Rabies-related knowledge and practices among persons at risk of bat exposures in Thailand

Knowledge, perceptions, and exposure to bats in communities living around bat roosts in Bundibugyo district, Uganda: implications for viral haemorrhagic fever prevention and control

BACKGROUND

Bats are a reservoir for many viruses causing haemorrhagic fevers. Proximity to bats is a risk factor for virus spillover to animals and humans. We conducted this study to assess knowledge, perceptions, and exposure to bats in communities living near bat roosts in Bundibugyo District, Uganda.

METHODS

A cross-sectional study using mixed methods with both quantitative and qualitative data was conducted between September and December 2022. Participants for the quantitative data (survey) (n = 384) resided near bat caves and/or roost sites and were selected using multistage random sampling. The survey investigated participants' prior exposure to bats, as well as knowledge and perceptions of bat exposure. Logistic regression was used to determine factors associated with bat exposure. Participants for the qualitative data (focus group discussions) (n = 10, 6-8 participants each) were purposely selected based on engagement in guano mining, hunting, and farming activities. Perceived risk associated with bat-related activities were identified and ranked in the focus group discussions using participatory epidemiology tools.

RESULTS

In total, (214/384, 55.7%) had a history of bat exposure and (208/384, 54.2%) had poor knowledge of risk factors associated with bat exposure. Increased exposure to bats was associated with being male (OR = 1.6; 95% CI: 1.0, 2.4 p-value = 0.038), staying in urban areas (OR = 1.9; p-value = 0.010), hunting (OR = 10.9; p-value = 0.024), and positive perception to bat guano being safe as fertiliser (OR = 2.5; p-value = 0.045). During the proportional piling process, a total of 7 risk factors were identified by 10 groups with hunting during an outbreak and consumption of bats being the most frequently identified. Overall, there was a strong statistical agreement in the ranking across the 10 focus groups (W = 0.52; p < 0.01; n = 10). Based on the provided data, the adjusted odds ratio of 0.7 for the good measures (p-value = 0.112), suggests a potential protective effect on the risk of bat exposure.

CONCLUSION

Communities living around bat roosts frequently come into contact with bats, yet there is inadequate awareness regarding the behaviors that can lead to the transmission of bat- borne diseases to humans. It is essential to undertake educational initiatives and preventive measures to minimise the risks of bat-related infections. The need for targeted health communication and education efforts to address these knowledge gaps and promote an accurate understanding of bats and disease transmission. Understanding of diseases associated with bats will minimize bat-related health risks especially in communities engaged in wildlife hunting.

Prevalence and public health significance of rabies virus in bats in the North Region of Cameroon

BACKGROUND

Rabies is a zoonotic disease of all warm-blooded animals including humans. There is a paucity of data on the status of rabies in wild animals in Cameroon and the disease is endemic in the country with dogs being the main source of transmission. Bat habitats are widespread in Cameroon, but there is limited information on the prevalence of rabies in bats, and their role of as potential reservoirs of rabies virus.

METHODS

A cross sectional study was carried out to estimate the prevalence and to assess risk factors of rabies virus in bats in the North Region of Cameroon. A total of 212 bats belonging to three families (Pteropodidae, Vespertilionidae and Molossidae) and 5 species were sampled in 7 localities in the North Region of Cameroon and were tested for rabies virus antigen using direct Immunofluorescence Test (IFA).

RESULTS

Overall, 26.9% (57/212) of the bats collected showed an IFA positive reaction. The prevalence was significantly higher (P<0.05) in adult bats (33.3% (36/108)) compared to young individuals (20.2%; 21/104). The main risk factors identified in the study for human exposure to bats were gender (Male), religion (Christianity), localities (Babla and Lagdo), the practice of bat hunting, bat consumption, unawareness of bat rabies and cohabitation with bats in close proximity.

CONCLUSION

The study revealed the first evidence of Lyssavirus in bats in Cameroon. This finding showed that bat rabies are real and represents a potential public health concern in communities with bat habitats in the North Region of Cameroon. Enhancing the level of public awareness and health education on the potential of bats as reservoirs of Lyssavirus in Cameroon as well as the integration of the "One Health" approach for effective management of animal and human rabies should be emphasized.

Public Health Awareness on Bat Rabies among Bat Handlers and Persons Residing near Bat Roosts in Makurdi, Nigeria

Rabies is a neglected disease endemic in Asia and Africa but is still a significant public and veterinary health threat. Whilst a key delicacy for the local diet, bats are a natural reservoir host for many viral zoonotic agents including lyssaviruses, the causative agent of rabies. Studies on knowledge and practices linked to the disease will help to identify gaps and define preventive strategies that may subsequently result in a reduction and the potential elimination of human rabies. In order to assess the public health awareness of bat rabies among specific population groups in Makurdi (Nigeria), structured questionnaires (n = 154) were administered by face-to-face interviews to bat handlers and persons residing near bat roost sites. A total of 59.7% of the respondents were persons residing near bat roost sites, 13% were bat hunters, 25.3% were bat meat consumers and 1.9% were university researchers. Only 6.5% of respondents reported using some form of personal protective equipment (PPE) ranging from hand gloves, face/nose masks and protective boots to lab coats/coveralls while handling bats, whilst the majority (93.5%) did not use any form of PPE. With a mean knowledge score of 8.34 out of a possible 12 points, 50.6% of respondents had good knowledge of bats and their disease-carrying potential, 39.6% had fair knowledge, while 9.7% had poor knowledge. Log linear models showed significant associations between knowledge score and level of education, as well as knowledge score and occupation. The latter highlights the requirement to enhance public education among bat handlers and persons residing near bat roosts on the need to protect themselves better, while handling bats particularly during processing of bats for food and on steps to take when exposed to bites from bats.

A strategy to assess spillover risk of bat SARS-related coronaviruses in Southeast Asia

Emerging diseases caused by coronaviruses of likely bat origin (e.g., SARS, MERS, SADS, COVID-19) have disrupted global health and economies for two decades. Evidence suggests that some bat SARS-related coronaviruses (SARSr-CoVs) could infect people directly, and that their spillover is more frequent than previously recognized. Each zoonotic spillover of a novel virus represents an opportunity for evolutionary adaptation and further spread; therefore, quantifying the extent of this spillover may help target prevention programs. We derive current range distributions for known bat SARSr-CoV hosts and quantify their overlap with human populations. We then use probabilistic risk assessment and data on human-bat contact, human viral seroprevalence, and antibody duration to estimate that a median of 66,280 people (95% CI: 65,351-67,131) are infected with SARSr-CoVs annually in Southeast Asia. These data on the geography and scale of spillover can be used to target surveillance and prevention programs for potential future bat-CoV emergence.

Behavioral-biological surveillance of emerging infectious diseases among a dynamic cohort in Thailand

Background

Interactions between humans and animals are the key elements of zoonotic spillover leading to zoonotic disease emergence. Research to understand the high-risk behaviors associated with disease transmission at the human-animal interface is limited, and few consider regional and local contexts.

Objective

This study employed an integrated behavioral–biological surveillance approach for the early detection of novel and known zoonotic viruses in potentially high-risk populations, in an effort to identify risk factors for spillover and to determine potential foci for risk-mitigation measures.

Method

Participants were enrolled at two community-based sites (n = 472) in eastern and western Thailand and two hospital (clinical) sites (n = 206) in northeastern and central Thailand. A behavioral questionnaire was administered to understand participants’ demographics, living conditions, health history, and animal-contact behaviors and attitudes. Biological specimens were tested for coronaviruses, filoviruses, flaviviruses, influenza viruses, and paramyxoviruses using pan (consensus) RNA Virus assays.

Results

Overall 61/678 (9%) of participants tested positive for the viral families screened which included influenza viruses (75%), paramyxoviruses (15%), human coronaviruses (3%), flaviviruses (3%), and enteroviruses (3%). The most salient predictors of reporting unusual symptoms (i.e., any illness or sickness that is not known or recognized in the community or diagnosed by medical providers) in the past year were having other household members who had unusual symptoms and being scratched or bitten by animals in the same year. Many participants reported raising and handling poultry (10.3% and 24.2%), swine (2%, 14.6%), and cattle (4.9%, 7.8%) and several participants also reported eating raw or undercooked meat of these animals (2.2%, 5.5%, 10.3% respectively). Twenty four participants (3.5%) reported handling bats or having bats in the house roof. Gender, age, and livelihood activities were shown to be significantly associated with participants’ interactions with animals. Participants’ knowledge of risks influenced their health-seeking behavior.

Conclusion

The results suggest that there is a high level of interaction between humans, livestock, and wild animals in communities at sites we investigated in Thailand. This study highlights important differences among demographic and occupational risk factors as they relate to animal contact and zoonotic disease risk, which can be used by policymakers and local public health programs to build more effective surveillance strategies and behavior-focused interventions.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12879-022-07439-7.

Rodent–Human Interface: Behavioral Risk Factors and Leptospirosis in a Province in the Central Region of Thailand

This sequential explanatory mixed-method study consisted of analytical, cross-sectional, and qualitative studies. The research was conducted in the Khao Nor and Khao Kaew areas of the Banphot Pisai districts of Nakhon Sawan Province in 2019. Here, we examined the rodent contact characteristics of villagers in these areas and determined the potential characteristics/risk factors associated with rodents using a semi-structured questionnaire, key informant interview (KII), and focus group discussion (FGD). Results of the quantitative study (N1 = 372) characterized participants that contacted rodents per gender, age, occupation, knowledge, attitude, and practice (KAP), including their cultural contexts, and beliefs. Ninety participants (24.2%) reported contact with rodents, and the reasons for their direct physical rodent contact were hunting (35, 9.4%), killing (41, 11.0%), preparing rodents as food (33, 8.9%), consuming cooked meats (12, 3.2%), feeding food (4, 1.1%), cleaning feces (17, 4.6%), and cleaning carcasses (33, 8.9%). Moreover, logistic regression results showed that males encountering rodents were statistically significant (Adjusted OR = 3.137, 95% CI 1.914–5.139, p < 0.001). Low monthly household income (<THB 15,000 or <USD 450) was also negatively statistically significant with encountering rodents (Adjusted OR = 0.57, 95% CI 0.33–0.99, p = 0.04). Additionally, the villagers had a low level of knowledge toward zoonotic diseases and inappropriate attitudes and practices toward contacting rodents and zoonotic diseases. Thirty-five qualitative study participants (N2) participated in the KIIs and FGDs. Various rodent contact activities were also reported among the qualitative research participants, such as hunting, consumption, and selling them to their friends and neighbors. However, these rodents also destroyed their belongings, crops, and plants. Some participants also reported that rodents accounted for leptospirosis transmission. As a result, communication intervention should be planned to provide appropriate knowledge and attitude to the villagers, especially among those who have close contact with rodents in the understudied area.

A strategy to assess spillover risk of bat SARS-related coronaviruses in Southeast Asia

Emerging diseases caused by coronaviruses of likely bat origin (e.g. SARS, MERS, SADS and COVID-19) have disrupted global health and economies for two decades. Evidence suggests that some bat SARS-related coronaviruses (SARSr-CoVs) could infect people directly, and that their spillover is more frequent than previously recognized. Each zoonotic spillover of a novel virus represents an opportunity for evolutionary adaptation and further spread; therefore, quantifying the extent of this "hidden" spillover may help target prevention programs. We derive biologically realistic range distributions for known bat SARSr-CoV hosts and quantify their overlap with human populations. We then use probabilistic risk assessment and data on human-bat contact, human SARSr-CoV seroprevalence, and antibody duration to estimate that ∼400,000 people (median: ∼50,000) are infected with SARSr-CoVs annually in South and Southeast Asia. These data on the geography and scale of spillover can be used to target surveillance and prevention programs for potential future bat-CoV emergence.

Bats and belief: A sequential qualitative study in Thailand

Bats are wildlife and distribute globally. In Thailand, there are hundreds of bat species in different locations within four regions. However, few motivations and influences for having contact with bats have been documented. This sequential qualitative study was conducted in ten provinces representing the four regions of Thailand from September 2016 to June 2017. The study was designed to obtain information on villagers' attitudes, perceptions, beliefs and cultural contexts in relation to bats. Focus group discussions (FGDs) were conducted with 305 respondents. Of these respondents, 142 (46.6%) reported coming into contact with bats through various activities, such as hunting, eating, cooking, collecting bat guano, cleaning bat feces, and finding carcasses in houses and communities. Villagers called bats by different names in different regions. They reported having been in contact with bats in different ways based on occupations, bat species, bat habitats, attitudes, perceptions, beliefs toward bats, and cultural contexts. Villagers in the northern and northeastern regions reported having regularly eaten bats. In contrast, the respondents in the central region did not eat bats due to local norms, religious beliefs, and regulations. By ethnicity, the Blu and Thai Dum groups reported coming into contact with and eating bats more often than the Thais. Our results provide evidence-based information on the human-bat interface in different regions in Thailand. The results of this qualitative study could be useful for strategic planning of proper education and interventions for bat conservation, bat contact behavior, and risk of bat-borne diseases among villagers in the future.

Risk factors for bat contact and consumption behaviors in Thailand; a quantitative study

BACKGROUND

Bats serve as an important reservoir for emerging infectious diseases. Bat contact and consumption, which persists in Asia, poses risks for the transmission of bat-borne infections.

METHODS

An analytical cross-sectional survey for risk factors associated with bat contact and consumption behaviors was conducted in ten provinces of Thailand from May 2016 to December 2017. A standardized questionnaire administered through face-to-face interviews was used to collect information from 626 villagers who lived in or nearby areas of high bat density. The questionnaire contained 23 independent variables related to sociodemographic, knowledge, attitudes, practices, and perceptions.

RESULTS

The respondents (n = 626) were 285 females and 341 males, mean age of respondents was 47.58 years-old and lived in rural setting. Our results showed that 36.42% of respondents (n1 = 228) in 10 provinces reported bat contact during the past 6 months. Furthermore, 15.34% of respondents (n2 = 96) in 9 out of 10 provinces reported of having consumed bat meat in the past 6 months. Risk factors for bat contact included sex (male) (OR = 1.56, 95% CI 1.09-2.28), educational attainment (lower than secondary school) (OR = 1.45, 95% CI 1.02-2.18), and the consideration of bats as being economically beneficial to the community (OR = 3.18, 95% CI 2.03-4.97), while agriculture-related occupation (OR = 0.54, 95% CI 0.37-0.79), knowledge that it is safe to eat bats (OR = 0.58, 95% CI 0.37-0.93), practice of allowing children to play with bats (OR = 0.65, 95% CI 0.44-0.96), and attitude of feeling safe in areas where bats live (OR = 0.56, 95% CI 0.38-0.86) were statistically significant protective factors against bat contact. Risk factors for bat consumption included sex (male) (OR = 2.48, 95% CI 1.49-4.11) and educational attainment (lower than secondary school) (OR = 2.21, 95% CI 1.27-3.85), while knowledge of whether bats are safe to eat (OR = 0.04, 95% CI 0.01-0.25), knowledge of whether there are laws pertaining to hunting bats for consumption (OR = 0.35, 95% CI 0.18-0.71), and the practice of allowing children to play with bats (OR = 0.51, 95% CI 0.31-0.81) were statistically significant protective factors against bat consumption.

CONCLUSIONS

This study provides a better understanding of the sociodemographic factors, knowledge, attitudes, perceptions and practices that might influence bat contact and bat consumption behaviors. Information on risk factors can be used for the development of appropriate education and communication interventions to promote proper knowledge, attitudes and practices regarding bats and bat-borne zoonotic diseases in Thailand and other areas in the Southeast Asia region with similar environmental and cultural characteristics.

Detection of Emerging Zoonotic Pathogens: An Integrated One Health Approach

The emergence of novel zoonotic pathogens is one of the greatest challenges to global health security. The advent of increasingly sophisticated diagnostics tools has revolutionized our capacity to detect and respond to these health threats more rapidly than ever before. Yet, no matter how sophisticated these tools become, the initial identification of emerging infectious diseases begins at the local community level. It is here that the initial human or animal case resides, and it is here that early pathogen detection would have maximum benefit. Unfortunately, many areas at highest risk of zoonotic disease emergence lack sufficient infrastructure capacity to support robust laboratory diagnostic systems. Multiple factors are essential for pathogen detection networks, including an understanding of the complex sociological and ecological factors influencing disease transmission risk, community engagement, surveillance along high-risk human-animal interfaces, and a skilled laboratory workforce. Here we discuss factors relevant to the emerging disease paradigm, recent technical advances in diagnostic methods, and strategies for comprehensive and sustainable approaches to rapid zoonotic disease detection.

Potential risk of viral transmission from flying foxes to domestic animals and humans on the southern coast of West Java, Indonesia

Flying foxes have been considered to be involved in the transmission of serious infectious diseases to humans. Using questionnaires, we aimed to determine the direct and/or indirect contacts of flying foxes in an Indonesian nature conservation area with domestic animals and humans living in the surrounding area. We surveyed 150 residents of 10 villages in West Java. Villages were classified into 3 groups: inside and/or within 1 km from the outer border of the conservation area and 1–5 km or 5–10 km away from the reserve’s outer border. Data were collected by direct interview using a structured questionnaire consisting of the respondent characteristics (age, sex and occupation); histories of contacts between flying foxes and humans, dogs and other domestic animals; and knowledge about infectious diseases, mainly rabies, in flying foxes. We found that flying foxes from the nature conservation area often enter residential areas at night to look for food, especially during the fruit season. In these residential areas, flying foxes had direct contacts with humans and a few contacts with domestic animals, especially dogs. People who encounter flying foxes seldom used personal protective equipment, such as leather gloves, goggles and caps. The residents living around the conservation area mostly had poor knowledge about flying foxes and disease transmission. This situation shows that the population in this region is at a quite high risk for contracting infectious diseases from flying foxes.

Coexistence and Conflict between the Island Flying fox (Pteropus hypomelanus) and Humans on Tioman Island, Peninsular Malaysia

As tropical landscapes become increasingly human-dominated, conflicts between people and wildlife threaten ecological processes. Old World fruit bats such as flying foxes are especially susceptible to extinction risk because there is low interest in their conservation, particularly when they are considered pests. In order to arrest fruit bat declines, there is an urgent need to understand human-bat conflict and its implications. On a tropical island in Peninsular Malaysia, we conducted a questionnaire survey to investigate coexistence between people and the island flying fox (Pteropus hypomelanus). Among 119 respondents, knowledge of ecosystem services provided by flying foxes was extremely low. Most respondents held negative attitudes towards the bats, and older male locals were more likely to support killing them. This was also true for older owners of fruit trees who derived income from selling fruit, and experienced flying fox raids. Our results can be used to design appropriate interventions to support conservation efforts, and has important implications for managing conflicts between humans and synanthropic wildlife.

Knowledge, attitudes and practices regarding rabies and exposure to bats in two rural communities in Guatemala

BACKGROUND

Rabies is a fatal encephalitis caused by rabies virus, of the genus Lyssavirus. The principal reservoir for rabies in Latin America is the common vampire bat (Desmodus rotundus), which feeds routinely on the blood of cattle, and when livestock are scarce, may prey on other mammals, including humans. Although rabies is endemic in common vampire bat populations in Guatemala, there is limited research on the extent of exposure to bats among human populations living near bat refuges.

RESULTS

A random sample of 270 of 473 households (57%) in two communities located within 2 Km of a known bat roost was selected and one adult from each household was interviewed. Exposure to bats (bites, scratches or bare skin contact) was reported by 96 (6%) of the 1,721 residents among the selected households. Of those exposed, 40% received rabies post-exposure prophylaxis. Four percent of household respondents reported that they would seek rabies post exposure prophylaxis if they were bitten by a bat.

CONCLUSIONS

These findings demonstrate that exposure to bats in communities near bat roosts is common but recognition of the potential for rabies transmission from bats is low. There is a need for educational outreach to raise awareness of bat-associated rabies, prevent exposures to bats and ensure appropriate health-seeking behaviours for bat-inflicted wounds, particularly among communities living near bat roosts in Guatemala.

Utility of the health belief model to assess predictors of rabies preventive measures

INTRODUCTION

Rabies is a fatal zoonotic viral disease that is spread to people through animal bites. Around 35,000-50,000 individuals worldwide die of rabies each year, of which more than 99% of deaths occur in the developing countries. Since legislative actions does not appear to have been effective in reducing the incidence and severity of the bites in some developed countries, it seems public education is key to reducing animal bites. For effective education, understanding factors affecting the preventive and protective behaviors based on appropriate health behavior change models is important. So, the study tried to examine the relationship between Health Belief Model (HBM) constructs and rabies preventive measures.

MATERIALS AND METHODS

In the cross-sectional study, a HBM-based researcher-designed questionnaire was completed by 204 participants who were selected via cluster sampling design from urban families of the Abadeh, Iran. The psychometric properties of the questionnaire were established. Descriptive statistics, independent sample t-test, bivariate correlations, and stepwise multiple regression analysis were applied to analyze data using SPSS 19. The level of significance was set a priori at 0.05.

RESULTS

The scale mean for the total knowledge of the participants about rabies was 14.12 ± 6.04 out of 29. Participants' preventive behaviors were significantly correlated with their total knowledge, perceived susceptibility, perceived severity, perceived benefits and cues to action, which 19% of the variation in these behaviors were explained by perceived benefits and cues to action. Protective activities of participants who kept animals in their house had statistically significant correlation with their total knowledge score and cues to action. 32.1% of the variation in these activities was explained by cues to action.

DISCUSSION

Findings indicate that participants had not enough knowledge about routes of infecting by rabies and how to prevent it. The most powerful predictors for preventive behaviors and protective activities were perceived benefits and cues to action, respectively, which indicate the importance of the availability of accurate information about efficacy of these behaviors, from sources that are easily accessible, such as healthcare providers and veterinary professionals.

CONCLUSION

Educational programs are needed for increasing public knowledge in this area. And more studies should be done to determine predictive factors of rabies preventive measures based on other health behavior change models.

Current and future tools for global canine rabies elimination

Even though rabies is almost uniformly fatal, it is readily preventable with currently available tools. Vaccination is highly efficacious for the pre-exposure prophylaxis (PrEP) of rabies in humans and animals, and prompt postexposure prophylaxis (PEP) with vaccine and rabies immune globulin (RIG) can reliably prevent disease in humans. However, access to these tools and knowledge of their proper use are often limited, especially in impoverished, rabies-enzootic countries with the highest disease burden. In the absence of reliable diagnostic capacity and risk assessments, vaccines and RIG are often administered inappropriately, leading to chronic supply shortages and otherwise preventable deaths. Rather than focusing solely on human prophylaxis, it is more cost-effective over the long term to eliminate canine rabies in its natural terrestrial reservoirs. Because more than 99% of human rabies deaths result from dog bites, prevention efforts should focus on dogs. A versatile "One Health" strategy for canine rabies elimination should aim to create sustainable herd immunity in dogs, using proven vaccination strategies at the local level, coupled with community education and humane population management. Such strategies have succeeded in both developed and developing countries, and can be adapted to any locality. Numerous examples in Africa, Asia, and Latin America have shown that community-based, locally guided vaccination and education programs, based on a shared vision and long-term commitment, can eliminate canine rabies. Such programs should have specific goals and measurable outcomes, and should be conducted under the guidance of supportive governments, in collaboration with international partners and nongovernmental organizations. In addition to currently available tools, rabies prevention can be augmented by new dose-sparing human vaccine schedules, alternative routes of vaccine administration, monoclonal antibodies as an alternative to RIG, sensitive and specific point-of-care diagnostics and the development of canine immunocontraceptive methods. Accurate risk assessments of potential human exposures and support for decentralized laboratory capacity will be essential to ensure the most effective utilization of vaccines and RIG until canine rabies has been eliminated.

Knowledge, attitude and practice about rabies among children receiving formal and informal education in Samaru, Zaria, Nigeria

Every year, about 50,000 people die of rabies of which about 55% of the mortalities occur in Asia and over 40% in Africa. Children are victims of up to 50% of these mortalities. The figure is alarming and immediate action is required to stop this scourge. This study was carried out to assess the knowledge, attitude and practice about rabies among children attending primary schools located in the Ahmadu Bello University (ABU) premises and those outside the university as well as those receiving informal education. The participants for this study were children drawn by random selection from the schools chosen by purposive sampling. With the aid of questionnaires, information was obtained from a total of 477 children with 400 from formal educational settings among 3 schools, and 77 from quaranic schools (almajiris) in the informal setting. More children receiving formal education were aware about the disease (50.8%) than those receiving informal education (32.5%), likewise those residing within ABU quarters (71%) were better informed than those residing outside ABU quarters (43.3%). Among children in the formal schools, 25.9% obtained information from friends and at school (25.9%), while in the informal setting, 56% obtained information from friends and only 16% from school. With regards to attitude and practice, 75.5% of children receiving formal education came from homes where dogs were vaccinated against rabies and 23.3% of them play with dogs they know, while 11.1% of those receiving informal education vaccinate their dogs and fewer of them (14.3%) play with dogs known to them. Many children (65.7%) of those in formal schools know the role of dogs in rabies transmission, compared to only 8% in the informal schools. However, only 9.7% of children in formal schools associate both signs of furious and dumb form of rabies with the disease, compared with 28% in informal schools.  Among children bitten by dogs, 87.5% of those receiving informal education received hospital treatment compared to 63.7% of those going to formal schools. About 13% in each of the two categories received traditional treatment. It is, therefore, important for children to be properly educated about rabies so that they can avoid dogs, recognise potential exposures, report to a responsible adult and pass on the knowledge to their peers.

Rabies in Asia: the classical zoonosis

Rabies remains a constant threat to humans throughout much of Asia. The dog is the main reservoir and vector with wildlife playing a very minor role. No Asian country or region has been declared rabies free by WHO in over two decades and there is evidence of canine rabies spread to new regions during the past 10 years. We now have the knowledge and technology to control canine rabies. The main barrier in managing this costly endemic is lack of motivation by authorities to address this issue along with regional inability of public health and livestock (agriculture) officials to tackle this issue in cooperation and coordination. Rabies is one of the first recognized zoonoses and a model for a true "One Health" management goal where human; veterinary, and government officials must work together in harmony to defeat this disease.