928] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Revised: 02/10/2020] [Accepted: 02/12/2020] [Indexed: 11/17/2022]
Affiliation(s)
- Eric Kazadi Kawaya
- Faculty of Veterinary Medicine, University of Kinshasa, BP 127 Kinshasa, Democratic Republic of the Congo; Faculty of Sciences, Namur Research Institute for Life Sciences (NARILIS), Department of Veterinary Medicine, Unit of Integrated Veterinary Research, University of Namur, Rue de Bruxelles, 61-5000, Namur, Belgium.
| | - Tanguy Marcotty
- Faculty of Sciences, Namur Research Institute for Life Sciences (NARILIS), Department of Veterinary Medicine, Unit of Integrated Veterinary Research, University of Namur, Rue de Bruxelles, 61-5000, Namur, Belgium
| | | | - Steven Van Gucht
- National Reference Laboratory of Rabies, Sciensano, Rue Juliette Wytsmanstraat, 14-1050 Brussels, Belgium
| | - Nathalie Kirschvink
- Faculty of Sciences, Namur Research Institute for Life Sciences (NARILIS), Department of Veterinary Medicine, Unit of Integrated Veterinary Research, University of Namur, Rue de Bruxelles, 61-5000, Namur, Belgium
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Mbilo C, Kabongo JB, Pyana PP, Nlonda L, Nzita RW, Luntadila B, Badibanga B, Hattendorf J, Zinsstag J. Dog Ecology, Bite Incidence, and Disease Awareness: A Cross-Sectional Survey among a Rabies-Affected Community in the Democratic Republic of the Congo. Vaccines (Basel) 2019; 7:E98. [PMID: 31454908 PMCID: PMC6789516 DOI: 10.3390/vaccines7030098] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 08/20/2019] [Accepted: 08/22/2019] [Indexed: 12/25/2022] Open
Abstract
Despite the existence of safe and efficacious human and animal rabies vaccines, millions of people remain at risk of exposure to this deadly zoonotic disease through bites of infected dogs. Sub-Saharan African countries, such as the Democratic Republic of the Congo (DRC), bear the highest per capita death rates from rabies where dog vaccination and availability of lifesaving post-exposure prophylaxis (PEP) is scarce. Mass dog vaccination is the most cost-effective and sustainable approach to prevent human rabies deaths. We conducted a cross-sectional household survey in a rabies-affected community in Matadi, DRC, to estimate the size of the owned dog population and dog bite incidence and assess knowledge and practices regarding rabies, as preparation for future mass dog vaccination campaigns. Our study revealed that the owned dog population in Matadi was almost ten times larger than assumed by local veterinary officials, with a large proportion of free-roaming unvaccinated dogs. The annual dog bite incidence of 5.2 per 1000 person years was high, whereas community rabies knowledge was low resulting in poor practices. Given these findings, human rabies deaths are likely to occur in this community. Lack of disease awareness could negatively affect participation in future mass dog vaccination campaigns. A public sensitization campaign is needed to promote appropriate rabies prevention (washing bite wounds and PEP) and control (dog vaccination) measures in this community.
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Affiliation(s)
- Céline Mbilo
- Swiss Tropical and Public Health Institute, P.O. Box, CH-4002 Basel, Switzerland
- University of Basel, Petersplatz 1, CH-4001 Basel, Switzerland
| | | | - Pati Patient Pyana
- Université Pédagogique Nationale de Kinshasa, BP 8815 Kinshasa, Congo
- Institut National de Recherche Biomédicale (INRB), Avenue de la Démocratie, BP 1197 Kinshasa/Gombe, Congo
| | - Léon Nlonda
- Clinique Vétérinaire d'Etat de Matadi, Matadi, Congo
| | | | - Bobo Luntadila
- Université Pédagogique Nationale de Kinshasa, BP 8815 Kinshasa, Congo
- Institut National de Recherche Biomédicale (INRB), Avenue de la Démocratie, BP 1197 Kinshasa/Gombe, Congo
| | - Badivé Badibanga
- Université Pédagogique Nationale de Kinshasa, BP 8815 Kinshasa, Congo
| | - Jan Hattendorf
- Swiss Tropical and Public Health Institute, P.O. Box, CH-4002 Basel, Switzerland
- University of Basel, Petersplatz 1, CH-4001 Basel, Switzerland
| | - Jakob Zinsstag
- Swiss Tropical and Public Health Institute, P.O. Box, CH-4002 Basel, Switzerland.
- University of Basel, Petersplatz 1, CH-4001 Basel, Switzerland.
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Salomão C, Nacima A, Cuamba L, Gujral L, Amiel O, Baltazar C, Cliff J, Gudo ES. Epidemiology, clinical features and risk factors for human rabies and animal bites during an outbreak of rabies in Maputo and Matola cities, Mozambique, 2014: Implications for public health interventions for rabies control. PLoS Negl Trop Dis 2017; 11:e0005787. [PMID: 28742094 PMCID: PMC5542695 DOI: 10.1371/journal.pntd.0005787] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 08/03/2017] [Accepted: 07/06/2017] [Indexed: 11/04/2022] Open
Abstract
Background In Mozambique, the majority of rabies outbreaks are unreported and data on the epidemiological features of human rabies and animal bites are scarce. An outbreak of human rabies in adjacent Maputo and Matola cities in 2014 prompted us to investigate the epidemiology, clinical features and risk factors of human rabies and animal bites in the two cities. Methodology/Principal findings We reviewed cases of human rabies and animal bites from April to July 2014, and carried out a community investigation in July and August in the neighborhoods where cases of human rabies resided. This investigation included collection of clinical, demographic and epidemiological information and a case control study to investigate the risk factors associated with human rabies. Fourteen cases of human rabies were detected in Maputo (n = 10) and Matola (n = 3) cities and neighbouring Boane district (n = 1) between April and August 2014, all of whom had been admitted to hospital. All had a recent history of dog bite. Of the 14 rabid dogs, only one had been immunized. 819 cases of animal bites were registered, of which 64.6% (529/819) were from Maputo City. Dogs were responsible for 97.8% (801/819) of all animal bites, but only 27.0% (126/467) were immunized. Factors significantly associated with human rabies were: age <15 years (p = 0.05), bite by stray dog (p = 0.002), deep wound (p = 0.02), bite in the head (p = 0.001), bite by unimmunized dog (p = 0.01), no use of soap and water (p = 0.001), and no post-exposure prophylaxis (p = 0.01). Conclusions/Significance Implementation of control measures for rabies is poor in Maputo and Matola cities, where cases of human rabies were strongly associated with bites by stray and unvaccinated dogs and irregular implementation of post-exposure measures. Rabies is a deadly neglected virus that causes an estimated 59,000 deaths each year worldwide. In 2014, an outbreak of human rabies in adjacent Maputo and Matola cities prompted us to investigate the epidemiology and risk factors of human rabies and animal bites in the two cities. We reviewed cases of human rabies and animal bites through both health facility and community investigations and carried out a case control study in affected neighborhoods. We found a total of 14 unreported human rabies cases in a four month period, and 819 cases of animal bites in a three month retrospective review of records. Dogs were responsible for all rabid bites and for 97.8% of animal bites. None of the rabid dogs had been vaccinated. Factors significantly associated with human rabies were: age <15 years, bite by a stray dog, deep wound, bite in the head, bite by an unimmunized dog, failure to use soap and water to cleanse the wound, and to vaccinate after the bite. We concluded that the poor implementation of control measures for rabies had led to the outbreak and recommended strengthening implementation, particularly in rapidly urbanizing areas.
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Affiliation(s)
- Cristolde Salomão
- Department of Surveillance, National Institute of Health, Maputo, Mozambique
- * E-mail:
| | - Amílcar Nacima
- Field Epidemiology and Laboratory Training Program, National Institute of Health, Maputo, Mozambique
| | - Lutero Cuamba
- Maputo City Health Directorate, Ministry of Health, Maputo, Mozambique
| | - Lorna Gujral
- Department of Epidemiology, National Directorate of Public Health, Ministry of Health, Maputo, Mozambique
| | - Olga Amiel
- Department of Neglected Tropical Diseases Program, National Directorate of Public Health, Maputo, Mozambique
| | - Cynthia Baltazar
- Department of Surveillance, National Institute of Health, Maputo, Mozambique
| | - Julie Cliff
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Eduardo Samo Gudo
- Department of Surveillance, National Institute of Health, Maputo, Mozambique
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Burchard GD, Grobusch MP. Central Africa. Infect Dis (Lond) 2017. [DOI: 10.1002/9781119085751.ch7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
| | - Martin P. Grobusch
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center; University of Amsterdam; Amsterdam The Netherlands
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Overview of Animal Rabies in Kinshasa Province in the Democratic Republic of Congo. PLoS One 2016; 11:e0150403. [PMID: 27054328 PMCID: PMC4824417 DOI: 10.1371/journal.pone.0150403] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 02/12/2016] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Rabies is one of the major public health problems mostly affecting developing countries in Africa and Asia where 99.9% of all rabies related human deaths are recorded each year. In Democratic Republic of Congo, repeated outbreaks have been reported. Despite this, there is little reliable epidemiological data about rabies in the country for the development of effective control strategies. MATERIALS AND METHODS A retrospective study was carried out in Kinshasa Province during a period of five years (2009-2013) to describe the proportion of rabid animals and the species involved in rabies transmission and maintenance. The survey also aimed at describing the spatial-temporal distribution of rabies. To gather information, the daily registers of institutions involved in rabies diagnosis were reviewed and each rabies case was traced back to area of occurrence for collection of geographic coordinates. RESULTS AND DISCUSSION A total of 5,053 attacks were registered involving six animal species including dog, cat, monkey, rabbit, rat, and pig. Based on clinical observations, rabies was reported in dogs and cats while data obtained from the laboratory confirmed rabies cases included dogs, cats and a goat. The annual distribution showed a significant decrease of rabies cases from 2009 up to 2011 and a later increase up to 2013. There was no difference in rabies occurrence between seasons (p = 0.721). Rabies cases were three times higher in peri-urban zone than in urban zone OR = 3.4 (95% CI: 2.3-5.1). The positive proportion of rabies was 2.6% (95% CI: 2.1-3) based on clinical evidence and 65.9% (95% CI: 50-79.5) for laboratory confirmed cases. CONCLUSION AND SUGGESTION This study confirms the endemicity of rabies in Kinshasa where occurrence of rabies cases was related to human population density and lifestyle. In order to control rabies, there is need to set up a surveillance program and implement efficient mass vaccination campaigns of susceptible animals.
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