1
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Overduin LA, Koopman JPR, Prins C, Verbeek-Menken PH, de Pijper CA, Heerink F, van Genderen PJJ, Grobusch MP, Visser LG. Rabies knowledge gaps and risk behaviour in Dutch travellers: An observational cohort study. Travel Med Infect Dis 2024; 60:102739. [PMID: 39009201 DOI: 10.1016/j.tmaid.2024.102739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 05/06/2024] [Accepted: 06/24/2024] [Indexed: 07/17/2024]
Abstract
BACKGROUND Travellers visiting rabies-endemic countries are at risk of rabies infection. Assessing travellers' knowledge and risk perception of rabies and risk behaviour during travel can help identify knowledge gaps and improve pre-travel risk education. METHODS Cohort study in Dutch adult travellers, using two surveys: one before travel to assess knowledge and perception of rabies, and one after return to identify risk behaviour during travel. RESULTS The pre-travel and post-travel survey were completed by 301 and 276 participants, respectively. 222 participants had travelled to a high-risk rabies-endemic country. 21.6 % of the participants scored their rabies knowledge as poor. Some participants were unaware cats or bats can transmit rabies (26.6 % and 13.6 %, respectively), or that post-exposure prophylaxis (PEP) is required for certain exposures such as skin abrasions without bleeding or licks on damaged skin (35.5 % and 18.9 %, respectively), while 27.9 % of participants did not know PEP needs to be administered within one day. 115 participants (51.8 %) reported any form of contact with any animal during travel. Two participants reported animal exposure, of which one took adequate PEP measures. Risk factors for animal contact abroad were regularly touching cats or dogs at home or abroad, longer travel duration, having pets during childhood and being an animal lover. CONCLUSIONS Pre-travel rabies risk education currently does not meet travellers' needs, which is reflected in knowledge gaps and engagement in risk behaviour during travel. During pre-travel health advice, avoiding animal contact abroad should be emphasized, and additional education is required about indications for PEP.
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Affiliation(s)
- Lisanne A Overduin
- Leiden University Center for Infectious Diseases, Leiden University Medical Centre, Leiden, the Netherlands.
| | - Jan Pieter R Koopman
- Leiden University Center for Infectious Diseases, Leiden University Medical Centre, Leiden, the Netherlands
| | - Corine Prins
- Leiden University Center for Infectious Diseases, Leiden University Medical Centre, Leiden, the Netherlands
| | - Petra H Verbeek-Menken
- Leiden University Center for Infectious Diseases, Leiden University Medical Centre, Leiden, the Netherlands
| | - Cornelis A de Pijper
- Centre for Tropical Medicine and Travel Medicine, Amsterdam University Medical Centers, Location AMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Fiona Heerink
- Leiden University Center for Infectious Diseases, Leiden University Medical Centre, Leiden, the Netherlands
| | | | - Martin P Grobusch
- Centre for Tropical Medicine and Travel Medicine, Amsterdam University Medical Centers, Location AMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Leo G Visser
- Leiden University Center for Infectious Diseases, Leiden University Medical Centre, Leiden, the Netherlands
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2
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Furuya-Kanamori L, Mills DJ, Zhu Y, Lau CL. Can a single visit rabies pre-exposure prophylaxis eliminate the need for rabies immunoglobulin in last minute travellers? J Travel Med 2023; 30:taad139. [PMID: 37941445 DOI: 10.1093/jtm/taad139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 10/29/2023] [Accepted: 11/03/2023] [Indexed: 11/10/2023]
Affiliation(s)
- Luis Furuya-Kanamori
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Australia
| | - Deborah J Mills
- Dr Deb The Travel Doctor, Travel Medicine Alliance, Brisbane, Australia
| | - Yan Zhu
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Australia
| | - Colleen L Lau
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Australia
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3
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Gautret P. Decline in rabies cases in international travelers during the COVID-19 pandemic. Travel Med Infect Dis 2023; 54:102592. [PMID: 37245851 PMCID: PMC10219673 DOI: 10.1016/j.tmaid.2023.102592] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 05/12/2023] [Accepted: 05/15/2023] [Indexed: 05/30/2023]
Affiliation(s)
- Philippe Gautret
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France; IHU-Méditerranée Infection, Marseille, France.
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4
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Tiwari HK, Gogoi-Tiwari J, Robertson ID. Eliminating dog-mediated rabies: challenges and strategies. ANIMAL DISEASES 2021. [DOI: 10.1186/s44149-021-00023-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
AbstractRabies is an acute encephalitis caused by a lyssavirus. It is primarily transmitted through bites of infected dogs which results in the worldwide death of an estimated 59000 humans every year. The disease is preventable through the application of post-exposure prophylaxis (PEP) and its elimination has been demonstrated in many countries by applying multiple interventions simultaneously. Nonetheless, rabies is still widespread in many developing countries, primarily due to the poor implementation of intervention strategies that include inadequate dog-bite wound management practices, unavailability/unaffordability of PEP by the communities, failure to control the disease in free-roaming dogs and wildlife, improper dog population management, weak surveillance and diagnostic facilities and a lack of a One Health approach to the disease. In this review, strategies to control dog-mediated rabies through a One Health approach were discussed. We recommend applying multiple interventions against the disease by involving all the concerned stakeholders in selected urban and rural areas of the countries where rabies is endemic. An empirical demonstration of disease freedom in the selected areas through a One Health approach is needed to convince policymakers to invest in rabies prevention and control on the national level. This multifaceted One Health control model will enhance the likelihood of achieving the goal of global rabies eradication by 2030.
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5
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Saha S. Life-Threatening Panfacial Wild Dog Bites in a Child. Wilderness Environ Med 2021; 32:511-516. [PMID: 34446361 DOI: 10.1016/j.wem.2021.07.001] [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: 09/29/2020] [Revised: 06/17/2021] [Accepted: 07/02/2021] [Indexed: 11/30/2022]
Abstract
Infants and toddlers can sustain grievous craniofacial injuries after dog bites, some of which may be life-threatening. An 18-mo-old male child presented to our emergency department with complex panfacial wounds after being bitten by an unvaccinated wild dog 6 h earlier. Primary management, hemostasis, and rabies postexposure prophylaxis were performed near his home. Initially, he was resuscitated from severe hemorrhagic shock and anemia in a pediatric intensive care unit. After stabilization, early primary repair of all facial injuries was performed. Surgical exploration revealed multiple full-thickness avulsions, lacerations, nasal bone fractures, facial muscle injuries, and right ear necrosis. Gentle tissue-handling and meticulous reconstruction satisfactorily restored his facial soft-tissue contours about 64 h after the bite injury. Postoperatively, recovery was uneventful except for localized soft-tissue infection caused by multidrug-resistant Pseudomonas, which resolved with appropriate antibiotics. Nine months later, his face and ear appeared almost symmetrical with well-settled scars. Psychological recovery progressed smoothly, excepting few incidences of panic attacks that were triggered by loud noises. Here, we observed that early primary reconstruction of severely mauled soft tissues after wild dog bites, performed within 72 h with adequate precautions, safely produced satisfying long-term outcomes.
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Affiliation(s)
- Srinjoy Saha
- Department of Plastic Surgery, Apollo Gleneagles Hospital, Kolkata, India.
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6
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Riccardi N, Giacomelli A, Antonello RM, Gobbi F, Angheben A. Rabies in Europe: An epidemiological and clinical update. Eur J Intern Med 2021; 88:15-20. [PMID: 33934971 DOI: 10.1016/j.ejim.2021.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 03/30/2021] [Accepted: 04/09/2021] [Indexed: 11/16/2022]
Abstract
Rabies is a vaccine preventable zoonotic disease with a significant mortality burden worldwide. Several years of vaccination campaigns in wildlife animals have now achieved the control of rabies in Western Europe through a vaccination belt in front of endemic Eastern European countries. Nevertheless, rabies could be imported both by travellers from areas without an active public control of the disease or by animals coming from areas where the virus circulates in wildlife fauna. The knowledge of the current world epidemiology combined with a high index of clinical suspicion are needed to reach a diagnosis of rabies, especially in case of atypical presentation or without a history of animal exposure. The pre-travel counselling to people visiting highly endemic areas is essential to give information on how to reduce exposure to potential sources of infection and to select those subjects who could benefit from pre-travel vaccination. Rabies is almost invariably fatal, but the prompt administration of a vaccine course combined with anti-rabies immunoglobulins significantly reduces the probability to develop life-threatening consequences. In this review, we give a brief epidemiological and clinical update about rabies in Europe.
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Affiliation(s)
- Niccolò Riccardi
- Department of Infectious, Tropical Diseases & Microbiology (DITM), IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy.
| | - Andrea Giacomelli
- III Infectious Diseases Unit, ASST Fatebenefratelli Sacco, Milano, Italy
| | - Roberta Maria Antonello
- Clinical Department of Medical, Surgical and Health Sciences, Trieste University Hospital, Trieste, Italy.
| | - Federico Gobbi
- Department of Infectious, Tropical Diseases & Microbiology (DITM), IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy.
| | - Andrea Angheben
- Department of Infectious, Tropical Diseases & Microbiology (DITM), IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy.
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7
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Soentjens P, Croughs M, Burm C, Declerq S, Clerinx J, Maniewski U, Van Den Broucke S, Theunissen C, Huits R, Brosius I, Florence E, Kenyon C, Van Griensven J, Van Ierssel S, Lynen L, Balliauw K, Van Gucht S, Van Esbroeck M, Vlieghe E, Bottieau E, Van Herrewege Y. Time of administration of rabies immunoglobulins and adequacy of antibody response upon post-exposure prophylaxis: a descriptive retrospective study in Belgium. Acta Clin Belg 2021; 76:91-97. [PMID: 31483218 DOI: 10.1080/17843286.2019.1662993] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Data on rabies post-exposure prophylaxis (PEP) and the use of human rabies immunoglobulins (HRIG) in Belgium are scarce. The main objective of this study was to evaluate the timely administration of HRIG after rabies exposure. The secondary objective was to evaluate the adequate antibody response following PEP.Methods: We reviewed all medical records from July 2017 to June 2018 of patients seeking care at, or referred to, the Institute of Tropical Medicine and the University Hospital, Antwerp for the administration of human rabies immunoglobulins following potential rabies exposure abroad or in Belgium.A timely response was defined as starting HRIG with a delay of ≤48 h and rabies vaccination in the first 7 days after exposure.Adequate antibody response was defined as a titer of >5.0 IU/mL in case of bat-related exposure and >3.0 IU/mL in case of exposure to other animals. Titers were measured 10 days after the last PEP vaccine dose, using the rapid fluorescent focus inhibition test (RFFIT).Results: Of the 92 cases treated with HRIG, 75 were evaluated.The majority of injuries were acquired in Asia (n = 26,34%) and in Western Europe (n = 18, 24%), of which 17 in Belgium. The five most frequently recorded countries overseas were Indonesia (n = 13), Thailand (n = 7), Morocco (n = 4), Peru (n = 3) and Costa Rica (n = 3). Administration of immunoglobulins was related to injuries by dogs (36%), monkeys (25%) or bats (22%).A timely response was observed in 16 (21,33%) and in 55 (73,33%) of subjects receiving HRIG (≤48 h) or rabies vaccine (<7days) respectively. The mean time between exposure and the first administered dose of rabies vaccine and HRIG was 7.7 and 8.7 days, respectively. The mean delay for HRIG administration was 9.6 days and 6 days for abroad and inland risks, respectively.In 15 of 16 (94%) bat-related cases the antibody titer after full PEP was >5.0 IU/ml. In 38 of 47 (81%) cases related to other animals the RFFIT titer was >3.0 IU/ml. All low-responders received additional rabies injections.Conclusion: This study showed a substantial time delay between the animal-related risk and the administration of HRIG, in particular when the injury occurred abroad. More targeted communication about the risks of rabies and preventable measures may reduce this delay.Furthermore, the antibody response was inadequate in some cases following full PEP administration according to the Belgian recommendation.
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Affiliation(s)
- Patrick Soentjens
- Centre for Infectious Diseases, Queen Astrid Military Hospital, Brussels, Belgium
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Mieke Croughs
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Christoph Burm
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Steven Declerq
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Jan Clerinx
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Ula Maniewski
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | | | - Caroline Theunissen
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Ralph Huits
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Isabel Brosius
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Eric Florence
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Chris Kenyon
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Johan Van Griensven
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Sabrina Van Ierssel
- Department of Infectious Diseases and Tropical Diseases, University Hospital Antwerp, Antwerp, Belgium
| | - Lut Lynen
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Katleen Balliauw
- Hospital Pharmacy, University Hospital Antwerp, Antwerp, Belgium
| | - Steven Van Gucht
- Department of Infectious Diseases and Tropical Diseases, University Hospital Antwerp, Antwerp, Belgium
| | - Marjan Van Esbroeck
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Erika Vlieghe
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
- Department of Infectious Diseases and Tropical Diseases, University Hospital Antwerp, Antwerp, Belgium
| | - Emmanuel Bottieau
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Yven Van Herrewege
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
- National Reference Centre for Rabies, Sciensano, Brussels, Belgium
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8
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Schreuder I, De Pijper C, van Kessel R, Visser L, van den Kerkhof H. Abandon of intramuscular administration of rabies immunoglobulin for post-exposure prophylaxis in the revised guidelines in the Netherlands in 2018: cost and volume savings. ACTA ACUST UNITED AC 2021; 25. [PMID: 32975188 PMCID: PMC7533622 DOI: 10.2807/1560-7917.es.2020.25.38.2000018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The World Health Organization (WHO) issued an updated position paper on rabies in 2018, mainly focusing on simplification of vaccination schedules and use of rabies immunoglobulin (RIG). The maximum amount of RIG anatomically feasible should be infiltrated exclusively in and around the wound and will no longer be calculated solely based on body weight. We describe the practical guideline implementing the revised RIG policy in the Netherlands on how to determine the amount of RIG for local administration. We calculated savings achieved through the revised WHO policy. We used information from a national database including rabies consultations in the Netherlands and clinical information from a public health service, clinical practitioners and national data on the amount of distributed RIG. Between 2008 and 2019, 5,164 consultations were registered. The most frequently affected anatomical location was hand or leg (43%). Around 80% concerned minor injuries (< 2 cm). From January 2016 to end December 2019, 7,361 mL RIG were distributed for 1,042 possible rabies exposures (EUR 1.4 million). Since implementing the revised policy, the amount of RIG distributed per order has sharply decreased (59%). Infiltrating RIG only locally saved large quantities of human RIG (EUR 1.1 million during 4 years) in the Netherlands.
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Affiliation(s)
- Imke Schreuder
- Dutch advisory committee on rabies; further members of the network are acknowledged at the end of the article.,National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Cornelis De Pijper
- Centre for Tropical Medicine and Travel Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.,Dutch advisory committee on rabies; further members of the network are acknowledged at the end of the article
| | - Rob van Kessel
- Municipal Health Service Utrecht region, Zeist, the Netherlands.,Dutch advisory committee on rabies; further members of the network are acknowledged at the end of the article.,National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Leo Visser
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, the Netherlands.,Dutch advisory committee on rabies; further members of the network are acknowledged at the end of the article
| | - Hans van den Kerkhof
- Dutch advisory committee on rabies; further members of the network are acknowledged at the end of the article.,National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
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- Dutch advisory committee on rabies; further members of the network are acknowledged at the end of the article
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9
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Flis M. Rabies in Europe in 2010-2019. BULGARIAN JOURNAL OF VETERINARY MEDICINE 2021. [DOI: 10.15547/bjvm.2020-0077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The paper presents the epizootic and epidemiological situation of rabies in European countries during the last decade. The presented results indicate that the oral immunisation of fox anti-rabies (ORV), used in many European countries, significantly reduced the number of rabies cases found in ground mammals, but did not eliminate the virus at all. Currently, the largest reservoir of the virus are Eastern European countries where there are no immunisation activities or their effectiveness is low. Due to the absence of geographical barriers, the virus reappears in countries that have been described as free from rabies. As a rule, it is dragged into these areas along with the movement of companion animals and by people travelling to countries where the prevalence of the virus is common. It should be emphasised that due to the significant elimination of the virus in wild and domestic animals, it found quite quickly found a new reservoir in a specific group of mammals, having the ability to fly, like bats. Currently there is no possibility of carrying out any preventive measures in bats, so all the virus strains found in this group of animals are dangerous to humans, raising possibilities of epidemiological threat. It should be noted that despite the significant elimination of rabies in many European countries, given the almost unlimited possibilities of virus transmission to new areas, it still poses a serious threat to public health. Thus, it is necessary to constantly monitor the occurrence of the virus and possibly take preventive actions in terms of its elimination from the environment.
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Affiliation(s)
- M. Flis
- Department of Animal Ethology and Wildlife Management, Faculty of Animal Sciences and Bioeconomy, University of Life Sciences in Lublin, Lublin, Poland
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10
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Heitkamp C, Stelzl DR, Ramharter M, Bühler S. Rabies exposure in travellers to Asia, the Middle East, Africa, South and Central America-a German Airport study. J Travel Med 2020; 27:5822104. [PMID: 32307548 DOI: 10.1093/jtm/taaa058] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 04/14/2020] [Accepted: 04/15/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND Rabies causes thousands of deaths worldwide and trips to rabies endemic countries are popular. Travellers are often uncertain whether pre-exposure prophylaxis (PrEP) is advisable since they find it difficult to estimate the exposure risk during travel and the availability of post-exposure prophylaxis in endemic regions. The aim of this study was to determine the potential rabies exposures in travellers and to assess their knowledge on rabies. Secondly, we explored the access to appropriate post-exposure medical care in respective countries. METHODS We conducted a cross-sectional study at Frankfurt Airport. Returning adult travellers arriving from Asia, the Middle East, Africa, South and Central America were invited to participate in this questionnaire-based study while waiting in the baggage claim area. RESULTS Over a one-month recruitment phase in March 2019, we enrolled 3066 travellers; 2929 were included in the analysis. The gender ratio was balanced; the median age was 42 years (range 18-83 years). Participants arrived from Asia (46%), Africa (29%), Central/South America (13%), the Middle East (8%) and the Caribbean (8%). Forty-five per cent sought pretravel advice and 22% received ≥2 injections of rabies PrEP. Travellers with pretravel advice from tropical medicine specialists reached significantly higher knowledge scores than others. We found that potential rabies exposure occurred in 2.0% (57/2915) of travellers with 31% (13/42) of the contacts being unprovoked; 19% (8/42) of the exposed sought medical care and 3/8 were adequately treated before returning to Germany. Risk factors for animal exposure were: male sex, young age, trips to Asia and a long stay abroad (>4 weeks). CONCLUSIONS A total of 2% of returning travellers (n = 2915) experienced a potential rabies exposure during their journey. A majority of the exposed individuals did not seek medical care; those seeking medical care were often treated inadequately. Rabies information must be emphasised during pretravel counselling and PrEP should be offered generously, especially to travellers with high exposure risks.
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Affiliation(s)
- Christian Heitkamp
- Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine & I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20359 Hamburg, Germany
| | - Daniel Robert Stelzl
- Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine & I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20359 Hamburg, Germany
| | - Michael Ramharter
- Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine & I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20359 Hamburg, Germany
| | - Silja Bühler
- Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine & I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20359 Hamburg, Germany
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11
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Muehlenbein MP, Angelo KM, Schlagenhauf P, Chen L, Grobusch MP, Gautret P, Duvignaud A, Chappuis F, Kain KC, Bottieau E, Epelboin L, Shaw M, Hynes N, Hamer DH. Traveller exposures to animals: a GeoSentinel analysis. J Travel Med 2020; 27:5716751. [PMID: 31993666 PMCID: PMC7384971 DOI: 10.1093/jtm/taaa010] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 01/21/2020] [Accepted: 01/23/2020] [Indexed: 01/25/2023]
Abstract
BACKGROUND Human coexistence with other animals can result in both intentional and unintentional contact with a variety of mammalian and non-mammalian species. International travellers are at risk for such encounters; travellers risk injury, infection and possibly death from domestic and wild animal bites, scratches, licks and other exposures. The aim of the present analysis was to understand the diversity and distribution of animal-related exposures among international travellers. METHODS Data from January 2007 through December 2018 from the GeoSentinel Surveillance Network were reviewed. Records were included if the exposure was non-migration travel with a diagnosis of an animal (dog, cat, monkey, snake or other) bite or other exposure (non-bite); records were excluded if the region of exposure was not ascertainable or if another, unrelated acute diagnosis was reported. RESULTS A total of 6470 animal exposures (bite or non-bite) were included. The majority (71%) occurred in Asia. Travellers to 167 countries had at least one report of an animal bite or non-bite exposure. The majority (76%) involved dogs, monkeys and cats, although a wide range of wild and domestic species were involved. Almost two-thirds (62.6%) of 4395 travellers with information available did not report a pretravel consultation with a healthcare provider. CONCLUSIONS Minimizing bites and other animal exposures requires education (particularly during pretravel consultations) and behavioral modification. These should be supplemented by the use of pre-exposure rabies vaccination for travellers to high-risk countries (especially to those with limited access to rabies immunoglobulin), as well as encouragement of timely (in-country) post-exposure prophylaxis for rabies and Macacine alphaherpesvirus 1 (herpesvirus B) when warranted.
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Affiliation(s)
| | - Kristina M Angelo
- Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, US Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, Georgia, 30333, USA
| | - Patricia Schlagenhauf
- WHO Collaborating Centre for Travellers' Health University of Zurich, Zurich, Switzerland, Department of Public and Global Health Hirschengraben 84, 8001 Zürich, Switzerland
| | - Lin Chen
- Department of Medicine, Mount Auburn Hospital, 330 Mount Auburn Street, Cambridge, Massachusetts, 02138, USA
| | - Martin P Grobusch
- Department of Infectious Diseases, Division of Internal MEdicine, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, PO Box 22660, Amsterdam, Netherlands 1100DD
| | - Philippe Gautret
- Méditerranée Infection Foundation, 19-21 Boulevard Jean Moulin, 13005, Marseille, France
| | - Alexandre Duvignaud
- Department of Infectious Diseases and Tropical Medicine , Division of Tropical Medicine and Clinical International Health, Centre Hospitalier Universitaire de Bordeaux, Hôpital Pellegrin, Place Amélie Raba Léon, 33076, Bordeaux, France
| | - François Chappuis
- Department of Primary Care Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva, Switzerland
| | - Kevin C Kain
- Department of Medicine, University of Toronto, Toronto General Hospital, MaRS Centre, 101 College St, TMDT 10-360A, Ontario, Canada M5G1L7
| | - Emmanuel Bottieau
- Department of Clinical Sciences, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium
| | - Loïc Epelboin
- Unité des Maladies Infectieuses et Tropicales, Centre Hospitalier Andree Rosemon, Ave des Flamboyants, 97300 Cayenne, French Guiana
| | - Marc Shaw
- Department of Tropical Medicine and Rehabilitation Services, James Cook University, 1 James Cook Drive, Townsville, Queensland 4811, Australia
| | - Noreen Hynes
- Division of Infectious Diseases, Department of Medicine, John Hopkins University School of Medicine, 1830 E Monument St, Suite 419, Baltimore, Maryland, 21205, USA
| | - Davidson H Hamer
- Department of Global Health, Boston University School of Public Health, Crosstown 3rd floor, 801 Massachusetts Ave, Boston, Massachusetts, 02118, USA
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12
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Gautret P, Al-Abri S, Al-Rawahi B, Memish ZA. Human rabies importation to the Middle East: An emerging threat? Int J Infect Dis 2020; 102:335-336. [PMID: 33157293 DOI: 10.1016/j.ijid.2020.10.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 10/27/2020] [Accepted: 10/27/2020] [Indexed: 11/19/2022] Open
Affiliation(s)
- Philippe Gautret
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France; IHU-Méditerranée Infection, Marseille, France.
| | - Seif Al-Abri
- Directorate General for Disease Surveillance and Control, Muscat, Oman
| | - Bader Al-Rawahi
- Directorate General for Disease Surveillance and Control, Muscat, Oman
| | - Ziad A Memish
- Research and Innovation Center, King Saud Medical City, Ministry of Health, Riyadh, Saudi Arabia; College of Medicine, Alfaisal University, Riyadh, Saudi Arabia; Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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13
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Suijkerbuijk AWM, Mangen MJJ, Haverkate MR, Luppino FS, Bantjes SE, Visser LG, Swaan CM, Ruijs WLM, Over EAB. Rabies vaccination strategies in the Netherlands in 2018: a cost evaluation. Euro Surveill 2020; 25:1900716. [PMID: 32975187 PMCID: PMC7533619 DOI: 10.2807/1560-7917.es.2020.25.38.1900716] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BackgroundThe risk of contracting rabies is low for travellers. However, the number of Dutch travellers potentially exposed abroad following an animal-associated injury and needing post-exposure prophylaxis (PEP) has increased, resulting in increased costs.AimHere, we evaluated the costs and the cost-effectiveness of different pre- and post-exposure interventions in the Netherlands, taking into account the 2018 World Health Organization (WHO) recommendations for the prevention of rabies.MethodsA decision tree-based economic model was constructed. We calculated and compared the cost of different WHO pre-exposure prophylaxis (PrEP) recommendations, intramuscular vs intradermal vaccination and PEP subsequent to increased vaccination coverage in risk groups. We estimated cost-effectiveness, expressed as incremental costs per rabies immunoglobulin (RIG) administration averted, using a societal perspective. Statistical uncertainty regarding number of travellers and vaccination coverage was assessed.ResultsTotal costs at the national level were highest using previous WHO recommendations from 2012, estimated at EUR 15.4 million annually. Intradermal vaccinations in combination with the current recommendations led to the lowest costs, estimated at EUR 10.3 million. Higher vaccination uptake resulted in higher overall costs. The incremental costs per RIG administration averted varied from EUR 21,300-46,800.ConclusionsThe change in rabies PrEP and PEP recommendations in 2018 reduced total costs. Strategies with increased pre-travel vaccination uptake led to fewer RIG administrations and fewer vaccinations after exposure but also to higher total costs. Although larger scale intradermal administration of rabies vaccine can reduce total costs of PrEP and can positively influence vaccination uptake, it remains a costly intervention.
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Affiliation(s)
- Anita WM Suijkerbuijk
- National Institute for Public Health and the Environment, RIVM, Bilthoven, the Netherlands
| | - Marie-Josee J Mangen
- National Institute for Public Health and the Environment, RIVM, Bilthoven, the Netherlands,These authors contributed equally to this manuscript
| | - Manon R Haverkate
- National Institute for Public Health and the Environment, RIVM, Bilthoven, the Netherlands,These authors contributed equally to this manuscript
| | | | - Sabine E Bantjes
- National Institute for Public Health and the Environment, RIVM, Bilthoven, the Netherlands
| | - Leo G Visser
- Leiden University Medical Center, Leiden, the Netherlands,Department of Infectious Diseases, Leiden University, Leiden, the Netherlands
| | - Corien M Swaan
- National Institute for Public Health and the Environment, RIVM, Bilthoven, the Netherlands
| | - Wilhelmina LM Ruijs
- National Institute for Public Health and the Environment, RIVM, Bilthoven, the Netherlands
| | - Eelco AB Over
- National Institute for Public Health and the Environment, RIVM, Bilthoven, the Netherlands
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Van Nieuwenhove MDM, Damanet B, Soentjens P. Timing of Intradermal Rabies Pre-exposure Prophylaxis Injections: Immunological Effect on Vaccination Response. Mil Med 2020; 184:e515-e521. [PMID: 31004174 DOI: 10.1093/milmed/usz048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 02/08/2019] [Accepted: 02/25/2019] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Rabies remains a global threat, with annually over 59,000 deaths. Intradermal (ID) pre-exposure prophylaxis (PrEP) is very efficient and reduces the need for rabies immunoglobulins. Not much is known about factors that influence the immune response to ID administered rabies vaccine. The aim of this study is to determine if variations in timing of vaccine administration and serology determination, age and gender have an influence on the levels of rabies virus neutralizing antibody (RVNA) after ID rabies vaccination. MATERIALS AND METHODS This is a retrospective study based on electronic health record vaccination data of Belgian military personnel who received ID rabies PrEP with a three injections regimen during the period 2014-2017. Serology was determined by using the RFFIT method. Fischer's exacts tests were used to evaluate the effect of each independent variable on RVNA levels. RESULTS In this study, 2,112 subjects were included. All but one seroconverted with a RVNA level ≥0.5 IU/mL. About 48% of subjects developed an antibody titer of >10 IU/mL, 36% had antibody levels 3-10 IU/mL and 16% had an antibody level 0.5-2.99 IU/mL. Statistically significant (p = 0.0018) higher RVNA levels are observed in the groups that received vaccination doses later as planned. Timing of serology determination also influenced RVNA levels significantly (p = 0.000). Antibody levels were significantly higher in females than in males (p = 0.000). Age did influence RVNA levels significantly (p = 0.022). CONCLUSIONS Timing of vaccine dose administration, timing of serology testing, sex and age do significantly influence the humoral B-cell response to ID administered rabies vaccine.
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Affiliation(s)
- Mathias D M Van Nieuwenhove
- Belgian Military Medical Service, Royal Military Academy, Avenue de la Renaissance 30, 1000 Brussels, Belgium
| | - Benjamin Damanet
- Travel Clinic, Centre for Infectious Diseases, Military Hospital Queen Astrid, Rue Bruyn 1, 1120 Neder-Over-Heembeek, Belgium
| | - Patrick Soentjens
- Travel Clinic, Centre for Infectious Diseases, Military Hospital Queen Astrid, Rue Bruyn 1, 1120 Neder-Over-Heembeek, Belgium.,Policlinic, Department of Clinical Sciences, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium
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15
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Epidemiology of rabies cases among international travellers, 2013-2019: A retrospective analysis of published reports. Travel Med Infect Dis 2020; 36:101766. [PMID: 32525075 DOI: 10.1016/j.tmaid.2020.101766] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 05/18/2020] [Accepted: 05/30/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Sixty cases of rabies in international travellers from 1990 to 2012 were previously reviewed. We present here an update of rabies cases in international travellers from 2013 to 2019. METHODS We systematically reviewed the existing literature and collected 23 cases of rabies in individuals who crossed an international border between the time of infection and diagnosis, or who were infected following expatriation or migration. RESULTS Most cases were in male adult travellers and diagnosed in Europe and the Middle East, with most exposures in Asia or in Africa. Migrants originating from rabies-endemic low-and-middle income countries and their descendants accounted for two thirds of cases. Other cases were in tourists, business travellers and expatriates. Median travel duration (excluding migration trip) was 60 days (range 7-240 days). Most cases were due to dog bites and most common clinical presentation was furious rabies. In most patients (74%), no rabies post-exposure prophylaxis (RPEP) was administered before rabies symptoms appeared. Other patients received incomplete RPEP series. CONCLUSION Rabies should be suspected in any patient with encephalitis or paralysis who travelled to, or migrated from a rabies-endemic country. Comprehensive information about a rabies risk should be given to travellers to rabies endemic countries, notably migrants visiting friends and relatives.
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16
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Epidemiological study on animal bite cases referred to Haji Daii health Center in Kermanshah province, Iran during 2013-2017. BMC Public Health 2020; 20:412. [PMID: 32228562 PMCID: PMC7106602 DOI: 10.1186/s12889-020-08556-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 03/19/2020] [Indexed: 11/13/2022] Open
Abstract
Background Over thousands of animal bite cases are reported annually worldwide and in Iran placing a large financial burden on the health and economy. The aim of this study was to evaluate the epidemiology of animal bite cases in Kermanshah, Iran through 2013–2017. Methods In this cross-sectional study, 5618 animal bite cases in Kermanshah from 2013 to 2017 were studied. Data were analyzed using descriptive and inferential statistics. Results In the study period, 5618 animal bite cases were found. The prevalence of animal bites was estimated between 42.55–45.66 per100000 populations during 2013–2017. An increasing significant trend was found for prevalence of animal bites (Average annual percent change [AAPC] + 4.9, P-trend< 0.001) over a 5-years’ time period. The mean age of the subjects was 32.7 ± 18.3 years. Of the studied subjects 76.3% were male, and 34% had non-governmental jobs. Dogs were found as the cause of animal bites in 72% of the cases. Of the studied cases, 82% had received rabies vaccination for three times. Conclusion The results showed an increasing significant trend for animal bites in Kermanshah. Development of interventional programs, such as limiting stray dogs, vaccination of dogs and raising public awareness are essential.
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17
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Nasser R, Rakedzon S, Dickstein Y, Mousa A, Solt I, Peterisel N, Feldman T, Neuberger A. Are all vaccines safe for the pregnant traveller? A systematic review and meta-analysis. J Travel Med 2020; 27:5588086. [PMID: 31616947 DOI: 10.1093/jtm/taz074] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 10/01/2019] [Accepted: 10/01/2019] [Indexed: 01/08/2023]
Abstract
Pregnant travellers and their offspring are vulnerable to severe outcomes following a wide range of infections. Vaccine-preventable diseases can have a particularly severe course in pregnant women, but little is known about the safety of travel vaccines in pregnant women. We performed a systematic review of all published literature concerning the safety of vaccines frequently given to travellers such as yellow fever, MMR (mumps, measles and rubella), influenza, Tdap (tetanus, diphtheria and pertussis), meningococcus, hepatitis A and B, rabies, polio, typhoid fever, tick-borne encephalitis and Japanese encephalitis vaccines. We included case series, cohort studies and randomized controlled trials (RCTs). For the meta-analysis, we included only RCTs that compared the administration of a vaccine to placebo or to no vaccine. Outcome measures included severe systemic adverse events, maternal outcomes related to the course of pregnancy, neonatal outcomes and local adverse events. We calculated the risk ratio and its 95% confidence interval as the summary measure. The safety of influenza vaccine is supported by high-quality evidence. For Tdap vaccine, no evidence of any harm was found in the meta-analysis of RCTs. A slight increase in chorioamnionitis rate was reported in 3 out of 12 observational studies. However, this small possible risk is far outweighed by a much larger benefit in terms of infant morbidity and mortality. Meningococcal vaccines are probably safe during pregnancy, as supported by RCTs comparing meningococcal vaccines to other vaccines. Data from observational studies support the safety of hepatitis A, hepatitis B and rabies vaccines, as well as that of the live attenuated yellow fever vaccine. We found little or no data about the safety of polio, typhoid, Japanese encephalitis, tick-borne encephalitis and MMR vaccines during pregnancy.
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Affiliation(s)
- Roni Nasser
- Department of Internal Medicine B, Rambam Health Care Campus, Haifa, Israel
| | - Stav Rakedzon
- Department of Internal Medicine B, Rambam Health Care Campus, Haifa, Israel
| | - Yaakov Dickstein
- Division of Infectious Diseases, Rambam Health Care Campus, Haifa, Israel
| | - Amjad Mousa
- Department of Internal Medicine B, Rambam Health Care Campus, Haifa, Israel
| | - Ido Solt
- The Rappaport's Faculty of Medicine, Technion Institute of Technology, Haifa, Israel.,Department of Gynaecology and Obstetrics, Rambam Healthcare Campus, Haifa, Israel
| | - Neta Peterisel
- Department of Internal Medicine B, Rambam Health Care Campus, Haifa, Israel.,Division of Infectious Diseases, Rambam Health Care Campus, Haifa, Israel
| | - Tzah Feldman
- Department of Immunology, Weizmann Institute of Science, Rehovot, Israel
| | - Ami Neuberger
- Department of Internal Medicine B, Rambam Health Care Campus, Haifa, Israel.,Division of Infectious Diseases, Rambam Health Care Campus, Haifa, Israel.,The Rappaport's Faculty of Medicine, Technion Institute of Technology, Haifa, Israel
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18
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Rothe C, Boecken G. Reiseimpfungen. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2020; 63:74-84. [DOI: 10.1007/s00103-019-03064-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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19
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Tian Z, Chen Y, Yan W. Clinical features of rabies patients with abnormal sexual behaviors as the presenting manifestations: a case report and literature review. BMC Infect Dis 2019; 19:679. [PMID: 31370800 PMCID: PMC6670183 DOI: 10.1186/s12879-019-4252-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Accepted: 07/03/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Abnormal sexual behaviors presenting as manifestations of rabies have occasionally been reported in the literature, although little attention has been paid to these cases to date. This study aimed to analyze the clinical features of rabies cases with abnormal sexual behaviors as the presenting manifestations. CASE PRESENTATION A case of 32-year-old man with frequent ejaculation as the initial symptom of rabies was first reported. Then, a literature review was conducted using databases including CNKI, SinoMed, VIP, Wanfang Data, ScienceDirect, ProQuest, OVID and PubMed. In addition to our case, 54 other rabies cases, with abnormal sexual behaviors as the presenting manifestations, have been reported since 1970. Among the 55 cases, 51 were male and three were female (unknown gender for one case), with ages ranging from 6 to 71 years. All cases were reported in developing countries, 46 in China. Dog bites were the major source of infection, and extremities were the main exposure sites. Overall, 46 (83.6%) cases had abnormal sexual behaviors as the initial symptoms. The major presenting manifestations were priapism and ejaculation in males and hypersexuality in females. All cases were clinically diagnosed based on medical history and clinical manifestations. Given no standardized post-exposure prophylaxis, all cases died with the survival time being between 1 and 15 days. CONCLUSIONS The rabies patients with abnormal sexual behaviors have unique clinical features. To avoid misdiagnosis, unexplained abnormal sexual behaviors should raise clinical suspicion of rabies.
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Affiliation(s)
- Zhaoxing Tian
- Department of Emergency Medicine, Peking University International Hospital, 1 Life Park Road, Zhongguancun Life Science Park, Changping District, Beijing, 102206 China
| | - Yingyu Chen
- Division of Education, Beijing Jishuitan Hospital, 31 Xinjiekou East Street, Xicheng District, Beijing, 100035 China
| | - Wei Yan
- Department of Respiratory Medicine, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191 People’s Republic of China
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20
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Al-Tayib OA. An Overview of the Most Significant Zoonotic Viral Pathogens Transmitted from Animal to Human in Saudi Arabia. Pathogens 2019; 8:E25. [PMID: 30813309 PMCID: PMC6471281 DOI: 10.3390/pathogens8010025] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 02/12/2019] [Accepted: 02/13/2019] [Indexed: 02/01/2023] Open
Abstract
Currently, there has been an increasing socioeconomic impact of zoonotic pathogens transmitted from animals to humans worldwide. Recently, in the Arabian Peninsula, including in Saudi Arabia, epidemiological data indicated an actual increase in the number of emerging and/or reemerging cases of several viral zoonotic diseases. Data presented in this review are very relevant because Saudi Arabia is considered the largest country in the Peninsula. We believe that zoonotic pathogens in Saudi Arabia remain an important public health problem; however, more than 10 million Muslim pilgrims from around 184 Islamic countries arrive yearly at Makkah for the Hajj season and/or for the Umrah. Therefore, for health reasons, several countries recommend vaccinations for various zoonotic diseases among preventive protocols that should be complied with before traveling to Saudi Arabia. However, there is a shortage of epidemiological data focusing on the emerging and reemerging of zoonotic pathogens transmitted from animal to humans in different densely populated cities and/or localities in Saudi Arabia. Therefore, further efforts might be needed to control the increasing impacts of zoonotic viral disease. Also, there is a need for a high collaboration to enhance the detection and determination of the prevalence, diagnosis, control, and prevention as well as intervention and reduction in outbreaks of these diseases in Saudi Arabia, particularly those from other countries. Persons in the health field including physicians and veterinarians, pet owners, pet store owners, exporters, border guards, and people involved in businesses related to animal products have adopted various preventive strategies. Some of these measures might pave the way to highly successful prevention and control results on the different transmission routes of these viral zoonotic diseases from or to Saudi Arabia. Moreover, the prevention of these viral pathogens depends on socioeconomic impacts, available data, improved diagnosis, and highly effective therapeutics or prophylaxis.
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Affiliation(s)
- Omar A Al-Tayib
- Abdullah Bagshan for Dental and Oral Rehabilitation (DOR), Dental College Research Center, King Saud University, Riyadh 12372, Saudi Arabia.
- Department of Pharmacology and Toxicology, Faculty of Veterinary Medicine, University of Khartoum, Khartoum 11111, Sudan.
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21
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Parize P, Dacheux L, Larrous F, Bourhy H. The shift in rabies epidemiology in France: time to adjust rabies post-exposure risk assessment. Euro Surveill 2018; 23:1700548. [PMID: 30280687 PMCID: PMC6169203 DOI: 10.2807/1560-7917.es.2018.23.39.1700548] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 02/11/2018] [Indexed: 12/25/2022] Open
Abstract
The epidemiology of rabies in France and western Europe has changed during the past 22 years. In France, rabies in non-flying terrestrial mammals was declared to be eliminated in 2001, and the risk of rabies is now limited to contact with bats, rabid animals illegally imported from rabies-enzootic countries and traveller exposure in enzootic areas. We analysed the epidemiology of rabies in France from 1995 to 2016, describing and analysing data on human rabies surveillance as well as data on post-exposure prophylaxis (PEP) collected from the network of French antirabies clinics. Over the study period, seven individuals were diagnosed with rabies in France, all of whom were infected outside mainland France. PEP data analysis revealed an expected overall decrease in PEP administration for individuals exposed in mainland France, but there was still overuse of anti-rabies drugs, given the very low epidemiological risk. On the other hand, a significant increase in PEP delivered to individuals exposed abroad was evidenced. These epidemiological trends indicate that clear guidelines should be provided to support physicians' efforts to adjust rabies risk assessment to the evolution of the epidemiological situation.
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Affiliation(s)
- Perrine Parize
- Institut Pasteur, Unit Lyssavirus Dynamics and Host Adaptation, National Reference Center for Rabies and WHO Collaborating Centre for Reference and Research on Rabies, Paris, France
| | - Laurent Dacheux
- Institut Pasteur, Unit Lyssavirus Dynamics and Host Adaptation, National Reference Center for Rabies and WHO Collaborating Centre for Reference and Research on Rabies, Paris, France
| | - Florence Larrous
- Institut Pasteur, Unit Lyssavirus Dynamics and Host Adaptation, National Reference Center for Rabies and WHO Collaborating Centre for Reference and Research on Rabies, Paris, France
| | - Hervé Bourhy
- Institut Pasteur, Unit Lyssavirus Dynamics and Host Adaptation, National Reference Center for Rabies and WHO Collaborating Centre for Reference and Research on Rabies, Paris, France
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22
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Gautret P, Pradines B, Memish ZA, Sokhna C, Parola P. Mobile populations across the Mediterranean Sea and beyond: travel medicine, mass gathering medicine and homeless health. New Microbes New Infect 2018; 26:S96-S99. [PMID: 30402250 PMCID: PMC6205569 DOI: 10.1016/j.nmni.2018.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 05/23/2018] [Accepted: 05/23/2018] [Indexed: 11/23/2022] Open
Abstract
The Méditerranée Infection institute is internationally recognized for its expertise in infectious diseases and tropical medicine, and is one of the most active research centres for infectious diseases in Europe. Surveillance and research addressing infectious diseases in globally mobile populations is one of the strong components of the research conducted at the institute. A significant amount of clinical, microbiologic and epidemiologic works have been conducted in international travellers, pilgrims participating in large international religious gatherings, economic migrants and homeless migrant people over the last decades by our group. Our strong anchoring in several countries around the Mediterranean Sea and beyond, as well as the pivotal role of Marseille in the EuroTravNet and GeoSentinel international networks that monitor travel-associated diseases, reinforce our leading position in the fields of travel and tropical medicine, mass gathering medicine and homeless health.
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Affiliation(s)
- P Gautret
- Aix-Marseille Université, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, France
| | - B Pradines
- Aix-Marseille Université, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, France.,Unité Parasitologie et Entomologie, Département des Maladies Infectieuses, Institut de Recherche Biomédicale des Armées, France.,Centre National de Référence du Paludisme, Institut Hospitalo-universitaire (IHU) Méditerranée Infection, Marseille, France
| | - Z A Memish
- Department of Medicine, College of Medicine, Alfaisal University & Infectious Diseases Division, Prince Mohamed Bin Abdulaziz Hospital, Ministry of Health, Riyadh, Saudi Arabia, Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - C Sokhna
- Aix-Marseille Université, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, France
| | - P Parola
- Aix-Marseille Université, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, France
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23
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Kong LY, Vincelette J, Laplante G, Duchesne JA, Libman M, Barkati S. Intradermal pre-exposure rabies vaccination in a Canadian travel clinic: 6-year retrospective observational study. CMAJ Open 2018; 6:E168-E175. [PMID: 29636332 PMCID: PMC7869659 DOI: 10.9778/cmajo.20170147] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The intradermal route of vaccine administration for pre-exposure rabies prophylaxis, endorsed by the Canadian National Advisory Committee on Immunization, was implemented at a large travel clinic in Montréal in 2008. We evaluated the effect of intradermal vaccination availability on uptake of pre-exposure rabies prophylaxis and rates of seroconversion with intradermal vaccination. METHODS We conducted a retrospective cross-sectional study using data from December 2008 to December 2014. The number of travellers who received pre-exposure rabies prophylaxis before and after the introduction of intradermal vaccination was compared. Postvaccination antibody titres were measured in intradermal vaccination recipients. We compared demographic and travel characteristics between vaccinated and unvaccinated travellers and between travellers in the intradermal and intramuscular groups using univariate and multivariate analyses. RESULTS The proportion of travellers who received pre-exposure prophylaxis increased after the introduction of intradermal vaccination (annual average of 300 travellers from December 2009 to December 2014 v. 183 travellers from December 2006 to December 2007). Seroconversion occurred in 99.9% of those in the intradermal group. Travellers who received pre-exposure prophylaxis were older (mean age 35.8 yr v. 32.1 yr) and had longer travel duration than those who did not receive pre-exposure prophylaxis. Travellers to Asia were more likely to receive pre-exposure prophylaxis, and travellers visiting friends and relatives were less likely to receive it. Travellers in the intradermal group were younger than those in the intramuscular group and were more likely to be travelling for tourism. INTERPRETATION The introduction of intradermal vaccination for pre-exposure rabies prophylaxis was associated with an increase in vaccination uptake. Reduced cost may be responsible for the increased coverage among younger travellers and those travelling for tourism. The high seroconversion rate after intradermal vaccination supports the effectiveness of this route of administration for pre-exposure rabies prophylaxis in immunocompetent people.
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Affiliation(s)
- Ling Yuan Kong
- Affiliations: J.D. MacLean Centre for Tropical Diseases (Kong, Libman, Barkati), McGill University Health Centre; Clinique Santé-voyage de la Fondation du Centre hospitalier de l'Université de Montréal (Vincelette, Laplante, Duchesne, Barkati); Centre hospitalier de l'Université de Montréal (Vincelette, Barkati), Montréal, Que
| | - Jean Vincelette
- Affiliations: J.D. MacLean Centre for Tropical Diseases (Kong, Libman, Barkati), McGill University Health Centre; Clinique Santé-voyage de la Fondation du Centre hospitalier de l'Université de Montréal (Vincelette, Laplante, Duchesne, Barkati); Centre hospitalier de l'Université de Montréal (Vincelette, Barkati), Montréal, Que
| | - Gaétan Laplante
- Affiliations: J.D. MacLean Centre for Tropical Diseases (Kong, Libman, Barkati), McGill University Health Centre; Clinique Santé-voyage de la Fondation du Centre hospitalier de l'Université de Montréal (Vincelette, Laplante, Duchesne, Barkati); Centre hospitalier de l'Université de Montréal (Vincelette, Barkati), Montréal, Que
| | - Jo-Anne Duchesne
- Affiliations: J.D. MacLean Centre for Tropical Diseases (Kong, Libman, Barkati), McGill University Health Centre; Clinique Santé-voyage de la Fondation du Centre hospitalier de l'Université de Montréal (Vincelette, Laplante, Duchesne, Barkati); Centre hospitalier de l'Université de Montréal (Vincelette, Barkati), Montréal, Que
| | - Michael Libman
- Affiliations: J.D. MacLean Centre for Tropical Diseases (Kong, Libman, Barkati), McGill University Health Centre; Clinique Santé-voyage de la Fondation du Centre hospitalier de l'Université de Montréal (Vincelette, Laplante, Duchesne, Barkati); Centre hospitalier de l'Université de Montréal (Vincelette, Barkati), Montréal, Que
| | - Sapha Barkati
- Affiliations: J.D. MacLean Centre for Tropical Diseases (Kong, Libman, Barkati), McGill University Health Centre; Clinique Santé-voyage de la Fondation du Centre hospitalier de l'Université de Montréal (Vincelette, Laplante, Duchesne, Barkati); Centre hospitalier de l'Université de Montréal (Vincelette, Barkati), Montréal, Que
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Ribadeau-Dumas F, Cliquet F, Gautret P, Robardet E, Le Pen C, Bourhy H. Travel-Associated Rabies in Pets and Residual Rabies Risk, Western Europe. Emerg Infect Dis 2018; 22:1268-71. [PMID: 27314463 PMCID: PMC4918150 DOI: 10.3201/eid2207.151733] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
In 2015, countries in western Europe were declared free of rabies in nonflying mammals. Surveillance data for 2001–2013 indicate that risk for residual rabies is not 0 because of pet importation from countries with enzootic rabies. However, the risk is so low (7.52 × 10−10) that it probably can be considered negligible.
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25
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Shlim DR. Preventing rabies: the new WHO recommendations and their impact on travel medicine practice. J Travel Med 2018; 25:5185179. [PMID: 30445647 DOI: 10.1093/jtm/tay119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Accepted: 11/15/2018] [Indexed: 11/14/2022]
Affiliation(s)
- David R Shlim
- Jackson Hole Travel and Tropical Medicine, Jackson Hole, WY, USA
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26
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Chen LH, Leder K, Barbre KA, Schlagenhauf P, Libman M, Keystone J, Mendelson M, Gautret P, Schwartz E, Shaw M, MacDonald S, McCarthy A, Connor BA, Esposito DH, Hamer D, Wilson ME. Business travel-associated illness: a GeoSentinel analysis. J Travel Med 2018; 25:4841826. [PMID: 29462444 PMCID: PMC5824651 DOI: 10.1093/jtm/tax097] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 01/02/2018] [Indexed: 01/23/2023]
Abstract
Background Analysis of a large cohort of business travelers will help clinicians focus on frequent and serious illnesses. We aimed to describe travel-related health problems in business travelers. Methods GeoSentinel Surveillance Network consists of 64 travel and tropical medicine clinics in 29 countries; descriptive analysis was performed on ill business travelers, defined as persons traveling for work, evaluated after international travel 1 January 1997 through 31 December 2014. Results Among 12 203 business travelers seen 1997-2014 (14 045 eligible diagnoses), the majority (97%) were adults aged 20-64 years; most (74%) reported from Western Europe or North America; two-thirds were male. Most (86%) were outpatients. Fewer than half (45%) reported a pre-travel healthcare encounter. Frequent regions of exposure were sub-Saharan Africa (37%), Southeast Asia (15%) and South Central Asia (14%). The most frequent diagnoses were malaria (9%), acute unspecified diarrhea (8%), viral syndrome (6%), acute bacterial diarrhea (5%) and chronic diarrhea (4%). Species was reported for 973 (90%) of 1079 patients with malaria, predominantly Plasmodium falciparum acquired in sub-Saharan Africa. Of 584 (54%) with malaria chemoprophylaxis information, 92% took none or incomplete courses. Thirteen deaths were reported, over half of which were due to malaria; others succumbed to pneumonia, typhoid fever, rabies, melioidosis and pyogenic abscess. Conclusions Diarrheal illness was a major cause of morbidity. Malaria contributed substantial morbidity and mortality, particularly among business travelers to sub-Saharan Africa. Underuse or non-use of chemoprophylaxis contributed to malaria cases. Deaths in business travelers could be reduced by improving adherence to malaria chemoprophylaxis and targeted vaccination for vaccine-preventable diseases. Pre-travel advice is indicated for business travelers and is currently under-utilized and needs improvement.
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Affiliation(s)
- Lin H. Chen
- Mount Auburn Hospital, Cambridge, Massachusetts, and Harvard Medical School, Boston, MA, USA
| | - Karin Leder
- Royal Melbourne Hospital and School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Kira A. Barbre
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Patricia Schlagenhauf
- University of Zürich Centre for Travel Medicine, WHO Collaborating Centre for Travellers’ Health, Epidemiology, Biostatistics and Prevention Institute, Zürich, Switzerland
| | - Michael Libman
- Montreal General Hospital and McGill University, Montreal, Quebec, Canada
| | - Jay Keystone
- Toronto General Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Marc Mendelson
- Division of Infectious Diseases & HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Philippe Gautret
- Aix Marseille Université, IHU—Méditerranée Infection, Marseille, France
| | - Eli Schwartz
- The Chaim Sheba Medical Center, Tel Hashomer, and Sackler Faculty of Medicine Tel-Aviv University, Israel
| | - Marc Shaw
- Worldwise Travellers Health Centres New Zealand and James Cook University, Australia
| | - Sue MacDonald
- Medicine and Quality, Interior Health, and University of British Columbia, Kelowna, British Columbia, Canada
| | - Anne McCarthy
- Ottawa Hospital and University of Ottawa, Ottawa, Ontario, Canada
| | - Bradley A. Connor
- The New York Center for Travel and Tropical Medicine and Weill Medical College of Cornell University, New York, NY, USA
| | - Douglas H. Esposito
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Davidson Hamer
- Center for Global Health and Development, Boston University School of Public Health, and Boston University School of Medicine, Boston, MA, USA
| | - Mary E. Wilson
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, CA, USA
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Singh R, Singh KP, Cherian S, Saminathan M, Kapoor S, Manjunatha Reddy GB, Panda S, Dhama K. Rabies - epidemiology, pathogenesis, public health concerns and advances in diagnosis and control: a comprehensive review. Vet Q 2017. [PMID: 28643547 DOI: 10.1080/01652176.2017.1343516] [Citation(s) in RCA: 106] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Rabies is a zoonotic, fatal and progressive neurological infection caused by rabies virus of the genus Lyssavirus and family Rhabdoviridae. It affects all warm-blooded animals and the disease is prevalent throughout the world and endemic in many countries except in Islands like Australia and Antarctica. Over 60,000 peoples die every year due to rabies, while approximately 15 million people receive rabies post-exposure prophylaxis (PEP) annually. Bite of rabid animals and saliva of infected host are mainly responsible for transmission and wildlife like raccoons, skunks, bats and foxes are main reservoirs for rabies. The incubation period is highly variable from 2 weeks to 6 years (avg. 2-3 months). Though severe neurologic signs and fatal outcome, neuropathological lesions are relatively mild. Rabies virus exploits various mechanisms to evade the host immune responses. Being a major zoonosis, precise and rapid diagnosis is important for early treatment and effective prevention and control measures. Traditional rapid Seller's staining and histopathological methods are still in use for diagnosis of rabies. Direct immunofluoroscent test (dFAT) is gold standard test and most commonly recommended for diagnosis of rabies in fresh brain tissues of dogs by both OIE and WHO. Mouse inoculation test (MIT) and polymerase chain reaction (PCR) are superior and used for routine diagnosis. Vaccination with live attenuated or inactivated viruses, DNA and recombinant vaccines can be done in endemic areas. This review describes in detail about epidemiology, transmission, pathogenesis, advances in diagnosis, vaccination and therapeutic approaches along with appropriate prevention and control strategies.
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Affiliation(s)
- Rajendra Singh
- a Division of Pathology , ICAR-Indian Veterinary Research Institute , Bareilly , Uttar Pradesh , India
| | - Karam Pal Singh
- b Centre for Animal Disease Research and Diagnosis (CADRAD) , ICAR-Indian Veterinary Research Institute , Bareilly , Uttar Pradesh , India
| | - Susan Cherian
- a Division of Pathology , ICAR-Indian Veterinary Research Institute , Bareilly , Uttar Pradesh , India
| | - Mani Saminathan
- a Division of Pathology , ICAR-Indian Veterinary Research Institute , Bareilly , Uttar Pradesh , India
| | - Sanjay Kapoor
- c Department of Veterinary Microbiology , LLR University of Veterinary and Animal Sciences , Hisar , Haryana , India
| | - G B Manjunatha Reddy
- d ICAR-National Institute of Veterinary Epidemiology and Disease Informatics , Bengaluru , Karnataka , India
| | - Shibani Panda
- a Division of Pathology , ICAR-Indian Veterinary Research Institute , Bareilly , Uttar Pradesh , India
| | - Kuldeep Dhama
- a Division of Pathology , ICAR-Indian Veterinary Research Institute , Bareilly , Uttar Pradesh , India
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Reiseimpfungen für Kinder. Monatsschr Kinderheilkd 2017. [DOI: 10.1007/s00112-017-0411-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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29
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Torresi J, Steffen R. Redefining priorities towards graded travel-related infectious disease research. J Travel Med 2017; 24:4359791. [PMID: 29088486 DOI: 10.1093/jtm/tax064] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Indexed: 01/01/2023]
Abstract
Our knowledge of the health problems and infections encountered by international travellers has evolved considerably in the past decades. The growth of global networks such as the GeoSentinel Surveillance network, TropNet Europe, EuroTravNet and networks based in North America have provided valuable information on the frequency of a wide array of travel-related diseases and accidents, including details on the destination of travel and trends over time. The information gained from these network studies has provided important data for the practice of travel medicine and in some instances for the development of practice guidelines. However, network data due to a lack of denominators usually cannot serve as a basis for a GRADE approach to guideline development. Although epidemiological network studies will continue to serve an important role in travel medicine we encourage an additional strong focus towards translational scientific research questions and towards the broader use of novel techniques to obtain more accurate epidemiological analyses to address the many unanswered questions in our field.
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Affiliation(s)
- Joseph Torresi
- Department of Microbiology and Immunology, The Peter Doherty Institute for Infection and Immunity, University of Melbourne, Parkville, Victoria 3010, Australia
| | - Robert Steffen
- Epidemiology, Biostatistics and Prevention Institute, Division of Communicable Diseases, WHO Collaborating Centre for Travellers' Health, University of Zurich, Zurich, Switzerland.,Division of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas School of Public Health, Houston, TX, USA
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30
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Murphy H, Abuova G, Pandey P. South Central Asia. Infect Dis (Lond) 2017. [DOI: 10.1002/9781119085751.ch14] [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: 11/11/2022] Open
Affiliation(s)
- Holy Murphy
- CIWEC Hospital and CIWEC Clinic Travel Medicine Center; Kathmandu Nepal
| | - Gulzhan Abuova
- Department of Infectious Diseases; South-Kazakhstan State Pharmaceutical Academy; Shymkent Kazakhstan
| | - Prativa Pandey
- CIWEC Hospital and CIWEC Clinic Travel Medicine Center; Kathmandu Nepal
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31
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Antwi S, Parola P, Sow D, Sornin V, Henrion M, Gautret P. Familial cluster of exposure to a confirmed rabid dog in travelers to Algeria. Travel Med Infect Dis 2017; 16:46-48. [PMID: 28089844 DOI: 10.1016/j.tmaid.2017.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 11/29/2016] [Accepted: 01/05/2017] [Indexed: 11/26/2022]
Abstract
A 10 person-family originating from Algeria traveled in rural Algeria for the purpose of visiting friends and relatives without seeking pre-travel advice, did not received pre-travel rabies immunization, and were exposed to a confirmed rabid dog including 8 within less than 4 days of arrival. Three received suckling mouse brain rabies vaccine although WHO strongly recommends that its production and administration be discontinued and seven received insufficient doses of equine rabies immune globulin abroad. Rabies treatment was completed on returning to France. This reports underline the fact that travelers visiting friends and relatives in dog rabies endemic country are at high risk of rabies exposure and unaware of such a risk in most instances. Rabies risk warning should be reinforced and rabies pre-exposure vaccination should be considered in all individuals traveling to North Africa (and to sub-Saharan Africa) whatever the duration of stay.
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Affiliation(s)
- Sylvie Antwi
- Institut Hospitalo-Universitaire Méditerranée Infection, 13005, Marseille, France
| | - Philippe Parola
- Institut Hospitalo-Universitaire Méditerranée Infection, 13005, Marseille, France; Aix Marseille Université, URMITE, UM63, CNRS 7278, IRD 198, INSERM 1095, Marseille, France
| | - Doudou Sow
- Service de Parasitologie-Mycologie, Faculté de médecine, UCAD, Dakar-Fann, Senegal
| | - Victoria Sornin
- Institut Hospitalo-Universitaire Méditerranée Infection, 13005, Marseille, France
| | - Maxime Henrion
- Aix Marseille Université, URMITE, UM63, CNRS 7278, IRD 198, INSERM 1095, Marseille, France
| | - Philippe Gautret
- Institut Hospitalo-Universitaire Méditerranée Infection, 13005, Marseille, France; Aix Marseille Université, URMITE, UM63, CNRS 7278, IRD 198, INSERM 1095, Marseille, France.
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Hsu CH, Brown CM, Murphy JM, Haskell MG, Williams C, Feldman K, Mitchell K, Blanton JD, Petersen BW, Wallace RM. Perceptions and Practices of Mass Bat Exposure Events in the Setting of Rabies Among U.S. Public Health Agencies. Zoonoses Public Health 2016; 64:127-136. [PMID: 27389926 PMCID: PMC5525325 DOI: 10.1111/zph.12289] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Indexed: 12/25/2022]
Abstract
Current guidelines in the setting of exposures to potentially rabid bats established by the Advisory Committee on Immunization Practices (ACIP) address post-exposure prophylaxis (PEP) administration in situations where a person may not be aware that a bite or direct contact has occurred and the bat is not available for diagnostic testing. These include instances when a bat is discovered in a room where a person awakens from sleep, is a child without an adult witness, has a mental disability or is intoxicated. The current ACIP guidelines, however, do not address PEP in the setting of multiple persons exposed to a bat or a bat colony, otherwise known as mass bat exposure (MBE) events. Due to a dearth of recommendations for response to these events, the reported reactions by public health agencies have varied widely. To address this perceived limitation, a survey of 45 state public health agencies was conducted to characterize prior experiences with MBE and practices to mitigate the public health risks. In general, most states (69% of the respondents) felt current ACIP guidelines were unclear in MBE scenarios. Thirty-three of the 45 states reported prior experience with MBE, receiving an average of 16.9 MBE calls per year and an investment of 106.7 person-hours annually on MBE investigations. PEP criteria, investigation methods and the experts recruited in MBE investigations varied between states. These dissimilarities could reflect differences in experience, scenario and resources. The lack of consistency in state responses to potential mass exposures to a highly fatal disease along with the large contingent of states dissatisfied with current ACIP guidance warrants the development of national guidelines in MBE settings.
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Affiliation(s)
- C H Hsu
- Centers for Disease Control and Prevention, Poxvirus and Rabies Branch, Atlanta, GA, USA.,Epidemic Intelligence Service, Atlanta, GA, USA
| | - C M Brown
- Massachusetts Department of Public Health State Laboratory Institute, Jamaica Plain, MA, USA
| | - J M Murphy
- Virginia Department of Health, Office of Epidemiology, Richmond, VA, USA
| | - M G Haskell
- Division of Public Health, Communicable Disease Branch, North Carolina Department of Health and Human Services, Raleigh, NC, USA
| | - C Williams
- Division of Public Health, Communicable Disease Branch, North Carolina Department of Health and Human Services, Raleigh, NC, USA
| | - K Feldman
- Center for Zoonotic and Vector-borne Diseases, Maryland Department of Health and Mental Hygiene, Baltimore, MD, USA
| | - K Mitchell
- Center for Zoonotic and Vector-borne Diseases, Maryland Department of Health and Mental Hygiene, Baltimore, MD, USA
| | - J D Blanton
- Centers for Disease Control and Prevention, Poxvirus and Rabies Branch, Atlanta, GA, USA
| | - B W Petersen
- Centers for Disease Control and Prevention, Poxvirus and Rabies Branch, Atlanta, GA, USA
| | - R M Wallace
- Centers for Disease Control and Prevention, Poxvirus and Rabies Branch, Atlanta, GA, USA
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Gautret P, Harvey K, Pandey P, Lim PL, Leder K, Piyaphanee W, Shaw M, McDonald SC, Schwartz E, Esposito DH, Parola P. Animal-associated exposure to rabies virus among travelers, 1997-2012. Emerg Infect Dis 2015; 21:569-77. [PMID: 25811076 PMCID: PMC4378464 DOI: 10.3201/eid2104.141479] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
No demographic characteristics identified who might benefit most from pretravel counseling. Among travelers, rabies cases are rare, but animal bites are relatively common. To determine which travelers are at highest risk for rabies, we studied 2,697 travelers receiving care for animal-related exposures and requiring rabies postexposure prophylaxis at GeoSentinel clinics during 1997–2012. No specific demographic characteristics differentiated these travelers from other travelers seeking medical care, making it challenging to identify travelers who might benefit from reinforced pretravel rabies prevention counseling. Median travel duration was short for these travelers: 15 days for those seeking care after completion of travel and 20 days for those seeking care during travel. This finding contradicts the view that preexposure rabies vaccine recommendations should be partly based on longer travel durations. Over half of exposures occurred in Thailand, Indonesia, Nepal, China, and India. International travelers to rabies-endemic regions, particularly Asia, should be informed about potential rabies exposure and benefits of pretravel vaccination, regardless of demographics or length of stay.
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Sainato RJ, Ottolini MG, Hickey PW, Rajnik M. Preparing Families With Children for International Travel. Curr Probl Pediatr Adolesc Health Care 2015; 45:215-30. [PMID: 26253890 DOI: 10.1016/j.cppeds.2015.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Rebecca J Sainato
- Department of Pediatrics, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814
| | - Martin G Ottolini
- Office of Curriculum, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814.
| | - Patrick W Hickey
- Department of Pediatrics, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814
| | - Michael Rajnik
- Department of Pediatrics, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814
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Memish ZA, Assiri AM, Gautret P. Rabies in Saudi Arabia: a need for epidemiological data. Int J Infect Dis 2015; 34:99-101. [PMID: 25820096 DOI: 10.1016/j.ijid.2015.03.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 03/19/2015] [Accepted: 03/20/2015] [Indexed: 11/25/2022] Open
Abstract
Rabies is endemic in animals in the Arabian Peninsula. Although Saudi Arabia is the largest country in the Peninsula, little has been published about the rabies situation in the country. A total of 11,069 animal bites to humans were reported during 2007-2009, and 40 animals suspected of rabies were examined for rabies infection from 2005 through 2010. Results suggest that animal-related injuries in Saudi Arabia remain a public health problem, with feral dogs accounting for the majority of bites to humans and for the majority of animals found to be rabid. Over the last 10 years, no confirmed human rabies case has been reported. More detailed information about the epidemiology of animal bites and that of animal rabies in Saudi Arabia would be of great interest, notably to provide a basis on which vaccination recommendations could be made for the numerous international travellers visiting the country.
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Affiliation(s)
- Ziad A Memish
- Saudi Ministry of Health, Riyadh, Kingdom of Saudi Arabia; College of Medicine, Alfaisal University, PO Box 54146, Riyadh 11514, Kingdom of Saudi Arabia.
| | | | - Philippe Gautret
- Aix Marseille Université, URMITE, UM63, CNRS 7278, IRD 198, Inserm 1095, Marseille, France; Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France
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36
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Schlagenhauf P, Weld L, Goorhuis A, Gautret P, Weber R, von Sonnenburg F, Lopez-Vélez R, Jensenius M, Cramer JP, Field VK, Odolini S, Gkrania-Klotsas E, Chappuis F, Malvy D, van Genderen PJJ, Mockenhaupt F, Jauréguiberry S, Smith C, Beeching NJ, Ursing J, Rapp C, Parola P, Grobusch MP. Travel-associated infection presenting in Europe (2008-12): an analysis of EuroTravNet longitudinal, surveillance data, and evaluation of the effect of the pre-travel consultation. THE LANCET. INFECTIOUS DISEASES 2014; 15:55-64. [PMID: 25477022 DOI: 10.1016/s1473-3099(14)71000-x] [Citation(s) in RCA: 172] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Travel is important in the acquisition and dissemination of infection. We aimed to assess European surveillance data for travel-related illness to profile imported infections, track trends, identify risk groups, and assess the usefulness of pre-travel advice. METHODS We analysed travel-associated morbidity in ill travellers presenting at EuroTravNet sites during the 5-year period of 2008-12. We calculated proportionate morbidity per 1000 ill travellers and made comparisons over time and between subgroups. We did 5-year trend analyses (2008-12) by testing differences in proportions between subgroups using Pearson's χ(2) test. We assessed the effect of the pre-travel consultation on infection acquisition and outcome by use of proportionate morbidity ratios. FINDINGS The top diagnoses in 32 136 patients, ranked by proportionate morbidity, were malaria and acute diarrhoea, both with high proportionate morbidity (>60). Dengue, giardiasis, and insect bites had high proportionate morbidity (>30) as well. 5-year analyses showed increases in vector borne infections with significant peaks in 2010; examples were increased Plasmodium falciparum malaria (χ(2)=37·57, p<0·001); increased dengue fever (χ(2)=135·9, p<0·001); and a widening geographic range of acquisition of chikungunya fever. The proportionate morbidity of dengue increased from 22 in 2008 to 36 in 2012. Five dengue cases acquired in Europe contributed to this increase. Dermatological diagnoses increased from 851 in 2008 to 1102 in 2012, especially insect bites and animal-related injuries. Respiratory infection trends were dominated by the influenza H1N1 pandemic in 2009. Illness acquired in Europe accounted for 1794 (6%) of all 32 136 cases-mainly, gastrointestinal (634) and respiratory (357) infections. Migration within Europe was associated with more serious infection such as hepatitis C, tuberculosis, hepatitis B, and HIV/AIDS. Pre-travel consultation was associated with significantly lower proportionate morbidity ratios for P falciparum malaria and also for acute hepatitis and HIV/AIDS. INTERPRETATION The pattern of travel-related infections presenting in Europe is complex. Trend analyses can inform on emerging infection threats. Pre-travel consultation is associated with reduced malaria proportionate morbidity ratios and less severe illness. These findings support the importance and effectiveness of pre-travel advice on malaria prevention, but cast doubt on the effectiveness of current strategies to prevent travel-related diarrhoea. FUNDING European Centre for Disease Prevention and Control, University Hospital Institute Méditerranée Infection, US Centers for Disease Control and Prevention, and the International Society of Travel Medicine.
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Affiliation(s)
- Patricia Schlagenhauf
- University of Zürich Centre for Travel Medicine, WHO Collaborating Centre for Travellers' Health, Epidemiology, Biostatistics, and Prevention Institute, Zürich, Switzerland.
| | | | - Abraham Goorhuis
- Centre for Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Philippe Gautret
- University Hospital Institute for Infectious and Tropical Diseases, Aix-Marseille University, Marseille, France
| | - Rainer Weber
- University Hospital, Department of Infectious Diseases, University of Zürich, Switzerland
| | - Frank von Sonnenburg
- Department of Infectious Diseases and Tropical Medicine, Ludwig-Maximilian's University of Munich, Munich, Germany
| | - Rogelio Lopez-Vélez
- Tropical Medicine and Clinical Parasitology, Infectious Diseases Department, Ramón y Cajal Hospital, Madrid, Spain
| | - Mogens Jensenius
- Department of Infectious Diseases, Oslo University Hospital, Oslo, Norway
| | - Jakob P Cramer
- University Medical Center Hamburg-Eppendorf, Department of Tropical Medicine and Infectious Diseases, Bernhard Nocht Clinic, Hamburg, Germany
| | - Vanessa K Field
- InterHealth Worldwide and National Travel Health Network and Centre (NaTHNaC), London, UK
| | - Silvia Odolini
- University Division of Infectious and Tropical Diseases, University of Brescia and Brescia Spedali Civili General Hospital, Brescia, Italy
| | | | - Francois Chappuis
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Denis Malvy
- Department of Internal Medicine and Tropical Disease, University Hospital Centre, Bordeaux, France
| | | | - Frank Mockenhaupt
- Institute of Tropical Medicine and International Health, Charité-Universitätsmedizin Berlin, Germany
| | - Stéphane Jauréguiberry
- Service des Maladies Infectieuses et Tropicales (Department of Infectious and Tropical Diseases), Hôpital Pitié-Salpétrière, Paris, France
| | - Catherine Smith
- Travel Medicine and International Health Team, Health Protection Scotland, NHS National Services Scotland, Glasgow, UK
| | - Nicholas J Beeching
- Liverpool School of Tropical Medicine and National Institute for Health Research Unit in Emerging and Zoonotic Infections, Liverpool, UK
| | - Johan Ursing
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | | | - Philippe Parola
- University Hospital Institute for Infectious and Tropical Diseases, Aix-Marseille University, Marseille, France
| | - Martin P Grobusch
- Centre for Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
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Rabies – An important zoonotic threat for travelers. Travel Med Infect Dis 2014; 12:557-8. [DOI: 10.1016/j.tmaid.2014.10.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2014] [Accepted: 10/13/2014] [Indexed: 12/25/2022]
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Suin V, Nazé F, Francart A, Lamoral S, De Craeye S, Kalai M, Van Gucht S. A two-step lyssavirus real-time polymerase chain reaction using degenerate primers with superior sensitivity to the fluorescent antigen test. BIOMED RESEARCH INTERNATIONAL 2014; 2014:256175. [PMID: 24822188 PMCID: PMC4009295 DOI: 10.1155/2014/256175] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Revised: 03/15/2014] [Accepted: 03/15/2014] [Indexed: 12/25/2022]
Abstract
A generic two-step lyssavirus real-time reverse transcriptase polymerase chain reaction (qRT-PCR), based on a nested PCR strategy, was validated for the detection of different lyssavirus species. Primers with 17 to 30% of degenerate bases were used in both consecutive steps. The assay could accurately detect RABV, LBV, MOKV, DUVV, EBLV-1, EBLV-2, and ABLV. In silico sequence alignment showed a functional match with the remaining lyssavirus species. The diagnostic specificity was 100% and the sensitivity proved to be superior to that of the fluorescent antigen test. The limit of detection was ≤ 1 50% tissue culture infectious dose. The related vesicular stomatitis virus was not recognized, confirming the selectivity for lyssaviruses. The assay was applied to follow the evolution of rabies virus infection in the brain of mice from 0 to 10 days after intranasal inoculation. The obtained RNA curve corresponded well with the curves obtained by a one-step monospecific RABV-qRT-PCR, the fluorescent antigen test, and virus titration. Despite the presence of degenerate bases, the assay proved to be highly sensitive, specific, and reproducible.
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Affiliation(s)
- Vanessa Suin
- National Reference Centre of Rabies, Viral Diseases, Communicable and Infectious Diseases, Scientific Institute of Public Health (WIV-ISP), Engeland Street 642, 1180 Brussels, Belgium
| | - Florence Nazé
- National Reference Centre of Rabies, Viral Diseases, Communicable and Infectious Diseases, Scientific Institute of Public Health (WIV-ISP), Engeland Street 642, 1180 Brussels, Belgium
| | - Aurélie Francart
- National Reference Centre of Rabies, Viral Diseases, Communicable and Infectious Diseases, Scientific Institute of Public Health (WIV-ISP), Engeland Street 642, 1180 Brussels, Belgium
| | - Sophie Lamoral
- National Reference Centre of Rabies, Viral Diseases, Communicable and Infectious Diseases, Scientific Institute of Public Health (WIV-ISP), Engeland Street 642, 1180 Brussels, Belgium
| | - Stéphane De Craeye
- Toxoplasma Laboratory, Food-borne Pathogens, Communicable and Infectious Diseases, Scientific Institute of Public Health (WIV-ISP), Engeland Street 642, 1180 Brussels, Belgium
| | - Michael Kalai
- National Reference Centre of Rabies, Viral Diseases, Communicable and Infectious Diseases, Scientific Institute of Public Health (WIV-ISP), Engeland Street 642, 1180 Brussels, Belgium
| | - Steven Van Gucht
- National Reference Centre of Rabies, Viral Diseases, Communicable and Infectious Diseases, Scientific Institute of Public Health (WIV-ISP), Engeland Street 642, 1180 Brussels, Belgium
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Gautret P, Carrara P, Parola P. Long incubation in imported human rabies. Ann Neurol 2014; 75:324-5. [DOI: 10.1002/ana.24092] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2013] [Revised: 12/01/2013] [Accepted: 12/14/2013] [Indexed: 11/07/2022]
Affiliation(s)
- Philippe Gautret
- Mediterranean Hospital-University Infection Institute, North University Hospital Center, Public Assistance Hospitals of Marseille
- Emerging Infectious and Tropical Diseases Research Unit, Faculty of Medicine; Aix-Marseille University; Marseille France
| | - Philippe Carrara
- Mediterranean Hospital-University Infection Institute, North University Hospital Center, Public Assistance Hospitals of Marseille
| | - Phillipe Parola
- Mediterranean Hospital-University Infection Institute, North University Hospital Center, Public Assistance Hospitals of Marseille
- Emerging Infectious and Tropical Diseases Research Unit, Faculty of Medicine; Aix-Marseille University; Marseille France
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Dolan SB, Jentes ES, Sotir MJ, Han P, Blanton JD, Rao SR, LaRocque RC, Ryan ET. Pre-exposure rabies vaccination among US international travelers: findings from the global TravEpiNet consortium. Vector Borne Zoonotic Dis 2014; 14:160-7. [PMID: 24359420 PMCID: PMC3928762 DOI: 10.1089/vbz.2013.1381] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND People who travel to areas with high rabies endemicity and have animal contact are at increased risk for rabies exposure. We examined characteristics of international travelers queried regarding rabies vaccination during pretravel consultations at Global TravEpiNet (GTEN) practices during 2009-2010. MATERIAL AND METHODS We performed bivariate and multivariable analyses of data collected from 18 GTEN clinics. Travel destinations were classified by strength level of rabies vaccination recommendation. RESULTS Of 13,235 travelers, 226 (2%) reported previous rabies vaccination, and 406 (3%) received rabies vaccine at the consultation. Common travel purposes for these 406 travelers were leisure (26%), research/education (17%), and nonmedical service work (14%). Excluding the 226 who were previously vaccinated, 8070 (62%) of 13,009 travelers intended to visit one or more countries with a strong recommendation for rabies vaccination; 1675 (21%) of these 8070 intended to travel for 1 month or more. Among these 1675 travelers, 145 (9%) were vaccinated, 498 (30%) declined vaccination, 832 (50%) had itineraries that clinicians determined did not indicate vaccination, and 200 (12%) remained unvaccinated for other reasons. In both bivariate and multivariate analyses, travelers with trip durations >6 months versus 1-3 months (adjusted odds ratio [OR]=4.9 [95% confidence interval [CI] 2.1, 11.4]) and those traveling for "research/education" or to "provide medical care" (adjusted OR=5.1 [95% CI 1.9, 13.7] and 9.5 [95% CI 2.2, 40.8], respectively), compared with leisure travelers, were more likely to receive rabies vaccination. CONCLUSIONS Few travelers at GTEN clinics received rabies vaccine, although many planned trips 1 month long or more to a strong-recommendation country. Clinicians often determined that vaccine was not indicated, and travelers often declined vaccine when it was offered. The decision to vaccinate should take into account the strength of the vaccine recommendation at the destination country, duration of stay, availability of postexposure prophylaxis, potential for exposure to animals, and likelihood of recurrent travel to high-risk destinations.
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Affiliation(s)
- Samantha B. Dolan
- Travelers' Health Branch, Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Emily S. Jentes
- Travelers' Health Branch, Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Mark J. Sotir
- Travelers' Health Branch, Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Pauline Han
- Travelers' Health Branch, Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jesse D. Blanton
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sowmya R. Rao
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
- Center for Health Quality, Outcomes and Economic Research, Bedford VA Medical Center, Bedford, Massachusetts
| | - Regina C. LaRocque
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Edward T. Ryan
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
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Mills D. Intradermal pre-exposure rabies vaccination. Promises and pitfalls. Travel Med Infect Dis 2013; 11:335-6. [DOI: 10.1016/j.tmaid.2013.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Accepted: 10/18/2013] [Indexed: 12/25/2022]
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Abstract
Rabies is one of the most important zoonotic infections worldwide. The burden of the disease continues to be significant in countries in the Middle East where the most important vector is stray dogs. Control efforts are hindered by lack of awareness and incomplete post-exposure prophylaxis. The aim of this article is to re-assess the situation of rabies in Lebanon and compare it to other Middle Eastern countries. Eight cases of rabies and 5280 incidents of animal bites to humans were reported to the Lebanese Ministry of Public Health between 2001 and 2012. Dogs were the only vector of infection and were responsible for most reported animal bites to humans. An average of 3·2 doses of vaccine per bite was administered as post-exposure prophylaxis. The status of human and canine rabies control, the risks associated with children's behaviour and the hazards of secondary wild reservoirs are discussed. Our data illustrates the importance of prevention through vector control, public awareness and education, and timely administration of active and passive immunization, as well as the significance of regional cooperation and monitoring the circulation of viral variants in wild animals.
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