Epidemiology, clinical features and risk factors for human rabies and animal bites during an outbreak of rabies in Maputo and Matola cities, Mozambique, 2014: Implications for public health interventions for rabies control

Prevalence of malaria and dengue co-infections among febrile patients during dengue transmission season in Kassala, eastern Sudan

BACKGROUND

Malaria and dengue are common mosquito-borne diseases around the world that cause high mortality and morbidity. The number of cases of both diseases is currently rising in Sudan and is associated with climate and environmental changes. Limited information is available on malaria and dengue co-infections and the severity of the two diseases among febrile patients in eastern Sudan. Thus, this study aimed to estimate the prevalence of malaria and dengue co-infections among febrile patients in Kassala, eastern Sudan.

METHODOLOGY/PRINCIPAL FINDINGS

A cross-sectional hospital-based study was conducted among febrile patients from September to December 2019. A total of 395 patients were enrolled after consenting to participate in the study. Demographic and clinical data were collected by structured questionnaires. Blood samples were provided to diagnose malaria infections using microscopy and polymerase chain reaction (PCR) and for serology diagnosis of dengue using enzyme-linked immune sorbent assay (ELISA) IgM. Multiple logistic regression analysis was used to assess the association between demographic information, clinical symptoms and malaria and dengue co-infections. Out of 395 febrile patients examined 158 (40%) were malaria positive and 67 (17%) were dengue positive. The prevalence of malaria and dengue co-infections was 6.6% (26/395). Results of multiple logistic regression indicated that elder patients (41-60 years) had less rate of co-infections (OR = 0.3, 95% CI 0.11 to 0.81, p-value = 0.018), while patients of co-infections were eight times more likely to have fatigue, and two times more likely to suffer from joint and muscle pain and this difference was statistically significant with (OR = 8.3, 95% CI: 1.89 to 37.22, p-value = 0.005) and (OR = 2.4, 95% CI 1.10 to 5.39, p-value = 0.027), respectively.

CONCLUSIONS/SIGNIFICANCE

This study confirmed the existence of malaria and dengue co-infections among febrile patients in Kassala, eastern Sudan for the first time. The severity of clinical symptoms of patients with malaria and dengue co-infections was observed, and the co-infections were found prevalent among young people.

Emerging Genomic Trends on Rabies Virus in Davao Region, Philippines, 2018-2021

Rabies, caused by the rabies virus (RABV), remains a significant public health issue in the Philippines despite efforts to control it. To eliminate rabies by 2030, effective surveillance strategies are crucial. In this study, we examined RABV evolution and phylodynamics in the Davao Region using genome sequences from Davao City and nearby provinces. We adapted the RABV ARTIC Protocol for Oxford Nanopore High-Throughput Sequencing to optimize workflow efficiency under limited resources. Comparing new virus samples collected from June 2019 to June 2021 (n = 38) with baseline samples from June 2018 to May 2019 (n = 49), new sub-clades were observed in the phylogenetic tree, suggesting divergence from older variants that were previously undetected. Most of the new viruses belonged to the Asian SEA4_A1.1.1 lineage, but new (SEA4_B1 and SEA4_B1.1) and emerging (SEA4_B1.1_E1) lineages that have never been reported in the Philippines were also identified. The baseline study reported phylogeographic clustering of RABV isolates from the same areas. However, this pattern was disrupted in the current biosurveillance, with variants detected in areas outside the original cluster. Furthermore, our findings revealed significant transmission routes between Davao City and neighboring provinces, contrasting with the predominantly intra-city transmission observed in the baseline study. These results underscore the need for ongoing and timely genomic surveillance to monitor genetic diversity changes and the emergence of novel strains, as well as to track alterations in transmission pathways. Implementing cost-effective next-generation sequencing workflows will facilitate the integration of genomic surveillance into rabies control programs, particularly in resource-limited settings. Collaborations between different sectors can empower local laboratories and experts in genomic technologies and analysis.

Canine rabies: An epidemiological significance, pathogenesis, diagnosis, prevention, and public health issues

Rabies is a zoonotic disease caused by rabies virus of the genus Lyssa virus and family Rhabdoviridae. It affects all mammals and is prevalent throughout the world and endemic in many countries except in Islands like Australia and Antarctica. It is highly fatal, but preventable. Disease causes threat to public health because rabid dogs bite humans, resulting in thousands of deaths every year. Around 59,000 people die every year from rabies in the world. Dogs play a vital role in most of the human exposure in rabies endemic areas. Transmission of virus occurs through the bite of an infected dog. Disease is manifested by fatal nervous symptoms leading to paralysis and death. Direct fluorescent antibody technique is the gold standard for the diagnosis of the disease in animals and humans. Prevention of rabies involves the vaccination of dogs and humans before or after an exposure. This review describes the etiology, pathogenesis, diagnosis, its prevention and control strategies.

Soares Magalhães R, Weese JS, Ahmed NO, Rupprecht CE, Clark NJ. Modelling modifiable factors associated with the probability of human rabies deaths among self-reported victims of dog bites in Abuja, Nigeria

Canine-mediated rabies kills tens of thousands of people annually in lesser-developed communities of Asia, Africa, and the Americas, primarily through bites from infected dogs. Multiple rabies outbreaks have been associated with human deaths in Nigeria. However, the lack of quality data on human rabies hinders advocacy and resource allocation for effective prevention and control. We obtained 20 years of dog bite surveillance data across 19 major hospitals in Abuja, incorporating modifiable and environmental covariates. To overcome the challenge of missing information, we used a Bayesian approach with expert-solicited prior information to jointly model missing covariate data and the additive effects of the covariates on the predicted probability of human death after rabies virus exposure. Only 1155 cases of dog bites were recorded throughout the study period, out of which 4.2% (N = 49) died of rabies. The odds for risk of human death were predicted to decrease among individuals who were bitten by owned dogs compared to those bitten by free-roaming dogs. Similarly, there was a predicted decrease in the probability of human death among victims bitten by vaccinated dogs compared to those bitten by unvaccinated dogs. The odds for the risk of human death after bitten individuals received rabies prophylaxis were predicted to decrease compared to no prophylaxis. We demonstrate the practical application of a regularised Bayesian approach to model sparse dog bite surveillance data to uncover risk factors for human rabies, with broader applications in other endemic rabies settings with similar profiles. The low reporting observed in this study underscores the need for community engagement and investment in surveillance to increase data availability. Better data on bite cases will help to estimate the burden of rabies in Nigeria and would be important to plan effective prevention and control of this disease.

Risk factors associated with rabies incidence in rabies endemic areas in West Kalimantan

Introduction

Rabies remains a significant health problem in many parts of the world. The World Health Organization (WHO) states that rabies is a disease neglected in its management and has become a problem, especially in poor areas. It is estimated that 55,000 rabies deaths occurred worldwide in 2018. From 2015 to 2019, there were 404,306 cases of rabigenic wounds inflicted by animal bites in Indonesia, with 544 deaths. West Kalimantan Province is one of the areas endemic to rabies and one of the five provinces with the highest number of deaths due to rabies.

Methods

This was a case-control study of patients who presented to the health service for potentially-rabigenic wounds inflicted by animal bites and being diagnosed with rabies exposure. The post-mortem examination was carried out to support the diagnosis of exposure to rabies. Cases were defined as those who had experienced dog bites from the health services medical register from 2015 to 2019. Controls were defined as those who lived in the same area as patients from the cases group and were owners of potentially rabigenic animals. The research was performed in Landak and Sanggau Regencies, West Kalimantan.

Results

The results showed an association between the following risk factors and the incidence of rabies: animal care (p=0.033), rabies vaccine (p=0.006), and behavior (p=0.011), while other risk factors were knowledge (p=1.000) and attitude (p=0.840).

Conclusions

The study's findings inform rabies prevention and eradication, particularly in the province of West Kalimantan, which has experienced issues related to the population power of rabies-transmitting animals, as well as the process of vaccinating rabies-transmitting animals and a lack of public awareness. These factors have a significant impact on the prevalence of rabies, as dogs in the province of West Kalimantan have rabies.

Rabies Virus Seroprevalence among Dogs in Limpopo National Park and the Phylogenetic Analyses of Rabies Viruses in Mozambique

Rabies is considered a neglected disease among many developing Asian and African countries, including Mozambique, where its re-emergence is often attributed to low dog parenteral vaccination coverage. The objectives of this study were two-fold: (1) to assess the level of antibodies against rabies virus in dogs (n = 418) in Limpopo National Park (LNP), and (2) to genetically characterise selected rabies viruses from brain tissue samples collected in 2017 and 2018. To meet the first objective, we used the BioProTM Rabies blocking ELISA antibody kit, and the results were expressed as the percentage of blocking (%PB). Dog sera with PB ≥ 40% were considered positive for antibodies to rabies virus, whereas sera with PB < 40% were negative. Just under ninety percent (89.2%; n = 373) of dogs were seronegative, and the rest (10.8%; n = 45) had detectable levels of rabies virus-specific antibodies. All eight brain tissue samples were positive for rabies virus antigen using a direct fluorescent antibody test and amplified in a quantitative real-time PCR, but only five (n = 4 from dogs and n = 1 from a cat) were amplified in a conventional reverse-transcription PCR targeting partial regions of the nucleoprotein (N) and the glycoprotein (G) genes. All samples were successfully sequenced. Phylogenetically, the rabies viruses were all of dog origin and were very closely related to each other (Africa 1b rabies virus lineage). Furthermore, the sequences had a common progenitor with other rabies viruses from southern Africa, confirming the transboundary nature of rabies and the pivotal role of dogs in maintaining rabies cycles. The study demonstrates the principal application of the BioProTM rabies ELISA antibody for the detection of anti-lyssavirus-specific antibodies in the serum samples of dogs, and most importantly, it highlights the low levels of antibodies against rabies virus in this dog population.

Knowledge, attitudes, practices (KAP) and control of rabies among community households and health practitioners at the human-wildlife interface in Limpopo National Park, Massingir District, Mozambique

Background

Rabies is a viral zoonotic disease that kills more than 26,000 people each year in Africa. In Mozambique, poverty and inadequate surveillance result in gross underreporting and ineffective control of the disease in animals and people. Little is known of the role of human attitudes and behaviour in prevention or control of rabies, thus this study was undertaken to assess the knowledge, attitudes and practices amongst selected households and health practitioners in one affected area, the Limpopo National Park (LNP), Massingir district.

Methodology

A cross-sectional study was conducted among 233 households in eight villages in LNP and among 42 health practitioners from eight health facilities in Massingir district between 2016 and 2018. Consenting household representatives aged 18 years or over were purposively selected. A KAP survey was administered to obtain information on dog ownership and knowledge of rabies, host species affected, modes of transmission, symptoms, recommended treatment and preventive methods.

Similar to household study participants, health practitioners were purposively selected and completed the questionnaire during the investigators’ visit. The questionnaire sought information on knowledge of rabies, management of bite wounds, vaccination sites and schedules of pre- and post-exposure prophylaxis. Descriptive and inferential data analyses were performed using SPSS software version 18.0.

Results

Approximately twenty per cent (18.9%; 95% CI: 14.3–24.3) and 13.3% (95% CI: 9.4–18.1) of households had good knowledge and practices of rabies, respectively. For health practitioners, only 16.7% (95% CI: 7.5–31.9) had good knowledge, whilst 33.3% (95% CI: 20.0–49.7) adopted adequate attitudes/practices towards the disease.

Conclusions/Significance

In conclusion, both households and health practitioners displayed poor levels of knowledge and adopted bad attitudes and practices towards rabies. The former, had more gaps in their attitudes and practices towards the disease. Village location and education level (P < .05) and similarly, sex and occupation, were found to be statistically associated with good knowledge of rabies among households as compared to HPs. Overall, a lack of community-based education and professional retraining courses contribute significantly to poor awareness of rabies in the LNP of Mozambique. Enhancing public health knowledge should consequently reduce dog-mediated human rabies deaths in this country.

In Mozambique, rabies is maintained primarily by the domestic dog, the principal vector and host species responsible for the majority of human cases dating back to the early 1900s. Control of animal rabies has historically been undertaken by government veterinary authorities, with limited involvement of the health and environment sectors. In the Massingir District in general, and in Limpopo National Park (LNP) in particular, parenteral dog rabies mass-vaccination campaigns and the provision of post-exposure prophylaxis are inconsistent. Limited resources for dog vaccination campaigns, insufficient veterinary field staff, inefficient disease notification procedures and inadequate training of health practitioners constraint effective rabies control across the country. Awareness of good practices regarding management of bite wounds among local community members and health practitioners is crucial to reducing rabies deaths. The results obtained in this study will inform government policy on practical interventions in the control of dog and human rabies.

Rabies mortality and morbidity associated with animal bites in Africa: a case for integrated rabies disease surveillance, prevention and control: a scoping review

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/).

Animal bites and post-exposure prophylaxis in Central-West Tunisia: a 15-year surveillance data

BACKGROUND

Rabies is a disease that still exists in developing countries and leads to more fatalities than other zoonotic diseases. Our study aimed to describe the profile of human exposures to animals over fifteen years and to assess the post-exposure prophylaxis (PEP) practices in the governorate of Kasserine (Tunisia) on pre- and post-revolution (2011).

METHODS

We carried out a descriptive study using surveillance data from a region in Central-West Tunisia. All humans exposed to animals, residents in Kasserine Governorate and declared to the regional directorate of primary health care (RDPH) from January 1st, 2004 to December 31st, 2018 were included.

RESULTS

A total of 45,564 cases of human exposures to animals were reported over the fifteen-year period of the study with an annual average of 3089.2 ± 403.1. The standardized incidence rate (SIR) of human exposures to animals was 694 per year per 100,000 inhabitants (inh). The most listed offending animal was the dog (91.3%) and the most reported type of exposure was bites (63.7%). The trend in human exposures to animals increased significantly over time. The number of exposures by vaccinated dogs decreased significantly and by unvaccinated and stray dogs increased steeply. When comparing pre-and post-revolution periods, the yearly average of animal exposures post-2011 was significantly greater than the average prior to 2011 (3200 ± 278.5 vs 2952.8 ± 483) (p < 0.001). The yearly average of animal bites post-2011 was significantly greater than the average prior to 2011 (2260.5 ± 372.1 vs 1609.8 ± 217.9) (p < 0.001). The average number of vaccine doses per animal exposure was 2.4. Concerning PEP protocols, protocol A (2 and 3 doses) was indicated in 79% of animal exposures cases. From 2004 to 2018, a downward trend was noted for protocol A (r = - 0.29, p < 0.001) and an upward trend for protocol B (3 and 5 doses) (r = 0.687, p < 0.001). During our study period, 5 fatal cases of human rabies were declared.

CONCLUSION

Rabies remains a major public health problem in Tunisia. The political dynamics had an impact on the health care system and rabies control. Preventive measures should be applied adequately to decrease the burden of this disease.

Clinical aspects of human rabies in the state of Ceará, Brazil: an overview of 63 cases

INTRODUCTION

Rabies is considered one of the most relevant public health problems owing to its high fatality rate and the high number of deaths worldwide.

METHODS

We included patients with human rabies who attended a reference hospital in the state of Ceará during 1976-2019.

RESULTS

Data were available for 63 out of 171 (36.8%) patients. Of these patients, 48 (76.2%) were attacked by dogs. In recent years, wild animals have been the most common aggressor species (marmosets and bats). Only 39 (70%) patients were initially correctly suspected with rabies. Bites were the most frequent exposure (56; 96%), most commonly on the hands (21; 42%) and the head (9; 18.4%). Only 14 (22%) patients had sought medical assistance before the onset of symptoms, and only one completed post-exposure prophylaxis. The most prevalent signs and symptoms included aggressiveness/irritability (50; 79.4%), fever (42; 66.7%), sore throat/dysphagia (40; 63.5%), and myalgia (28; 44.4%). Hydrophobia was present in 17 patients (22.0%).

CONCLUSIONS

Most cases of human rabies in Ceará occurred due to the failure to seek medical assistance and/or the failure of the health system in initiating early post-exposure prophylaxis. There is a need for specific information and education campaigns focusing on the cycle of sylvatic rabies as well as prevention measures. Health professionals should undergo refresher training courses on the signs and symptoms of rabies and on the specific epidemiological features of the disease in Brazil.

Large scale dog population demography, dog management and bite risk factors analysis: A crucial step towards rabies control in Cambodia

Cambodia is a rabid-endemic country. However, data on dog population characteristics are lacking, and there is no national dog vaccination program. We implemented the first extensive door-to-door longitudinal survey in 2 Cambodian provinces, namely Kandal and Battambang, to estimate dog population demographic parameters, identify dog ownership determinants, analyze dog management practices and estimate the yearly cumulative bite incidence and associated factors. During the first session, more than 5000 dogs were recorded and identified. Data on families, dogs and cats characteristics, as well as the number of bites experienced the year before in the family, were recorded. One year later, a second session was performed in both provinces to record missing dogs and the reasons for missing. Age-specific survival rates of the dog populations were computed using Kaplan-Meier estimates. Ownership determinants and bite risk factors were identified using a negative binomial regression model. Dog trade and dog meat consumption were often reported. We estimated high dog-to-human ratios (1:3.8 in Kandal, and 1:3.3 in Battambang). The mean age of dog populations was 26.4 months in Kandal against 24.3 in Battambang, with a survival rate of 52% at 24 months in Kandal (34% only in Battambang). They were no feral dogs, but the large majority of recorded dogs were free roaming. In both provinces, the number of dogs significantly increased in families with children younger than 15, and when the head of the family was a male. The estimated yearly cumulative bite incidences were 2.3 and 3.1% in Kandal and Battambang provinces respectively, and are among the highest in the world. Our survey provides valuable data to focus information programs, parametrize transmission models and identify efficient vaccination strategies to control rabies in Cambodia in the future.

Genome-based local dynamics of canine rabies virus epidemiology, transmission, and evolution in Davao City, Philippines, 2018-2019

Rabies is a fatal zoonotic and neglected tropical disease caused by the rabies virus (RABV) and is associated with neuronal dysfunction and death, with dogs as the predominant carrier. The Philippines plans to eradicate rabies by 2022, but this is challenged with sub-optimal coverage of vaccination programs coupled with sustained transmission chains, making it unable to eradicate the disease. We investigated the dynamics of canine rabies in the highly urbanized Davao City of the Philippines and its neighboring localities by assessing genetic relationships, transmission patterns, selection pressure, and recombination events using the whole genome sequence of 49 RABV cases from June 2018 to May 2019, majority of which (46%) were from the district of Talomo, Davao City. Although phylogeographic clustering was observed, local variants also exhibited genetic sub-lineages. Phylogenetic and spatial transmission analysis provided evidence for intra- and inter-city transmission predominantly through the Talomo district of Davao City. Around 84% of the cases were owned dogs, but the genetic similiarity of RABVs from stray and owned dogs further alluded to the role of the former as transmission vectors. The high rate of improper vaccination among the affected dogs (80%) was also a likely contributor to transmission. The RABV population under Investigation is generally under strong purifying selection with no evidence of vaccine evasion due to the genetic homogeneity of viruses from vaccinated and improperly vaccinated dogs. However, some homologous recombination (HR) events were identified along the G and L genes, also predominantly associated with viruses from Talomo. The complementary findings on epidemiology, transmission, and recombination for Talomo suggest that high incidence areas can be seeds for virus dispersal and evolution. We recommend further Investigations on the possibility of HR in future large-scale genome studies. Finally, districts associated with these phenomena can be targeted for evidence-based local strategies that can help break RABV transmission chains and prevent emergence of novel strains in Davao City.

Epidemiology and preclinical management of dog bites among humans in Wakiso and Kampala districts, Uganda: Implications for prevention of dog bites and rabies

In rabies endemic areas, appropriate management of dog bites is critical in human rabies prevention. Victims must immediately wash bite wound for 15 minutes with water, soap, and a disinfectant before seeking medical care. This study investigated the epidemiology of dog bites and the determinants of compliance to these pre-clinical guidelines requirements among dog bite victims from high rabies-burden areas of Wakiso and Kampala, Uganda. An explanatory sequential mixed-methods study design was used. Quantitative data were collected from 376 dog-bite patients at two healthcare facilities. Qualitative data were also collected through 13 in-depth interviews with patients, healthcare workers, herbalists, and veterinarians. Qualitative data were analyzed using a deductive thematic approach. Generalized linear models were used to determine factors associated with compliance. Nearly half (190, 51%) of the patients were from Wakiso District and 293 (77.9%) had grade II wounds. Most of the wounds (171, 45.5%) were on the legs. Two-thirds of the bites occurred in public places. Only 70 (19%) of the bite patients had complied with pre-clinical guidelines. Nearly half of the patients had applied substances that were not recommended e.g. herbs (47/193), antiseptics (46/193), "black stone" (25/193), and unknown creams (10/193). Factors negatively associated with compliance included: being aged 15 years or older, adjPR = 0.70 (0.47-0.92) and knowing the dog owner, adjPR = 0.65 (0.36-0.93). However, attainment of secondary or higher education, adjPR = 1.76 (1.24-3.79), being in employment, adjPR = 1.48 (1.09-2.31), perception that the dog was sick, adjPR = 1.47 (1.02-2.72) and knowledge about the dog's subsequent victim(s) adjPR = 0.35 (0.17-0.70) were positively associated with compliance. High occurrence of dog bites in public places by free-roaming dogs suggests the need for deliberate promotion of responsible dog ownership. Additionally, targeted health education may be required to improve the low compliance to pre-clinical guidelines.

A dog bite study in a dog rabies-affected area in South Africa

Background

Rabies is an untreatable and highly fatal viral zoonosis. Despite the ability to control and prevent the disease, it is estimated that one person dies of rabies every 10 minutes in developing countries. However, the true burden of the disease remains undefined in most developing countries because of a lack of systematic surveillance. Dog bite data obtained from healthcare facilities where dog bite victims seek medical care may provide an additional source of information that can be used to inform the burden of disease and identify points for interventions for improved delivery of post-exposure prophylaxis (PEP) to prevent the disease.

Methods

A descriptive epidemiological study was conducted using data obtained from dog bite registers and patient case files at a healthcare facility for a two year period (2015-2017).

Results

The study reported frequency, demographics, source, geographic and temporal distribution of bite cases reported to a hospital serving a rabies-affected community. In addition, the post-exposure management of dog bite cases at this facility is described.

Conclusion

Dog bites was not an infrequently reported at the healthcare facility, with up to 29 cases reported in a month during the study period. The affected population was defined and it is motivated that this information is useful for targeted health interventions. Findings related to the delivery of PEP may also be used to direct training and re-training of healthcare workers for improved delivery of PEP.

Epidemiological study on animal bite cases referred to Haji Daii health Center in Kermanshah province, Iran during 2013-2017

Background

Over thousands of animal bite cases are reported annually worldwide and in Iran placing a large financial burden on the health and economy. The aim of this study was to evaluate the epidemiology of animal bite cases in Kermanshah, Iran through 2013–2017.

Methods

In this cross-sectional study, 5618 animal bite cases in Kermanshah from 2013 to 2017 were studied. Data were analyzed using descriptive and inferential statistics.

Results

In the study period, 5618 animal bite cases were found. The prevalence of animal bites was estimated between 42.55–45.66 per100000 populations during 2013–2017. An increasing significant trend was found for prevalence of animal bites (Average annual percent change [AAPC] + 4.9, P-trend< 0.001) over a 5-years’ time period. The mean age of the subjects was 32.7 ± 18.3 years. Of the studied subjects 76.3% were male, and 34% had non-governmental jobs. Dogs were found as the cause of animal bites in 72% of the cases. Of the studied cases, 82% had received rabies vaccination for three times.

Conclusion

The results showed an increasing significant trend for animal bites in Kermanshah. Development of interventional programs, such as limiting stray dogs, vaccination of dogs and raising public awareness are essential.

[Research on Healthy Neighborhood Evaluation System Based on the Combined Perspectives of Urban Planning and Public Health]

Neighborhoods are places where people spend the most time in their lives. Neighborhoods have a decisive impact on the residents' health. With several important tasks, including the transformation of old neighborhoods, the maintenance of existing neighborhoods, and the construction of new neighborhoods in the future, a scientific and reasonable evaluation standard is urgently needed to guide the development of healthy neighborhoods. To build the evaluation system, this paper first clarifies the principles for selecting evaluation indicators, which include: 1) the indicators are selected from a humanistic perspective; 2) the pathways between neighborhoods environment and health outcomes are deeply considered; 3) the indicators are selected from multiple scales. Secondly, based on the combined perspectives of urban planning and public health, it identifies the indicators that affect the residents' health in neighborhoods and searches the literature through the quality assessment to provide evidence to support the accuracy and effectiveness of the indicators. Finally, it proposes prospect to the evaluation, including 1) it is urgent to improve and utilize the healthy neighborhoods based on the Chinese condition; 2) advanced technologies need to be widely applied in neighborhoods in the future; 3) the transitions in cities should be considered in the future development of neighborhoods. It hopes that relevant researchers and government leaders to realize the importance and urgency of healthy neighborhoods to build more healthy neighborhoods in China.

Frequency and distribution of neglected tropical diseases in Mozambique: a systematic review

BACKGROUND

Neglected tropical diseases (NTDs) affect more than one billion people living in vulnerable conditions. In spite of initiatives recently contributing to fill NTDs gaps on national and local prevalence and distribution, more epidemiological data are still needed for effective control and elimination interventions.

MAIN TEXT

Mozambique is considered one of the countries with highest NTDs burden although available data is scarce. This study aims to conduct a systematic review on published available data about the burden and distribution of the different NTDs across Mozambique since January 1950 until December 2018. We identified manuscripts from electronic databases (Pubmed, EmBase and Global Health) and paper publications and grey literature from Mozambique Ministry of Health. Manuscripts fulfilling inclusion criteria were: cross-sectional studies, ecological studies, cohorts, reports, systematic reviews, and narrative reviews capturing epidemiological information of endemic NTDs in Mozambique. Case-control studies, letters to editor, case reports and case series of imported cases were excluded. A total of 466 manuscripts were initially identified and 98 were finally included after the revision following PRISMA guidelines. Eleven NTDs were reported in Mozambique during the study span. Northern provinces (Nampula, Cabo Delgado, Niassa, Tete and Zambezia) and Maputo province had the higher number of NTDs detected. Every disease had their own report profile: while schistosomiasis have been continuously reported since 1952 until nowadays, onchocerciasis and cysticercosis last available data is from 2007 and Echinococcosis have never been evaluated in the country. Thus, both space and time gaps on NTDs epidemiology have been identified.

CONCLUSIONS

This review assembles NTDs burden and distribution in Mozambique. Thus, contributes to the understanding of NTDs epidemiology in Mozambique and highlights knowledge gaps. Hence, the study provides key elements to progress towards the control and interruption of transmission of these diseases in the country.

Dog Ecology, Bite Incidence, and Disease Awareness: A Cross-Sectional Survey among a Rabies-Affected Community in the Democratic Republic of the Congo

Despite the existence of safe and efficacious human and animal rabies vaccines, millions of people remain at risk of exposure to this deadly zoonotic disease through bites of infected dogs. Sub-Saharan African countries, such as the Democratic Republic of the Congo (DRC), bear the highest per capita death rates from rabies where dog vaccination and availability of lifesaving post-exposure prophylaxis (PEP) is scarce. Mass dog vaccination is the most cost-effective and sustainable approach to prevent human rabies deaths. We conducted a cross-sectional household survey in a rabies-affected community in Matadi, DRC, to estimate the size of the owned dog population and dog bite incidence and assess knowledge and practices regarding rabies, as preparation for future mass dog vaccination campaigns. Our study revealed that the owned dog population in Matadi was almost ten times larger than assumed by local veterinary officials, with a large proportion of free-roaming unvaccinated dogs. The annual dog bite incidence of 5.2 per 1000 person years was high, whereas community rabies knowledge was low resulting in poor practices. Given these findings, human rabies deaths are likely to occur in this community. Lack of disease awareness could negatively affect participation in future mass dog vaccination campaigns. A public sensitization campaign is needed to promote appropriate rabies prevention (washing bite wounds and PEP) and control (dog vaccination) measures in this community.

Dog Owners' Knowledge about Rabies and Other Factors That Influence Canine Anti-Rabies Vaccination in the Upper East Region of Ghana

BACKGROUND

Human rabies, often contracted through dog bites, is a serious but neglected public health problem in the tropics, including Ghana. Due to its high fatality rate, adequate knowledge and vaccination of domestic dogs against the disease are very crucial in reducing its burden. We examined dog owners' knowledge level on rabies and factors that influenced anti-rabies vaccination of dogs in the Upper East Region of Ghana.

METHODS

This descriptive cross-sectional study was conducted among 260 randomly sampled dog owners in six communities from six Districts using a multistage sampling technique, in the Upper East Region of Ghana. An interviewer-administered questionnaire was used to collect data from the respondents. Descriptive and inferential analyses were done using STATA 14.1.

RESULTS

While knowledge about rabies was 199 (76.5%), that about anti-rabies vaccination was 137 (52.7%). District of residence (χ2 = 112.59, p < 0.001), sex (χ2 = 6.14, p = 0.013), education (χ2 = 20.45, p < 0.001) as well as occupation (χ2 = 11.97, p = 0.007) were significantly associated with rabies knowledge. District of residence (χ2 = 57.61, p < 0.001), Educational level (χ2 = 15.37, p = 0.004), occupation (χ2 = 11.66, p = 0.009), religion (χ2 = 8.25, p = 0.016) and knowledge on rabies (χ2 = 42.13, p < 0.001) were also statistically associated with dog vaccination against rabies. Dog owners with good knowledge on rabies for instance, were more likely to vaccinate their dogs against rabies compared to those with poor knowledge [AOR = 1.99 (95% CI: 0.68, 5.86), p = 0.210]. Dog owners with tertiary level of education were also 76.31 times more likely (95% CI: 6.20, 938.49, p = 0.001) to have good knowledge about rabies compared to those with no formal education.

CONCLUSIONS

Dog owners in the Upper East Region of Ghana had good knowledge about rabies. This, however, did not translate into correspondingly high levels of dog vaccination against the disease. Rabies awareness and vaccination campaigns should, therefore, be intensified in the region, especially among the least educated and female dog owners.

Forecasting delay times in post-exposure prophylaxis to human animal bite injuries in Central Iran: A decision tree analysis

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.

Impact of Integrating Rabies Education Into the Curriculum of Public Elementary Schools in Ilocos Norte, Philippines on Rabies Knowledge, and Animal Bite Incidence

As part of a province wide rabies elimination program, rabies specific information was integrated into the curriculum of all public elementary schools in Ilocos Norte, Philippines using a specifically developed teachers' manual. The rabies educational messages included rabies, animal bite prevention, bite management and responsible pet ownership and were integrated into lessons in several subjects. Four elementary schools were randomly selected and an assessment of the change in student's rabies knowledge and animal bite incidence were conducted. The study tested all students in grades 1-5 before the curriculum integration was implemented and retested these cohorts 1 year later, after implementation. Awareness of rabies was high before the implementation, likely due to the province-wide elimination campaign. However, awareness still increased significantly across all schools, and detailed knowledge of rabies increased significantly in all but one school and age cohort. Bite incidence in the 6 months prior to each survey was also recorded and the percentage of students suffering animal bites fell significantly between the two tests. The data suggested that knowledge increase correlated with decreased bite incidence in some groups but not all, suggesting a more complex relationship between knowledge acquisition and behavioral change which warrants further investigation.

Epidemiological aspects of the persistent transmission of rabies during an outbreak (2010 - 2017) in Harare, Zimbabwe

Canine-mediated human rabies is endemic to the entire African continent, where the disease burden is often highest in rural communities of resource-limited countries. In this study, we analysed an animal rabies outbreak, which had persisted since 2010 in the predominantly metropolitan capital city of Zimbabwe, Harare. As rabies is considered to disproportionally affect rural communities, the persistence of urban rabies in this metropolitan setting is of interest. In order to gain an improved understanding of the epidemiology of the outbreak under investigation, we utilised both routine surveillance data that had been collected during the first eight years of the outbreak (2010-2017), as well as molecular epidemiological analyses relying on the Bayesian Markov Chain Monte Carlo methodology. This approach allowed us to characterize virus transmission by identifying specific suburbs within the city limits where persistent disease transmission took place, while also confirming that immunologically naïve dogs were the most likely reservoir species in and around the city. In addition to gaining an improved local understanding of the outbreak, we are also able to infer that rabies was likely introduced to the city in 2010 when a rabid animal was moved from the north-east of Zimbabwe into Harare-resulting in an epizootic event. The work presented here not only showcased the value of combining conventional and molecular epidemiological data, but also highlighted the importance of maintaining rabies vaccination coverage and continued public awareness in urban areas where the risk appears to be low. By educating the general population on rabies and relying on owners to bring their companion animals to strategically placed vaccination points, the control and elimination of rabies from Harare may be feasible.

Healthcare utilization, provisioning of post-exposure prophylaxis, and estimation of human rabies burden in Madagascar

In Madagascar, dog-mediated rabies has been endemic for over a century, however there is little data on its incidence or impact. We collected data over a 16-month period on provisioning of post-exposure prophylaxis (PEP) at a focal clinic in the Moramanga District and determined the rabies status of biting animals using clinical and laboratory diagnosis. We find that animal rabies cases are widespread, and clinic-based triage and investigation are effective ways to increase detection of rabies exposures and to rule out non-cases. A high proportion of rabies-exposed persons from Moramanga sought (84%) and completed PEP (90% of those that initiated PEP), likely reflecting the access and free provisioning of PEP in the district. Current clinic vial sharing practices demonstrate the potential for intradermal administration of PEP in endemic African settings, reducing vaccine use by 50% in comparison to intramuscular administration. A high proportion of PEP demand was attributed to rabies cases, with approximately 20% of PEP administered to probable rabies exposures and an additional 20% to low-to-no risk contacts with confirmed/probable animal or human cases. Using a simplified decision tree and our data on rabies exposure status and health-seeking behavior, we estimated an annual incidence of 42-110 rabies exposures and 1-3 deaths per 100,000 persons annually. Extrapolating to Madagascar, we estimate an annual burden of 282-745 human rabies deaths with current PEP provisioning averting 1499-3958 deaths each year. Data from other clinics and districts are needed to improve these estimates, particularly given that PEP availability is currently limited to only 31 clinics in the country. A combined strategy of mass dog vaccination, enhanced surveillance, and expanded access to PEP along with more judicious guidelines for administration could effectively reduce and eventually eliminate the burden of rabies in Madagascar.

Post-exposure prophylaxis (PEP) for rabies with purified chick embryo cell vaccine: a systematic literature review and meta-analysis

INTRODUCTION

Fifteen million people each year receive post-exposure prophylaxis (PEP) to prevent rabies, yet the disease remains neglected and highly under-reported.

AREAS COVERED

In this systematic literature review, we assessed the immunogenicity, efficacy, and safety of a purified chick embryo cell-culture rabies vaccine (PCECV) for PEP against rabies by intramuscular (IM) or intradermal (ID) administration. We performed meta-analyses to compare immunogenicity according to the route of vaccine administration, study population, and PEP regimen, such as number of doses, and concomitant rabies immunoglobulin.

EXPERT COMMENTARY

There were 54 estimates of immune responses to vaccination, which showed that in the overall population, after starting PEP with PCECV by the IM or ID route (≥2.5 IU per dose), almost all individuals had rabies virus neutralizing antibody (RVNA) titers above the World Health Organization (WHO) recommended serological threshold for an adequate immune response to vaccination (RVNA ≥0.5 IU/ml by day 14). In the overall population, PCECV had an acceptable safety profile. However, given that there are 59,000 human rabies deaths reported annually, the challenge is to improve access to PCECV for PEP against human rabies.