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Estel K, Scheuermann-Poley C, Goertz O, Urban J, Landscheidt K, Wenzel W, Willy C. [Trauma surgical relevance of bite injuries by animals and humans]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2024:10.1007/s00113-024-01441-1. [PMID: 38884780 DOI: 10.1007/s00113-024-01441-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/08/2024] [Indexed: 06/18/2024]
Abstract
Bite injuries require differentiated treatment due to the deeply inoculated polymicrobial pathogen spectrum, possible concomitant injuries and pronounced soft tissue damage. Dog bites are the most common bite injuries but are less complicated to heal than human and cat bites. The location of the bite greatly depends on the age and the size of the bite victim as well as the type of bite perpetrator. In every case detection of the pathogen should be carried out to provide the best possible adapted treatment in the event of an exacerbation. The primary antibiotic treatment should be empirical with amoxicillin + clavulanic acid or ampicillin + sulbactam and, if necessary, adjusted according to the antibiogram. Depending on the findings, surgical treatment includes excision of the bite canal and a customized wound debridement. It is important to check the vaccination status of those involved and if indicated, to carry out postexposure prophylaxis for tetanus and rabies.
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Affiliation(s)
- Katharina Estel
- Klinik für Unfallchirurgie, Orthopädie und Septisch-Rekonstruktive Chirurgie, Bundeswehrkrankenhaus Berlin, 10115, Berlin, Deutschland
| | - Catharina Scheuermann-Poley
- Klinik für Unfallchirurgie, Orthopädie und Septisch-Rekonstruktive Chirurgie, Bundeswehrkrankenhaus Berlin, 10115, Berlin, Deutschland
| | - Ole Goertz
- Klinik für Plastische, Rekonstruktive & Ästhetische Chirurgie, Handchirurgie, Martin Luther Krankenhaus und Evangelische Elisabeth Klinik Berlin, Berlin, Deutschland
| | - Jennifer Urban
- Klinik für Plastische, Rekonstruktive & Ästhetische Chirurgie, Handchirurgie, Martin Luther Krankenhaus und Evangelische Elisabeth Klinik Berlin, Berlin, Deutschland
| | - Kristina Landscheidt
- Klinik für Plastische, Rekonstruktive & Ästhetische Chirurgie, Handchirurgie, Martin Luther Krankenhaus und Evangelische Elisabeth Klinik Berlin, Berlin, Deutschland
| | - Werner Wenzel
- Klinik für Mikrobiologie, Bundeswehrkrankenhaus Berlin, Berlin, Deutschland
| | - Christian Willy
- Klinik für Unfallchirurgie, Orthopädie und Septisch-Rekonstruktive Chirurgie, Bundeswehrkrankenhaus Berlin, 10115, Berlin, Deutschland.
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Tenzin T, Hikufe EH, Hedimbi N, Athingo R, Shikongo MB, Shuro T, Iipinge J, Herman N, Naunyango M, Haufiku F, Peter J, Hango L, Gottlieb S, Shoombe K, Denzin N, Busch F, Lohr F, Letshwenyo M, Torres G, Freuling CM, Müller T, Shilongo A. Dog ecology and rabies knowledge, attitude and practice (KAP) in the Northern Communal Areas of Namibia. PLoS Negl Trop Dis 2024; 18:e0011631. [PMID: 38315727 PMCID: PMC10881021 DOI: 10.1371/journal.pntd.0011631] [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: 08/31/2023] [Revised: 02/21/2024] [Accepted: 01/24/2024] [Indexed: 02/07/2024] Open
Abstract
In 2021, a comprehensive dog demographic questionnaire combined with a KAP survey were conducted in the northern communal areas (NCAs) of Namibia with the aim of gaining a better understanding of dog populations, owner behaviour, and knowledge, attitudes and practices (KAP) relating to rabies. The survey of 3,726 households across the eight regions of the NCAs provided insights that will inform interventions in order to improve human rabies prevention and Namibia's dog rabies control strategy. The results showed a relatively low average human/dog ratio (HDR) of 5.4:1 indicating a surprisingly high dog population of at least 272,000 dogs in the NCAs, 93% of which appear to be owned but are free-roaming. Data analysis revealed opportunities but also highlighted needs for improvements in rabies surveillance and mass dog vaccinations. Although knowledge, attitude, and practice scores towards epidemiologic and clinical aspects, human rabies prevention, and dog rabies vaccination were deemed to be acceptable, the survey nevertheless revealed deficiencies in certain aspects in some of the population. Interestingly, data seemed to indicate relatively high dog bite incidences per 100,000 people, ranging between 262 and 1,369 and a certain number of unreported human rabies cases. Despite the very high number of dogs, only 50% of dog-owning households reported having vaccinated their dogs. In order to address these issues, the planning, announcement, and implementation of mass dog vaccination campaigns needs to be adapted to achieve adequate vaccination coverage. Another focus needs to be on rabies awareness and education if Namibia is to be significantly contributing to the global goal of "Zero by 30".
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Affiliation(s)
- Tenzin Tenzin
- World Organisation for Animal Health (WOAH), Sub-Regional Representation for Southern Africa, Gaborone, Botswana
| | - Emmanuel H. Hikufe
- Directorate of Veterinary Services, Ministry of Agriculture, Water and Land Reform, Windhoek, Namibia
| | - Nehemia Hedimbi
- State Veterinary Office, Ministry of Agriculture, Water & Land Reform, Directorate of Veterinary Services, Kunene region, Opuwo, Namibia
| | - Rauna Athingo
- Animal Disease Control—North, State Veterinary Office, Ministry of Agriculture, Water & Land Reform, Directorate of Veterinary Services, Ongwediva, Namibia
| | - Mainelo Beatrice Shikongo
- State Veterinary Office, Ministry of Agriculture, Water & Land Reform, Directorate of Veterinary Services, Zambezi region, Katima Mulilo, Namibia
| | - Thompson Shuro
- State Veterinary Office, Ministry of Agriculture, Water & Land Reform, Directorate of Veterinary Services, Kavango East region, Rundu, Namibia
| | - Johannes Iipinge
- State Veterinary Office, Ministry of Agriculture, Water & Land Reform, Directorate of Veterinary Services, Oshana region, Ondangwa, Namibia
| | - Nelson Herman
- State Veterinary Office, Ministry of Agriculture, Water & Land Reform, Directorate of Veterinary Services, Oshana region, Ondangwa, Namibia
| | - Matias Naunyango
- State Veterinary Office, Ministry of Agriculture, Water & Land Reform, Directorate of Veterinary Services, Ohangwena region, Eenhana, Namibia
| | - Frenada Haufiku
- State Veterinary Office, Ministry of Agriculture, Water & Land Reform, Directorate of Veterinary Services, Oshikoto region, Omuthiya, Namibia
| | - Josephat Peter
- State Veterinary Office, Ministry of Agriculture, Water & Land Reform, Directorate of Veterinary Services, Omusati region, Outapi, Namibia
| | - Laina Hango
- State Veterinary Office, Ministry of Agriculture, Water & Land Reform, Directorate of Veterinary Services, Omusati region, Outapi, Namibia
| | - Sara Gottlieb
- State Veterinary Office, Ministry of Agriculture, Water & Land Reform, Directorate of Veterinary Services, Kavango East region, Nkurunkuru, Namibia
| | - Kenneth Shoombe
- Animal Disease Control—North, State Veterinary Office, Ministry of Agriculture, Water & Land Reform, Directorate of Veterinary Services, Ongwediva, Namibia
| | - Nicolai Denzin
- Institute of Epidemiology, Friedrich-Loeffler-Institut (FLI), Greifswald-Insel Riems, Germany
| | - Frank Busch
- Institute of International Animal Health/One Health, Friedrich-Loeffler-Institut (FLI), Greifswald-Insel Riems, Germany
| | | | - Moetapele Letshwenyo
- World Organisation for Animal Health (WOAH), Sub-Regional Representation for Southern Africa, Gaborone, Botswana
| | | | - Conrad M. Freuling
- Institute of Molecular Virology and Cell Biology, Friedrich-Loeffler-Institut (FLI), WHO Collaborating Centre for Rabies Surveillance and Research, WOAH Reference Laboratory for Rabies, Greifswald-Insel Riems, Germany
| | - Thomas Müller
- Institute of Molecular Virology and Cell Biology, Friedrich-Loeffler-Institut (FLI), WHO Collaborating Centre for Rabies Surveillance and Research, WOAH Reference Laboratory for Rabies, Greifswald-Insel Riems, Germany
| | - Albertina Shilongo
- Directorate of Veterinary Services, Ministry of Agriculture, Water and Land Reform, Windhoek, Namibia
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Iddi S, Mlenga F, Hamasaki K, Mwita S, Konje E. Assessment of knowledge, attitude, and practice of dog owners to rabies disease in Kahama town council, Shinyanga region, Tanzania. PLoS Negl Trop Dis 2023; 17:e0011580. [PMID: 37672544 PMCID: PMC10482259 DOI: 10.1371/journal.pntd.0011580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 08/09/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND Rabies is a fatal zoonotic disease of significant public health importance. Domestic dogs are the main reservoir and transmitter of this disease, particularly in developing countries. Community awareness about rabies is one of the key components of prevention. This study describes the knowledge, attitudes, and practices about rabies disease among dog owners at Kahama town council, Shinyanga Region, Tanzania. METHODOLOGY This was a cross sectional community-based study which was done in May 2021. Structured questionnaires were administered to collect the data among 422 dog owners. The information collected included demographic characteristics of the dog owners, as well as their knowledge, attitude and practice towards rabies. Data were analyzed using SPSS statistical software version 20. RESULTS Out of 422 respondents, 421 (99.76%) knew that rabies can be transmitted by dogs, 384 (91%) knew that rabies can be prevented by vaccination of dogs, 269 (63.74%) knew the symptoms and signs, and 379 (89.81%) believed that it was necessary to vaccinate all owned dogs, but 227 (53.79%) had not vaccinated their dogs. Education level (p = 0.006) and occupation (p = 0.002) were significantly associated with a positive attitude, whereby those with a higher level of education and farmers were more likely to have a positive attitude. Also there was statistically significant association between gender (p = 0.038), marital status (p < 0.001) occupation (p < 0.001), education level (p = 0.006) and the practices of the respondents in the community whereby majority of male, unmarried dog owner who are farmer with primary education level had lower practice score. CONCLUSION This study concludes that respondents had good knowledge, a relatively good attitude, and poor practice towards rabies prevention and control. Rabies awareness with an emphasis on the importance of vaccination as well as vaccination campaigns should, therefore, be intensified, especially among the least educated dog owners.
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Affiliation(s)
- Shabani Iddi
- Department of Physiology, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Farida Mlenga
- Department of Pharmaceutics and Pharmacy Practice, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Kayo Hamasaki
- Department of Pharmaceutics and Pharmacy Practice, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Stanley Mwita
- Department of Pharmaceutics and Pharmacy Practice, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Eveline Konje
- Department of Biostatistics Epidemiology and Behavioral Sciences, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
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Warmerdam AMT, Luppino FS, Visser LG. The occurrence and extent of anxiety and distress among Dutch travellers after encountering an animal associated injury. Trop Dis Travel Med Vaccines 2023; 9:11. [PMID: 37580813 PMCID: PMC10426805 DOI: 10.1186/s40794-023-00193-x] [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: 02/15/2023] [Accepted: 05/29/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Prompt administration of post-exposure prophylaxis (PEP) is crucial to prevent a fatal rabies infection after an animal associated injury (AAI), preferably within 24 h. PEP, especially in case of a type III injury for which rabies immune globulin (RIG) is needed, is difficult to obtain abroad. This, along with the fear of potentially having contracted a lethal disease, might be an important source for anxiety and distress. We investigated the occurrence and extent of self-reported anxiety and distress at different timepoints among Dutch travellers after encountering an AAI, and the involved factors. METHODS A retrospective quantitative observational study was conducted including insured Dutch travellers who actively contacted Eurocross Assistance after encountering an AAI abroad. An online questionnaire was designed to measure anxiety and distress levels, using the HADS (Hospital Anxiety and Depression Scale) and distress thermometer at three time points: departure from home (T1), post-AAI (T2), and treatment administration (T3). Statistical analyses included T-tests, Chi-square tests, and ANCOVA analyses. RESULTS We showed a significant increase in mean anxiety and distress scores at T2, and a significant decrease at T3. Women were more often anxious and distressed. Between T1 and T2, PrEP, and being aware of the risks were positively associated with anxiety levels, and PrEP and WHO region Africa with distress levels. Between T2 and T3, anxiety levels remained higher for monkey-induced injury, thoracic injuries, and WHO region Southeast Asia. PEP-delay between 24-48 h resulted in decreased distress levels at this time period, while type II injury elevated distress levels. CONCLUSIONS This study showed significant anxiety and distress levels after an AAI among the vast majority of travellers, which is detrimental to their health-related quality of life (HR-QOL). This highlights the importance of proper pre-travel information. In the context of rabies prevention, these results suggest that pre-travel advice and policy makers should also take aspects of HR-QOL into consideration.
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Affiliation(s)
| | | | - Leo G Visser
- Department of Infectious Diseases, Leiden University Medical Centre, Leiden, the Netherlands
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Khan UR, Soomar SM, Ghazi SM, Naeem R, Kerai S, Jamali S. Epidemiological pattern and management of dog bite injuries in Karachi, Pakistan: A cross-sectional study. Injury 2023; 54 Suppl 4:110473. [PMID: 37573070 DOI: 10.1016/j.injury.2022.11.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 10/19/2022] [Accepted: 11/07/2022] [Indexed: 08/14/2023]
Abstract
BACKGROUND Dog bite injuries are a common problem globally; however, little is known about the epidemiology of dog bite injury from a low-and-middle-income country like Pakistan. This study aims to determine the epidemiology of dog bite injuries among children and adults from a tertiary care hospital in Karachi, Pakistan. METHODS We conducted a cross-sectional study on dog bite patients visiting the emergency department from November 2015 to August 2016 of a major public tertiary care hospital. Data was collected using a structured questionnaire on demographic details, bite history, and management of dog bite victims. Descriptive analysis was reported. Chi-square test was applied to check the associations between age-specific dog bite cases and independent variables. RESULTS 2178 participants were included in the analysis. 715 (38.8%) were children less than 18 years old, and 1463 (61.2%) were adults over 18 years. A majority of the patients were males (1909, 87.7%). Results show that most dog bite injuries (2052, 94.2%) tend to occur outside the house by stray dogs biting without provocation. People aged 18 years and above (61.2%) and males (children: 84.6%, adults: 89.1%) tend to be bitten more often. Lower limbs are most frequently bitten (children: 69.5%, adults: 85.8%). Free-roaming stray dogs (children: 73.4%, adults: 74.9%) were involved in reported biting cases. Many of the patients did not receive appropriate first aid and instead just washed the wound with soap and water (children: 45.1%, adults: 43.7%). 99% of the victims received Tetanus toxoid, Rabies vaccine, and immunoglobulins while in the emergency department. CONCLUSION There is a high burden of dog bite injuries from stray dogs in Karachi, Pakistan. Efforts should be made to create awareness among the general public on the risks of dog bites and on seeking appropriate first aid and medical attention for a dog bite injury.
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Affiliation(s)
- Uzma Rahim Khan
- Instructor (Research), Department of Emergency Medicine, Aga Khan University Hospital, Main Stadium Road, Karachi 75300, Pakistan
| | - Salman Muhammad Soomar
- Instructor (Research), Department of Emergency Medicine, Aga Khan University Hospital, Main Stadium Road, Karachi 75300, Pakistan.
| | - Sanam Mir Ghazi
- Instructor (Research), Department of Emergency Medicine, Aga Khan University Hospital, Main Stadium Road, Karachi 75300, Pakistan
| | - Rubaba Naeem
- Instructor (Research), Department of Emergency Medicine, Aga Khan University Hospital, Main Stadium Road, Karachi 75300, Pakistan
| | - Salima Kerai
- Instructor (Research), Department of Emergency Medicine, Aga Khan University Hospital, Main Stadium Road, Karachi 75300, Pakistan
| | - Seemin Jamali
- Jinnah Postgraduate Medical Centre, Karachi, Pakistan
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Hellgren F, Cagigi A, Arcoverde Cerveira R, Ols S, Kern T, Lin A, Eriksson B, Dodds MG, Jasny E, Schwendt K, Freuling C, Müller T, Corcoran M, Karlsson Hedestam GB, Petsch B, Loré K. Unmodified rabies mRNA vaccine elicits high cross-neutralizing antibody titers and diverse B cell memory responses. Nat Commun 2023; 14:3713. [PMID: 37349310 PMCID: PMC10287699 DOI: 10.1038/s41467-023-39421-5] [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: 07/23/2022] [Accepted: 06/13/2023] [Indexed: 06/24/2023] Open
Abstract
Licensed rabies virus vaccines based on whole inactivated virus are effective in humans. However, there is a lack of detailed investigations of the elicited immune response, and whether responses can be improved using novel vaccine platforms. Here we show that two doses of a lipid nanoparticle-formulated unmodified mRNA vaccine encoding the rabies virus glycoprotein (RABV-G) induces higher levels of RABV-G specific plasmablasts and T cells in blood, and plasma cells in the bone marrow compared to two doses of Rabipur in non-human primates. The mRNA vaccine also generates higher RABV-G binding and neutralizing antibody titers than Rabipur, while the degree of somatic hypermutation and clonal diversity of the response are similar for the two vaccines. The higher overall antibody titers induced by the mRNA vaccine translates into improved cross-neutralization of related lyssavirus strains, suggesting that this platform has potential for the development of a broadly protective vaccine against these viruses.
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Affiliation(s)
- Fredrika Hellgren
- Division of Immunology and Allergy, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
- Center of Molecular Medicine, Stockholm, Sweden
| | - Alberto Cagigi
- Division of Immunology and Allergy, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
- Center of Molecular Medicine, Stockholm, Sweden
- Nykode Therapeutics, Oslo, Norway
| | - Rodrigo Arcoverde Cerveira
- Division of Immunology and Allergy, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
- Center of Molecular Medicine, Stockholm, Sweden
| | - Sebastian Ols
- Division of Immunology and Allergy, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
- Center of Molecular Medicine, Stockholm, Sweden
| | - Theresa Kern
- Division of Immunology and Allergy, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
- Center of Molecular Medicine, Stockholm, Sweden
| | - Ang Lin
- Division of Immunology and Allergy, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
- Center of Molecular Medicine, Stockholm, Sweden
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Bengt Eriksson
- Astrid Fagraeus Laboratory, Comparative Medicine, Karolinska Institutet, Stockholm, Sweden
| | | | | | | | - Conrad Freuling
- Institute for Molecular Virology and Cell Biology, Friedrich-Loeffler-Institut, Greifswald-Insel Riems, Greifswald, Germany
| | - Thomas Müller
- Institute for Molecular Virology and Cell Biology, Friedrich-Loeffler-Institut, Greifswald-Insel Riems, Greifswald, Germany
| | - Martin Corcoran
- Department of Microbiology and Tumor Biology, Karolinska Institutet, Stockholm, Sweden
| | | | | | - Karin Loré
- Division of Immunology and Allergy, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.
- Center of Molecular Medicine, Stockholm, Sweden.
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Chuchu VM, Mutono N, Bichanga P, Kitala PM, Ksee D, Muturi M, Mwatondo A, Nasimiyu C, Akunga L, Amiche A, Hampson K, Thumbi SM. Effect of Phone Text Message Reminders on Compliance with Rabies Post-Exposure Prophylaxis following Dog Bites in Rural Kenya. Vaccines (Basel) 2023; 11:1112. [PMID: 37376501 DOI: 10.3390/vaccines11061112] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 05/29/2023] [Accepted: 06/08/2023] [Indexed: 06/29/2023] Open
Abstract
The prompt administration of post-exposure prophylaxis (PEP) is one of the key strategies for ending human deaths from rabies. A delay in seeking the first dose of rabies PEP, or failure to complete the recommended dosage, may result in clinical rabies and death. We assessed the efficacy of short message system (SMS) phone texts in improving the adherence to scheduled PEP doses among bite patients in rural eastern Kenya. We conducted a single-arm, before-after field trial that compared adherence among bite patients presenting at Makueni Referral Hospital between October and December 2018 (control) and between January and March 2019 (intervention). Data on their demographics, socio-economic status, circumstances surrounding the bite, and expenditures related to the bite were collected. A total of 186 bite patients were enrolled, with 82 (44%) in the intervention group, and 104 (56%) in the control group. The odds of PEP completion were three times (OR 3.37, 95% CI 1.28, 10.20) more likely among patients who received the SMS reminder, compared to the control. The intervention group had better compliance on the scheduled doses 2 to 5, with a mean deviation of 0.18 days compared to 0.79 days for the control group (p = 0.004). The main reasons for non-compliance included lack of funds (30%), and forgetfulness (23%) on days for follow-up treatment, among others. Nearly all (96%, n = 179) the bite patients incurred indirect transport costs, at an average of USD 4 (USD 0-45) per visit. This study suggests that the integration of SMS reminders into healthcare service delivery increases compliance with PEP, and may strengthen rabies control and elimination strategies.
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Affiliation(s)
- Veronicah M Chuchu
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu 1578-40100, Kenya
- Department of Public Health, Pharmacology and Toxicology, University of Nairobi, Nairobi 29053-00625, Kenya
- Paul G. Allen School for Global Health, Washington State University, Pullman, WA 99164-7090, USA
| | - Nyamai Mutono
- Paul G. Allen School for Global Health, Washington State University, Pullman, WA 99164-7090, USA
- Centre for Epidemiological Modelling and Analysis, University of Nairobi, Nairobi 19676-00202, Kenya
| | - Philet Bichanga
- Department of Health Services, Government of Makueni County, Makueni 95-90300, Kenya
| | - Philip M Kitala
- Department of Public Health, Pharmacology and Toxicology, University of Nairobi, Nairobi 29053-00625, Kenya
| | - Daniel Ksee
- Department of Agriculture, Irrigation, Livestock and Fisheries Development, Government of Makueni County, Makueni 78-90300, Kenya
| | - Mathew Muturi
- Zoonotic Disease Unit, Joint One Health Office of the Ministry of Health and the Ministry of Agriculture, Livestock and Fisheries, Government of Kenya, Nairobi 20811-00202, Kenya
| | - Athman Mwatondo
- Zoonotic Disease Unit, Joint One Health Office of the Ministry of Health and the Ministry of Agriculture, Livestock and Fisheries, Government of Kenya, Nairobi 20811-00202, Kenya
| | - Carolyne Nasimiyu
- Paul G. Allen School for Global Health, Washington State University, Pullman, WA 99164-7090, USA
| | | | | | - Katie Hampson
- Institute of Biodiversity, Animal Health & Comparative Medicine, Graham Kerr Building, University of Glasgow, Glasgow G12 8QQ, UK
| | - Samuel M Thumbi
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu 1578-40100, Kenya
- Paul G. Allen School for Global Health, Washington State University, Pullman, WA 99164-7090, USA
- Centre for Epidemiological Modelling and Analysis, University of Nairobi, Nairobi 19676-00202, Kenya
- Institute of Immunology and Infection Research, School of Biological Sciences, University of Edinburgh, Edinburgh EH8 9YL, UK
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Gborie SR, Issahaku GR, Bonful HA, Bandoh DA, Squire J, Ameme DK, Kenu E. Analysis of dog bite surveillance data, Volta Region, Ghana, 2020. FRONTIERS IN TROPICAL DISEASES 2023. [DOI: 10.3389/fitd.2023.1096275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Abstract
IntroductionDog bite is the second most common injury sustained by humans after snake bites, and it is amongst the top 12 causes of non-fatal injuries worldwide. Globally, 59,000 human deaths occur annually due to rabies, and 95% of these deaths occur in Asia and Africa. Dog bites remained a public health concern in Ghana, with three out of every 1000 incidence resulting in human rabies. Analysis of the surveillance data is key in understanding the burden of dog bites in the Volta region. This study describes the epidemiology of dog bites in the Volta Region, Ghana, to inform policy on prevention and control.MethodsWe conducted a descriptive analysis of secondary data on dog bites. We obtained aggregate data from 2015 to 2019 from the District Health Management Information System (DHMIS). Variables extracted were gender, age, and location. Data were entered into a Microsoft Excel cleaned, reviewed, and analyzed. We used descriptive statistics to summarize results into frequency and proportion and displayed results in tables, graphs, and maps.ResultsDuring the study period, 4737 dog bite cases were identified from a population of 1,907,529 (incidence of 248 per 100,000). Twelve (0.25%) humans were confirmed for rabies with a 100% case fatality rate. Males accounted for 2455 (51.8%) of dog bite cases. The age group between 10 and 19 years (21.9%) was most affected. About 35.0% (1640/4737) were administered with the anti-rabies vaccine, and 25.3% (1200/4737) were administered anti-tetanus toxoid. Keta district (550 per 100000) reported the highest incidence of dog bites. Dog bite cases were highest in the third and fourth quarters of 2016 and the first quarter of 2017.ConclusionThe incidence of dog bites and rabies was high in the Volta region. Children and adolescents were mostly affected. There was a low coverage rate of anti-rabies vaccine and anti-tetanus toxoids usage. We recommended that the Regional Health Directorates and the Regional Veterinary Department develop robust strategies to control stray or free-roaming dogs in the Volta region.
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Kisaka S, Makumbi F, Majalija S, Bahizi G, Thumbi SM. Delays in initiating rabies post-exposure prophylaxis among dog bite victims in Wakiso and Kampala districts, Uganda. AAS Open Res 2022; 4:49. [PMID: 36419540 PMCID: PMC9648361 DOI: 10.12688/aasopenres.13311.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2022] [Indexed: 12/13/2022] Open
Abstract
Background Although rabies in dog bite patients is preventable through timely initiation of post-exposure prophylaxis (PEP), a number of barriers to achieving PEP exist. This study investigated the delays to initiation of PEP among dog bite patients in the emergency departments of two PEP centers in Uganda. Methods A cross-sectional study was conducted among dog-bite patients that presented to two selected rabies PEP centers. A semi-structured questionnaire was used to collect data. Delay to receive PEP was defined as reporting for PEP beyond 24 hours after the bite event. Generalized linear models were used to calculate prevalence ratios and the 95% confidence intervals as a measure of association between delay and patient factors. Results Out of 376 participants, just over half (53.5%) were males. The majority of participants (54.0%) were 15 years or older and 28.5% had no formal education. Just over three-quarters (77.9%) had category II dog bite wounds. Nearly 40% delayed to receive PEP, and median (inter quartile range) lag time between bite event and seeking medical care of 18 (41) hours. Compared to education level of secondary or above, patients with no formal education (adj. PR=4.06, 95% CI: 2.69 - 6.10) or primary education (adj.PR=2.15, 95% CI: 1.37 - 3.35), belonging to the lowest socio-economic tertile as compared to the highest (adj.PR=1.58, 95% CI: 1.10 - 2.28), knowing the owner of the biting dog (adj.PR=1.30, 95% CI: 1.02 - 1.65) and having category II wounds (adj.PR=2.31, 95% CI: 1.43 - 3.71) were all associated with delayed presentation for PEP. Conclusions and recommendations Delays to receive PEP are common and are associated with poor level of education or low socio-economic status, knowledge of who the dog owner is and less severity of bite wounds. Seeking care irrespective of wound severity or knowledge of dog owner should be promoted.
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Affiliation(s)
- Stevens Kisaka
- University of Nairobi Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, 00254, Kenya
- School of Public Health, Makerere University, Kampala, 00256, Uganda
- College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, 00256, Uganda
| | - Fredrick Makumbi
- School of Public Health, Makerere University, Kampala, 00256, Uganda
| | - Samuel Majalija
- College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, 00256, Uganda
| | - Gloria Bahizi
- School of Public Health, Makerere University, Kampala, 00256, Uganda
- Department of National Disease Control, Ministry of Health, Uganda, Kampala, 00256, Uganda
| | - SM Thumbi
- University of Nairobi Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, 00254, Kenya
- Paul G Allen School for Global Animal Health, Washington State University, Washington, 001, USA
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10
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Whitehouse ER, Mandra A, Bonwitt J, Beasley EA, Taliano J, Rao AK. Human rabies despite post-exposure prophylaxis: a systematic review of fatal breakthrough infections after zoonotic exposures. THE LANCET INFECTIOUS DISEASES 2022; 23:e167-e174. [PMID: 36535276 DOI: 10.1016/s1473-3099(22)00641-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 08/05/2022] [Accepted: 09/06/2022] [Indexed: 12/23/2022]
Abstract
Post-exposure prophylaxis (PEP) for rabies is widely administered and highly effective. Nevertheless, sporadic breakthrough infections (ie, rabies in people who have started PEP) have been reported. We conducted a systematic review of articles published between Jan 1, 1980 and June 1, 2022 to characterise breakthrough infections. After reviewing 3380 articles from across all continents, we identified 52 articles, which included a total of 122 breakthrough infections. We classified breakthrough infections on the basis of adherence to core practices (ie, wound cleaning and vaccine administration). Of 86 breakthrough infections with data, median time from exposure to symptom onset was 20 days (IQR 16-24). Most (89 [77%] of 115) participants received PEP within 2 days of an exposure. Severe wounds (defined as those involving multiple wound sites or bites to the head, face, or neck) were common (80 [69%] of 116 [with data]). Deviations from core practices were reported in 68 (56%) of 122 cases. Other possible causes for breakthrough infections included errors in the administration of rabies immunoglobulin, delays in seeking health care, and comorbidities or immunosuppression. Cold-chain integrity assessments and potency testing of PEP biologics were only rarely assessed (8 [7%] of 122 cases), neither of which were found to be a cause of breakthrough infections. Timely and appropriate administration of PEP is crucial to prevent rabies, and although people with high-risk exposures or immunosuppression can develop rabies despite adherence to core practices, this occurrence remains exceedingly rare.
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Swedberg C, Mazeri S, Mellanby RJ, Hampson K, Chng NR. Implementing a One Health Approach to Rabies Surveillance: Lessons From Integrated Bite Case Management. FRONTIERS IN TROPICAL DISEASES 2022; 3:829132. [PMID: 36945698 PMCID: PMC7614337 DOI: 10.3389/fitd.2022.829132] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
As part of the 'Zero by 30' strategy to end human deaths from dog-mediated rabies by 2030, international organizations recommend a One Health framework that includes Integrated Bite Case Management (IBCM). However, little is understood about the implementation of IBCM in practice. This study aims to understand how IBCM is conceptualized, exploring how IBCM has been operationalized in different contexts, as well as barriers and facilitators to implementation. Semi-structured interviews were conducted with seventeen practitioners and researchers with international, national, and local expertise across Africa, Asia, and the Americas. Thematic analysis was undertaken using both inductive and deductive approaches. Four main themes were identified: 1) stakeholders' and practitioners' conceptualization of IBCM and its role in rabies elimination; 2) variation in how IBCM operates across different contexts; 3) barriers and facilitators of IBCM implementation in relation to risk assessment, PEP provisioning, animal investigation, One Health collaboration, and data reporting; and 4) the impact of the COVID-19 pandemic on IBCM programs. This study highlights the diversity within experts' conceptualization of IBCM, and its operationalization. The range of perspectives revealed that there are different ways of organizing IBCM within health systems and it is not a one-size-fits-all approach. The issue of sustainability remains the greatest challenge to implementation. Contextual features of each location influenced the delivery and the potential impact of IBCM. Programs spanned from highly endemic settings with limited access to PEP charged to the patient, to low endemicity settings with a large patient load associated with free PEP policies and sensitization. In practice, IBCM was tailored to meet the demands of the local context and level of rabies control. Thus, experts' experiences did not necessarily translate across contexts, affecting perceptions about the function, motivation for, and implementation of IBCM. To design and implement future and current programs, guidance should be provided for health workers receiving patients on assessing the history and signs of rabies in the biting animal. The study findings provide insights in relation to implementation of IBCM and how it can support programs aiming to reach the Zero by 30 goal.
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Affiliation(s)
- Catherine Swedberg
- Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, United Kingdom
| | - Stella Mazeri
- Royal (Dick) School of Veterinary Studies and the Roslin Institute, University of Edinburgh, Easter Bush Campus, Roslin, United Kingdom
| | - Richard J. Mellanby
- Royal (Dick) School of Veterinary Studies and the Roslin Institute, University of Edinburgh, Easter Bush Campus, Roslin, United Kingdom
| | - Katie Hampson
- Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, United Kingdom
| | - Nai Rui Chng
- Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
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Voupawoe G, Anthony W, Hattendorft J, Odermatt P, Zinsstag J, Mauti S. Preparing liberia for rabies control: Human-dog relationship and practices, and vaccination scenarios. Acta Trop 2022; 229:106331. [PMID: 35139326 DOI: 10.1016/j.actatropica.2022.106331] [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: 08/06/2021] [Revised: 01/22/2022] [Accepted: 01/23/2022] [Indexed: 11/29/2022]
Abstract
To reach zero dog-related human rabies deaths by 2030, Liberia must prioritize rabies as a public health threat. Understanding dog demography parameters are imperative and sets the basis for planning cost-effective and sustainable mass dog vaccination programs nationwide. We conducted a cross-sectional household survey in eleven rural districts of Bong and one urban district of Montserrado County to gather baseline information on the canine population, human-mediated dog movements, people's relationships and practices towards dogs, and further information to estimate costs for a nationwide campaign. In total, 1282 respondents were interviewed (612 rural and 670 urban). About 34% of the rural and 37% of the urban households owned at least one dog. The canine: human ratios were 1:6.1 in the rural and1:5.6 in the urban area and did not differ notably among both counties. The estimated canine population for Liberia is 594,640. The majority of respondents (55%) reported poor waste disposal. Muslims were less likely to own a dog than Christians (39% vs 19% OR: 0.4 95% CI: 0.2-0.6) (p< 0.001). Six percent of respondents mentioned that a family member was exposed to a dog bite in the past year, and most victims were adult males. Four of the victims reportedly died after showing rabies compatible symptoms. Twenty-seven percent of dog-owning households in rural areas reported that at least one dog originated from urban areas, and 2% of urban households brought in dogs from another country. In addition, 43% of respondents consumed dog meat at least once. Fifty percent of the respondents claimed knowledge of rabies but only 5.7% and 1.9% mentioned rabies transmission through rabies-infected saliva and rabies-infected mucus on broken skin. Forty percent of the respondents did not know whether rabies was incurable in humans once clinical signs appear. Assuming 30 vaccinators could vaccinate 50 dogs per day for eighteen months (371 working days), the total cost for the vaccination of the national Liberian canine population is estimated at 1.6 million (USD) for one vaccination round. Our study reveals an overall poor disease knowledge and the potential for spread of rabies in the study areas. A nationwide rabies awareness is crucial to enhance rabies prevention and control through mass dog vaccination.
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Affiliation(s)
- Garmie Voupawoe
- Swiss Tropical and Public Health Institute, P.O. BoX, CH-4002 Basel, Switzerland; University of Basel, Petersplatz 1, CH-4001 Basel, Switzerland; Leon Quist Ledlum Central Veterinary Laboratory, Ministry of Agriculture, Republic of Liberia.
| | - Watta Anthony
- Leon Quist Ledlum Central Veterinary Laboratory, Ministry of Agriculture, Republic of Liberia
| | - Jan Hattendorft
- Swiss Tropical and Public Health Institute, P.O. BoX, CH-4002 Basel, Switzerland; University of Basel, Petersplatz 1, CH-4001 Basel, Switzerland
| | - Peter Odermatt
- Swiss Tropical and Public Health Institute, P.O. BoX, CH-4002 Basel, Switzerland; University of Basel, Petersplatz 1, CH-4001 Basel, Switzerland
| | - Jakob Zinsstag
- Swiss Tropical and Public Health Institute, P.O. BoX, CH-4002 Basel, Switzerland; University of Basel, Petersplatz 1, CH-4001 Basel, Switzerland
| | - Stephanie Mauti
- Swiss Tropical and Public Health Institute, P.O. BoX, CH-4002 Basel, Switzerland; University of Basel, Petersplatz 1, CH-4001 Basel, Switzerland
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Burke RV, Russo P, Sicilia M, Wolowich W, Amega N, Nguyen HB. Epidemiology of rabies immune globulin use in paediatric and adult patients in the USA: a cross-sectional prevalence study. BMJ Open 2022; 12:e055411. [PMID: 35473745 PMCID: PMC9045048 DOI: 10.1136/bmjopen-2021-055411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES To compare the epidemiology of paediatric and adult patients receiving rabies immune globulin (RIG). DESIGN Cross-sectional prevalence study. SETTING Eligible participants from the Symphony Integrated Dataverse presenting between 2013 and 2019. PARTICIPANTS All adult and paediatric patients with integrated claims and demographic data associated with RIG use from the Symphony Integrated Dataverse from 2013 to 2019. PRIMARY AND SECONDARY OUTCOME MEASURES Prevalence of diagnoses and procedures associated with paediatric and adult patient population based on frequency of International Classification of Diseases (ICD-9/ICD-10) and Current Procedural Terminology codes, respectively. METHODS We used mutual information to identify features that differentiate the paediatric from adult patient population. Prevalence ratios were calculated to compare adult and paediatric patients. RESULTS There were 79 766 adult and 20 381 paediatric patients who met the inclusion criteria. Paediatric patients had a 5.92-fold higher prevalence of 'open wounds to the head; neck; and trunk', 3.10-fold higher prevalence of 'abrasion or friction burn of face; neck; and scalp except eye; without mention of infection', 4.44-fold higher prevalence of 'open wound of scalp; without mention of complication' and 6.75-fold higher prevalence of 'laceration of skin of eyelid and periocular area | laceration of eyelid involving lacrimal passages'. Paediatric patients had a 3.83-fold higher prevalence of complex repairs compared with adult patients (n=157, 0.7% vs n=157, 0.2%, respectively). CONCLUSIONS Paediatric patients represent a significant proportion of the patient population receiving RIG, and are associated with higher prevalence of codes reporting repair of larger, more complex wounds in highly innervated anatomical regions. Dosing and administration of RIG must be informed by animal bite wound characteristics; clinicians should understand the differences between presentations in adults and children and treat accordingly.
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Affiliation(s)
- Rita V Burke
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | | | - Michael Sicilia
- Eversana Life Science Services, Milwaukee (HQ), Wisconsin, USA
| | | | - Novinyo Amega
- Department of Medical Affairs, Kedrion Biopharma, Fort Lee, New Jersey, USA
| | - Huy-Binh Nguyen
- Department of Medical Affairs, Kedrion Biopharma, Fort Lee, New Jersey, USA
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Nyasulu PS, Weyer J, Tschopp R, Mihret A, Aseffa A, Nuvor SV, Tamuzi JL, Nyakarahuka L, Helegbe GK, Ntinginya NE, Gebreyesus MT, Doumbia S, Busse R, Drosten C. Rabies mortality and morbidity associated with animal bites in Africa: a case for integrated rabies disease surveillance, prevention and control: a scoping review. BMJ Open 2021; 11:e048551. [PMID: 34857556 PMCID: PMC8640643 DOI: 10.1136/bmjopen-2020-048551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 09/08/2021] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE The objective of this scoping review was to map the current situation and available evidence and gaps on rabies morbidity, mortality, integrated rabies surveillance programmes, and existing prevention and control strategies in Africa. METHODS We conducted a systematic scoping review following the Joanna Briggs methodology and Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews checklist. Medline, Embase, CINAHL (EBSCOHost), Scopus, Web of Science and rabies web conferences were used to search for peer-reviewed publications between January 1946 and May 2020. Two researchers reviewed the studies and extracted data based on author (year) and region, study design and data collection duration, participants/comparators, interventions, control conditions/exposures and outcomes (rabies mortality and morbidity) and key findings/gaps/challenges. The results were reported narratively using Arksey and O'Malley's methodological framework. RESULTS Electronic search yielded 2775 records, of which 43 studies were included. A total of 543 714 bite victims were censored through the included studies. Most of the victims were less than 15 years of age. The studies included rabies morbidity (21) and mortality (15) fluctuating in space and time across Africa depending on countries' rabies prevention and control practices (16). Others were surveillance (nine studies); surveillance and prevention (five studies); management and control (seven studies); and surveillance, prevention and control (six studies). We found challenges in rabies reporting, existing dog vaccination programmes and post-exposure prophylaxis availability or compliance. CONCLUSION This study found challenges for dog rabies control and elimination in Africa and the need for a policy to drive the goal of zero dog-transmitted rabies to humans by 2030.This is an open-access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build on this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated and the use is non-commercial (see http://creativecommons.org/licenses/by-nc/4.0/).
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Affiliation(s)
- Peter Suwirakwenda Nyasulu
- Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jacqueline Weyer
- Centre for Emerging Zoonosis and Parasitic Diseases, National Institute of Communicable Diseases, Johannesburg, South Africa
- Department of Microbiology and Infectious Diseases, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Rea Tschopp
- Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Adane Mihret
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Abraham Aseffa
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Samuel Victor Nuvor
- Department of Microbiology and Immunology, School of Medical Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Jacques Lukenze Tamuzi
- Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Luke Nyakarahuka
- Department of Biosecurity, Ecosystems and Veterinary Public Health, College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, Uganda
| | - Gideon Kofi Helegbe
- Department of Biochemistry and Molecular Medicine, School of Medicine, University for Development Studies, Tamale, Ghana
| | - Nyanda Elias Ntinginya
- Mbeya Medical Research Centre, National Institute of Medical Research, Mbeya, Tanzania, United Republic of
| | | | - Seydou Doumbia
- Faculty of Medicine and Odontostomatology & University Clinical Research Center, University of Sciences, Techniques and Technology of Bamako, Bamako, Mali
| | - Reinhard Busse
- Department of Health Care Management, Technical University Berlin, Berlin, Germany
| | - Christian Drosten
- Institute of Virology, Charité-University Medicine Berlin, Berlin, Germany
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Kisaka S, Makumbi F, Majalija S, Bahizi G, Thumbi SM. Delays in initiating rabies post-exposure prophylaxis among dog bite victims in Wakiso and Kampala districts, Uganda. AAS Open Res 2021; 4:49. [PMID: 36419540 PMCID: PMC9648361 DOI: 10.12688/aasopenres.13311.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Although rabies in dog bite patients is preventable through timely initiation of post-exposure prophylaxis (PEP), a number of barriers to achieving PEP exist. This study investigated the delays to initiation of PEP among dog bite patients in the emergency departments of two PEP centers in Uganda. Methods: A cross-sectional study was conducted among dog-bite patients that presented to two selected rabies PEP centers. A semi-structured questionnaire was used to collect data. Delay to receive PEP was defined as reporting for PEP beyond 24 hours after the bite event. Generalized linear models were used to calculate prevalence ratios and the 95% confidence intervals as a measure of association between delay and patient factors. Results: Out of 376 participants, just over half (53.5%) were males. The majority of participants (54.0%) were 15 years or older and 28.5% had no formal education. Just over three-quarters (77.9%) had category II dog bite wounds. Nearly 40% delayed to receive PEP, and median (inter quartile range) lag time between bite event and seeking medical care of 18 (41) hours. Compared to education level of secondary or above, patients with no formal education (adj. PR=4.06, 95% CI: 2.69 - 6.10) or primary education (adj.PR=2.15, 95% CI: 1.37 - 3.35), belonging to the lowest socio-economic tertile as compared to the highest (adj.PR=1.58, 95% CI: 1.10 - 2.28), knowing the owner of the biting dog (adj.PR=1.30, 95% CI: 1.02 - 1.65) and having category II wounds (adj.PR=2.31, 95% CI: 1.43 - 3.71) were all associated with delayed presentation for PEP. Conclusions and recommendations: Delays to receive PEP are common and are associated with poor level of education or low socio-economic status, knowledge of who the dog owner is and less severity of bite wounds. Seeking care irrespective of wound severity or knowledge of dog owner should be promoted.
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Affiliation(s)
- Stevens Kisaka
- University of Nairobi Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, 00254, Kenya
- School of Public Health, Makerere University, Kampala, 00256, Uganda
- College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, 00256, Uganda
| | - Fredrick Makumbi
- School of Public Health, Makerere University, Kampala, 00256, Uganda
| | - Samuel Majalija
- College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, 00256, Uganda
| | - Gloria Bahizi
- School of Public Health, Makerere University, Kampala, 00256, Uganda
- Department of National Disease Control, Ministry of Health, Uganda, Kampala, 00256, Uganda
| | - SM Thumbi
- University of Nairobi Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, 00254, Kenya
- Paul G Allen School for Global Animal Health, Washington State University, Washington, 001, USA
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Li D, Liao H, Chen F, Jiang Q, Wang T, Lu Z, Liu Q, Cao S. The wound severity of animal bite victims visiting rabies prevention clinics and the influencing factors in Central China: a cross-sectional investigation. BMC Public Health 2021; 21:2125. [PMID: 34798864 PMCID: PMC8605553 DOI: 10.1186/s12889-021-12207-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 10/29/2021] [Indexed: 01/02/2023] Open
Abstract
Background Animal bites are a major public health problem. The more serious the bite wound is, the higher the risk of developing rabies is. This study aimed to investigate the severity of wounds among animal bite victims and identify the influencing factors in Wuhan, China. Methods A cross-sectional study was conducted among 1015 animal bite victims visiting rabies prevention clinics. We performed a face-to-face interview to collect information on the exposure category of the bite wound, the type of the offending animal, exposure-to-risk situations, etc. Factors associated with exposure categories were identified by multivariate logistic regression analysis. Results Five hundred and sixty-four (55.57%) cases were category III exposures, 418 (41.18%) were category II exposures, and 33 (3.25%) were category I exposures. People who were hurt by their own domestic animals (odds ratio [OR] = 1.55, 95% confidence interval [CI]: 1.14–2.10), and those exposed to animals unvaccinated against rabies (OR = 1.45, 95% CI: 1.08–1.95) had a higher risk for category III exposures. Respondents who did not know the fatality of rabies were more likely to be injured seriously compared to those who knew that rabies is fatal, and the OR was 1.40 (95% CI, 1.05–1.86). Conclusions This study showed that factors associated with the severity of bite wounds mainly included types of the offending animal, vaccination status of the animal, and knowledge of rabies fatality. Educational programs and awareness-raising campaigns should be provided to decrease severe animal bites, especially targeting pet owners and those with limited rabies knowledge.
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Affiliation(s)
- Dandan Li
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hanlin Liao
- Department of Medical Services Section, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Fan Chen
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qingqing Jiang
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tiantian Wang
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zuxun Lu
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qiaoyan Liu
- Research Institute of Rehabilitation Information, China Rehabilitation Science Institute, Beijing, China. .,China Rehabilitation Research Center, Beijing, China.
| | - Shiyi Cao
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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Whitehouse ER, Person MK, Brown CM, Slavinski S, Rao AK, Blanton JD. Evaluating Surveillance for and Estimating Administration of Rabies Postexposure Prophylaxis in the United States, 2012-2018. PLoS Negl Trop Dis 2021; 15:e0009878. [PMID: 34695115 PMCID: PMC8568135 DOI: 10.1371/journal.pntd.0009878] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 11/04/2021] [Accepted: 10/05/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND An evaluation of postexposure prophylaxis (PEP) surveillance has not been conducted in over 10 years in the United States. An accurate assessment would be important to understand current rabies trends and inform public health preparedness and response to human rabies. METHODOLOGY/PRINCIPLE FINDINGS To understand PEP surveillance, we sent a survey to public health leads for rabies in 50 U.S. states, Puerto Rico, Washington DC, Philadelphia, and New York City. Of leads from 54 jurisdictions, 39 (72%) responded to the survey; 12 reported having PEP-specific surveillance, five had animal bite surveillance that included data about PEP, four had animal bite surveillance without data about PEP, and 18 (46%) had neither. Although 12 jurisdictions provided data about PEP use, poor data quality and lack of national representativeness prevented use of this data to derive a national-level PEP estimate. We used national-level and state specific data from the Healthcare Cost & Utilization Project (HCUP) to estimate the number of people who received PEP based on emergency department (ED) visits. The estimated annual average of initial ED visits for PEP administration during 2012-2017 in the United States was 46,814 (SE: 1,697), costing upwards of 165 million USD. State-level ED data for initial visits for administration of PEP for rabies exposure using HCUP data was compared to state-level surveillance data from Maryland, Vermont, and Georgia between 2012-2017. In all states, state-level surveillance data was consistently lower than estimates of initial ED visits, suggesting even states with robust PEP surveillance may not adequately capture individuals who receive PEP. CONCLUSIONS Our findings suggest that making PEP a nationally reportable condition may not be feasible. Other methods of tracking administration of PEP such as syndromic surveillance or identification of sentinel states should be considered to obtain an accurate assessment.
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Affiliation(s)
- Erin R. Whitehouse
- Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- * E-mail:
| | - Marissa K. Person
- Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Catherine M. Brown
- Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health, Boston, Massachusetts, United States of America
| | - Sally Slavinski
- New York City Department of Health and Mental Hygiene, New York, New York, United States of America
| | - Agam K. Rao
- Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Jesse D. Blanton
- Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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18
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Kisaka S, Makumbi F, Majalija S, Bahizi G, Thumbi SM. Delays in initiating rabies post-exposure prophylaxis among dog bite victims in Wakiso and Kampala districts, Uganda. AAS Open Res 2021; 4:49. [PMID: 36419540 PMCID: PMC9648361 DOI: 10.12688/aasopenres.13311.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Although rabies in dog bite patients is preventable through timely initiation of post-exposure prophylaxis (PEP), a number of barriers to achieving PEP exist. This study investigated the delays to initiation of PEP among dog bite patients in the emergency departments of two PEP centers in Uganda. Methods: A cross-sectional study was conducted among dog-bite patients that presented to two selected rabies PEP centers. A semi-structured questionnaire was used to collect data. Delay to receive PEP was defined as reporting for PEP beyond 24 hours after the bite event. Generalized linear models were used to calculate prevalence ratios and the 95% confidence intervals as a measure of association between delay and patient factors. Results: Out of 376 participants, just over half (53.5%) were males. The majority of participants (54.0%) were 15 years or older and 28.5% had no formal education. Just over three-quarters (77.9%) had category II dog bite wounds. Nearly 40% delayed to receive PEP, and median (IQR) lag time between bite event and seeking medical care of 18 (41) hours. Compared to education level of secondary or above, patients with no formal education (adj. PR=4.06, 95% CI: 2.69 - 6.10) or primary education (adj.PR=2.15, 95% CI: 1.37 - 3.35), belonging to the lowest socio-economic tertile as compared to the highest (adj.PR=1.58, 95% CI: 1.10 - 2.28), knowing the owner of the biting dog (adj.PR=1.30, 95% CI: 1.02 - 1.65) and having category II wounds (adj.PR=2.31, 95% CI: 1.43 - 3.71) were all associated with delayed presentation for PEP. Conclusions and recommendations: Delays to receive PEP are common and are associated with poor level of education or low socio-economic status, knowledge of who the dog owner is and less severity of bite wounds. Seeking care irrespective of wound severity or knowledge of dog owner should be promoted.
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Affiliation(s)
- Stevens Kisaka
- University of Nairobi Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, 00254, Kenya
- School of Public Health, Makerere University, Kampala, 00256, Uganda
- College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, 00256, Uganda
| | - Fredrick Makumbi
- School of Public Health, Makerere University, Kampala, 00256, Uganda
| | - Samuel Majalija
- College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, 00256, Uganda
| | - Gloria Bahizi
- School of Public Health, Makerere University, Kampala, 00256, Uganda
- Department of National Disease Control, Ministry of Health, Uganda, Kampala, 00256, Uganda
| | - SM Thumbi
- University of Nairobi Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, 00254, Kenya
- Paul G Allen School for Global Animal Health, Washington State University, Washington, 001, USA
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19
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Savu AN, Schoenbrunner AR, Politi R, Janis JE. Practical Review of the Management of Animal Bites. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3778. [PMID: 34522565 PMCID: PMC8432645 DOI: 10.1097/gox.0000000000003778] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 07/01/2021] [Indexed: 11/26/2022]
Abstract
Animal bites are common worldwide. Due to the plethora of animals, there are diverse pathogens with specific associated risks and treatment algorithms. It is crucial to understand these to develop and execute appropriate management plans. This practical review was designed to amalgamate the most common bites worldwide and synthesize data to help guide treatment plans. METHODS A PubMed literature search was performed focusing on the major animal bites. High-level studies were preferred and analyzed but lower-level studies were also used if high-level studies did not exist. RESULTS The tables presented in this article cover the pertinent information regarding the incidence, common presentation, initial treatment, and potential complications associated with bites from dogs, cats, horses, rodents, snakes, marine life, and spiders. Many of the pathogens associated with the bites are treatable with various and somewhat common antimicrobials, though some are less easy to access. Basic irrigation, debridement, and wound culture are common to almost every animal and should be the first step in treatment. CONCLUSIONS Based on the current studies, the most important factor in treating animal bites is timely presentation to a medical facility and/or physician. It is critical that the offending animal be accurately identified to help guide medical and surgical algorithms, including specific antimicrobial treatment guided by the most commonly presenting pathogens specific to certain animals.
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Affiliation(s)
- Andrei N. Savu
- From the Ohio State College of Medicine, The Ohio State University, Columbus, Ohio
| | - Anna R. Schoenbrunner
- Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
- The University of Virginia School of Medicine, The University of Virginia, Charlottesville, Va
| | - Rachel Politi
- Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
- The University of Virginia School of Medicine, The University of Virginia, Charlottesville, Va
| | - Jeffrey E. Janis
- The University of Virginia School of Medicine, The University of Virginia, Charlottesville, Va
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20
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Williams BM, Purcell L, Kayange L, Gallaher J, Charles A. Characteristic and outcomes of human and animal bites in Malawi. Injury 2021; 52:2188-2193. [PMID: 33785190 PMCID: PMC8380653 DOI: 10.1016/j.injury.2021.03.045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 03/14/2021] [Accepted: 03/17/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Bites are an important contributor to traumatic injury worldwide. In low- and middle-income countries, data regarding bite injuries outside of rabies is limited. Therefore, we sought to describe the injury characteristics and outcomes of bites in Lilongwe, Malawi, and determine risk factors for animals and human bites. METHODS We performed a retrospective analysis of the Kamuzu Central Hospital trauma registry from 2008-2018. We performed Bivariate analyses comparing bite to non-bite trauma and human to animal bites. Multivariable Poisson regression modeling then estimated risk factors for bites. RESULTS A total of 124,394 patients were captured by the registry, of which 3,680 (3%) had a bite injury mechanism. Human bites accounted for 14.5% of bite injuries, and animals represented the remaining 85.5%. In rare cases, animal bite victims had serious complications, such as amputation (n = 6, 0.2%), orthopedic procedures (n = 5, 0.2%), and death (n = 7, 0.2%). Risk factors for an animal bite included being on a farm, field, or lake and being at home, whereas risk factors for a human bite included alcohol use and being at home. CONCLUSION Animal bite injuries in Malawi can confer a risk of serious complications, such as amputation and, in rare cases, death. Alcohol-associated, in-home interpersonal violence is a significant risk factor for human bite injuries. Further studies are needed to identify risk factors for complications and mortality.
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Affiliation(s)
- Brittney M Williams
- Department of Surgery, University of North Carolina, Chapel Hill, North Carolina 27599, USA
| | - Laura Purcell
- Department of Surgery, University of North Carolina, Chapel Hill, North Carolina 27599, USA
| | - Linda Kayange
- Department of Surgery, Kamuzu Central Hospital, Lilongwe Malawi
| | - Jared Gallaher
- Department of Surgery, University of North Carolina, Chapel Hill, North Carolina 27599, USA
| | - Anthony Charles
- Department of Surgery, University of North Carolina, Chapel Hill, North Carolina 27599, USA; Department of Surgery, Kamuzu Central Hospital, Lilongwe Malawi.
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21
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Tasiame W, El-Duah P, Johnson SAM, Owiredu EW, Bleicker T, Veith T, Schneider J, Emikpe B, Folitse RD, Burimuah V, Akyereko E, Drosten C, Corman VM. Rabies virus in slaughtered dogs for meat consumption in Ghana: A potential risk for rabies transmission. Transbound Emerg Dis 2021; 69:e71-e81. [PMID: 34331389 DOI: 10.1111/tbed.14266] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/25/2021] [Accepted: 07/26/2021] [Indexed: 11/29/2022]
Abstract
Dog-mediated rabies is responsible for approximately 60,000 human deaths annually worldwide. Although dog slaughter for human consumption and its potential risk for rabies transmission has been reported, mainly in some parts of Western Africa and South-East Asia, more information on this and factors that influence dog meat consumption is required for a better understanding from places like Ghana where the practice is common. We tested 144 brain tissues from apparently healthy dogs slaughtered for human consumption for the presence of rabies viruses using a Lyssavirus-specific real-Time RT-PCR. Positive samples were confirmed by virus genome sequencing. We also administered questionnaires to 541 dog owners from three regions in Ghana and evaluated factors that could influence dog meat consumption. We interacted with butchers and observed slaughtering and meat preparation procedures. Three out of 144 (2.1%) brain tissues from apparently healthy dogs tested positive for rabies virus RNA. Two of the viruses with complete genomes were distinct from one another, but both belonged to the Africa 2 lineage. The third virus with a partial genome fragment had high sequence identity to the other two and also belonged to the Africa 2 lineage. Almost half of the study participants practiced dog consumption [49% (265/541)]. Males were almost twice (cOR = 1.72, 95% CI (1.17-2.52), p-value = .006) as likely to consume dog meat compared to females. Likewise, the Frafra tribe from northern Ghana [cOR = 825.1, 95% CI (185.3-3672.9), p-value < .0001] and those with non-specific tribes [cOR = 47.05, 95% CI (10.18-217.41), p-value < .0001] presented with higher odds of dog consumption compared to Ewes. The butchers used bare hands in meat preparation. This study demonstrates the presence of rabies virus RNA in apparently healthy dogs slaughtered for human consumption in Ghana and suggests a potential risk for rabies transmission. Veterinary departments and local assemblies are recommended to monitor and regulate this practice.
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Affiliation(s)
- William Tasiame
- School of Veterinary Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.,Institute of Virology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Philip El-Duah
- Institute of Virology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Sherry A M Johnson
- School of Veterinary Medicine, CBAS, University of Ghana, Legon, Accra, Ghana
| | - Eddie-Williams Owiredu
- Department of Molecular Medicine, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Tobias Bleicker
- Institute of Virology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Talitha Veith
- Institute of Virology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Julia Schneider
- Institute of Virology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Benjamin Emikpe
- School of Veterinary Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Raphael D Folitse
- School of Veterinary Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Vitus Burimuah
- School of Veterinary Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Ernest Akyereko
- Disease Surveillance Department, Ghana Health Service, Accra, Ghana
| | - Christian Drosten
- Institute of Virology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,German Centre for Infection Research (DZIF), Associated Partner Site at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Victor Max Corman
- Institute of Virology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,German Centre for Infection Research (DZIF), Associated Partner Site at Charité - Universitätsmedizin Berlin, Berlin, Germany
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22
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Croughs M, van den Hoogen GAL, van Jaarsveld CHM, Bantjes SE, Pijtak-Radersma AH, Haverkate MR, Swaan CM, Ruijs WLM. Rabies risk behaviour in a cohort of Dutch travel clinic visitors: A retrospective analysis. Travel Med Infect Dis 2021; 43:102102. [PMID: 34098095 DOI: 10.1016/j.tmaid.2021.102102] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 04/28/2021] [Accepted: 06/01/2021] [Indexed: 01/27/2023]
Abstract
BACKGROUND Travellers to rabies endemic countries should be counselled on rabies risk and, in case of high-risk, pre-exposure vaccination is advised. However, it is not clear which travellers exactly are at high risk. In this study we determined the incidence of possible rabies exposure in travel clinic visitors and compliance with pre-travel advice. METHODS Travellers to rabies endemic countries who visited a Dutch travel clinic between September 2017 and May 2018, were invited to participate. RESULTS Of 980 travellers, one percent was injured by a potentially rabid animal. Compliance with advice was low as 59% reported proximity to a potentially rabid animal and only half of those exposed sought medical advice. The most important predictors of proximity to a potentially rabid animal were young age, long travel duration, visiting a monkey forest and hiking for more than one day. Travel for business was associated with lower risk. CONCLUSION Despite pre-travel advice, rabies risk behaviour was high. Therefore, we would recommend to keep the threshold for pre-travel vaccination low. Pending more data on rabies exposure risk, the identified predictors of proximity to potentially rabid animals could be used to tailor indications for pre-travel rabies vaccination.
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Affiliation(s)
- Mieke Croughs
- Institute of Tropical Medicine, Department of Clinical Sciences, Antwerp, Belgium; GGD Hart voor Brabant, Tilburg, Travel Clinic, Until 2019, the Netherlands
| | - Godelief A L van den Hoogen
- Mensely Occupational Health Service Company, Utrecht, the Netherlands; GGD West Brabant, Department of Infectious Diseases, Breda, the Netherlands
| | - Cornelia H M van Jaarsveld
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, the Netherlands.
| | - Sabine E Bantjes
- RIVM National Institute for Public Health and the Environment, National Coordination Centre for Communicable Disease Control, Bilthoven, the Netherlands
| | - Atie H Pijtak-Radersma
- Public Health Service Regio Utrecht, Department of Travel Medicine, Utrecht, the Netherlands
| | - Manon R Haverkate
- RIVM National Institute for Public Health and the Environment, National Coordination Centre for Communicable Disease Control, Bilthoven, the Netherlands
| | - Corien M Swaan
- RIVM National Institute for Public Health and the Environment, National Coordination Centre for Communicable Disease Control, Bilthoven, the Netherlands
| | - Wilhelmina L M Ruijs
- RIVM National Institute for Public Health and the Environment, National Coordination Centre for Communicable Disease Control, Bilthoven, the Netherlands
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23
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Wright N, Subedi D, Pantha S, Acharya KP, Nel LH. The Role of Waste Management in Control of Rabies: A Neglected Issue. Viruses 2021; 13:225. [PMID: 33535718 PMCID: PMC7912825 DOI: 10.3390/v13020225] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 01/25/2021] [Accepted: 01/28/2021] [Indexed: 12/25/2022] Open
Abstract
Despite being vaccine preventable, the global burden of dog rabies remains significant, and historically it is the rural and marginalized communities in developing countries of Africa and Asia that are most threatened by the disease. In recent years, the developing world has been experiencing unprecedented increases in urbanization, with a correspondingly massive increase in municipal solid waste generation, among other things. Inefficient and inadequate waste collection and management, due to lack of resources and planning, led to significant increases in the volumes of waste on the streets and in open dumps, where it serves as food sources for free-roaming dogs. In this commentary, we discuss examples of poor waste management and the likely impact on rabies control efforts through the sustenance of free-roaming dogs in some dog rabies-endemic countries. We aim to stress the importance of implementing strategies that effectively address this particular issue as an important component of humane dog population management, as it relates to aspirations for the control and elimination of dog rabies per se.
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Affiliation(s)
- Nicolette Wright
- Department of Biochemistry, Genetics and Microbiology, Faculty of Natural and Agricultural Sciences, University of Pretoria, Pretoria 0083, South Africa;
| | - Deepak Subedi
- Paklihawa Campus, Institute of Agriculture and Animal Science, Tribhuvan University, Paklihawa, Rupandehi 32900, Nepal; (D.S.); (S.P.)
| | - Saurav Pantha
- Paklihawa Campus, Institute of Agriculture and Animal Science, Tribhuvan University, Paklihawa, Rupandehi 32900, Nepal; (D.S.); (S.P.)
| | - Krishna Prasad Acharya
- Animal Quarantine Office (AQO), Department of Livestock Services, Kathmandu 44600, Nepal;
| | - Louis Hendrik Nel
- Department of Biochemistry, Genetics and Microbiology, Faculty of Natural and Agricultural Sciences, University of Pretoria, Pretoria 0083, South Africa;
- Global Alliance for Rabies Control SA NPC, Erasmus Forum A434, South Erasmus Rand, Pretoria 0181, South Africa
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24
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Barrios CL, Bustos-López C, Pavletic C, Parra A, Vidal M, Bowen J, Fatjó J. Epidemiology of Dog Bite Incidents in Chile: Factors Related to the Patterns of Human-Dog Relationship. Animals (Basel) 2021; 11:E96. [PMID: 33419043 PMCID: PMC7825333 DOI: 10.3390/ani11010096] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 12/14/2020] [Accepted: 12/21/2020] [Indexed: 01/18/2023] Open
Abstract
Dog bites are one of the main public health problems. They produce important consequences for those who suffer them (physical and psychological injuries, secondary infections, sequelae, risk of transmission of zoonoses and surgeries, among others). The objective of this study was to characterize epidemiologically the incidents of bites in Chile and the patterns of human-dog relationship involved. The records analyzed in this article were obtained from bitten patients who attended the main public health facilities in Chile during the period 17 September 2017 and 17 September 2018: In the period studied, 17,299 animal bites were recorded; however, only 7220 (41.74%) cases were analyzed in which the offending species could be identified. Of the bites analyzed, 6533 were caused by dogs (90.48%). Of these, 41.05% were caused by medium-sized dogs. Most bites were caused by dogs of mixed breeds (55.99%), followed by dogs of the German Shepherd breed (8.50%). Most of the dogs that bit were known to the victim (99.95%) and most of the attacks occurred indoors (57.48%). Although dog bite records have improved in Chile, it would be useful to also include background information on the context in which the incident occurred, which would be very useful for developing effective bite prevention programs.
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Affiliation(s)
- Carmen Luz Barrios
- Cátedra Fundación Affinity Animales y Salud, Universitat Autónoma de Barcelona, Parque de Investigación Biomédica de Barcelona, C/Dr. Aiguader 88, 08003 Barcelona, Spain;
- Escuela de Medicina Veterinaria, Facultad de Ciencias, Universidad Mayor, Camino La Pirámide 5750, Huechuraba, Región Metropolitana 8580745, Chile;
| | - Carlos Bustos-López
- Departamento de Ciencias Básicas, Facultad de Ciencias, Universidad Santo Tomás, Santiago, Chile, Av. Ejército Libertador 146, Santiago, Región Metropolitana 8320000, Chile;
| | - Carlos Pavletic
- Departamento de Zoonosis y Vectores, Ministerio de Salud, Enrique Mac Iver 541, Santiago, Región Metropolitana 8320064, Chile; (C.P.); (A.P.)
| | - Alonso Parra
- Departamento de Zoonosis y Vectores, Ministerio de Salud, Enrique Mac Iver 541, Santiago, Región Metropolitana 8320064, Chile; (C.P.); (A.P.)
| | - Macarena Vidal
- Escuela de Medicina Veterinaria, Facultad de Ciencias, Universidad Mayor, Camino La Pirámide 5750, Huechuraba, Región Metropolitana 8580745, Chile;
| | - Jonathan Bowen
- Queen Mother Hospital for Small Animals, Royal Veterinary College, Hawkshead Lane, North Mymms, Hertfordshire AL9 7TA, UK;
| | - Jaume Fatjó
- Cátedra Fundación Affinity Animales y Salud, Universitat Autónoma de Barcelona, Parque de Investigación Biomédica de Barcelona, C/Dr. Aiguader 88, 08003 Barcelona, Spain;
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25
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Munibullah, Habibullah, Rashid HB, Mushtaq MH, Sadiq S, Hasan S, Chaudhry M. Incidence of Animal-Bite Injuries Registered in Public Hospitals of Post-Conflict Swat District, Pakistan in 2014. Am J Trop Med Hyg 2020; 104:329-337. [PMID: 33544696 DOI: 10.4269/ajtmh.20-0208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 09/06/2020] [Indexed: 10/23/2022] Open
Abstract
The Swat district, a conflict-hit territory due to Taliban militancy, had a damaged local health infrastructure. Animal-bite injuries leading to rabies is one of the major health concerns in developing countries, especially within conflict zones. The current prospective epidemiological study was conducted to estimate the cumulative incidence of animal-bite injuries, to summarize characteristics of bite victims and biting animals, and to collect information about post-exposure prophylaxis (PEP) practices in Swat district, Pakistan, during 2014. A questionnaire was designed to collect data about the sociodemography of the patients, bite incident situation (provoked or unprovoked), injury pattern, animal type, PEP, and vaccination. Descriptive analyses were conducted using bar graphs, frequency tables, and chi-square tests were used to determine associations. The cumulative incidence of animal-bite injuries was 39 per 100,000 people during the study period (May-August 2014). The majority of incidents were reported from rural regions (77.7%) and were males (76.6%) younger than 10 years (37.3%). Dogs were the most frequent biting animal (86.8%) followed by rats (4.7%). About 77.7% patients washed their wound before arrival at hospital. After an eclipse phase of 10 days, 44 (10.1%) animals developed sign of rabies. The current study has highlighted a topic of interest for health, education, veterinary, and local government policy makers regarding prevention of animal bites, benefits of PEP, vaccination of human and domestic animals, control of stray dogs, and eradication of rabies in developing countries with damaged healthcare structures.
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Affiliation(s)
- Munibullah
- 1Department of Epidemiology and Public Health, University of Veterinary and Animal Sciences, Lahore, Pakistan.,2Graduate School of Chinese Academy of Agriculture Science, Lanzhou Veterinary Research Institute, Lanzhou, China
| | | | - Hamad Bin Rashid
- 4Department of Clinical Medicine and Surgery, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Muhammad Hassan Mushtaq
- 1Department of Epidemiology and Public Health, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Shakera Sadiq
- 1Department of Epidemiology and Public Health, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Saima Hasan
- 1Department of Epidemiology and Public Health, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Mamoona Chaudhry
- 1Department of Epidemiology and Public Health, University of Veterinary and Animal Sciences, Lahore, Pakistan
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26
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Ahmed T, Hussain S, Zia UUR, Rinchen S, Yasir A, Ahmed S, Khan WA, Tahir MF, Ricketson R. Knowledge, attitude and practice (KAP) survey of canine rabies in Khyber Pakhtunkhwa and Punjab Province of Pakistan. BMC Public Health 2020; 20:1293. [PMID: 32847503 PMCID: PMC7448460 DOI: 10.1186/s12889-020-09388-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 08/16/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study aimed to assess the extent of knowledge and understanding of rabies disease in rural and urban communities of Pakistan. It also identified malpractices after suspected dog bite that might pose a risk for humans contracting rabies. METHODS A cross-sectional study was conducted (n = 1466) on people having different age groups and educational levels in four different geographic regions of Punjab and Khyber Pakhtunkhwa provinces in Pakistan. Knowledge, attitude, and practices of people were assessed using a structured questionnaire. We used a bivariate and multivariate analysis to study the association between rabies related mortalities in near or extended family members and different risk behaviors. RESULTS Our results demonstrate that the majority of the juvenile population (less than 18 years of age) were not aware of the clinical signs of rabies in animals. 75% of the total respondents were not vaccinated against rabies, 60% did not seek a doctor's advice after a suspected animal bite, and 55% had inadequate health care facilities for rabies patients in local hospitals. Respondents that had pets at home had not vaccinated (38%; p < 0.05; odds ratio 1.58) themselves against rabies due to lack of knowledge and awareness of pre-exposure prophylaxis for rabies (51%; p < 0.05; odds ratio 1.25). They also tend to not visit doctor after suspected bite (52%; p < 0.05; odds ratio 1.97), which may had resulted in more deaths (65%; p < 0.05; odds ratio 1.73) of someone in their near or extended family due to rabies. CONCLUSIONS Lack of knowledge about the nature of rabies disease and prophylaxis has contributed to increase of rabies related deaths. Inadequate health care facilities and poor attitude of not seeking medical attention after suspected dog bite are the major reasons of rabies related deaths. These findings could help in devising a targeted management strategy and awareness program to control and reduce the incidence of human rabies related deaths in Pakistan.
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Affiliation(s)
- Touseef Ahmed
- Department of Epidemiology and Public Health, University of Veterinary and Animal Sciences, Lahore, Pakistan.
- Department of Biological Sciences, Texas Tech University, Lubbock, TX, USA.
| | - Sabir Hussain
- Department of Epidemiology and Public Health, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Ubaid-Ur-Rehman Zia
- Department of Epidemiology and Public Health, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Sangay Rinchen
- Regional Livestock Development Centre, Department of Livestock, Tsimasham, Chukha, Bhutan
| | - Ammar Yasir
- Department of Epidemiology and Public Health, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Shafique Ahmed
- Centre of Excellence in Molecular Biology, Lahore, Pakistan
| | - Waqar Ali Khan
- Department of Clinical Medicine and Surgery, University of Veterinary and Animal Sciences, Lahore, Pakistan
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27
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Bashir K, Haq I, Khan SMS, Qurieshi MA. One-year descriptive analysis of patients treated at an anti-rabies clinic-A retrospective study from Kashmir. PLoS Negl Trop Dis 2020; 14:e0007477. [PMID: 32841227 PMCID: PMC7473535 DOI: 10.1371/journal.pntd.0007477] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 09/04/2020] [Accepted: 06/20/2020] [Indexed: 11/30/2022] Open
Abstract
Dog bites in humans are a major public health problem in India in general and Kashmir in particular. Canine rabies is almost non-existent in developed countries and exists mainly in the poorer, low socioeconomic strata of society in the developing world. The objective of this study was to determine the characteristics, pattern, and burden of dog bite injuries in the Kashmir valley. Data from Anti-Rabies Clinic of a tertiary care hospital in Srinagar, the summer capital of the state of Jammu & Kashmir, was collated and analyzed. Analysis of records of all the patients who had reported between April 2016 and March 2017 was done. A total of 6172 patients had reported to the Anti-Rabies Clinic for management of animal bites from 1st April 2016 to 31st March 2017. Most of the patients were young males. Almost half (47.7%) of the patients were bitten in the afternoon. Lower limbs were the most common site of bite (71.7%). Most of the bites were of Category III (57.6%) followed by Category II (42.3%); only one case of Category I was recorded. Almost all (98.0%) cases reported being bitten by dogs. Conclusions: Category III dog bites on lower limbs were the most common type of animal bites presenting to the Anti-Rabies Clinic of a tertiary care hospital. Children have more chances of a bite on head and neck region. Serious and workable efforts have to be made to reduce the incidence and consequences of animal bites.
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Affiliation(s)
- Khalid Bashir
- Department of Community Medicine, Government Medical College, Anantnag, Jammu & Kashmir, India
| | - Inaamul Haq
- Department of Community Medicine, Government Medical College, Srinagar, Jammu & Kashmir, India
| | - S. Muhammad Salim Khan
- Department of Community Medicine, Government Medical College, Srinagar, Jammu & Kashmir, India
| | - Mariya Amin Qurieshi
- Department of Community Medicine, Government Medical College, Srinagar, Jammu & Kashmir, India
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28
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Ferguson AW, Muloi D, Ngatia DK, Kiongo W, Kimuyu DM, Webala PW, Olum MO, Muturi M, Thumbi SM, Woodroffe R, Murugi L, Fèvre EM, Murray S, Martins DJ. Volunteer based approach to dog vaccination campaigns to eliminate human rabies: Lessons from Laikipia County, Kenya. PLoS Negl Trop Dis 2020; 14:e0008260. [PMID: 32614827 PMCID: PMC7331976 DOI: 10.1371/journal.pntd.0008260] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 03/29/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND An estimated 59,000 people die from rabies annually, with 99% of those deaths attributable to bites from domestic dogs (Canis lupus familiaris). This preventable Neglected Tropical Disease has a large impact across continental Africa, especially for rural populations living in close contact with livestock and wildlife. Mass vaccinations of domestic dogs are effective at eliminating rabies but require large amounts of resources, planning, and political will to implement. Grassroots campaigns provide an alternative method to successful implementation of rabies control but remain understudied in their effectiveness to eliminate the disease from larger regions. METHODOLOGY/PRINCIPAL FINDINGS We report on the development, implementation, and effectiveness of a grassroots mass dog rabies vaccination campaign in Kenya, the Laikipia Rabies Vaccination Campaign. During 2015-2017, a total of 13,155 domestic dogs were vaccinated against rabies in 17 communities covering approximately 1500 km2. Based on an estimated population size of 34,275 domestic dogs, percent coverages increased across years, from 2% in 2015 to 24% in 2017, with only 3 of 38 community-years of vaccination exceeding the 70% target. The average cost of vaccinating an animal was $3.44 USD with in-kind contributions and $7.44 USD without in-kind contributions. CONCLUSIONS/SIGNIFICANCE The evolution of the Laikipia Rabies Vaccination Campaign from a localized volunteer-effort to a large-scale program attempting to eliminate rabies at the landscape scale provides a unique opportunity to examine successes, failures, and challenges facing grassroots campaigns. Success, in the form of vaccinating more dogs across the study area, was relatively straightforward to achieve. However, lack of effective post-vaccination monitoring and education programs, limited funding, and working in diverse community types appeared to hinder achievement of 70% coverage levels. These results indicate that grassroots campaigns will inevitably be faced with a philosophical question regarding the value of local impacts versus their contributions to a larger effort to eliminate rabies at the regional, country, or global scale.
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Affiliation(s)
- Adam W. Ferguson
- Global Health Program, Smithsonian Conservation Biology Institute, Washington, United States of America
| | - Dishon Muloi
- Usher Institute of Population Health Sciences & Informatics, University of Edinburgh, Charlotte Auerbach Road,Edinburgh, United Kingdom
- Centre for Immunity, Infection and Evolution, University of Edinburgh, Edinburgh, United Kingdom
- International Livestock Research Institute,Nairobi, Kenya
| | - Dedan K. Ngatia
- School of Natural Resources & Environmental Studies, Karatina University, Karatina, Kenya
| | - Wangechi Kiongo
- School of Natural Resources & Environmental Studies, Karatina University, Karatina, Kenya
| | - Duncan M. Kimuyu
- School of Natural Resources & Environmental Studies, Karatina University, Karatina, Kenya
| | - Paul W. Webala
- Department of Forestry and Wildlife Management, Maasai Mara University, Narok, Kenya
| | - Moses O. Olum
- Kenya Agricultural and Livestock Research Organization, Muguga North,Kikuyu, Kenya
| | - Mathew Muturi
- Kenya Zoonotic Disease Unit, Ministry of Health and Ministry of Agriculture, Livestock, and Fisheries, Nairobi, Kenya
| | - Samuel M. Thumbi
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, Washington, United States of America
- Rabies Free Africa, Washington State University, Pullman, Washington, United States of America
| | - Rosie Woodroffe
- Institute of Zoology, Zoological Society of London, Regent’s Park, London, United Kingdom
| | - Lucy Murugi
- Ministry of Agriculture, Livestock, and Fisheries, County Government of Laikipia, Nanyuki, Kenya
| | - Eric M. Fèvre
- International Livestock Research Institute,Nairobi, Kenya
- Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, Leahurst Campus, Neston, United Kingdom
| | - Suzan Murray
- Global Health Program, Smithsonian Conservation Biology Institute, Washington, United States of America
| | - Dino J. Martins
- Mpala Research Centre, Nanyuki, Kenya
- Department of Ecology and Evolution, Princeton University, Princeton, New Jersey, United States of America
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KODİK MS, GÖKÇEK K, UZ İ, KIYAN GS. Bir acil serviste hayvan kökenli yaralanmaların incelenmesi. EGE TIP DERGISI 2020. [DOI: 10.19161/etd.756389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Julien DA, Sargeant JM, Filejski C, Harper SL. Ouch! A cross-sectional study investigating self-reported human exposure to dog bites in rural and urban households in southern Ontario, Canada. Zoonoses Public Health 2020; 67:554-565. [PMID: 32421250 DOI: 10.1111/zph.12719] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 01/10/2020] [Accepted: 03/31/2020] [Indexed: 11/28/2022]
Abstract
This study investigated self-reported dog bites in humans in rural and urban households in southern Ontario, Canada. Our objectives were to determine, and compare, the incidence of dog bites in rural and urban households, and to describe the profile of bite victims, biting dogs, and the proportion of biting dogs that respondents self-reported as being not up to date on rabies vaccination. We conducted a cross-sectional observational study using an online questionnaire. The 2,006 respondents, each representing one household, included 1,002 rural and 1,004 urban residences. The incidence risk of at least one person in the household being bitten over the previous year in rural households (6.09% per year) was less than in urban households (10.76% per year). In 53.20% of households from which at least one person had been bitten within the past year, only a single person had been bitten. Mostly, victims were 25 to 34 years old (21.67%), male (54.19%), and playing with or interacting with the biting dog at the time of the incident (59.11%). Most biting dogs were 3 to 5 years old (32.02%), males (53.69%), and unleashed (76.85%). Based on self-reporting by respondents, 83.33% of respondent-owned biting dogs were vaccinated against rabies at the time of the biting incident. Irrespective of dog ownership, the odds of an individual in a rural household being bitten by a dog were 0.53 (95% CI: 0.38-0.73) the odds for an individual in an urban household. Dog bites constitute a serious, yet preventable, public health concern that requires targeted, community-specific efforts. Public health organizations could consider findings in developing messaging, particularly as we highlight biting dogs reported by their owners as not up to date on rabies vaccination.
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Affiliation(s)
- Danielle A Julien
- Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada.,Centre for Public Health and Zoonoses, University of Guelph, Guelph, ON, Canada
| | - Jan M Sargeant
- Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada.,Centre for Public Health and Zoonoses, University of Guelph, Guelph, ON, Canada
| | - Catherine Filejski
- Office of Chief Medical Officer of Health, Ontario Ministry of Health, Toronto, ON, Canada.,Canadian Animal Health Institute, Guelph, ON, Canada
| | - Sherilee L Harper
- Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada.,Centre for Public Health and Zoonoses, University of Guelph, Guelph, ON, Canada.,School of Public Health, University of Alberta, Edmonton, AB, Canada
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Abstract
Background: Animal bite due to the risk of rabies is a major public health problem. Rabies is of great importance because of fatalities and economic damage. Objective: This study was conducted to investigate the epidemiological patterns of animal bite in Najaf Abad during the years of 2012 to 2017. Methods: This is a cross-sectional study. All records (4,104) were registered in the registration offices of animal bites during the years of 2012 to 2017 at the rabies treatment centres of Najafabad by census method. Demographic characteristics, animal type and sometime clinical patterns of the wounded were examined. Results: The mean age of the injured was 31.28 ± 15.28 years. Of the 4,104 injured, 3648 (88%) were male and the rest of them were women. In terms of residential area, 3645 people (88%) were in urban areas and the rest were in rural areas in the place of occurrence of bites. Most cases of animal biting occurred in dogs (70.9%) and then cat (24.3%). The most affected part was 51% with shoulder and hand. In this study, the incidence of animal bites is estimated as 100,000 people per year in Najaf Abad in in 2012 it was 206.4, with an increasing trend to 212.9 in 2019 (P < 0.001). Conclusion: The results of the study showed that most cases of animal bites were related to dogs, urban areas and male sex variables. The incidence of animal bites was also increasing. Due to the importance of this disease and its financial losses, it is recommended that prevention methods should be used to control stray dogs, vaccination of domesticated dogs and to raise awareness of the people.
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Bucak I, Turgut K, Almis H, Turgut M. Childhood horse and donkey bites; a single tertiary health center experience in a rural area. Avicenna J Med 2020; 10:1-5. [PMID: 32110542 PMCID: PMC7014996 DOI: 10.4103/ajm.ajm_158_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: The aim of this study was to examine the characteristics of patients presenting to a pediatric emergency department in a rural province of Turkey due to horse and donkey bites and to analyze whether these features differ from those of more common animal bites in rural areas. Materials and Methods: The records of patients presenting to the pediatric emergency department of a tertiary hospital due to horse and donkey bites over a 3-year period were examined retrospectively. Demographic data, month of presentation, animal species involved (horse or donkey), the body area bitten, treatment applied to the wound site, whether tetanus and rabies vaccinations were administered, and whether or not antibiotics were prescribed on discharge from the emergency department were recorded from these files. Results: The annual incidence of horse and donkey bites was determined as 7.8/100,000. Thirty-six patients, 24 (66.7%) boys and 12 (33.3%) girls, with a mean age of 95.6 ± 33.9 (48–190) months, were included in the study. Twenty-six patients (72.2%) were bitten by donkeys, and 10 (27.8%) by horses. Bites were most common in September (30.6%). The most commonly bitten areas were the back and/or upper extremities. Rabies vaccination was administered in all cases. Amoxicillin–clavulanic acid was prescribed in 28 (77.8%) cases. Conclusion: Horse and donkey bites are frequently observed in rural areas. The inhabitants of such areas should therefore be educated concerning horse and donkey bites. Health workers encountering such bites should behave in the same way as in more common animal bites in terms of patient management. Our results will be instructive for other developing countries similar to Turkey.
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Benavides JA, Megid J, Campos A, Rocha S, Vigilato MAN, Hampson K. An evaluation of Brazil's surveillance and prophylaxis of canine rabies between 2008 and 2017. PLoS Negl Trop Dis 2019; 13:e0007564. [PMID: 31381564 PMCID: PMC6709922 DOI: 10.1371/journal.pntd.0007564] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 08/26/2019] [Accepted: 06/20/2019] [Indexed: 11/18/2022] Open
Abstract
An effective surveillance system is critical for the elimination of canine rabies in Latin America. Brazil has made substantial progress towards canine rabies elimination, but outbreaks still occurred in the last decade in two states. Brazil uses a health information system (SINAN) to record patients seeking post-exposure prophylaxis (PEP) following contact with an animal suspected of having rabies. This study evaluated: (i) whether SINAN can be reliably used for rabies surveillance; (ii) if patients in Brazil are receiving appropriate PEP and (iii) the benefits of implementing the latest World Health Organization (WHO) recommendations on PEP. Analysing SINAN records from 2008 to 2017 reveals an average of 506,148 bite-injury patients/year [range: 437k-545k] in the country, equivalent to an incidence of 255 bite-injuries/100,000 people/year [range: 231–280]. The number of reports of bites from suspect rabid dogs generally increased over time. In most states, records from SINAN indicating a suspect rabid dog do not correlate with confirmed dog rabies cases reported to the Regional Information System for Epidemiological Surveillance of Rabies (SIRVERA) maintained by the Pan American Health Organization (PAHO). Analyses showed that in 2017, only 45% of patients received appropriate PEP as indicated by the Brazilian Ministry of Health guidance. Implementation of the latest WHO guidance using an abridged intradermal post-exposure vaccination regimen including one precautionary dose for dog bites prior to observation would reduce the volume of vaccine required by up to 64%, with potential for annual savings of over USD 6 million from reduced vaccine use. Our results highlight the need to improve the implementation of SINAN, including training of health workers responsible for delivering PEP using an Integrated Bite Case Management approach so that SINAN can serve as a reliable surveillance tool for canine rabies elimination. Dog-mediated rabies has declined to only a few cases in Latin America over the last decade. Brazil has the largest human and dog population of Latin America. Despite the decline of canine rabies, the country’s public health system still spends millions of dollars annually on half a million patients seeking health care for dog bites. In this study, we analysed a decade of national surveillance data on dog bites. These data suggest that health workers report dog rabies in many states where the disease is likely to be absent, with false positive cases frequently reported into the surveillance system. In addition, only half of patients appear to receive the appropriate rabies post-exposure prophylaxis as recommended by the Ministry of Health. We estimated that Brazil could save up to USD 6 million per annum on vaccine by reducing the number of doses administered during prophylaxis and adopting the intradermal vaccine delivery technique following the latest WHO recommendations. Our study highlights an urgent need for updating health care workers on canine rabies knowledge, prophylaxis and assessment of dog bites to improve prophylaxis provision and surveillance of dog rabies.
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Affiliation(s)
- Julio A. Benavides
- Departamento de Ecología y Biodiversidad, Facultad de Ciencias de la Vida, Universidad Andrés Bello, Santiago, Chile
- UNESP - Faculdade de Medicina Veterinária e Zootecnia, Departamento De Higiene Veterinária e Saúde Pública, Botucatu, São Paulo, Brazil
- Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, United Kingdom
- Centro de Investigación para la Sustentabilidad, Facultad de Ciencias de la Vida, Universidad Andrés Bello, Santiago, Chile
- * E-mail:
| | - Jane Megid
- UNESP - Faculdade de Medicina Veterinária e Zootecnia, Departamento De Higiene Veterinária e Saúde Pública, Botucatu, São Paulo, Brazil
| | - Aline Campos
- Programa Estadual de Controle e Profilaxia da Raiva, Health Secretary of Rio Grande do Sul, Porto Alegre, Brazil
| | - Silene Rocha
- Pan-American Health Organization, Veterinary Public Health Unit – PANAFTOSA, Rio de Janeiro, Brazil
| | - Marco A. N. Vigilato
- Pan-American Health Organization, Veterinary Public Health Unit – PANAFTOSA, Rio de Janeiro, Brazil
| | - Katie Hampson
- Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, United Kingdom
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Hamta A, Saghafipour A, Hosseinalipour SA, Rezaei F. Forecasting delay times in post-exposure prophylaxis to human animal bite injuries in Central Iran: A decision tree analysis. Vet World 2019; 12:965-971. [PMID: 31528019 PMCID: PMC6702578 DOI: 10.14202/vetworld.2019.965-971] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Accepted: 05/15/2019] [Indexed: 11/25/2022] Open
Abstract
Background and Aim: Data mining in medical sciences provides countless opportunities for demonstrating hidden patterns of a data set. These patterns can help general physicians and health workers in preventing diseases. This study aimed to forecast delay times in post-exposure prophylaxis (PEP) to human animal bite injuries in central Iran using a decision tree analysis. Materials and Methods: The data of 2072 human animal bite cases were collected from Centers for Disease Control and Prevention unit of Qom Provincial Health Center, Iran from January 2017 to December 2018. The information related to animal bite incidents, including the biting animal characteristics and data on the bitten humans, was obtained by investigating the epidemiological survey forms of human animal bites. The decision tree model was applied to forecast the delay time of receiving PEP. Results: A delay of more than 48 h in the initiation of PEP was estimated among 12.73% of animal bite victims. The most important variables to predict delay time of receiving PEP were the species of biting animal, time and cause of animal bite occurrences in 24 h a day, respectively. Hence, the model showed a delay in the initiation of PEP if the biting animal was a cattle or, a carnivore, and the time of being bitten was from 7 am to 1 pm, or if the animal was carnivore and the time of being bitten was between 1 and 7 pm, and the cause of animal bite was playing with the animal. Conclusion: Based on the findings of the study on different variables affecting the initiation of PEP, the concepts related to animal bite and rabies, including the timely injection of anti-rabies vaccine to prevent rabies, it is a must to educate and train, all the people, especially housewives and students.
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Affiliation(s)
- Amir Hamta
- Department of Social Medicine, Faculty of Medical Sciences, Qom University of Medical Sciences, Qom, Iran
| | - Abedin Saghafipour
- Department of Public Health, Faculty of Health, Qom University of Medical Sciences, Qom, Iran
| | | | - Fatemeh Rezaei
- Department of Social Medicine, Faculty of Medical Sciences, Jahrom University of Medical Sciences, Jahrom, Iran
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New Rabies Vaccines for Use in Humans. Vaccines (Basel) 2019; 7:vaccines7020054. [PMID: 31226750 PMCID: PMC6631309 DOI: 10.3390/vaccines7020054] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 06/17/2019] [Accepted: 06/19/2019] [Indexed: 12/11/2022] Open
Abstract
Although vaccines are available, rabies still claims more than 55,000 human lives each year. In most cases, rabies vaccines are given to humans after their exposure to a rabid animal; pre-exposure vaccination is largely reserved for humans at high risk for contacts with the virus. Most cases of human rabies are transmitted by dogs. Dog rabies control by mass canine vaccination campaigns combined with intensive surveillance programs has led to a decline of human rabies in many countries but has been unsuccessful in others. Animal vaccination programs are also not suited to control human rabies caused by bat transmission, which is common in some Central American countries. Alternatively, or in addition, more widespread pre-exposure vaccination, especially in highly endemic remote areas, could be implemented. With the multiple dose regimens of current vaccines, pre-exposure vaccination is not cost effective for most countries and this warrants the development of new rabies vaccines, which are as safe as current vaccines, but achieve protective immunity after a single dose, and most importantly, are less costly. This chapter discusses novel rabies vaccines that are in late stage pre-clinical testing or have undergone clinical testing and their potential for replacing current vaccines.
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