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Nujum ZT, Indu PS, Ramesh J, Philip RR, S S, A R S, N LR, Balaram NA. Rabies death in an adolescent tribal girl diagnosed postmortem, in Kerala - the precious life, preventable loss and equity concerns. Int J Equity Health 2024; 23:104. [PMID: 38783326 PMCID: PMC11112861 DOI: 10.1186/s12939-024-02164-w] [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: 04/12/2023] [Accepted: 03/28/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Rabies is a neglected tropical disease endemic in 150 countries, including India where it is present in all states and union territories except Andaman and Nicobar Islands Lakshadweep. Kerala reports high incidence of animal bites. This article discusses the preventable death of a 17-year-old tribal girl due to rabies in Kerala and the equity concerns it raises. METHODS The case study was conducted using qualitative methods such as rapid key informant interviews, interactions in tribal assembly meetings, unstructured participant observations, and document verification. Thematic analysis was used, and the results are presented as an ethnographic summary with the use of quotes to substantiate the observations. RESULTS The girl had gone to a town with her sister for a few days when she developed difficulty in eating, behavioral abnormalities, and injuries on her body. She subsequently died, and a post-mortem revealed Negri bodies in her brain, confirming rabies as the cause of death. The girl had been bitten by a puppy from the forest eight months prior, but she did not receive post-exposure prophylaxis. Multiple dogs are kept in each household in the settlement, and the community takes good care of them since they protect them from wild animals. However, awareness about the need for post-exposure prophylaxis is low, and access to it is difficult for this population. The social problems in the settlement affect their quality of life and their interactions with the outside world. CONCLUSIONS To prevent such deaths, it is essential to increase awareness and ensure equitable access to life-saving vaccines and immunoglobulin in hard-to-reach tribal areas. The cost-effectiveness of pre-exposure prophylaxis for children in high-risk areas such as this tribal settlement should be evaluated and compared with the WHO-recommended strategies of mass canine vaccination and One Health.
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Affiliation(s)
- Zinia T Nujum
- Community Medicine, Government Medical College, Kollam, Kerala, India.
- School of Public Health, Kerala University of Health Sciences, Medical College Campus, Thiruvannthapuram, Kerala, India.
| | | | - Jeena Ramesh
- Community Medicine, Government Medical College, Kollam, Kerala, India
| | | | - Smitha S
- Forensic Medicine, Government Medical College, Kollam, Kerala, India
| | - Seena A R
- Pathology, Government Medical College, Kollam, Kerala, India
| | - Laila Raji N
- Pathology, Government Medical College, Kollam, Kerala, India
| | - N A Balaram
- Forensic Medicine, Government Medical College, Kollam, Kerala, India
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Nujum ZT, Asaria M, Kurup KK, Mini M, Mazumdar S, Daptardar M, Tiwari H. Cost-effectiveness of One Health interventions for rabies elimination: a systematic review. Trans R Soc Trop Med Hyg 2024; 118:223-233. [PMID: 37903657 DOI: 10.1093/trstmh/trad074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 08/31/2023] [Accepted: 10/05/2023] [Indexed: 11/01/2023] Open
Abstract
The 'One Health' (OH) approach is the most promising idea in realising the global goal of eliminating canine-mediated human rabies by 2030. However, taking an OH approach to rabies elimination can mean many different things to different people. We conducted a systematic review scrutinizing economic evaluations (EEs) retrieved from MEDLINE OVID, Embase OVID, Global Health OVID, CINAHL EBSCO and ECONLIT EBSCO that used the OH approach with the intent of identifying cost-effective sets of interventions that can be combined to implement an optimal OH-based rabies elimination program and highlight key gaps in the knowledge base. Our review suggests that an optimal OH program to tackle rabies should incorporate mass dog vaccination and integrated bite case management in combination with efficient use of post-exposure prophylaxis along with a shift to a 1-week abbreviated intradermal rabies vaccine regimen in humans. We recommend that future EEs of OH interventions for rabies elimination should be performed alongside implementation research to ensure proposed interventions are feasible and adopt a wider societal perspective taking into account costs and outcomes across both the human health and animal welfare sectors. The systematic review has been registered with PROSPERO.
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Affiliation(s)
- Zinia T Nujum
- Senior Visiting Fellow, Department of Health Policy, London School of Economics and Political Science, London WC2A2AE, UK
| | - Miqdad Asaria
- Assistant Professor, Department of Health Policy, London School of Economics and Political Science, London WC2A2AE, UK
| | - Karishma Krishna Kurup
- Research Fellow, Center for Universal Health, Chatham House (Royal Institute of International Affairs) London, UK
| | - Malathi Mini
- MSc Global Health Policy Candidate, London School of Economics and Political Science, London WC2A2AE, UK
| | - Sumit Mazumdar
- Research Fellow (Global Health), Centre for Health Economics, University of York Visiting Senior Fellow, Institute for Human Development, New Delhi, India
| | | | - Harish Tiwari
- DBT Wellcome India Alliance CPH Intermediate Fellow, Indian Institute of Technology Guwahati, Assam, India
- Research Affiliate, University of Sydney, Sydney, NSW, Australia
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Alemayehu T, Oguttu B, Rupprecht CE, Niyas VKM. Rabies vaccinations save lives but where are the vaccines? Global vaccine inequity and escalating rabies-related mortality in low- and middle-income countries. Int J Infect Dis 2024; 140:49-51. [PMID: 38232796 DOI: 10.1016/j.ijid.2024.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024] Open
Affiliation(s)
- Tinsae Alemayehu
- International Society for Infectious Diseases, Boston, Massachusetts, USA; Department of Pediatrics and Adolescent health, University of Botswana, Gaborone, Botswana; Department of Pediatrics and Adolescent health, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.
| | - Benson Oguttu
- Kampala International University Teaching Hospital, Kampala, Uganda
| | - Charles E Rupprecht
- College of Forestry, Wildlife and Environment, College of Veterinary Medicine, Auburn University, Auburn, Alabama, USA
| | - Vettakkara Kandy Muhammed Niyas
- International Society for Infectious Diseases, Boston, Massachusetts, USA; Department of Infectious Diseases, KIMSHEALTH, Thiruvananthapuram, Kerala, India
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Lacy M, Phasuk N, Scholand SJ. Human Rabies Treatment-From Palliation to Promise. Viruses 2024; 16:160. [PMID: 38275970 PMCID: PMC10819634 DOI: 10.3390/v16010160] [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: 12/28/2023] [Revised: 01/19/2024] [Accepted: 01/19/2024] [Indexed: 01/27/2024] Open
Abstract
Rabies encephalitis has plagued humankind for thousands of years. In developed countries, access to preventive care, both pre-exposure and post-exposure, has significantly reduced the burden of suffering and disease. However, around the world, rabies remains a neglected tropical disease, largely due to uncontrolled dog rabies, and tens of thousands perish each year. Currently, the standard of care for management of rabies encephalitis is palliation. Heroic attempts to treat human rabies patients over the last few decades have yielded glimpses into our understanding of pathophysiology, opening the door to the development of new antiviral therapies and modalities of treatment. Researchers continue to investigate new compounds and approaches to therapy, yet there remain real challenges given the complexity of the disease. We explore and review some of the promising therapies on the horizon in pursuit of a salvage treatment for rabies.
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Affiliation(s)
- Marian Lacy
- College of Medicine, University of Arizona, Tucson, AZ 85721, USA;
| | - Nonthapan Phasuk
- School of Medicine, Walailak University, Nakhon Si Thammarat 80160, Thailand;
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Mukhida S, Das NK, Palal D, Verma P, Johnson S. Does India's Zero by 30 Strategic Plan Need the Addition of the Rabies Vaccine to the Universal Immunisation Programme? Health Serv Insights 2023; 16:11786329231207930. [PMID: 37915424 PMCID: PMC10617289 DOI: 10.1177/11786329231207930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023] Open
Affiliation(s)
- Sahjid Mukhida
- Department of Microbiology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune, Maharashtra, India
| | - Nikunja Kumar Das
- Department of Microbiology, MAEER MIT Pune’s MIMER Medical College & Dr. BSTR Hospital, Talegaon (D), Pune, Maharashtra, India
| | - Deepu Palal
- Department of Community Medicine, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune, Maharashtra, India
| | - Prerna Verma
- Department of Community Medicine, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune, Maharashtra, India
| | - S Johnson
- Department of Community Medicine, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune, Maharashtra, India
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Rupprecht CE, Mshelbwala PP, Reeves RG, Kuzmin IV. Rabies in a postpandemic world: resilient reservoirs, redoubtable riposte, recurrent roadblocks, and resolute recidivism. ANIMAL DISEASES 2023; 3:15. [PMID: 37252063 PMCID: PMC10195671 DOI: 10.1186/s44149-023-00078-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 04/02/2023] [Indexed: 05/31/2023] Open
Abstract
Rabies is an ancient disease. Two centuries since Pasteur, fundamental progress occurred in virology, vaccinology, and diagnostics-and an understanding of pathobiology and epizootiology of rabies in testament to One Health-before common terminological coinage. Prevention, control, selective elimination, and even the unthinkable-occasional treatment-of this zoonosis dawned by the twenty-first century. However, in contrast to smallpox and rinderpest, eradication is a wishful misnomer applied to rabies, particularly post-COVID-19 pandemic. Reasons are minion. Polyhostality encompasses bats and mesocarnivores, but other mammals represent a diverse spectrum of potential hosts. While rabies virus is the classical member of the genus, other species of lyssaviruses also cause the disease. Some reservoirs remain cryptic. Although global, this viral encephalitis is untreatable and often ignored. As with other neglected diseases, laboratory-based surveillance falls short of the notifiable ideal, especially in lower- and middle-income countries. Calculation of actual burden defaults to a flux within broad health economic models. Competing priorities, lack of defined, long-term international donors, and shrinking local champions challenge human prophylaxis and mass dog vaccination toward targets of 2030 for even canine rabies impacts. For prevention, all licensed vaccines are delivered to the individual, whether parenteral or oral-essentially 'one and done'. Exploiting mammalian social behaviors, future 'spreadable vaccines' might increase the proportion of immunized hosts per unit effort. However, the release of replication-competent, genetically modified organisms selectively engineered to spread intentionally throughout a population raises significant biological, ethical, and regulatory issues in need of broader, transdisciplinary discourse. How this rather curious idea will evolve toward actual unconventional prevention, control, or elimination in the near term remains debatable. In the interim, more precise terminology and realistic expectations serve as the norm for diverse, collective constituents to maintain progress in the field.
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Affiliation(s)
- Charles E. Rupprecht
- College of Forestry, Wildlife & Environment, College of Veterinary Medicine, Auburn University, Auburn, AL 36849 USA
| | - Philip P. Mshelbwala
- School of Veterinary Science, University of Queensland, Gatton, Australia
- Department of Veterinary Medicine, Faculty of Veterinary Medicine, University of Abuja, Abuja, Nigeria
| | - R. Guy Reeves
- Max Planck Institut Für Evolutionsbiologie, 24306 Plön, Germany
| | - Ivan V. Kuzmin
- Department of Pathology, University of Texas Medical Branch, Galveston, TX 77555 USA
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Maddeh M, Hajjej F, Alazzam MB, Otaibi SA, Turki NA, Ayouni S. Spatio-Temporal Cluster Mapping System in Smart Beds for Patient Monitoring. SENSORS (BASEL, SWITZERLAND) 2023; 23:4614. [PMID: 37430526 DOI: 10.3390/s23104614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 04/03/2023] [Accepted: 05/06/2023] [Indexed: 07/12/2023]
Abstract
Innovative technological solutions are required to improve patients' quality of life and deliver suitable treatment. Healthcare workers may be able to watch patients from a distance using the Internet of Things (IoT) by using big data algorithms to analyze instrument outputs. Therefore, it is essential to gather information on use and health problems in order to improve the remedies. To ensure seamless incorporation for use in healthcare institutions, senior communities, or private homes, these technological tools must first and foremost be easy to use and implement. We provide a network cluster-based system known as smart patient room usage in order to achieve this. As a result, nursing staff or caretakers can use it efficiently and swiftly. This work focuses on the exterior unit that makes up a network cluster, a cloud storage mechanism for data processing and storage, as well as a wireless or unique radio frequency send module for data transfer. In this article, a spatio-temporal cluster mapping system is presented and described. This system creates time series data using sense data collected from various clusters. The suggested method is the ideal tool to use in a variety of circumstances to improve medical and healthcare services. The suggested model's ability to anticipate moving behavior with high precision is its most important feature. The time series graphic displays a regular light movement that continued almost the entire night. The last 12 h' lowest and highest moving duration numbers were roughly 40% and 50%, respectively. When there is little movement, the model assumes a normal posture. Particularly, the moving duration ranges from 7% to 14%, with an average of 7.0%.
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Affiliation(s)
- Mohamed Maddeh
- College of Applied Computer Science, King Saud University, Riyadh 11451, Saudi Arabia
| | - Fahima Hajjej
- Department of Information Systems, College of Computer and Information Sciences, Princess Nourah bint Abdulrahman University, Riyadh 11671, Saudi Arabia
| | - Malik Bader Alazzam
- Information Technology College, Ajloun National University, Irbid 21163, Jordan
| | - Shaha Al Otaibi
- Department of Information Systems, College of Computer and Information Sciences, Princess Nourah bint Abdulrahman University, Riyadh 11671, Saudi Arabia
| | - Nazek Al Turki
- Department of Information Systems, College of Computer and Information Sciences, Princess Nourah bint Abdulrahman University, Riyadh 11671, Saudi Arabia
| | - Sarra Ayouni
- Department of Information Systems, College of Computer and Information Sciences, Princess Nourah bint Abdulrahman University, Riyadh 11671, Saudi Arabia
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Royal A, John D, Bharti O, Tanwar R, Bhagat DK, Padmawati RS, Chaudhary V, Umapathi R, Bhadola P, Utarini A. Reply to Kapur, V. Is Pre-Exposure Prophylaxis a Cost-Effective Intervention to Avert Rabies Deaths among School-Aged Children in India? Comment on “Royal et al. A Cost-Effectiveness Analysis of Pre-Exposure Prophylaxis to Avert Rabies Deaths in School-Aged Children in India. Vaccines 2023, 11, 88”. Vaccines (Basel) 2023; 11:vaccines11040807. [PMID: 37112719 PMCID: PMC10141556 DOI: 10.3390/vaccines11040807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 04/03/2023] [Indexed: 04/08/2023] Open
Abstract
Thank you so much for forwarding the critical analysis the author (VK) conducted on our recently published modelling study ‘A Cost-Effectiveness Analysis of Pre-Exposure Prophylaxis to Avert Rabies Deaths in School-Aged Children in India’ in your reputed journal [...]
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Affiliation(s)
- Abhishek Royal
- Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta 55281, Indonesia
| | - Denny John
- Faculty of Life and Allied Health Sciences, Ramaiah University of Applied Sciences, Bengaluru 560054, India
| | - Omesh Bharti
- State Institute of Health and Family Welfare, Department of Health & Family Welfare, Government of Himachal Pradesh, Shimla 171009, India
| | - Ritesh Tanwar
- Directorate of Health Services, Government of Madhya Pradesh, Bhopal 462002, India
| | - Deepak Kumar Bhagat
- Centre of Social Medicine and Community Health, Jawaharlal Nehru University, Delhi 110067, India
| | - Retna Siwi Padmawati
- Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta 55281, Indonesia
| | - Vishal Chaudhary
- Department of Physics, Bhagini Nivedita College, University of Delhi, Delhi 110021, India
| | - Reddicherla Umapathi
- Department of Biological Sciences and Bioengineering, Inha University, Incheon 22212, Republic of Korea
| | - Pradeep Bhadola
- Centre for Theoretical Physics and Natural Philosophy, Mahidol University, Nakhonsawan Campus, Phayuha Khiri, NakhonSawan 60130, Thailand
| | - Adi Utarini
- Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta 55281, Indonesia
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Is Pre-Exposure Prophylaxis a Cost-Effective Intervention to Avert Rabies Deaths among School-Aged Children in India? Comment on Royal et al. A Cost-Effectiveness Analysis of Pre-Exposure Prophylaxis to Avert Rabies Deaths in School-Aged Children in India. Vaccines 2023, 11, 88. Vaccines (Basel) 2023; 11:vaccines11030677. [PMID: 36992260 DOI: 10.3390/vaccines11030677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 02/13/2023] [Accepted: 03/02/2023] [Indexed: 03/19/2023] Open
Abstract
I read with interest the article “A Cost-Effectiveness Analysis of Pre-Exposure Prophylaxis to Avert Rabies Deaths in School-Aged Children in India” by Royal et al., recently published in Vaccines [...]
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Royal A, John D, Bharti O, Dhupar D, Diksha, Padmawati RS, Utarini A. Cost analysis of implementation of a population level rabies control programme for children in India. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2023. [DOI: 10.1016/j.cegh.2023.101244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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