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Roberti J, Ini N, Belizan M, Alonso JP. Barriers and facilitators to vaccination in Latin America: a thematic synthesis of qualitative studies. CAD SAUDE PUBLICA 2024; 40:e00165023. [PMID: 38922226 PMCID: PMC11192573 DOI: 10.1590/0102-311xen165023] [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: 09/05/2023] [Revised: 04/01/2024] [Accepted: 04/09/2024] [Indexed: 06/27/2024] Open
Abstract
Vaccines are often undervalued or underused for a variety of reasons, and vaccine hesitancy is a global challenge that threatens vaccine acceptance and the goals of immunization programs. This review aimed to describe the barriers and facilitators to vaccination in Latin America. The study design was a systematic review and thematic synthesis of qualitative studies reporting on the knowledge or attitudes of adults, parents of children at vaccination age, adolescents and health professionals towards vaccination in Latin America. The databases searched were PubMed, CENTRAL, Scopus, LILACS, SciELO, and CINAHL. A total of 56 studies were included. Facilitators included vaccination being recognized as an effective strategy for preventing infectious diseases and as a requirement for access to social assistance programs, schooling or employment. Recommendations from health professionals and positive experiences with health services were also identified as facilitators. The main barriers were lack of information or counseling, structural problems such as shortages of vaccines and limited hours of operation, the inability to afford over-the-counter vaccines or transportation to health facilities, certain religious beliefs, misconceptions and safety concerns. Qualitative research can contribute to understanding perceptions and decision-making about vaccination and to designing policies and interventions to increase coverage.
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Affiliation(s)
- Javier Roberti
- Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina
| | - Natalí Ini
- Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina
| | - Maria Belizan
- Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
| | - Juan Pedro Alonso
- Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina
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2
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Kuye A, Dauda M, Ameh AO, Danladi MI, Atuman YJ, Kia GSN, Häsler B. An assessment of the operationality and factors influencing the effectiveness of rabies surveillance in Gombe State, Nigeria. PLoS Negl Trop Dis 2024; 18:e0012154. [PMID: 38713728 PMCID: PMC11108123 DOI: 10.1371/journal.pntd.0012154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 05/21/2024] [Accepted: 04/16/2024] [Indexed: 05/09/2024] Open
Abstract
Rabies remains a burden in Africa, disproportionately affecting the most vulnerable despite the availability of effective vaccines. Nigeria, the most populous African country, needs rapid disease control actions and commitments to achieve the goal of eliminating dog-mediated rabies by 2030. Surveillance is an essential element of effective disease control strategies. This study examined the current state of operationality of the rabies surveillance system for early case detection and management in Gombe state, Nigeria, through a One Health lens. It further examined the barriers impeding the effectiveness of the surveillance based on the perception of surveillance workers. Qualitative and quantitative methods were used to assess the structure of the system and its functioning. Data on dog bite and rabid cases obtained from the veterinary services in Gombe state were analysed descriptively. A total of 13 key informants were interviewed using a semi-structured interview guide. Qualitative data were analysed using thematic analysis to explore in depth the factors that influenced the operationality of the system. A total of 157 potential human exposures to rabies were identified in this study, out of which two people reportedly died at the health facility after showing symptoms highly suggestive of rabies. In terms of rabies surveillance and control, cross-sectoral collaboration was found between the human health and veterinary sectors for risk assessment of potential rabies exposures and its management. Some identified factors affecting the operations of the surveillance were inadequate funding, lack of infrastructure, lack of feedback from higher authorities and insufficient knowledge of rabies prevention and management. To improve the capacity for case detection and management within the state, the appropriate authorities may focus on increasing awareness about the disease to the populace to increase the number of cases identified by the system, employ more workers and strengthen the surveillance capability of existing workers.
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Affiliation(s)
- Adebanwo Kuye
- Department of Pathobiology and Population Sciences, Royal Veterinary College, Hatfield, United Kingdom
| | - Mishel Dauda
- Regional Disease Surveillance Enhancement Project (REDISSE), Gombe State Ministry of Agriculture and Animal husbandry, Gombe, Nigeria
| | | | | | - Yakubu Joel Atuman
- Bauchi Outstation Diagnostic Laboratory, National Veterinary Research Institute, Jos Plateau State, Vom, Nigeria
| | - Grace Sabo Nok Kia
- Department of Veterinary Public Health and Preventive Medicine, Faculty of Veterinary Medicine, Ahmadu Bello University, Zaria, Nigeria
| | - Barbara Häsler
- Department of Pathobiology and Population Sciences, Royal Veterinary College, Hatfield, United Kingdom
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Perraud V, Vanderhoydonck B, Bouvier G, Dias de Melo G, Kilonda A, Koukni M, Jochmans D, Rogée S, Ben Khalifa Y, Kergoat L, Lannoy J, Van Buyten T, Izadi-Pruneyre N, Chaltin P, Neyts J, Marchand A, Larrous F, Bourhy H. Mechanism of action of phthalazinone derivatives against rabies virus. Antiviral Res 2024; 224:105838. [PMID: 38373533 DOI: 10.1016/j.antiviral.2024.105838] [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: 12/14/2023] [Revised: 02/13/2024] [Accepted: 02/16/2024] [Indexed: 02/21/2024]
Abstract
Rabies, a viral zoonosis, is responsible for almost 59,000 deaths each year, despite the existence of an effective post-exposure prophylaxis. Indeed, rabies causes acute encephalomyelitis, with a case-fatality rate of 100 % after the onset of neurological clinical signs. Therefore, the development of therapies to inhibit the rabies virus (RABV) is crucial. Here, we identified, from a 30,000 compound library screening, phthalazinone derivative compounds as potent inhibitors of RABV infection and more broadly of Lyssavirus and even Mononegavirales infections. Combining in vitro experiments, structural modelling, in silico docking and in vivo assays, we demonstrated that phthalazinone derivatives display a strong inhibition of lyssaviruses infection by acting directly on the replication complex of the virus, and with noticeable effects in delaying the onset of the clinical signs in our mouse model.
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Affiliation(s)
- Victoire Perraud
- Institut Pasteur, Université Paris Cité, Unité Lyssavirus, Epidémiologie et Neuropathologie, WHO Collaborating Centre for Reference and Research on Rabies, F-75015, Paris, France
| | - Bart Vanderhoydonck
- Center for Innovation and Stimulation of Drug Discovery (Cistim) Leuven, Belgium
| | - Guillaume Bouvier
- Institut Pasteur, Université Paris Cité, CNRS UMR3528, Structural Bioinformatics Unit, F-75015, Paris, France
| | - Guilherme Dias de Melo
- Institut Pasteur, Université Paris Cité, Unité Lyssavirus, Epidémiologie et Neuropathologie, WHO Collaborating Centre for Reference and Research on Rabies, F-75015, Paris, France
| | - Amuri Kilonda
- Center for Innovation and Stimulation of Drug Discovery (Cistim) Leuven, Belgium
| | - Mohamed Koukni
- Center for Innovation and Stimulation of Drug Discovery (Cistim) Leuven, Belgium
| | | | - Sophie Rogée
- Institut Pasteur, Université Paris Cité, Unité Lyssavirus, Epidémiologie et Neuropathologie, WHO Collaborating Centre for Reference and Research on Rabies, F-75015, Paris, France
| | - Youcef Ben Khalifa
- Institut Pasteur, Université Paris Cité, Unité Lyssavirus, Epidémiologie et Neuropathologie, WHO Collaborating Centre for Reference and Research on Rabies, F-75015, Paris, France
| | - Lauriane Kergoat
- Institut Pasteur, Université Paris Cité, Unité Lyssavirus, Epidémiologie et Neuropathologie, WHO Collaborating Centre for Reference and Research on Rabies, F-75015, Paris, France
| | - Julien Lannoy
- Institut Pasteur, Université Paris Cité, Unité Lyssavirus, Epidémiologie et Neuropathologie, WHO Collaborating Centre for Reference and Research on Rabies, F-75015, Paris, France
| | | | - Nadia Izadi-Pruneyre
- Institut Pasteur, Université Paris Cité, CNRS UMR3528, Bacterial Transmembrane Systems Unit, F-75015, Paris, France
| | - Patrick Chaltin
- Center for Innovation and Stimulation of Drug Discovery (Cistim) Leuven, Belgium; Centre for Drug Design and Discovery (CD3), Katholieke Universiteit Leuven, Leuven, Belgium
| | - Johan Neyts
- Katholieke Universiteit Leuven, Leuven, Belgium
| | - Arnaud Marchand
- Center for Innovation and Stimulation of Drug Discovery (Cistim) Leuven, Belgium
| | - Florence Larrous
- Institut Pasteur, Université Paris Cité, Unité Lyssavirus, Epidémiologie et Neuropathologie, WHO Collaborating Centre for Reference and Research on Rabies, F-75015, Paris, France.
| | - Hervé Bourhy
- Institut Pasteur, Université Paris Cité, Unité Lyssavirus, Epidémiologie et Neuropathologie, WHO Collaborating Centre for Reference and Research on Rabies, F-75015, Paris, France.
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Leblanc C, Kassié D, Ranaivoharimina M, Rakotomanana EFN, Mangahasimbola RT, Randrianarijaona A, Ramiandrasoa R, Nely AJ, Razafindraibe NP, Andriamandimby SF, Ranoaritiana DB, Rajaonarivony V, Randrianasolo L, Baril L, Mattern C, Ratovoson R, Guis H. Mixed methods to evaluate knowledge, attitudes and practices (KAP) towards rabies in central and remote communities of Moramanga district, Madagascar. PLoS Negl Trop Dis 2024; 18:e0012064. [PMID: 38551968 PMCID: PMC11006160 DOI: 10.1371/journal.pntd.0012064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 04/10/2024] [Accepted: 03/12/2024] [Indexed: 04/11/2024] Open
Abstract
Control of dog-mediated rabies relies on raising awareness, access to post-exposure prophylaxis (PEP) and mass dog vaccination. To assess rabies awareness in Moramanga district, Madagascar, where rabies is endemic, two complementary quantitative and qualitative approaches were carried out in 2018. In the quantitative approach, a standardized questionnaire was administered to 334 randomized participants living in 170 households located less than 5 km from the anti-rabies treatment center (ARTC) located in Moramanga city (thereafter called the central area), and in 164 households located more than 15 km away from the ARTC in two rural communes (thereafter called the remote area). Logistic regression models were fitted to identify factors influencing knowledge and practice scores. The qualitative approach consisted in semi-structured interviews conducted with 28 bite victims who had consulted the ARTC, three owners of biting dogs, three ARTC staff and two local authorities. Overall, 15.6% (52/334) of households owned at least one dog. The dog-to-human ratio was 1:17.6. The central area had a significantly higher dog bite incidence (0.53 per 100 person-years, 95% CI: 0.31-0.85) compared to the remote area (0.22 per 100 person-years, 95% CI: 0.09-0.43) (p = 0.03). The care pathway following a bite depended on wound severity, how the dog was perceived and its owner's willingness to cover costs. Rabies vaccination coverage in dogs in the remote area was extremely low (2.4%). Respondents knew that vaccination prevented animal rabies but owners considered that their own dogs were harmless and cited access and cost of vaccine as main barriers. Most respondents were not aware of the existence of the ARTC (85.3%), did not know the importance of timely access to PEP (92.2%) or that biting dogs should be isolated (89.5%) and monitored. Good knowledge scores were significantly associated with having a higher socio-economic status (OR = 2.08, CI = 1.33-3.26) and living in central area (OR = 1.91, CI = 1.22-3.00). Good practice scores were significantly associated with living in central area (OR = 4.78, CI = 2.98-7.77) and being aware of the ARTC's existence (OR = 2.29, CI = 1.14-4.80). In Madagascar, knowledge on rabies was disparate with important gaps on PEP and animal management. Awareness campaigns should inform communities (i) on the importance of seeking PEP as soon as possible after an exposure, whatever the severity of the wound and the type of biting dog who caused it, and (ii) on the existence and location of ARTCs where free-of-charge PEP is available. They should also encourage owners to isolate and monitor the health of biting dogs. Above all, awareness and dog vaccination campaigns should be designed so as to reach the more vulnerable remote rural populations as knowledge, good practices and vaccination coverage were lower in these areas. They should also target households with a lower socio-economic status. If awareness campaigns are likely to succeed in improving access to ARTCs in Madagascar, their impact on prompting dog owners to vaccinate their own dogs seems more uncertain given the financial and access barriers. Therefore, to reach the 70% dog vaccination coverage goal targeted in rabies elimination programs, awareness campaigns must be combined with free-of-charge mass dog vaccination.
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Affiliation(s)
- Claire Leblanc
- Epidemiology and Clinical Research Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
- General Paediatrics and Paediatric Infectious Disease Unit, Nantes University Hospital, Nantes, France
| | - Daouda Kassié
- Epidemiology and Clinical Research Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
- CIRAD, UMR ASTRE, Antananarivo, Madagascar
- ASTRE, Univ Montpellier, CIRAD, INRAE, Montpellier, France
| | - Mendrika Ranaivoharimina
- Epidemiology and Clinical Research Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | | | | | - Anjasoa Randrianarijaona
- Epidemiology and Clinical Research Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - Ravo Ramiandrasoa
- Vaccination Center, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - Alphonse José Nely
- Service for the Fight against Plague, Emerging and Re-emerging Diseases and Neglected Tropical Endemo-Epidemic Diseases, Ministry of Public Health, Antananarivo, Madagascar
- WHO Madagascar, Antananarivo 101, Madagascar
| | | | - Soa Fy Andriamandimby
- National Laboratory of Rabies, Virology Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - Dany Bakoly Ranoaritiana
- Direction of Health Monitoring, Epidemiological Surveillance and Response (DVSSER), Ministry of Public Health, Antananarivo, Madagascar
| | - Virginie Rajaonarivony
- Service for the Fight against Plague, Emerging and Re-emerging Diseases and Neglected Tropical Endemo-Epidemic Diseases, Ministry of Public Health, Antananarivo, Madagascar
| | - Laurence Randrianasolo
- Epidemiology and Clinical Research Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - Laurence Baril
- Epidemiology and Clinical Research Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
- Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Chiarella Mattern
- Epidemiology and Clinical Research Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
- Ceped (Institut de Recherche pour le Développement, Université de Paris, INSERM), Paris, France
| | - Rila Ratovoson
- Epidemiology and Clinical Research Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - Hélène Guis
- Epidemiology and Clinical Research Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
- CIRAD, UMR ASTRE, Antananarivo, Madagascar
- ASTRE, Univ Montpellier, CIRAD, INRAE, Montpellier, France
- Institut Pasteur du Cambodge, Phnom Penh, Cambodia
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Nadal D, Bote K, Masthi R, Narayana A, Ross Y, Wallace R, Abela B. Rabies post-exposure prophylaxis delivery to ensure treatment efficacy and increase compliance. IJID ONE HEALTH 2023; 1:100006. [PMID: 38152594 PMCID: PMC10752235 DOI: 10.1016/j.ijidoh.2023.100006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 08/10/2023] [Accepted: 09/05/2023] [Indexed: 12/29/2023]
Abstract
Objectives Since rabies is lethal once symptoms appear, its prevention including community awareness, mass dog vaccination and post-exposure prophylaxis (PEP) is crucial. Although safe and potent rabies vaccines have long been available, the global rabies burden is still high and access to adequately-delivered PEP remains challenging. Here we offer healthcare providers up-to-date, simple, exhaustive, visual guidance on how to perform PEP steps correctly. Protocol PEP consists of 1) washing the wound with water and soap for 15 min, 2) assessing the need for rabies biologicals based on specific criteria; 3) administering, if required, rabies immunoglobulin or monoclonal antibodies deep in and around all wounds; 4) starting, if necessary, the WHO-recommended intradermal 1-week vaccination regimen; 5) informing patients adequately throughout the PEP process to increase compliance and avoid dangerous misconceptions about animal bite treatment and rabies risk. Discussion The intradermal 1-week vaccination regimen recommended by WHO is as safe as other regimens but carries important cost-, dose- and time-sparing benefits. As fundamental as the correct administration of rabies biologicals is clear doctor-patient communication and sharing of up-to-date knowledge among healthcare professionals. Conclusions This resource will help ensuring that no life is lost to rabies, an incurable yet preventable disease.
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Affiliation(s)
- Deborah Nadal
- Department of Humanities, Ca’ Foscari University of Venice: Malcanton Marcorà, Dorsoduro 3484/D, 30123 Venice, Italy
- Department of Control of Neglected Tropical Diseases, World Health Organization, Avenue Appia 20, 1202 Geneva, Switzerland
| | - Katrin Bote
- Department of Control of Neglected Tropical Diseases, World Health Organization, Avenue Appia 20, 1202 Geneva, Switzerland
| | - Ramesh Masthi
- Department of Community Medicine at the Kempegowda Institute of Medical Sciences Hospital & Research Centre, Krishna Rajendra Road, 560004 Bengaluru, Karnataka, India
| | - Ashwath Narayana
- Department of Community Medicine at the Kempegowda Institute of Medical Sciences Hospital & Research Centre, Krishna Rajendra Road, 560004 Bengaluru, Karnataka, India
| | - Yasmeen Ross
- US Centers for Disease Control and Prevention, Clifton Road 1600, 30333 Atlanta, GA, United States
| | - Ryan Wallace
- US Centers for Disease Control and Prevention, Clifton Road 1600, 30333 Atlanta, GA, United States
| | - Bernadette Abela
- Department of Control of Neglected Tropical Diseases, World Health Organization, Avenue Appia 20, 1202 Geneva, Switzerland
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Nadal D, Hampson K, Lembo T, Rodrigues R, Vanak AT, Cleaveland S. Where Rabies Is Not a Disease. Bridging Healthworlds to Improve Mutual Understanding and Prevention of Rabies. Front Vet Sci 2022; 9:867266. [PMID: 35782552 PMCID: PMC9240625 DOI: 10.3389/fvets.2022.867266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 05/23/2022] [Indexed: 11/13/2022] Open
Abstract
Deeply embedded in local social, cultural, and religious settings, traditional healing is part of dog bite and rabies management in many rabies endemic countries. Faith healing, which usually encompasses a more holistic approach to health including physical, mental and social dimensions, is rare in the context of rabies. In Gujarat, Western India, the Hindu goddess Hadkai Mata is worshiped by low-caste communities as the Mother of Rabies in the event of a dog bite to a person or their livestock. This belief might influence people's attitudes and behaviors toward rabies prevention but has never been investigated. Through 31 in-depth interviews with healers and staff of Hadkai Mata temples, this paper explores the system of knowledge around dog and human rabies that is built and shared in these places of worship and healing. Qualitative and quantitative data were analyzed looking for convergences and divergences with the recently launched National Action Plan for dog-mediated Rabies Elimination. Results suggest that while the etiology of human rabies as a social illness is usually explained as the goddess's wish to correct misbehaving people and restore positive interpersonal relations, there is some appreciation for the biological processes of infection that lead to rabies as a physical disease. Hadkai Mata is believed to cure rabies if her patients undergo the necessary process of moral growth. Although conventional post-exposure prophylaxis is not opposed per se, it is often delayed by patients who seek traditional treatment first. Some reluctance was expressed toward mass dog vaccination because it is seen as an interference in how the goddess controls dogs, by enraging them-hence infecting them with rabies-and sending them to bite wrongdoers. Addressing these cultural perceptions is likely to be critical in achieving effective control of dog rabies in this region. The study highlights the value of multidisciplinary approaches in the control and elimination of rabies, as well as other zoonoses. This includes the importance of understanding different culturally- and religiously- mediated ways in which humans relate to animals; and looking for points of convergence and mutual understanding, upon which context-tailored, linguistically-accurate, locally acceptable, feasible and effective strategies can be designed.
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Affiliation(s)
- Deborah Nadal
- Institute of Biodiversity, Animal Health & Comparative Medicine, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, United Kingdom
- Center for One Health Research, School of Public Health, University of Washington, Seattle, WA, United States
| | - Katie Hampson
- Institute of Biodiversity, Animal Health & Comparative Medicine, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Tiziana Lembo
- Institute of Biodiversity, Animal Health & Comparative Medicine, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Rebecca Rodrigues
- Centre for Biodiversity and Conservation, Ashoka Trust for Research in Ecology and The Environment, Bangalore, India
| | - Abi Tamim Vanak
- Centre for Biodiversity and Conservation, Ashoka Trust for Research in Ecology and The Environment, Bangalore, India
- School of Life Sciences, University of KwaZulu-Natal, Westville, South Africa
- DBT/Wellcome Trust India Alliance Program, Hyderabad, India
| | - Sarah Cleaveland
- Institute of Biodiversity, Animal Health & Comparative Medicine, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, United Kingdom
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Rupprecht CE, Mani RS, Mshelbwala PP, Recuenco SE, Ward MP. Rabies in the Tropics. CURRENT TROPICAL MEDICINE REPORTS 2022; 9:28-39. [PMID: 35371908 PMCID: PMC8960221 DOI: 10.1007/s40475-022-00257-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2022] [Indexed: 11/25/2022]
Abstract
Purpose of Review Rabies is an ancient yet still neglected tropical disease (NTD). This review focuses upon highlights of recent research and peer-reviewed communications on the underestimated tropical burden of disease and its management due to the complicated dynamics of virulent viral species, diverse mammalian reservoirs, and tens of millions of exposed humans and animals - and how laboratory-based surveillance at each level informs upon pathogen spread and risks of transmission, for targeted prevention and control. Recent Findings While both human and rabies animal cases in enzootic areas over the past 5 years were reported to PAHO/WHO and OIE by member countries, still there is a huge gap between these "official" data and the need for enhanced surveillance efforts to meet global program goals. Summary A review of the complex aspects of rabies perpetuation in human, domestic animal, and wildlife communities, coupled with a high fatality rate despite the existence of efficacious biologics (but no therapeutics), warrants the need for a One Health approach toward detection via improved laboratory-based surveillance, with focal management at the viral source. More effective methods to prevent the spread of rabies from enzootic to free zones are needed.
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Affiliation(s)
- Charles E. Rupprecht
- LYSSA LLC, Atlanta, GA USA
- School of Forestry and Wildlife Sciences, Auburn University, Auburn, AL USA
| | - Reeta S. Mani
- Department of Neurovirology, WHO Collaborating Centre for Reference and Research in Rabies, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka India
| | - Philip P. Mshelbwala
- School of Veterinary Science, The University of Queensland, Brisbane, Australia
- Faculty of Veterinary Medicine, University of Abuja, Abuja, Nigeria
| | - Sergio E. Recuenco
- Facultad de Medicina San Fernando, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Michael P. Ward
- Sydney School of Veterinary Science, Faculty of Science, The University of Sydney, Camden, NSW Australia
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Buttenheim AM, Thirumurthy H. Pay-for-performance incentives for health worker vaccination: looking under the hood. BMJ Qual Saf 2022; 31:623-626. [PMID: 35149601 DOI: 10.1136/bmjqs-2021-014269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2022] [Indexed: 11/04/2022]
Affiliation(s)
- Alison M Buttenheim
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA .,Center for Health Incentives and Behavioral Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Harsha Thirumurthy
- Center for Health Incentives and Behavioral Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Medical Ethics and Health Policy, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania
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9
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Brewer JD, Shinnick J, Román K, Santos MP, Paz-Soldan VA, Buttenheim AM. Behavioral Insights Into Micronutrient Powder Use for Childhood Anemia in Arequipa, Peru. GLOBAL HEALTH: SCIENCE AND PRACTICE 2020; 8:721-731. [PMID: 33361238 PMCID: PMC7784068 DOI: 10.9745/ghsp-d-20-00078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 10/06/2020] [Indexed: 11/23/2022]
Abstract
Health care provider-caregiver interactions and caregivers’ shifting emotional states between intention formation and use affected their adherence to a government-provided micronutrient powder intervention to prevent childhood anemia. In counseling directed to caregivers, we suggest providers offer clear messaging on MNP impact and planning for challenges during MNP use. Childhood anemia remains a significant driver of morbidity in low- and middle-income countries, including Peru. To identify behavioral challenges to using micronutrient powder (MNP) that is given to supplement children’s diets and prevent anemia, we applied a behavioral design approach to interviews and focus groups with 129 caregivers in Arequipa, Peru. We examined 3 key points in the decision-making process: accessing MNP through the health system; forming intentions to use MNP; and MNP use at the time of child feeding. Using the NUDGE (Narrow, Understand, Discover, Generate, Evaluate) approach, we identified the following behavioral barriers and facilitators: (1) caregivers’ experiences with health care providers shaped their motivation to access MNP; (2) caregivers felt accessing MNP at clinics was inconvenient and created hassle factors; (3) caregivers’ mental models about anemia prevention shaped MNP intentions and use; (4) caregivers’ salient negative experiences could have caused them to stop giving MNP; (5) caregivers forgot to give MNP if they did not have cues to remind them but could be prompted with salient cues; and (6) caregivers were affected by emotional, cognitive, and attentional factors during feeding that were difficult to anticipate. Our results, based on a behavioral design approach, suggest opportunities to adapt current messaging, counseling, and education around MNP use. Adaptations include providing culturally relevant messages, leveraging caregivers’ emotional and cognitive states, and encouraging small but impactful changes to feeding routines to address barriers to MNP use.
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Affiliation(s)
- Jessica D Brewer
- Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA.
| | - Julianna Shinnick
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Karina Román
- Department of Health Management, Universidad Peruana Cayetano Heredia Facultad de Salud Pública y Administración Carlos Vidal Layseca, Lima, Peru.,Asociación Benéfica PRISMA, Lima, Peru
| | - Maria P Santos
- Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Valerie A Paz-Soldan
- Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA.,Asociación Benéfica PRISMA, Lima, Peru.,Zoonotic Disease Research Lab, Universidad Peruana Cayetano Heredia Facultad de Salud Pública y Administración Carlos Vidal Layseca, Arequipa, Peru
| | - Alison M Buttenheim
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA.,Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, PA, USA
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Rohde RE, Rupprecht CE. Update on lyssaviruses and rabies: will past progress play as prologue in the near term towards future elimination? Fac Rev 2020; 9:9. [PMID: 33659941 PMCID: PMC7886060 DOI: 10.12703/b/9-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Rabies is an ancient, much-feared, and neglected infectious disease. Caused by pathogens in the family Rhabdoviridae, genus Lyssavirus, and distributed globally, this viral zoonosis results in tens of thousands of human fatalities and millions of exposures annually. All mammals are believed susceptible, but only certain taxa act as reservoirs. Dependence upon direct routing to, replication within, and passage from the central nervous system serves as a basic viral strategy for perpetuation. By a combination of stealth and subversion, lyssaviruses are quintessential neurotropic agents and cause an acute, progressive encephalitis. No treatment exists, so prevention is the key. Although not a disease considered for eradication, something of a modern rebirth has been occurring within the field as of late with regard to detection, prevention, and management as well as applied research. For example, within the past decade, new lyssaviruses have been characterized; sensitive and specific diagnostics have been optimized; pure, potent, safe, and efficacious human biologics have improved human prophylaxis; regional efforts have controlled canine rabies by mass immunization; wildlife rabies has been controlled by oral rabies vaccination over large geographic areas in Europe and North America; and debate has resumed over the controversial topic of therapy. Based upon such progress to date, there are certain expectations for the next 10 years. These include pathogen discovery, to uncover additional lyssaviruses in the Old World; laboratory-based surveillance enhancement by simplified, rapid testing; anti-viral drug appearance, based upon an improved appreciation of viral pathobiology and host response; and improvements to canine rabies elimination regionally throughout Africa, Asia, and the Americas by application of the best technical, organizational, economic, and socio-political practices. Significantly, anticipated Gavi support will enable improved access of human rabies vaccines in lesser developed countries at a national level, with integrated bite management, dose-sparing regimens, and a 1 week vaccination schedule.
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Affiliation(s)
- Rodney E Rohde
- Clinical Laboratory Science, Texas State University, San Marcos, TX, 78666, USA
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De la Puente-León M, Levy MZ, Toledo AM, Recuenco S, Shinnick J, Castillo-Neyra R. Spatial Inequality Hides the Burden of Dog Bites and the Risk of Dog-Mediated Human Rabies. Am J Trop Med Hyg 2020; 103:1247-1257. [PMID: 32662391 PMCID: PMC7470517 DOI: 10.4269/ajtmh.20-0180] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 05/25/2020] [Indexed: 12/21/2022] Open
Abstract
Since its reintroduction in 2015, rabies has been established as an enzootic disease among the dog population of Arequipa, Peru. Given the unknown rate of dog bites, the risk of human rabies transmission is concerning. Our objective was to estimate the rate of dog bites in the city and to identify factors associated with seeking health care in a medical facility for wound care and rabies prevention follow-up. To this end, we conducted a door-to-door survey with 4,370 adults in 21 urban and 21 peri-urban communities. We then analyzed associations between seeking health care following dog bites and various socioeconomic factors, stratifying by urban and peri-urban localities. We found a high annual rate of dog bites in peri-urban communities (12.4%), which was 2.6 times higher than that in urban areas (4.8%). Among those who were bitten, the percentage of people who sought medical treatment was almost twice as high in urban areas (39.1%) as in peri-urban areas (21.4%).
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Affiliation(s)
- Micaela De la Puente-León
- Zoonotic Disease Research Laboratory, One Health Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Arequipa, Perú
| | - Michael Z. Levy
- Zoonotic Disease Research Laboratory, One Health Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Arequipa, Perú
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Amparo M. Toledo
- Zoonotic Disease Research Laboratory, One Health Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Arequipa, Perú
| | - Sergio Recuenco
- Centro de Investigaciones Tecnológicas, Biomédicas y Medioambientales, Universidad Nacional Mayor de San Marcos, Lima, Perú
| | - Julianna Shinnick
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ricardo Castillo-Neyra
- Zoonotic Disease Research Laboratory, One Health Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Arequipa, Perú
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania
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