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Khairullah AR, Kurniawan SC, Hasib A, Silaen OSM, Widodo A, Effendi MH, Ramandinianto SC, Moses IB, Riwu KHP, Yanestria SM. Tracking lethal threat: in-depth review of rabies. Open Vet J 2023; 13:1385-1399. [PMID: 38107233 PMCID: PMC10725282 DOI: 10.5455/ovj.2023.v13.i11.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 10/10/2023] [Indexed: 12/19/2023] Open
Abstract
An infectious disease known as rabies (family Rhabdoviridae, genus Lyssavirus) causes severe damage to mammals' central nervous systems (CNS). This illness has been around for a very long time. The majority of human cases of rabies take place in underdeveloped regions of Africa and Asia. Following viral transmission, the Rhabdovirus enters the peripheral nervous system and proceeds to the CNS, where it targets the encephalon and produces encephalomyelitis. Postbite prophylaxis requires laboratory confirmation of rabies in both people and animals. All warm-blooded animals can transmit the Lyssavirus infection, while the virus can also develop in the cells of cold-blooded animals. In the 21st century, more than 3 billion people are in danger of contracting the rabies virus in more than 100 different nations, resulting in an annual death toll of 50,000-59,000. There are three important elements in handling rabies disease in post exposure prophylaxis (PEP), namely wound care, administration of anti-rabies serum, and anti-rabies vaccine. Social costs include death, lost productivity as a result of early death, illness as a result of vaccination side effects, and the psychological toll that exposure to these deadly diseases has on people. Humans are most frequently exposed to canine rabies, especially youngsters and the poor, and there are few resources available to treat or prevent exposure, making prevention of human rabies challenging.
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Affiliation(s)
- Aswin Rafif Khairullah
- Division of Animal Husbandry, Faculty of Veterinary Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Shendy Canadya Kurniawan
- Master Program of Animal Sciences, Department of Animal Sciences, Specialisation in Molecule, Cell and Organ Functioning, Wageningen University and Research, Wageningen, Netherlands
| | - Abdullah Hasib
- School of Agriculture and Food Sustainability, The University of Queensland, Gatton, Australia
| | - Otto Sahat Martua Silaen
- Doctoral Program in Biomedical Science, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Agus Widodo
- Department of Health, Faculty of Vocational Studies, Universitas Airlangga, Surabaya, Indonesia
| | - Mustofa Helmi Effendi
- Division of Veterinary Public Health, Faculty of Veterinary Medicine, Universitas Airlangga, Surabaya, Indonesia
| | | | - Ikechukwu Benjamin Moses
- Department of Applied Microbiology, Faculty of Science, Ebonyi State University, Abakaliki, Nigeria
| | - Katty Hendriana Priscilia Riwu
- Department of Veterinary Public Health, Faculty of Veterinary Medicine, Universitas Pendidikan Mandalika, Mataram, Indonesia
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Rolfe RJ, Ryan ET, LaRocque RC. Travel Medicine. Ann Intern Med 2023; 176:ITC129-ITC144. [PMID: 37696033 DOI: 10.7326/aitc202309190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/13/2023] Open
Abstract
International travel can cause new illness or exacerbate existing conditions. Because primary care providers are frequent sources of health advice to travelers, they should be familiar with destination-specific disease risks, be knowledgeable about travel and routine vaccines, be prepared to prescribe chemoprophylaxis and self-treatment regimens, and be aware of travel medicine resources. Primary care providers should recognize travelers who would benefit from referral to a specialized travel clinic for evaluation. Those requiring yellow fever vaccination, immunocompromised hosts, pregnant persons, persons with multiple comorbid conditions, or travelers with complex itineraries may warrant specialty referral.
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Affiliation(s)
- Robert J Rolfe
- Duke University School of Medicine, Durham, North Carolina (R.J.R.)
| | - Edward T Ryan
- Harvard Medical School, Boston, Massachusetts (E.T.R., R.C.L.)
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3
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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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4
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Saffar F, Heinemann M, Heitkamp C, Stelzl DR, Ramharter M, Schunk M, Rothe C, Bühler S. Rabies post-exposure prophylaxis of international travellers - Results from two major German travel clinics. Travel Med Infect Dis 2023; 53:102573. [PMID: 37087082 DOI: 10.1016/j.tmaid.2023.102573] [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: 01/14/2023] [Revised: 03/31/2023] [Accepted: 04/11/2023] [Indexed: 04/24/2023]
Abstract
BACKGROUND Travel to regions with rabies risk has increased. However, data on adequate rabies post exposure prophylaxis (PEP) abroad is scarce. The aim of this study was to assess the appropriateness of medical management following suspected rabies exposure (SRE) in international travellers. METHOD A cross-sectional questionnaire-based study in returning travellers with reported SRE who sought post-exposure medical care was conducted in two large German travel clinics. RESULTS The 75 included SRE cases had a median age of 34 years (range 26-43) and showed a female predominance (59%, 44/75). Most participants returned from Asia (47%, 34/72). About 28% had received pre-exposure prophylaxis (PrEP, ≥2 vaccine doses) (20/71). In 51% the animal was actively approached (34/67). All patients had category II/III exposure according to the World Health Organization (65% category III, 49/75). With 78% (52/67), most patients cleaned the wound after SRE; 36% (24/67) used water and soap. Only 57% (41/72) of participants sought medical care during their trip. Overall, 45% (33/74) received rabies vaccination abroad which corresponds to 80% out of those who sought healthcare (33/41). CONCLUSIONS Awareness for appropriate first aid and the urgency of seeking timely professional treatment including PEP after an SRE seems to be insufficient in German travellers. Travel practitioners need to educate travellers about rabies risk, prevention measures and the correct behaviour after SRE including adequate wound treatment and seeking immediate medical help for PEP. PrEP should be offered generously especially to travellers with high rabies-exposure risk and those visiting areas with limited healthcare access.
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Affiliation(s)
- Farah Saffar
- Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine & I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Melina Heinemann
- Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine & I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Christian Heitkamp
- Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine & I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Daniel Robert Stelzl
- Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine & I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Ramharter
- Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine & I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Mirjam Schunk
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the LMU Munich, Germany
| | - Camilla Rothe
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the LMU Munich, Germany
| | - Silja Bühler
- Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine & I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Division of Hygiene and Infectious Diseases, Institute for Hygiene and Environment, Hamburg, Germany; Postgraduate Training for Applied Epidemiology (PAE), Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany.
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5
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Bonilla-Aldana DK, Ruiz-Saenz J, Martinez-Gutierrez M, Villamil-Gomez W, Mantilla-Meluk H, Arrieta G, León-Figueroa DA, Benites-Zapata V, Barboza JJ, Muñoz-Del-Carpio-Toia A, Franco OH, Cabrera M, Sah R, Al-Tawfiq JA, Memish ZA, Amer FA, Suárez JA, Henao-Martinez AF, Franco-Paredes C, Zumla A, Rodriguez-Morales AJ. Zero by 2030 and OneHealth: The multidisciplinary challenges of rabies control and elimination. Travel Med Infect Dis 2023; 51:102509. [PMID: 36435448 DOI: 10.1016/j.tmaid.2022.102509] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 11/21/2022] [Indexed: 11/24/2022]
Affiliation(s)
- D Katterine Bonilla-Aldana
- Research Unit, Universidad Continental, Huancayo, Peru; Committee of Tropical Medicine, Zoonoses and Travel Medicine, Asociación Colombiana de Infectología (ACIN), Bogotá, DC, Colombia
| | - Julian Ruiz-Saenz
- Committee of Tropical Medicine, Zoonoses and Travel Medicine, Asociación Colombiana de Infectología (ACIN), Bogotá, DC, Colombia; Grupo de Investigación en Ciencias Animales-GRICA, Universidad Cooperativa de Colombia, Bucaramanga, Colombia
| | - Marlen Martinez-Gutierrez
- Committee of Tropical Medicine, Zoonoses and Travel Medicine, Asociación Colombiana de Infectología (ACIN), Bogotá, DC, Colombia; Grupo de Investigación en Microbiología Veterinaria, Escuela de Microbiología, Universidad de Antioquia, Medellín, Colombia
| | - Wilmer Villamil-Gomez
- Committee of Tropical Medicine, Zoonoses and Travel Medicine, Asociación Colombiana de Infectología (ACIN), Bogotá, DC, Colombia; Secretaría de Salud de Barranquilla, Barranquilla, Atlántico, Colombia
| | - Hugo Mantilla-Meluk
- Colección de Mastozoología y Centro de Estudios de Alta Montaña, Universidad del Quindío, Carrera 15 Calle 12N, Armenia, Quindío, Colombia
| | - German Arrieta
- Committee of Tropical Medicine, Zoonoses and Travel Medicine, Asociación Colombiana de Infectología ACIN, Bogotá, DC, Colombia; Universidad de Córdoba, Instituto de Investigaciones Biológicas del Trópico, Clínica Salud Social Sincelejo, Corporación Universitaria del Caribe: CECAR, Sucre, Colombia
| | - Darwin A León-Figueroa
- Facultad de Medicina Humana, Universidad de San Martín de Porres, Chiclayo, Peru; Unidad de Revisiones Sistemáticas y Meta-Análisis, Tau-Relaped Group, Trujillo, Peru
| | - Vicente Benites-Zapata
- Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Peru
| | - Joshuan J Barboza
- Vicerrectorado de Investigación, Universidad Norbert Wiener, Lima, Peru
| | | | - Oscar H Franco
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Maritza Cabrera
- Centro de Investigación de Estudios Avanzados del Maule CIEAM, Universidad Católica del Maule, Talca, 3480094, Chile; Facultad Ciencias de la Salud, Universidad Católica del Maule, Talca, 3480094, Chile
| | - Ranjit Sah
- Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal; Research Scholar, Harvard Medical School, Boston, MA, USA; Dr. D.Y Patil Medical College, Hospital and Research Centre, Dr. D.Y. Patil Vidyapeeth, Pune, Maharashtra, India
| | - Jaffar A Al-Tawfiq
- Specialty Internal Medicine and Quality Department, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia; Infectious Diseases Division, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA; Infectious Diseases Division, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ziad A Memish
- Al-Faisal University, Riyadh, Saudi Arabia; King Saud Medical City, Ministry of Health, Riyadh, Saudi Arabia; Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Fatma A Amer
- Medical Microbiology and Immunology Department, Faculty of Medicine, Zagazig, Egypt; Chair of Viral Infection Working Group, and Executive Committee Member, International Society for Antimicrobial Chemotherapy VIWG/ISAC, Egypt
| | - José Antonio Suárez
- Instituto Conmemorativo Gorgas de Estudios de la Salud, Investigator 1 of the SNI, Senacyt, Panama City, Panama
| | - Andres F Henao-Martinez
- Division of Infectious Diseases, School of Medicine, University of Colorado Anschutz Medical Campus, 12700 E. 19th Avenue, Mail Stop B168, Aurora, CO, 80045, USA
| | - Carlos Franco-Paredes
- Hospital Infantil de México, Federico Gómez, México City, Mexico; Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, CO, USA
| | - Alimuddin Zumla
- Division of Infection and Immunity, University College London, London, UK; NIHR Biomedical Research Centre, University College London Hospitals, London, UK
| | - Alfonso J Rodriguez-Morales
- Committee of Tropical Medicine, Zoonoses and Travel Medicine, Asociación Colombiana de Infectología ACIN, Bogotá, DC, Colombia; Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Beirut, Lebanon; Master of Clinical Epidemiology and Biostatistics, Universidad Científica del Sur, Lima, 4861, Peru; Grupo de Investigación Biomedicina, Faculty of Medicine, Fundación Universitaria Autónoma de las Américas - Institución Universitaria Visión de las Américas, 660003, Pereira, Risaralda, Colombia; Editor-in-Chief, Travel Medicine and Infectious Diseases.
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6
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Predictors of possible exposure to rabies in travellers: A case-control study. Travel Med Infect Dis 2022; 47:102316. [DOI: 10.1016/j.tmaid.2022.102316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 03/15/2022] [Accepted: 03/18/2022] [Indexed: 11/20/2022]
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Reasons for seeking care and adherence to pretravel preparation in expatriate or long-term travelers' children in the tropics: A French prospective study. Travel Med Infect Dis 2021; 46:102184. [PMID: 34699957 DOI: 10.1016/j.tmaid.2021.102184] [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: 02/17/2021] [Revised: 09/16/2021] [Accepted: 10/18/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Studies on pediatric travelers' health rarely address expat or long-term travelers' children. METHOD To investigate reasons for seeking care and adherence to pretravel preparation, we prospectively enrolled French children 0-15 years old, either expatriates or staying >6 months in tropical areas, who attended a French health center in Africa, Central America or Southern Pacific regions from October 01, 2011 to October 31, 2012. A standardized questionnaire was completed by a general practitioner at each visit, then anonymized and included in our database. RESULTS 464 questionnaires were collected from 367 children (sex ratio M/F: 1:1). Median age was 6.4 years (IQR: 3.6; 10.3). Reasons for seeking care were mostly infections (n = 378), of which 12 (3.2%) were tropical. There were no deaths, but one child with tuberculosis was repatriated. Coverage was high for routine immunization, but less for travel-related vaccines. Personal antivectorial protection was significantly lower in children aged >5 y or in non-malarial areas. Where indicated, malarial chemoprophylaxis was prescribed to only one third of the children, of whom 60% were poorly compliant. Advice regarding measures against diarrhea and sunburn was followed significantly more for stays >2 yrs. CONCLUSION Mild cosmopolitan illnesses predominated but protection against tropical threats should be optimized before and during the stay.
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8
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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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9
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Riccardi N, Giacomelli A, Antonello RM, Gobbi F, Angheben A. Rabies in Europe: An epidemiological and clinical update. Eur J Intern Med 2021; 88:15-20. [PMID: 33934971 DOI: 10.1016/j.ejim.2021.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 03/30/2021] [Accepted: 04/09/2021] [Indexed: 11/16/2022]
Abstract
Rabies is a vaccine preventable zoonotic disease with a significant mortality burden worldwide. Several years of vaccination campaigns in wildlife animals have now achieved the control of rabies in Western Europe through a vaccination belt in front of endemic Eastern European countries. Nevertheless, rabies could be imported both by travellers from areas without an active public control of the disease or by animals coming from areas where the virus circulates in wildlife fauna. The knowledge of the current world epidemiology combined with a high index of clinical suspicion are needed to reach a diagnosis of rabies, especially in case of atypical presentation or without a history of animal exposure. The pre-travel counselling to people visiting highly endemic areas is essential to give information on how to reduce exposure to potential sources of infection and to select those subjects who could benefit from pre-travel vaccination. Rabies is almost invariably fatal, but the prompt administration of a vaccine course combined with anti-rabies immunoglobulins significantly reduces the probability to develop life-threatening consequences. In this review, we give a brief epidemiological and clinical update about rabies in Europe.
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Affiliation(s)
- Niccolò Riccardi
- Department of Infectious, Tropical Diseases & Microbiology (DITM), IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy.
| | - Andrea Giacomelli
- III Infectious Diseases Unit, ASST Fatebenefratelli Sacco, Milano, Italy
| | - Roberta Maria Antonello
- Clinical Department of Medical, Surgical and Health Sciences, Trieste University Hospital, Trieste, Italy.
| | - Federico Gobbi
- Department of Infectious, Tropical Diseases & Microbiology (DITM), IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy.
| | - Andrea Angheben
- Department of Infectious, Tropical Diseases & Microbiology (DITM), IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy.
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10
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Soentjens P, Croughs M, Burm C, Declerq S, Clerinx J, Maniewski U, Van Den Broucke S, Theunissen C, Huits R, Brosius I, Florence E, Kenyon C, Van Griensven J, Van Ierssel S, Lynen L, Balliauw K, Van Gucht S, Van Esbroeck M, Vlieghe E, Bottieau E, Van Herrewege Y. Time of administration of rabies immunoglobulins and adequacy of antibody response upon post-exposure prophylaxis: a descriptive retrospective study in Belgium. Acta Clin Belg 2021; 76:91-97. [PMID: 31483218 DOI: 10.1080/17843286.2019.1662993] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Data on rabies post-exposure prophylaxis (PEP) and the use of human rabies immunoglobulins (HRIG) in Belgium are scarce. The main objective of this study was to evaluate the timely administration of HRIG after rabies exposure. The secondary objective was to evaluate the adequate antibody response following PEP.Methods: We reviewed all medical records from July 2017 to June 2018 of patients seeking care at, or referred to, the Institute of Tropical Medicine and the University Hospital, Antwerp for the administration of human rabies immunoglobulins following potential rabies exposure abroad or in Belgium.A timely response was defined as starting HRIG with a delay of ≤48 h and rabies vaccination in the first 7 days after exposure.Adequate antibody response was defined as a titer of >5.0 IU/mL in case of bat-related exposure and >3.0 IU/mL in case of exposure to other animals. Titers were measured 10 days after the last PEP vaccine dose, using the rapid fluorescent focus inhibition test (RFFIT).Results: Of the 92 cases treated with HRIG, 75 were evaluated.The majority of injuries were acquired in Asia (n = 26,34%) and in Western Europe (n = 18, 24%), of which 17 in Belgium. The five most frequently recorded countries overseas were Indonesia (n = 13), Thailand (n = 7), Morocco (n = 4), Peru (n = 3) and Costa Rica (n = 3). Administration of immunoglobulins was related to injuries by dogs (36%), monkeys (25%) or bats (22%).A timely response was observed in 16 (21,33%) and in 55 (73,33%) of subjects receiving HRIG (≤48 h) or rabies vaccine (<7days) respectively. The mean time between exposure and the first administered dose of rabies vaccine and HRIG was 7.7 and 8.7 days, respectively. The mean delay for HRIG administration was 9.6 days and 6 days for abroad and inland risks, respectively.In 15 of 16 (94%) bat-related cases the antibody titer after full PEP was >5.0 IU/ml. In 38 of 47 (81%) cases related to other animals the RFFIT titer was >3.0 IU/ml. All low-responders received additional rabies injections.Conclusion: This study showed a substantial time delay between the animal-related risk and the administration of HRIG, in particular when the injury occurred abroad. More targeted communication about the risks of rabies and preventable measures may reduce this delay.Furthermore, the antibody response was inadequate in some cases following full PEP administration according to the Belgian recommendation.
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Affiliation(s)
- Patrick Soentjens
- Centre for Infectious Diseases, Queen Astrid Military Hospital, Brussels, Belgium
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Mieke Croughs
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Christoph Burm
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Steven Declerq
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Jan Clerinx
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Ula Maniewski
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | | | - Caroline Theunissen
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Ralph Huits
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Isabel Brosius
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Eric Florence
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Chris Kenyon
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Johan Van Griensven
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Sabrina Van Ierssel
- Department of Infectious Diseases and Tropical Diseases, University Hospital Antwerp, Antwerp, Belgium
| | - Lut Lynen
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Katleen Balliauw
- Hospital Pharmacy, University Hospital Antwerp, Antwerp, Belgium
| | - Steven Van Gucht
- Department of Infectious Diseases and Tropical Diseases, University Hospital Antwerp, Antwerp, Belgium
| | - Marjan Van Esbroeck
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Erika Vlieghe
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
- Department of Infectious Diseases and Tropical Diseases, University Hospital Antwerp, Antwerp, Belgium
| | - Emmanuel Bottieau
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Yven Van Herrewege
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
- National Reference Centre for Rabies, Sciensano, Brussels, Belgium
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11
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Abstract
Rabies post-exposure prophylaxis (R-PEP) including wound treatment, vaccination and application of rabies immunoglobulin (RIG) is essential in preventing rabies mortality. Today, Germany is officially declared free from terrestrial rabies and rabies is only found in bats. However, physicians in A&E Departments are frequently consulted on the need for R-PEP. We retrospectively analysed patients who received R-PEP at the A&E Department of the University Hospital Bonn between 01.01.2013 and 30.06.2019. Demographic data, travel history, clinical and laboratory findings, previous rabies vaccinations and R-PEP vaccination regimen were recorded. During the study period, 90 patients received R-PEP at the University Hospital Bonn, in 10 cases without indication for R-PEP. Altogether, we found deviations from R-PEP guidelines in 51% (n = 41/80). Infiltration of RIG was missed in 12 patients and incorrectly administrated in 24 patients. Furthermore, vaccination scheme was incorrect in 11 patients. Correct wound washing and documentation of tetanus status was missing in 14% and 63% of patients, respectively. Despite rabies elimination in Germany patients frequently seek advice for R-PEP, the majority returning from foreign travel. Our data show that there is a high need for education on indication for R-PEP before and after travel and for implementation of precise R-PEP guidelines in daily clinical practice.
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Preventable public health challenge: Rabies suspected exposure and prophylaxis practices in southwestern of Turkey. J Infect Public Health 2021; 14:221-226. [PMID: 33493918 DOI: 10.1016/j.jiph.2020.12.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 11/30/2020] [Accepted: 12/04/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Rabies is found in many countries of the eastern Mediterranean and is one of the most important zoonotic diseases in the world. The study aims to describe rabies suspected exposures (RSE) and rabies prophylaxis practices in Antalya-Turkey between 2010 and 2013. METHODS All 2513 RSE cases presenting to a rabies vaccination center in Antalya, southwestern Turkey, were retrospectively investigated. RESULTS The mean age of the RSE cases was 30.04±19.63 years with male predominance (63.6%). The vast majority was from urban areas (91.7%), and a postexposure rabies vaccination program was applied to 79.7% of participants. Dogs were the primary source of RSE cases (61.2%). The 39.2% of animals were under observation, and 9.53% of them died. Forty-two animals (1.7%) were laboratory confirmed rabid; 61.9% of them were cows. The rabid animal rate in the rural area was significantly higher than the urban area (18.2% versus 0.2%; p=0.001). CONCLUSIONS This study includes a large number of RSE cases and prophylaxis practices in southwestern Turkey. Most RSE cases had dog or cat contact. As most RSE cases were in urban areas; more focused efforts should be made for elimination and vaccination of feral dog and cat population in Turkey.
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Heitkamp C, Stelzl DR, Ramharter M, Bühler S. Rabies exposure in travellers to Asia, the Middle East, Africa, South and Central America-a German Airport study. J Travel Med 2020; 27:5822104. [PMID: 32307548 DOI: 10.1093/jtm/taaa058] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 04/14/2020] [Accepted: 04/15/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND Rabies causes thousands of deaths worldwide and trips to rabies endemic countries are popular. Travellers are often uncertain whether pre-exposure prophylaxis (PrEP) is advisable since they find it difficult to estimate the exposure risk during travel and the availability of post-exposure prophylaxis in endemic regions. The aim of this study was to determine the potential rabies exposures in travellers and to assess their knowledge on rabies. Secondly, we explored the access to appropriate post-exposure medical care in respective countries. METHODS We conducted a cross-sectional study at Frankfurt Airport. Returning adult travellers arriving from Asia, the Middle East, Africa, South and Central America were invited to participate in this questionnaire-based study while waiting in the baggage claim area. RESULTS Over a one-month recruitment phase in March 2019, we enrolled 3066 travellers; 2929 were included in the analysis. The gender ratio was balanced; the median age was 42 years (range 18-83 years). Participants arrived from Asia (46%), Africa (29%), Central/South America (13%), the Middle East (8%) and the Caribbean (8%). Forty-five per cent sought pretravel advice and 22% received ≥2 injections of rabies PrEP. Travellers with pretravel advice from tropical medicine specialists reached significantly higher knowledge scores than others. We found that potential rabies exposure occurred in 2.0% (57/2915) of travellers with 31% (13/42) of the contacts being unprovoked; 19% (8/42) of the exposed sought medical care and 3/8 were adequately treated before returning to Germany. Risk factors for animal exposure were: male sex, young age, trips to Asia and a long stay abroad (>4 weeks). CONCLUSIONS A total of 2% of returning travellers (n = 2915) experienced a potential rabies exposure during their journey. A majority of the exposed individuals did not seek medical care; those seeking medical care were often treated inadequately. Rabies information must be emphasised during pretravel counselling and PrEP should be offered generously, especially to travellers with high exposure risks.
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Affiliation(s)
- Christian Heitkamp
- Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine & I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20359 Hamburg, Germany
| | - Daniel Robert Stelzl
- Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine & I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20359 Hamburg, Germany
| | - Michael Ramharter
- Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine & I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20359 Hamburg, Germany
| | - Silja Bühler
- Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine & I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20359 Hamburg, Germany
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Factors influencing the immune response after a single-dose 3-visit pre-exposure rabies intradermal vaccination schedule: A retrospective multivariate analysis. Travel Med Infect Dis 2020; 37:101867. [PMID: 32871278 DOI: 10.1016/j.tmaid.2020.101867] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 08/24/2020] [Accepted: 08/25/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND The World Health Organization (WHO) recommends intradermal (ID) rabies vaccination as a safe and immunogenic alternative to intramuscular administration. The aim of this study is to determine which factors influence the levels of rabies virus neutralizing antibodies (RVNA) after a 3-visit ID rabies vaccination. METHODS This is a retrospective secondary data analysis study based on electronic health record vaccination data of Belgian military subjects who received ID rabies Pre-exposure prophylaxis (PrEP) with a single-dose 3-visit regimen during the period 2014-2017. Logistic regression was performed to identify predictive factors of RVNA level ≥3.0 IU/mL and >10 IU/mL. RESULTS The second analysis performed on the 2025 subjects (100% seroconverted with a RVNA ≥ 0.5 IU/mL) shows a significantly better immune response in subjects younger than 30 years compared to all other age-groups, a gender-difference to predict RVNA ≥ 3.0 IU/mL (OR 2.30 [1.26-4.22] comparing "female" to "male") and the influence of the vaccination schedule (OR 2.28 [1.15-4.53] comparing "late - very variable" to "correct" schedule) to predict > 10 IU/ml. Multivariate analysis also demonstrates that a postponed serology control significantly influences the Rapid Fluorescent Focus Inhibition Test (RFFIT). CONCLUSION Gender and age significantly influence the response to ID rabies vaccine. Timing of RVNA determination is important to correctly assess the response to vaccination. A single-dose 3-visit ID rabies PrEP schedule is a dose-sparing effective alternative to the double-dose 2-visit ID schedule. When the minimum time interval between doses is respected, RVNA determination is not necessary.
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Epidemiology of rabies cases among international travellers, 2013-2019: A retrospective analysis of published reports. Travel Med Infect Dis 2020; 36:101766. [PMID: 32525075 DOI: 10.1016/j.tmaid.2020.101766] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 05/18/2020] [Accepted: 05/30/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Sixty cases of rabies in international travellers from 1990 to 2012 were previously reviewed. We present here an update of rabies cases in international travellers from 2013 to 2019. METHODS We systematically reviewed the existing literature and collected 23 cases of rabies in individuals who crossed an international border between the time of infection and diagnosis, or who were infected following expatriation or migration. RESULTS Most cases were in male adult travellers and diagnosed in Europe and the Middle East, with most exposures in Asia or in Africa. Migrants originating from rabies-endemic low-and-middle income countries and their descendants accounted for two thirds of cases. Other cases were in tourists, business travellers and expatriates. Median travel duration (excluding migration trip) was 60 days (range 7-240 days). Most cases were due to dog bites and most common clinical presentation was furious rabies. In most patients (74%), no rabies post-exposure prophylaxis (RPEP) was administered before rabies symptoms appeared. Other patients received incomplete RPEP series. CONCLUSION Rabies should be suspected in any patient with encephalitis or paralysis who travelled to, or migrated from a rabies-endemic country. Comprehensive information about a rabies risk should be given to travellers to rabies endemic countries, notably migrants visiting friends and relatives.
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Hiranrusme T, Piyaphanee W, Kaewkungwal J, Silachamroon U, Leowattana W, Chatapat L, Matsee W. Risk perception of health problems among travelers visiting a travel clinic in Bangkok, Thailand. Trop Dis Travel Med Vaccines 2020; 6:7. [PMID: 32477584 PMCID: PMC7238588 DOI: 10.1186/s40794-020-00108-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 05/08/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Effective pre-travel consultations cannot be achieved only through individual risk assessment and advice on vaccinations and chemoprophylaxis. Travelers' perceptions of the risk of health problems represent another key factor in successful risk communication and co-operation with pre-travel advice. The objective of this study was to determine perception of travel-related health risks among Thais and westerners visiting the Thai Travel Clinic for consultation before visiting developing countries. METHODS A novel pictorial scale questionnaire-based study was conducted with both Thai and western travelers who visited the Thai Travel Clinic for pre-travel consultation. All participants were approached before and after completing the consultation, and were asked about their demographic data and perceptions of travel-related health risk. The perceptions of risk before and after consultation were compared using the McNemar test, and were also compared with the actual estimated risk. RESULTS During May to November 2019, 594 travelers (330 Thais and 264 Westerners) were enrolled and completed the pictorial scale questionnaires. Most Thai travelers visited Africa/South America (63%), and 20% had previously received counseling. Westerners were mostly backpackers (37.5%), traveling for > 30 days (71.6%), while 43.6% had previously received counseling. Overall, the westerners (n = 264) changed their risk perceptions slightly after counseling in contrast with the Thais. The change in perception of most health problems was observed statistically significant (p-value < 0.05) after receiving pre-travel consultation among both groups of travelers. Risk perception among western travelers after consultation compared with estimated actual risk showed accurate risk perception toward most of health problems especially in travelers who had previously received counseling in ones' home countries. CONCLUSIONS Risk perception of health problems plays an important role in successful risk communication and their response to pre-travel advices. Differences in risk perceptions were evident between the two groups. Therefore, this highlight the importance of obtaining pre-travel advice in one's home country before travelling. Raised awareness of the risks should be emphasized during consultations for underestimated health risks, especially for rabid animal exposure and sexually transmitted diseases.
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Affiliation(s)
- Thanyapat Hiranrusme
- 1Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, 420/6 Ratchawithi Road, Bangkok, 10400 Thailand
| | - Watcharapong Piyaphanee
- 1Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, 420/6 Ratchawithi Road, Bangkok, 10400 Thailand
| | - Jaranit Kaewkungwal
- 2Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Udomsak Silachamroon
- 1Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, 420/6 Ratchawithi Road, Bangkok, 10400 Thailand
| | - Wattana Leowattana
- 1Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, 420/6 Ratchawithi Road, Bangkok, 10400 Thailand
| | - Lapakorn Chatapat
- 1Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, 420/6 Ratchawithi Road, Bangkok, 10400 Thailand
| | - Wasin Matsee
- 1Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, 420/6 Ratchawithi Road, Bangkok, 10400 Thailand
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Factors influencing the immune response after a double-dose 2-visit pre-exposure rabies intradermal vaccination schedule: A retrospective study. Travel Med Infect Dis 2020; 33:101554. [PMID: 31931134 DOI: 10.1016/j.tmaid.2020.101554] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 01/04/2020] [Accepted: 01/07/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Double-dose 2-visit intradermal rabies schedules (22ID) have recently been accepted by the World Health Organization (WHO) as Pre-Exposure Prophylaxis (PrEP). The aim of this study is to determine which factors influence the levels of rabies virus neutralizing antibodies (RVNA) after a 22ID rabies vaccination schedule. METHODS This is a retrospective study based on electronic health record vaccination data of subjects from the Belgian Armed Forces who received the 22ID rabies PrEP. An antibody titer ≥0.5 IU/mL, measured by rapid fluorescent focus inhibition test, is defined by the WHO as an adequate immune response after PrEP. Logistic regression was performed in order to identify predictive factors of RVNA level ≥3.0 IU/ml and >10 IU/ml. RESULTS 301 subjects were included. 297 (98,6%) seroconverted with a RVNA ≥ 0.5 IU/ml. Multivariate analysis shows a significant better immune response in the subjects where the second dose was administered later on than on day 7 (RVNA >10 IU/ml (OR: 3.01 [1.36-6.67])). Postponing the timing of the serology control also influenced significantly the rapid fluorescent focus inhibition test (RVNA ≥ 3.0 IU/ml (OR: 0.12 [0.06-0.24]) and RVNA > 10 IU/ml (OR: 0.14 [0.06-0.29])). CONCLUSION A 22ID rabies PrEP vaccination schedule is highly effective and provides an adequate immune response in most subjects in a real live setting. Timing of the second vaccine dose significantly influences the response to ID rabies vaccine. Timing of RVNA determination is important in order to correctly assess the response to vaccination.
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18
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Rothe C, Boecken G. Reiseimpfungen. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2020; 63:74-84. [DOI: 10.1007/s00103-019-03064-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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19
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Gautret P, Schlagenhauf P, Fischer PR. One-week, two-visit, double-dose, intra-dermal (22ID) rabies vaccination schedule for travelers: Time/dose sparing, effective but “off label”. Travel Med Infect Dis 2020; 33:101563. [DOI: 10.1016/j.tmaid.2020.101563] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 01/21/2020] [Indexed: 10/25/2022]
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20
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Freedman DO, Chen LH. Vaccines for International Travel. Mayo Clin Proc 2019; 94:2314-2339. [PMID: 31685156 DOI: 10.1016/j.mayocp.2019.02.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 01/16/2019] [Accepted: 02/14/2019] [Indexed: 01/02/2023]
Abstract
The pretravel management of the international traveler should be based on risk management principles. Prevention strategies and medical interventions should be based on the itinerary, preexisting health factors, and behaviors that are unique to the traveler. A structured approach to the patient interaction provides a general framework for an efficient consultation. Vaccine-preventable diseases play an important role in travel-related illnesses, and their impact is not restricted to exotic diseases in developing countries. Therefore, an immunization encounter before travel is an ideal time to update all age-appropriate immunizations as well as providing protection against diseases that pose additional risk to travelers that may be delineated by their destinations or activities. This review focuses on indications for each travel-related vaccine together with a structured synthesis and graphics that show the geographic distribution of major travel-related diseases and highlight particularly high-risk destinations and behaviors. Dosing, route of administration, need for boosters, and possible accelerated regimens for vaccines administered prior to travel are presented. Different underlying illnesses and medications produce different levels of immunocompromise, and there is much unknown in this discipline. Recommendations regarding vaccination of immunocompromised travelers have less of an evidence base than for other categories of travelers. The review presents a structured synthesis of issues pertinent to considerations for 5 special populations of traveler: child traveler, pregnant traveler, severely immunocompromised traveler, HIV-infected traveler, and traveler with other chronic underlying disease including asplenia, diabetes, and chronic liver disease.
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Affiliation(s)
- David O Freedman
- Division of Infectious Diseases, William C. Gorgas Center for Geographic Medicine, University of Alabama at Birmingham.
| | - Lin H Chen
- Division of Infectious Diseases and Travel Medicine, Mount Auburn Hospital, Cambridge, MA; Department of Medicine, Harvard Medical School, Boston, MA
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21
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Debnath A, Pathak DC, Ramamurthy N, Mohd G, Pandey AB, Upmanyu V, Tiwari AK, Saravanan R, Chellappa MM, Dey S. Serological profiling of rabies antibodies by enzyme-linked immunosorbent assay and its comparative analysis with rapid fluorescent focus inhibition test in mouse model. Vet World 2019; 12:126-130. [PMID: 30936665 PMCID: PMC6431817 DOI: 10.14202/vetworld.2019.126-130] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 12/11/2018] [Indexed: 11/30/2022] Open
Abstract
Aim: In this study, we have used enzyme-linked immunosorbent assay (ELISA) as an alternative test to replace the cumbersome rapid fluorescent focus inhibition test (RFFIT) to ascertain the immune status of immunized mice against rabies virus. Materials and Methods: Rabies is a devastating disease worldwide caused by rabies virus. Proper usage of pre- or post-exposure rabies vaccine can prevent the disease transmission. In this study, mice were immunized with Vero cell-adapted inactivated rabies vaccine. RFFIT was used as a test to determine the serum neutralizing titers in infected/vaccinated mice. Seroprofiling of mice sera was done in vitro by ELISA. Results: Twenty-one days post-immunization, both ELISA and RFFIT assays indicated similar antibody levels in mice sera that were immunized with Vero cell-adapted inactivated rabies vaccine. Both the tests were correlated, and the linearity was verified by the regression line (R²=0.979). Conclusion: In this study, we profiled the serological status of Vero cell-adapted inactivated rabies vaccine through ELISA in mice model that correlated well with the OIE gold standard test RFFIT.
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Affiliation(s)
- Ashis Debnath
- Recombinant DNA Laboratory, Division of Veterinary Biotechnology, Indian Veterinary Research Institute, Izatnagar, Bareilly, Uttar Pradesh, India
| | - Dinesh C Pathak
- Recombinant DNA Laboratory, Division of Veterinary Biotechnology, Indian Veterinary Research Institute, Izatnagar, Bareilly, Uttar Pradesh, India
| | - Narayan Ramamurthy
- Recombinant DNA Laboratory, Division of Veterinary Biotechnology, Indian Veterinary Research Institute, Izatnagar, Bareilly, Uttar Pradesh, India
| | - Gulam Mohd
- Division of Biological Standardization, Indian Veterinary Research Institute, Izatnagar, Bareilly, Uttar Pradesh, India
| | - A B Pandey
- Division of Biological Standardization, Indian Veterinary Research Institute, Izatnagar, Bareilly, Uttar Pradesh, India
| | - Vikramaditya Upmanyu
- Division of Biological Standardization, Indian Veterinary Research Institute, Izatnagar, Bareilly, Uttar Pradesh, India
| | - A K Tiwari
- Division of Biological Standardization, Indian Veterinary Research Institute, Izatnagar, Bareilly, Uttar Pradesh, India
| | - R Saravanan
- Immunology Section, Indian Veterinary Research Institute, Izatnagar, Bareilly, Uttar Pradesh, India
| | - Madhan Mohan Chellappa
- Recombinant DNA Laboratory, Division of Veterinary Biotechnology, Indian Veterinary Research Institute, Izatnagar, Bareilly, Uttar Pradesh, India
| | - Sohini Dey
- Recombinant DNA Laboratory, Division of Veterinary Biotechnology, Indian Veterinary Research Institute, Izatnagar, Bareilly, Uttar Pradesh, India
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Gautret P, Angelo KM, Asgeirsson H, Lalloo DG, Shaw M, Schwartz E, Libman M, Kain KC, Piyaphanee W, Murphy H, Leder K, Vincelette J, Jensenius M, Waggoner J, Leung D, Borwein S, Blumberg L, Schlagenhauf P, Barnett ED, Hamer DH. Rabies post-exposure prophylaxis started during or after travel: A GeoSentinel analysis. PLoS Negl Trop Dis 2018; 12:e0006951. [PMID: 30422981 PMCID: PMC6258561 DOI: 10.1371/journal.pntd.0006951] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 11/27/2018] [Accepted: 10/26/2018] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Recent studies demonstrate that rabies post-exposure prophylaxis (RPEP) in international travelers is suboptimal, with only 5-20% of travelers receiving rabies immune globulin (RIG) in the country of exposure when indicated. We hypothesized that travelers may not be receiving RIG appropriately, and practices may vary between countries. We aim to describe the characteristics of travelers who received RIG and/or RPEP during travel. METHODOLOGY/PRINCIPAL FINDINGS We conducted a multi-center review of international travelers exposed to potentially rabid animals, collecting information on RPEP administration. Travelers who started RPEP before (Group A) and at (Group B) presentation to a GeoSentinel clinic during September 2014-July 2017 were included. We included 920 travelers who started RPEP. About two-thirds of Group A travelers with an indication for rabies immunoglobulin (RIG) did not receive it. Travelers exposed in Indonesia were less likely to receive RIG in the country of exposure (relative risk: 0.30; 95% confidence interval: 0.12-0.73; P = 0.01). Travelers exposed in Thailand [Relative risk (RR) 1.38, 95% Confidence Interval (95% CI): 1.0-1.8; P = 0.02], Sri Lanka (RR 3.99, 95% CI: 3.99-11.9; P = 0.013), and the Philippines (RR 19.95, 95% CI: 2.5-157.2; P = 0.01), were more likely to receive RIG in the country of exposure. CONCLUSIONS/SIGNIFICANCE This analysis highlights gaps in early delivery of RIG to travelers and identifies specific countries where travelers may be more or less likely to receive RIG. More detailed country-level information helps inform risk education of international travelers regarding appropriate rabies prevention.
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Affiliation(s)
- Philippe Gautret
- Institut Méditerranée Infection, Aix-Marseille University, Marseille, France
| | - Kristina M. Angelo
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Hilmir Asgeirsson
- Department of Infectious Diseases, Karolinska University Hospital, and Unit of Infectious Diseases, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - David G. Lalloo
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Marc Shaw
- Public Health and Tropical Medicine Department, James Cook University, Townsville, Australia, and WORLDWISE Travellers Health Centres of New Zealand
| | - Eli Schwartz
- The Center of Geographical Medicine, Sheba Medical Center, Tel HaShomer, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michael Libman
- J.D. MacLean Centre for Tropical Diseases, McGill University, Montreal, Canada
| | - Kevin C. Kain
- Tropical Disease Unit, UHN-Toronto General Hospital, University of Toronto, Toronto, Canada
| | - Watcharapong Piyaphanee
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Holly Murphy
- CIWEC Hospital and Travel Medicine Center, Kathmandu, Nepal
| | - Karin Leder
- School of Epidemiology and Preventive Medicine, Monash University, and Victorian Infectious Disease Service, Royal Melbourne Hospital at the Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Jean Vincelette
- Clinique Santé-voyage, Fondation du CHUM, Université de Montréal, Montreal, Canada
| | - Mogens Jensenius
- Department of Infectious Diseases - Oslo University Hospital, Oslo, Norway
| | - Jesse Waggoner
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Daniel Leung
- Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
| | - Sarah Borwein
- TravelSafe Medical Centre - Central Health Medical Practice, Hong Kong, China
| | | | - Patricia Schlagenhauf
- University of Zürich Centre for Travel Medicine, WHO Collaborating Centre for Travellers’ Health, Epidemiology, Biostatistics and Prevention Institute, University of Zürich, Switzerland
| | - Elizabeth D. Barnett
- Maxwell Finland Laboratory for Infectious Diseases, Boston Medical Center, and Department of Pediatrics, Boston University School of Medicine, Boston, Massachusetts, United States of America
| | - Davidson H. Hamer
- Department of Global Health, Boston University School of Public Health and Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, United States of America
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Parize P, Dacheux L, Larrous F, Bourhy H. The shift in rabies epidemiology in France: time to adjust rabies post-exposure risk assessment. Euro Surveill 2018; 23:1700548. [PMID: 30280687 PMCID: PMC6169203 DOI: 10.2807/1560-7917.es.2018.23.39.1700548] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 02/11/2018] [Indexed: 12/25/2022] Open
Abstract
The epidemiology of rabies in France and western Europe has changed during the past 22 years. In France, rabies in non-flying terrestrial mammals was declared to be eliminated in 2001, and the risk of rabies is now limited to contact with bats, rabid animals illegally imported from rabies-enzootic countries and traveller exposure in enzootic areas. We analysed the epidemiology of rabies in France from 1995 to 2016, describing and analysing data on human rabies surveillance as well as data on post-exposure prophylaxis (PEP) collected from the network of French antirabies clinics. Over the study period, seven individuals were diagnosed with rabies in France, all of whom were infected outside mainland France. PEP data analysis revealed an expected overall decrease in PEP administration for individuals exposed in mainland France, but there was still overuse of anti-rabies drugs, given the very low epidemiological risk. On the other hand, a significant increase in PEP delivered to individuals exposed abroad was evidenced. These epidemiological trends indicate that clear guidelines should be provided to support physicians' efforts to adjust rabies risk assessment to the evolution of the epidemiological situation.
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Affiliation(s)
- Perrine Parize
- Institut Pasteur, Unit Lyssavirus Dynamics and Host Adaptation, National Reference Center for Rabies and WHO Collaborating Centre for Reference and Research on Rabies, Paris, France
| | - Laurent Dacheux
- Institut Pasteur, Unit Lyssavirus Dynamics and Host Adaptation, National Reference Center for Rabies and WHO Collaborating Centre for Reference and Research on Rabies, Paris, France
| | - Florence Larrous
- Institut Pasteur, Unit Lyssavirus Dynamics and Host Adaptation, National Reference Center for Rabies and WHO Collaborating Centre for Reference and Research on Rabies, Paris, France
| | - Hervé Bourhy
- Institut Pasteur, Unit Lyssavirus Dynamics and Host Adaptation, National Reference Center for Rabies and WHO Collaborating Centre for Reference and Research on Rabies, Paris, France
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Gautret P, Pradines B, Memish ZA, Sokhna C, Parola P. Mobile populations across the Mediterranean Sea and beyond: travel medicine, mass gathering medicine and homeless health. New Microbes New Infect 2018; 26:S96-S99. [PMID: 30402250 PMCID: PMC6205569 DOI: 10.1016/j.nmni.2018.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 05/23/2018] [Accepted: 05/23/2018] [Indexed: 11/23/2022] Open
Abstract
The Méditerranée Infection institute is internationally recognized for its expertise in infectious diseases and tropical medicine, and is one of the most active research centres for infectious diseases in Europe. Surveillance and research addressing infectious diseases in globally mobile populations is one of the strong components of the research conducted at the institute. A significant amount of clinical, microbiologic and epidemiologic works have been conducted in international travellers, pilgrims participating in large international religious gatherings, economic migrants and homeless migrant people over the last decades by our group. Our strong anchoring in several countries around the Mediterranean Sea and beyond, as well as the pivotal role of Marseille in the EuroTravNet and GeoSentinel international networks that monitor travel-associated diseases, reinforce our leading position in the fields of travel and tropical medicine, mass gathering medicine and homeless health.
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Affiliation(s)
- P Gautret
- Aix-Marseille Université, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, France
| | - B Pradines
- Aix-Marseille Université, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, France.,Unité Parasitologie et Entomologie, Département des Maladies Infectieuses, Institut de Recherche Biomédicale des Armées, France.,Centre National de Référence du Paludisme, Institut Hospitalo-universitaire (IHU) Méditerranée Infection, Marseille, France
| | - Z A Memish
- Department of Medicine, College of Medicine, Alfaisal University & Infectious Diseases Division, Prince Mohamed Bin Abdulaziz Hospital, Ministry of Health, Riyadh, Saudi Arabia, Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - C Sokhna
- Aix-Marseille Université, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, France
| | - P Parola
- Aix-Marseille Université, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, France
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Rabies Preexposure Prophylaxis: Application of Updated World Health Organization Position to Travelers. Clin Infect Dis 2018; 67:1948-1950. [DOI: 10.1093/cid/ciy422] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 05/10/2018] [Indexed: 11/14/2022] Open
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Kong LY, Vincelette J, Laplante G, Duchesne JA, Libman M, Barkati S. Intradermal pre-exposure rabies vaccination in a Canadian travel clinic: 6-year retrospective observational study. CMAJ Open 2018; 6:E168-E175. [PMID: 29636332 PMCID: PMC7869659 DOI: 10.9778/cmajo.20170147] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The intradermal route of vaccine administration for pre-exposure rabies prophylaxis, endorsed by the Canadian National Advisory Committee on Immunization, was implemented at a large travel clinic in Montréal in 2008. We evaluated the effect of intradermal vaccination availability on uptake of pre-exposure rabies prophylaxis and rates of seroconversion with intradermal vaccination. METHODS We conducted a retrospective cross-sectional study using data from December 2008 to December 2014. The number of travellers who received pre-exposure rabies prophylaxis before and after the introduction of intradermal vaccination was compared. Postvaccination antibody titres were measured in intradermal vaccination recipients. We compared demographic and travel characteristics between vaccinated and unvaccinated travellers and between travellers in the intradermal and intramuscular groups using univariate and multivariate analyses. RESULTS The proportion of travellers who received pre-exposure prophylaxis increased after the introduction of intradermal vaccination (annual average of 300 travellers from December 2009 to December 2014 v. 183 travellers from December 2006 to December 2007). Seroconversion occurred in 99.9% of those in the intradermal group. Travellers who received pre-exposure prophylaxis were older (mean age 35.8 yr v. 32.1 yr) and had longer travel duration than those who did not receive pre-exposure prophylaxis. Travellers to Asia were more likely to receive pre-exposure prophylaxis, and travellers visiting friends and relatives were less likely to receive it. Travellers in the intradermal group were younger than those in the intramuscular group and were more likely to be travelling for tourism. INTERPRETATION The introduction of intradermal vaccination for pre-exposure rabies prophylaxis was associated with an increase in vaccination uptake. Reduced cost may be responsible for the increased coverage among younger travellers and those travelling for tourism. The high seroconversion rate after intradermal vaccination supports the effectiveness of this route of administration for pre-exposure rabies prophylaxis in immunocompetent people.
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Affiliation(s)
- Ling Yuan Kong
- Affiliations: J.D. MacLean Centre for Tropical Diseases (Kong, Libman, Barkati), McGill University Health Centre; Clinique Santé-voyage de la Fondation du Centre hospitalier de l'Université de Montréal (Vincelette, Laplante, Duchesne, Barkati); Centre hospitalier de l'Université de Montréal (Vincelette, Barkati), Montréal, Que
| | - Jean Vincelette
- Affiliations: J.D. MacLean Centre for Tropical Diseases (Kong, Libman, Barkati), McGill University Health Centre; Clinique Santé-voyage de la Fondation du Centre hospitalier de l'Université de Montréal (Vincelette, Laplante, Duchesne, Barkati); Centre hospitalier de l'Université de Montréal (Vincelette, Barkati), Montréal, Que
| | - Gaétan Laplante
- Affiliations: J.D. MacLean Centre for Tropical Diseases (Kong, Libman, Barkati), McGill University Health Centre; Clinique Santé-voyage de la Fondation du Centre hospitalier de l'Université de Montréal (Vincelette, Laplante, Duchesne, Barkati); Centre hospitalier de l'Université de Montréal (Vincelette, Barkati), Montréal, Que
| | - Jo-Anne Duchesne
- Affiliations: J.D. MacLean Centre for Tropical Diseases (Kong, Libman, Barkati), McGill University Health Centre; Clinique Santé-voyage de la Fondation du Centre hospitalier de l'Université de Montréal (Vincelette, Laplante, Duchesne, Barkati); Centre hospitalier de l'Université de Montréal (Vincelette, Barkati), Montréal, Que
| | - Michael Libman
- Affiliations: J.D. MacLean Centre for Tropical Diseases (Kong, Libman, Barkati), McGill University Health Centre; Clinique Santé-voyage de la Fondation du Centre hospitalier de l'Université de Montréal (Vincelette, Laplante, Duchesne, Barkati); Centre hospitalier de l'Université de Montréal (Vincelette, Barkati), Montréal, Que
| | - Sapha Barkati
- Affiliations: J.D. MacLean Centre for Tropical Diseases (Kong, Libman, Barkati), McGill University Health Centre; Clinique Santé-voyage de la Fondation du Centre hospitalier de l'Université de Montréal (Vincelette, Laplante, Duchesne, Barkati); Centre hospitalier de l'Université de Montréal (Vincelette, Barkati), Montréal, Que
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Griffiths KM, Savini H, Brouqui P, Simon F, Parola P, Gautret P. Surveillance of travel-associated diseases at two referral centres in Marseille, France: a 12-year survey. J Travel Med 2018; 25:4965003. [PMID: 29672709 PMCID: PMC7107586 DOI: 10.1093/jtm/tay007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Revised: 01/14/2018] [Accepted: 01/24/2018] [Indexed: 11/13/2022]
Abstract
Background With increasing international travel and historically high numbers of residents visiting friends and relatives overseas, travel-associated illnesses are frequent in Marseille, France. We report the changing epidemiology of travel-related illnesses over a 12-year period. Methods A single site GeoSentinel surveillance analysis was undertaken for 3460 ill returned travellers presenting to two public hospitals in Marseille, France from March 2003 to October 2015, with travel-related illnesses. Demographic characteristics, travel history, presenting symptoms and information on pre-travel consultations were collected. Results There was a predominance of travel to sub-Saharan Africa, in particular to Comoros archipelago. Tourism was the main reason for travel (1591/3460, 46%), followed by visiting friends or relatives (VFR) (895/3460, 26%), with a mean duration of 29 days; 35% (1212/3460) of travellers reported a pre-travel health consultation. The most common syndromic diagnoses were febrile systemic illness (1343, 39%), dermatologic (716, 21%), gastrointestinal (340, 10%) and respiratory/ear-nose-throat (331, ENT) (10%). Hospitalization rates were highest amongst travellers from sub-Saharan Africa (858/ 1632, 53%), and VFR (573/ 895, 64%, P < 0.001). Frequent diagnoses included malaria (797, 23%), dengue (96, 2.77%) and chikungunya (75, 2.17%), reflecting global trends. Comparison of two periods (2003-10 to 2011-15) demonstrated an increase in chikungunya and decrease in malaria and influenza-like illness. We report an increase in ill travellers from the Caribbean, Middle East and South-East Asia. Conclusion Surveillance of travellers provides relevant sentinel information on the changing epidemiology of infectious diseases across the globe, most notably for malaria, dengue and chikungunya. We demonstrate the use of travel surveillance in improving pre-travel consultation needs and to address autochthonous vector-borne viral risks.
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Affiliation(s)
- Karolina M Griffiths
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Marseille, France
| | - Hélène Savini
- Department of Tropical Medicine and Infectious Diseases, Laveran Military Teaching Hospital, Marseille, France
| | - Philippe Brouqui
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Marseille, France
| | - Fabrice Simon
- Department of Tropical Medicine and Infectious Diseases, Laveran Military Teaching Hospital, Marseille, France
| | - Philippe Parola
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Marseille, France
| | - Philippe Gautret
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Marseille, France
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Bhandari D, Pandey P. Health Problems while Working as a Volunteer or Humanitarian Aid Worker in Post-Earthquake Nepal. JNMA J Nepal Med Assoc 2018; 56:691-695. [PMID: 30381767 PMCID: PMC8997265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
INTRODUCTION Volunteers and humanitarian aid workers working in disaster struck areas of the world are a vulnerable group of travelers. Nepal saw an influx of these humanitarian aid workers following earthquakes in April and May 2015. This study was undertaken to find out the pre-travel preparation and to estimate the risk of disease while the volunteers were deployed in Nepal. METHODS This was a descriptive cross-sectional study conducted at CIWEC Hospital located in Kathmandu. A questionnaire was given to all volunteers and aid workers who arrived at the hospital for evaluation of health related problems and agreed to be part of the study. RESULTS Ninety-five volunteers were enrolled in the study. Among these, 65 (68%) were female and 30 (32%) were male. The immunizations received before travel were Hepatitis A 82 (86%), Hepatitis B 82 (86%), Typhoid 70 (73%), Rabies 38 (40%), Japanese Encephalitis 34 (36%), Influenza within last one year 23 (24%), measles 48 (51%), Cholera 34 (36%),Tetanus within 10 years 71 (75%) and Varicella 38 (40%). Forty-four (45%) of travelers carried medication for treatment of Traveler's Diarrhea (TD) which included Ciprofloxacin, Azithromycin, Loperamide and others like Metronidazole and Charcoal. The common illnesses encountered were gastrointestinal, skin problems , injury and musculoskeletal problems, respiratory problems, genitourinary problems, cardiovascular, psychological problems, syncope, and miscellaneous. CONCLUSIONS Traveler's Diarrhea and dermatological problems were the most common health related problems. Volunteers were not properly prepared for self-treatment and pre-travel preparation was sub-optimal. Important pre travel health advice will decrease the incidence of health problems in this group.
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Affiliation(s)
- Durga Bhandari
- CIWEC Hospital and Travel Medicine Center, Kapurdhara Marg, Kathmandu, Nepal,Department of Internal Medicine, Kantipur Dental College Teaching Hospital and Research Center, Kathmandu, Nepal,Correspondence: Dr. Durga Bhandari, CIWEC Hospital and Travel Medicine Center, Kapurdhara Marg, Kathmandu, Nepal. , Phone: +977-1-4424111
| | - Prativa Pandey
- CIWEC Hospital and Travel Medicine Center, Kapurdhara Marg, Kathmandu, Nepal
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Schwartz KL, Keystone JS. Protection of Travelers. PRINCIPLES AND PRACTICE OF PEDIATRIC INFECTIOUS DISEASES 2018. [PMCID: PMC7152348 DOI: 10.1016/b978-0-323-40181-4.00008-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Asokan GV, Vanitha A. Disaster response under One Health in the aftermath of Nepal earthquake, 2015. J Epidemiol Glob Health 2017; 7:91-96. [PMID: 27059251 PMCID: PMC7320513 DOI: 10.1016/j.jegh.2016.03.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 03/02/2016] [Accepted: 03/08/2016] [Indexed: 12/03/2022] Open
Abstract
Until now, an estimate quotes that 1100 healthcare facilities were damaged and over 100,000 livestock lost in the two earthquakes that occurred in April and May of 2015 in Nepal. Threats of infectious diseases, mostly zoonoses, could affect Nepal's economy, trade, and tourism, and reaching the targets of the United Nations Millennium Development Goals. Historically, outbreaks of infectious diseases, including zoonoses, were largely associated with the aftereffects of the earthquakes. It has been documented that zoonoses constitute 61% of all known infectious diseases. Therefore, the purpose of this communication was to examine the infectious disease outbreaks after earthquakes around the world and explore the risk assessment of the zoonoses threats reported in Nepal and highlight adopting One Health. Our summaries on reported zoonoses in Nepal have shown that parasitic zoonoses were predominant, but other infectious disease outbreaks can occur. The fragile public health infrastructure and inadequately trained public health personnel can accelerate the transmission of infections, mostly zoonoses, in the post impact phase of the earthquake in Nepal. Therefore, we believe that with the support of aid agencies, veterinarians and health professionals can team up to resolve the crisis under One Health.
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Affiliation(s)
- G V Asokan
- Public Health Program, College of Health Sciences, University of Bahrain, PO Box- 32038, Bahrain.
| | - A Vanitha
- Pediatrics Department, American Mission Hospital, Manama, PO Box- 1, Bahrain.
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Murphy H, Abuova G, Pandey P. South Central Asia. Infect Dis (Lond) 2017. [DOI: 10.1002/9781119085751.ch14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Holy Murphy
- CIWEC Hospital and CIWEC Clinic Travel Medicine Center; Kathmandu Nepal
| | - Gulzhan Abuova
- Department of Infectious Diseases; South-Kazakhstan State Pharmaceutical Academy; Shymkent Kazakhstan
| | - Prativa Pandey
- CIWEC Hospital and CIWEC Clinic Travel Medicine Center; Kathmandu Nepal
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Antwi S, Parola P, Sow D, Sornin V, Henrion M, Gautret P. Familial cluster of exposure to a confirmed rabid dog in travelers to Algeria. Travel Med Infect Dis 2017; 16:46-48. [PMID: 28089844 DOI: 10.1016/j.tmaid.2017.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 11/29/2016] [Accepted: 01/05/2017] [Indexed: 11/26/2022]
Abstract
A 10 person-family originating from Algeria traveled in rural Algeria for the purpose of visiting friends and relatives without seeking pre-travel advice, did not received pre-travel rabies immunization, and were exposed to a confirmed rabid dog including 8 within less than 4 days of arrival. Three received suckling mouse brain rabies vaccine although WHO strongly recommends that its production and administration be discontinued and seven received insufficient doses of equine rabies immune globulin abroad. Rabies treatment was completed on returning to France. This reports underline the fact that travelers visiting friends and relatives in dog rabies endemic country are at high risk of rabies exposure and unaware of such a risk in most instances. Rabies risk warning should be reinforced and rabies pre-exposure vaccination should be considered in all individuals traveling to North Africa (and to sub-Saharan Africa) whatever the duration of stay.
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Affiliation(s)
- Sylvie Antwi
- Institut Hospitalo-Universitaire Méditerranée Infection, 13005, Marseille, France
| | - Philippe Parola
- Institut Hospitalo-Universitaire Méditerranée Infection, 13005, Marseille, France; Aix Marseille Université, URMITE, UM63, CNRS 7278, IRD 198, INSERM 1095, Marseille, France
| | - Doudou Sow
- Service de Parasitologie-Mycologie, Faculté de médecine, UCAD, Dakar-Fann, Senegal
| | - Victoria Sornin
- Institut Hospitalo-Universitaire Méditerranée Infection, 13005, Marseille, France
| | - Maxime Henrion
- Aix Marseille Université, URMITE, UM63, CNRS 7278, IRD 198, INSERM 1095, Marseille, France
| | - Philippe Gautret
- Institut Hospitalo-Universitaire Méditerranée Infection, 13005, Marseille, France; Aix Marseille Université, URMITE, UM63, CNRS 7278, IRD 198, INSERM 1095, Marseille, France.
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Blaise A, Parola P, Brouqui P, Gautret P. Rabies Postexposure Prophylaxis for Travelers Injured by Nonhuman Primates, Marseille, France, 2001-2014. Emerg Infect Dis 2016. [PMID: 26196180 PMCID: PMC4517731 DOI: 10.3201/eid2108.150346] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Most exposures of residents of Marseille to nonhuman primates occurred among unvaccinated adult travelers to Southeast Asia within the first 10 days of their arrival at 2 major tourist locations in Thailand and 1 in Indonesia. A small proportion of travelers received rabies immunoglobulin in the country of exposure.
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Devleesschauwer B, Aryal A, Sharma BK, Ale A, Declercq A, Depraz S, Gaire TN, Gongal G, Karki S, Pandey BD, Pun SB, Duchateau L, Dorny P, Speybroeck N. Epidemiology, Impact and Control of Rabies in Nepal: A Systematic Review. PLoS Negl Trop Dis 2016; 10:e0004461. [PMID: 26871689 PMCID: PMC4752342 DOI: 10.1371/journal.pntd.0004461] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 01/23/2016] [Indexed: 01/15/2023] Open
Abstract
Background Rabies is a vaccine-preventable viral zoonosis belonging to the group of neglected tropical diseases. Exposure to a rabid animal may result in a fatal acute encephalitis if effective post-exposure prophylaxis is not provided. Rabies occurs worldwide, but its burden is disproportionately high in developing countries, including Nepal. We aimed to summarize current knowledge on the epidemiology, impact and control of rabies in Nepal. Methods We performed a systematic review of international and national scientific literature and searched grey literature through the World Health Organization Digital Library and the library of the National Zoonoses and Food Hygiene Research Centre, Nepal, and through searching Google and Google Scholar. Further data on animal and human rabies were obtained from the relevant Nepalese government agencies. Finally, we surveyed the archives of a Nepalese daily to obtain qualitative information on rabies in Nepal. Findings So far, only little original research has been conducted on the epidemiology and impact of rabies in Nepal. Per year, rabies is reported to kill about 100 livestock and 10–100 humans, while about 1,000 livestock and 35,000 humans are reported to receive rabies post-exposure prophylaxis. However, these estimates are very likely to be serious underestimations of the true rabies burden. Significant progress has been made in the production of cell culture-based anti-rabies vaccine and rabies immunoglobulin, but availability and supply remain a matter of concern, especially in remote areas. Different state and non-state actors have initiated rabies control activities over the years, but efforts typically remained focalized, of short duration and not harmonized. Communication and coordination between veterinary and human health authorities is limited at present, further complicating rabies control in Nepal. Important research gaps include the reporting biases for both human and animal rabies, the ecology of stray dog populations and the true contribution of the sylvatic cycle. Interpretation Better data are needed to unravel the true burden of animal and human rabies. More collaboration, both within the country and within the region, is needed to control rabies. To achieve these goals, high level political commitment is essential. We therefore propose to make rabies the model zoonosis for successful control in Nepal. Rabies has been known as a deadly disease in Nepal for decades, but information on epidemiology, impact and control remains scattered. We collected and summarized information from a variety of sources, including scientific literature and government agencies. Only little original research has been conducted on the epidemiology and impact of rabies in Nepal, leaving many questions unanswered. Official reports show that each year 100 livestock and 10–100 humans die of rabies, but these numbers very likely underestimate the true rabies burden. Availability and supply of anti-rabies vaccines have remained suboptimal and rabies control activities have been hampered by a lack of collaboration and comprehensiveness. High level political commitment is essential to overcome these problems and to reduce the burden of rabies. We therefore propose to make rabies the model zoonosis for successful control in Nepal.
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Affiliation(s)
- Brecht Devleesschauwer
- Department of Virology, Parasitology and Immunology, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium
- Institute of Health and Society (IRSS), Université catholique de Louvain, Brussels, Belgium
- Emerging Pathogens Institute and Department of Animal Sciences, University of Florida, Gainesville, Florida, United States of America
- * E-mail:
| | - Arjun Aryal
- Central Veterinary Hospital, Ministry of Agricultural Development, Kathmandu, Nepal
| | - Barun Kumar Sharma
- Department of Livestock Services, Ministry of Agricultural Development, Kathmandu, Nepal
- Institute of Veterinary, Animal and Biomedical Sciences, Massey University, Palmerston North, New Zealand
| | - Anita Ale
- National Zoonoses and Food Hygiene Research Centre, Kathmandu, Nepal
| | - Anne Declercq
- Laboratory of Experimental Hematology, Vaccine and Infectious Disease Institute (Vaxinfectio), Faculty of Medicine and Health Sciences, University of Antwerp, Edegem, Belgium
| | - Stephanie Depraz
- Unité Mixte de Recherche - Contrôle des Maladies Animales, Exotiques et Émergentes (UMR CMAEE), CIRAD, Petit-Bourg, Guadeloupe, France
| | - Tara Nath Gaire
- Department of Livestock Services, Ministry of Agricultural Development, Kathmandu, Nepal
| | - Gyanendra Gongal
- Disease Surveillance and Epidemiology, WHO Regional Office for South East Asia, New Delhi, India
| | - Surendra Karki
- Department of Pathobiology, College of Veterinary Medicine, University of Illinois, Urbana-Champaign, Illinois, United States of America
| | - Basu Dev Pandey
- Leprosy Control Division, Department of Health Services, Ministry of Health and Population, Kathmandu, Nepal
| | - Sher Bahadur Pun
- Clinical Research Unit, Sukraraj Tropical & Infectious Disease Hospital, Teku, Kathmandu, Nepal
| | - Luc Duchateau
- Department of Comparative Physiology and Biometrics, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium
| | - Pierre Dorny
- Department of Virology, Parasitology and Immunology, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Niko Speybroeck
- Institute of Health and Society (IRSS), Université catholique de Louvain, Brussels, Belgium
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