Hospital records of human rabies and antirabies prophylaxis in Nigeria 1969-78

Knowledge, attitudes and practices towards rabies prevention among residents of Abuja municipal area council, Federal Capital Territory, Nigeria

INTRODUCTION

Rabies is a fatal neglected zoonosis killing 55,000 people worldwide annually. It is endemic in Nigeria with 10,000 people exposed annually through dog-bites. To inform adequate intervention due to the rise in reported dog-bite cases, we assessed knowledge, attitudes and practices (KAP).

METHODS

We carried out a cross-sectional study among 224 residents in Abuja Municipal Area Council. We used structured questionnaires to collect data on sociodemographic characteristics, knowledge and attitudes on rabies prevention. Knowledge score of ≥ 8 points based on ten-point domain question were regarded as satisfactory. We analyzed data using Epi-Info and Excel for proportions and associations were determined at 5% significance level.

RESULTS

A total of 123 (55%) respondents owned dogs. One hundred and eighty four (82%) respondents had satisfactory knowledge on rabies prevention, about 87% knew where to get dogs vaccinated and would seek medical treatment from the hospital when bitten by a dog. Majority (58%) did not know the frequency of anti-rabies administration for dogs and 63.3% did not know the appropriate first aid actions following dog-bites. Of 123 dog owners, 35% would allow their dogs roam without restriction and 94% reported vaccinating their dogs against rabies. Dog owners were more likely to have satisfactory knowledge of rabies compared to non-dog owners (OR 7.8, 95% CI 1.0-62.0, p = 0.02).

CONCLUSION

Knowledge on rabies is satisfactory but with gaps in the frequency of dog anti-rabies vaccination, appropriate first-aid following dog bites and non restriction of dog movement. To prevent rabies, these gaps need to be addressed through public enlightenment and enforcement of dog movement restrictions laws.

Rabies surveillance in dogs in Lao PDR from 2010-2016

BACKGROUND

Rabies is a fatal viral disease that continues to threaten both human and animal health in endemic countries. The Lao People's Democratic Republic (Lao PDR) is a rabies-endemic country in which dogs are the main reservoir and continue to present health risks for both human and animals throughout the country.

METHODS

Passive, laboratory-based rabies surveillance was performed for suspected cases of dog rabies in Vientiane Capital during 2010-2016 and eight additional provinces between 2015-2016 using the Direct Fluorescent Antibody Test (DFAT).

RESULTS

There were 284 rabies positive cases from 415 dog samples submitted for diagnosis. 257 cases were from Vientiane Capital (2010-2016) and the remaining 27 cases were submitted during 2015-2016 from Champassak (16 cases), Vientiane Province (4 cases), Xieng Kuang (3 cases), Luang Prabang (2 cases), Saravan (1 case), Saisomboun (1 case) and Bokeo (1 case). There was a significant increase in rabies cases during the dry season (p = 0.004) (November to April; i.e., <100mm of rainfall per month). No significant differences were noted between age, sex, locality of rabies cases.

CONCLUSION

The use of laboratory-based rabies surveillance is a useful method of monitoring rabies in Lao PDR and should be expanded to other provincial centers, particularly where there are active rabies control programs.

Profile of dog bite victims in Jos Plateau State, Nigeria: a review of dog bite records (2006-2008)

Introduction

Dogs are the major reservoir of rabies virus in Nigeria; transmission to humans is via a bite by rabid dog. Between 2006 and 2008 National Veterinary Research Institute (NVRI) rabies laboratory reported increased numbers of rabies in dogs and human dog bites. The objective of the study was to use veterinary and health records to develop a profile of bite victims and recommend appropriate public health actions.

Methods

We used the dog brain specimen result register of Rabies Laboratory of NVRI, from “January, 2006” to “December, 2008” and traced dog bite cases. Structured questionnaires were administered to persons who reported dog bite incident and could be traced. We reviewed records from Evangelical Churches of West Africa (ECWA) clinic from “January, 2006” to “December, 2008” to collect detailed profiles of bite victims.

Results

Bite victims linked to positive dog samples were traced to “ECWA clinic” from “January, 2006” to “December, 2008”. Most bite victims were <16 years 141 (72.3%), male 128 (65.6%), and 48.2% had primary school education. Bites were unprovoked 184 (94.4%), mostly on arms. 54.4% victims received complete post exposure prophylaxis (PEP). Majority of the biting dogs were housed and unvaccinated.

Conclusion

This study provided important information on the profile of dog bite victims and highlights the need for a sustained awareness and education of children on the dangers of dog bite. It has shown lack of enforcement of regulations for licensing of dogs and rabies vaccination.

Epidemiology

This chapter provides an overview of the global epidemiology of rabies, focusing on major changes over the past half-century and highlighting recent discoveries. This chapter also describes the natural and iatrogenic routes of transmission, as well as the risk and necessary actions for the prevention of rabies following an exposure. It reviews the methods for rabies diagnosis and the biologics for prevention, in addition to differences in rabies prophylaxis recommendations among advisory committees. The chapter also considers epidemiology and trends in global human rabies and the dynamics of the corresponding mammalian reservoir hosts for each area. Furthermore, it considers the phylogenetics of rabies virus, other lyssaviruses, and specific rabies virus variants in the context of regional rabies and the potential for novel emergences. Special attention is paid to developed countries, where existing surveillance and diagnostic infrastructure have provided detailed insights into the nature changing patterns in rabies epidemiology-patterns expected to be increasingly relevant to other less-developed nations based on current trends. Special attention is afforded to canine rabies, as dogs remain responsible for over 99% of all human exposures to the virus, including the methods and problems associated with intentional and unintentional movement of dogs at national and international levels. Finally, the chapter discusses the economic burden of rabies in terms of human and infrastructure support.

A retrospective study of rabies in humans in Zimbabwe, between 1992 and 2003

This study aimed at examining the epidemiological features of rabies in humans in Zimbabwe. The data were taken from internal reports of the department of veterinary technical services at Harare covering the period 1st January 1992-31st December 2003 inclusive. Positive cases were examined in relation to age and sex of the victim, animal vector involved, season, and land-use categories. The majority of the confirmed positive human cases (85.7%) were recorded in communal areas. The 5-19 year age group and males constituted a highly vulnerable group. Over 90% of the cases were due to dog bites with jackals (Canis adustus and C. mesomelas), and honey badgers (Mellivora capensis) also contributing to the positive cases. Rabid cats and rabid wild animals had a high relative risk (RR) of biting humans. Animal-to-human transmission was highest during the dry months of July to November.

Antigenic characterization of rabies virus isolates from vaccinated dogs in plateau state, Nigeria

Rabies isolates (genotype 1 lyssaviruses) from vaccinated dogs that died of rabies infection in the Plateau area of Nigeria were characterized using monoclonal antibodies (MAbs). The isolates were examined for rabies (genotype 1) and rabies-related (genotypes 2, 3 and 4) viruses by the indirect fluorescent antibody test carried out with MAb 502-2, which recognizes the nucleocapsid protein of all known lyssaviruses, and with MAb 422-5, which identifies only rabies-related viruses. All three isolates showed positive immunofluorescence with MAb 502-2 and were negative with MAb 422-5, indicating that they were all rabies (genotype 1) viruses. Characterization with a panel of 36 anti-nucleocapsid monoclonal antibodies showed that all three isolates reacted positively with 35 of the anti-nucleocapsid MAbs, including MAb 102-27 and MAb 377-7. Characterization using a panel of 44 anti-glycoprotein MAbs differentiated the isolates sharply from LEP Flury and PM vaccine viruses. The pattern of anti-glycoprotein reactivity of the isolates showed them to belong to one distinct viral subtype, except for a minor variation in one isolate that was not neutralized by MAb 1101-3. None of the three isolates was identified as the Flury low egg passage (LEP) vaccine strain used for vaccinating dogs in Nigeria. In fact, all the three isolates had the typical pattern of reactivity of isolates from unvaccinated dogs, including MASS 83, a rabies virus isolated in Nigeria and characterized at the Wister Institute before this study.

Antigenic characterisation of virus isolates from vaccinated dogs dying of rabies

Four rabies virus isolates from dogs that succumbed to rabies infection in Nigeria within one year of anti-rabies vaccination were characterised by monoclonal antibodies (MAbs). The samples were screened for rabies and rabies-related viral antigens by the indirect fluorescent antibody test, performed with MAb 502-2, which recognises the nucleocapsid (NC) protein of all known Lyssaviruses and with MAb 422-5 which identifies African rabies-related viruses. All four canine virus isolates displayed positive fluorescence with MAb 502-2 and were negative with MAb 422-5. In the anti-NC MAb characterisation with a panel of 34 additional MAbs, all isolates displayed positive staining with 32 of the MAbs, were negative with MAb 102-27 and all displayed poor immunofluorescence with MAb 377-7. On the basis of reactivity with a panel of 40 anti-glycoprotein (G) MAbs the isolates were separated into four distinct viral subtypes. None of these canine isolates was identified as the common attenuated Flury LEP rabies strain used for domestic animal vaccination and none resembled other previously characterised rabies viruses from Nigeria.

The serological response of young dogs to the Flury LEP strain of rabies virus vaccine

The serological response of puppies from Nigeria to live Flury low egg passage (LEP) rabies vaccine was determined. Two sets of puppies were used: one set from rabies-vaccinated bitches and another set from non-vaccinated bitches. Puppies were vaccinated intramuscularly with Flury LEP strain rabies vaccine and serially bled from the 4th week to the 30th week. Serum rabies virus neutralizing antibodies (VNA) were measured by a modified rapid fluorescent focus inhibition test (RFFIT). Puppies from non-vaccinated bitches responded well to vaccination after the 4th week and through to the 10th week of age, showing a progressive increase in VNA. In contrast, puppies from vaccinated bitches responded well to rabies vaccination only at 10 weeks of age, although detectable maternal rabies VNA and rabies anti-ribonucleoprotein (RNP) antibodies had decreased by 6 weeks post partum.

Trial of economical regimens of suckling mouse brain rabies vaccine for postexposure prophylaxis in Lagos, Nigeria

The suckling mouse brain rabies vaccine, recommended for production and routine use in Nigeria from our previous study, was investigated in the present study in an effort to reduce the cost of antirabies treatment in the country. This is needed for economic reasons. Instead of seven daily doses followed by three boosters, we tried five daily doses followed by three boosters, with or without equine hyperimmune serum given on day 0 (40 IU per kg body weight). Fifty dog-bite, victims, aged 3-81 years, were placed on this regimen, 25 with serum and 25 without serum, according to the history of the case. The serum had no effect on the kinetics of antibody development and both serum and vaccine were well tolerated. The geometric mean titres (GMTs) of antirabies antibodies in the sera of recipients of vaccine alone on days 10, 28 and 90 were 3.05 equivalent units ml-1 (EU ml-1), 4.35 EU ml-1 and 2.54 EU ml-1 respectively. Among those who had received antiserum and vaccine the titres were respectively 3.19 EU ml-1, 4.35 EU ml-1 and 3.02 EU ml-1. Of the 50 subjects, 49 showed detectable antibodies by day 28, and all the 50 survived. This regimen is therefore recommended for further trial in countries where rabies is endemic but potent antirabies vaccines are scarce and expensive. Another 23 subjects, considered not to be at risk of rabies, were given a one-tenth dose, two-site intradermal inoculation of the same vaccine on days 0, 3, 7, 14, 28 and 90.(ABSTRACT TRUNCATED AT 250 WORDS)

Vaccination challenge studies with variants of street rabies virus isolated in Nigeria

In a preliminary study it was observed that adult ICR mice immunized with serial dilutions of an inactivated experimental human rabies vaccine from the Pitman-Moore (PM) vaccine virus were well protected against challenge with homologous virulent PM virus and challenge virus standard (CVS). However only one of five variant representatives in five of seven groups of 41 isolates of street rabies virus from Nigeria characterized by hybridoma monoclonal antibodies specific for the nucleocapsid and glycoprotein antigens of rabies virion was protected for by the vaccine. Guinea pigs immunized with a live attenuated low egg passage (LEP, Flury strain) vaccine currently used in canine vaccination in Nigeria protected against challenge with all five variants. The LEP vaccine protected against the variants and CVS quite well even when 1:125 dilution of the vaccine was used.

Emergence of antirabies vaccine of unknown origin for human treatment in Nigeria

Rabies is endemic in Nigeria. It is one of the most important and dreadful zoonotic diseases in the country and the dog is seen as the principal host and reservoir animal. Fatal human rabies resulting from dog bites has been reported. Dog bites in Nigeria occur regularly throughout the year and the rate of bite could be considered very high. The treatment of the exposed has been a matter of concern.

Anti-rabies treatment of dog-bite victims in Lagos, Nigeria: trial of suckling mouse brain and fetal bovine kidney cell rabies vaccines

Human rabies is common in Nigeria, a country known for rabies endemicity. Yet the supply of anti-rabies vaccines for human use (adult sheep brain origin, produced locally, and duck embryo and human diploid cell vaccines, imported) is grossly inadequate. This study involved controlled treatment of dog-bite victims with suckling mouse brain (SMBV) or fetal bovine kidney (FBKV) rabies vaccines in an effort to determine which type to recommend for production and use in Nigeria. Dog-bite victims treated were aged three to 74 years, with about equal numbers of males and females. Of the 136 patients, 116 (85.3%) completed at least the primo-series of vaccinations, and all have survived without any evidence of clinical rabies. Recipients of the SMBV showed local and generalized reactions in 11.1% and 2.5% of the cases, respectively. Recipients of the FBKV administered subcutaneously showed local and generalized reactions, in 12.5% and 9.4% of cases, respectively. There were no side effects attributable to the vaccine among patients who received the FBKV intramuscularly. By day 7, 26.7% of SMBV recipients and 28.6% of FBKV recipients showed antibody response, with titres of at least one Equivalent Unit ml-1. These percentages increased to 95.1 and 81.1, respectively, by day 14, and by day 20 (for SMBV recipients) or day 30 (FBKV recipients) the response was 100%. Titres dropped by day 90, but in no case to below 1 EU ml-1. We have concluded that both vaccines are equally efficacious and well tolerated. In view of the simple technology required, and the resultant lower cost, the SMBV is being recommended for production and use in Nigeria.