A retrospective review of rabies post-exposure prophylaxis queries, South Africa, 2016­2019

Background: The National Institute for Communicable Diseases (NICDs) of South Africa (SA) provides technical support to healthcare workers (HCWs) with regard to infectious diseases through the NICD clinician hotline. Queries to the hotline are often about rabies prophylaxis. An analysis of these queries may help to identify knowledge gaps amongst HCWs regarding prevention of rabies in humans in SA. Methods: A retrospective descriptive review was conducted to analyse rabies post-exposure prophylaxis (PEP) queries received by the NICD from 01 January 2016 to 31 December 2019. Results: A total of 4655 queries were received by the NICD clinician hotline for the study period, of which 2461 pertained to rabies PEP (52.87%). The largest number of calls were placedby HCWs (n = 2313/2437; 94.9%). Queries originated mainly from Gauteng (n = 912/2443; 37.3%) and KwaZulu-Natal (n = 875/2443; 35.8%) provinces. A total of 50 different types of animals were related to exposures involving humans. Dogs (67.7%) and cats (11.8%) were the animals most frequently reported and exposure category III was most common (88.6%). Approximately equal numbers of callers were advised active management of administering rabies PEP and conservative management of withholding PEP. This did not seem to be affected by the exposure category related to the call. Conclusion: This analysis shows the ongoing demand by HCWs for technical support regarding patient management following potential exposure to rabies. Gaps in HCWs rabies knowledge provide unique learning points on guiding training to achieve the goal of eliminating dog-mediated human rabies deaths by 2030.

Management of rabies

Rabies is endemic in South Africa and human rabies cases continue to be reported annually. Most human cases in South Africa are dog-transmitted. Whilst efforts are underway to control and eventually eliminate dog rabies in the country, prevention of the disease through appropriate use of rabies postexposure prophylaxis is critical to save lives. This article provides a summary of rabies in South Africa and key aspects of the prevention of the disease in exposed humans

Assessment of public knowledge, attitude and practices towards rabies in the community of Kombolcha, Southern Wollo, Amhara Reginal State, Ethiopia

The study was conducted from November 2016 to April 2017 in 12 kebeles (the smallest administrative unit of Ethiopia) of Kombolcha, Southern Wollo Amhara Regional State, Ethiopia. The aims of the study were to assess the knowledge, attitudes and practices (KAP) of Kombolcha's community toward rabies and associated risk factors. A cross-sectional study design and multistage sampling procedures were employed to select households for the study. Kebeles were randomly selected using lottery method from list of kebeles in the study area, followed by selection of households from each kebele by systematic random sampling. Data were collected from 384 households through face to face interview using pre-tested and well-structured questionnaires. Socio-demographically, out of the 384 respondents interviewed, 223 (58.1%) were males and 161 (41.9%) were females. From 384 respondents, 345 (89.8%) had heard about rabies before and the majority of the study participants, 329 (85.7%) had good level of KAP. There were statistically significant associations (p<0.05) between KAP scores and age, house hold size, educational status, and occupation. In conclusion, the study revealed that, Kombolcha's community has good knowledge, attitude and practice toward rabies. However, there are some inconsistencies on mode of transmission, symptoms, appropriate prevention and treatment measures. Therefore, continuous and strategic health programs are expected from health professionals, governmental and non-governmental organizations to control and prevent the disease and secure rabies free zone

Rage furieuse transmise par un chien errant

Nous rapportons une observation d'un cas de rage furieuse survenue suite à la morsure par un chien errant. La discussion porte sur la clinique, sur la démarche à suivre après morsure par un chien et les difficultés de diagnostic de cette affection dans notre contexte. Les auteurs recommandent le traitement prophylactique antirabique en cas de morsure par un chien errant. Ils rappellent également que la rage est transmise par un animal enragé, et ils interpellent les autorités sanitaires sur la nécessité de former le personnel de santé, de rendre accessible les vaccins et les immunoglobulines antirabiques. Aussi le renforcement de la surveillance de cette anthropozoonose nécessite un laboratoire et un plateau technique capable de confirmer les cas humains de rage. Une action en amont basée sur la vaccination des animaux de compagnie, l'abattage des chiens errants et le traitement prophylactique en cas d'exposition, contribuera à réduire de façon significative l'ampleur de cette maladie./p>

Dog Bites and Human Rabies in the Uthungulu District Of Kwazulu-Natal Province; 2008-2010: a Review of Surveillance Data

The Uthungulu District in KwaZulu-Natal province is the area that is most affected by rabies in South Africa. Usually; the transmission of rabies to humans occurs through the bites of infected dogs. In 2008; Uthungulu commenced a programme to eliminate human rabies in the district. This paper describes the epidemiology of dog bites and human rabies in the UThungulu District from 2008-2010; and the extent of adherence to rabies post-exposure prophylaxis (PEP). The method was a retrospective analysis of dog-bite and human rabies surveillance data that were collected in Uthungulu from January 2008-December 2010. Dog-bite injuries in Uthungulu increased from 1 176 in 2008 to 2 365 in 2009; and decreased to 1 598 in 2010. Of 2 601 patients who were offered rabies PEP in 2009 and 2010; 83.7 [95 confidence interval (CI): 82.4-85.2] completed the treatment. Logistic regression analysis found that investigation of the report by an environmental healthcare practitioner [odds ratio (OR) = 3.95; 95 CI: 2.43-6.43; p-value = 0 .0001]; the availability of patient telephone contact details in the healthcare facility's records (OR = 1.76; 95 CI: 1.02-3.03; p-value = 0.041); and bite wounds that were classified as Category 3 exposure injuries (OR = 2.96; 95 CI: 1.39-6.29; p-value = 0.004); were independently associated with completion of rabies PEP. Seven human rabies cases were reported (four in 2008; two in 2009 and one in 2010). Annualised human rabies incidence rates decreased from four cases per million in 2008 to one case per million in 2010. The findings suggest that the rabies elimination initiative is having an impact on the reduction of the incidence of human rabies in Uthungulu. The district should strengthen the follow-up of people who are exposed to rabies to ensure PEP completion

Incidence of dog bite injuries and clinical rabies in a tertiary health care institution: A 10-year retrospective study

Background: It is widely recognized that rabies is grossly under-reported even though it is a notifiable disease and a lack of accurate figures has rendered rabies a low public health and veterinary priority. This study aimed at determining the incidence of dog bite injuries and clinical rabies in a tertiary health care centre.Materials and Methods: Case records of patients managed at the accident and emergency unit of Ahmadu Bello University Teaching Hospital, Zaria, between June 2000 and May 2010 with diagnosis of dog bite and rabies were retrieved. Relevant clinical data were extracted using a structured questionnaire designed for the study.Results: Eighty-one persons out of 24,683 consultations in the accident and emergency unit presented with dog bite injuries with two clinical cases of human rabies. Mean age of victims of dog bite injuries was 21.1 ± 14.3 years and the majority (55.6%) were children. Males were more affected than females with a male:female ratio of 4.8:1, lower limb/buttock injuries were significantly higher in children than adults, but the adults sustained significantly more severe (type III) injury. The majority of dog bite injuries were washed with soap and irrigated with water or saline and 87.7% of the victim of dog bite received postexposure anti-rabies vaccine.Conclusion: Hospital incidence of dog bite injuries was low, but the use of postexposure prophylaxis was high

Ten-Year (1993 ­ 2002) retrospective evaluation of vaccination of dogs against rabies at the University of Ibadan, Nigeria

Record books in form of one thousand, four hundred and seventy eight (1478) registers, case notes and vaccination certificates of registered dogs were assessed for rabies vaccination and its booster coverage. The dogs which consisted of 850 males and 628 females were presented at the Small Animal and Preventive Veterinary Medicine Clinics, Veterinary Teaching Hospital, University of Ibadan between January 1993 and December 2002. Among the registered dogs, 155 (10.5%) with annual mean of 9.1 + 9.1% were vaccinated. Although more females (83 or 13.2%) were vaccinated than male dogs (72 or 8.5%), the difference was not significant (p>0.05). Most vaccinated dogs (121 or 78.1%), were at the initial vaccination age of 3 months and had the highest vaccination coverage (51 dogs (males and females) or 44.3%) while 53 (males and females) dogs (43.8%) were adequately vaccinated. Also, 12 (35.3%) among 34 dogs with booster vaccination were adequately protected against rabies. The current study showed increase in registration of dogs and the cost of vaccination in the clinics. However declined vaccination and booster coverages were observed compared to the previous 5 ­ year observations of 36.5% vaccination and 59.5% booster coverages. These observations were far below the recommendation of WHO (1989, 1990, 2001) to prevent urban rabies epizootics and epidemics in the area. Since rabies is zoonotic, the study indicated increase danger of contracting rabies by veterinarians, their assistants, dog owners, their family members and the general public

Aspects épidémiologiques de la rage humaine dans le District de Bamako de 2000 à 2003

Le but de notre étude était de décrire le profil épidémiologique de la rage humaine dans le district de Bamako. La démarche méthodologique s'est basée sur une étude rétrospective et descriptive de la rage humaine de janvier 2000 à décembre 2003 à partir des informations tirées des supports et registres des services techniques du district : Etaient inclus dans cette étude tous les sujets vivants dans le district de Bamako et mordus par un animal. Nous avons obtenu les résultats suivants : Au total 5870 personnes ont été mordues avec une fréquence annuelle d'environ 1467 par an. L'animal mordeur est le chien dans 97,07% des cas. La prévalence de la rage humaine à Bamako est de 0,0098 pour mille. La prévalence de la rage humaine dans l'échantillon recensé est de 0,17 % (10 victimes pour 5870 cas de morsure). L'homme est mordu plus souvent que la femme avec un sexe ratio de 1,95 quel que soit l'âge considéré. La fréquence des morsures diminue avec l'âge. Toutes les communes sont touchées par le fléau. La commune 5 a la plus forte fréquence estimée à 28,09%. La prévalence de la rage animale dans l'échantillon recensé est de 3,186 % (187 cas pour 5870 animaux

Rabies in Sri Lanka: Splendid Isolation

Rabies virus exists in dogs on Sri Lanka as a single; minimally divergent lineage only distantly related to other rabies virus lineages in Asia. Stable; geographically isolated virus populations are susceptible to local extinction. A fully implemented rabies-control campaign could make Sri Lanka the first Asian country in 30 years to become free of rabies virus

Evaluation du cout direct de la prise en charge d'un sujet expose a la rage a Abidjan

Notre etude prospective s'est deroulee au centre antirabique d'Abidjan en 2000. Elle a porte sur l'evaluation du cout direct de la prise en charge d'un sujet expose a la rage a Abidjan. Ce cout varie de 9.100 F a 53.875 F. En cas d'exposition rabique; le patient paye en moyenne 71;86 pour cent du cout direct de la vaccination et pour la serotherapie le patient paye 68;36 pour cent du cout direct. Ce cout prend en compte le cout de la vaccination; le cout du traitement adjuvant; le cout du transport et le cout de la consultation veterinaire. Sur 300 sujets exposes au risque d'infection rabique; 49 pour cent n'ont pu acheve le traitement malgre le tarif social applique par I'INHP afin que le maximum de patient puisse avoir acces au traitement antirabique. Dans le but de reduire certains elements du cout direct de la rage et favoriser l'observance du traitement; nous proposons plusieurs recommandations dont les principales sont : -La decentralisation du Centre Antirabique dans les 10 communes d'Abidjan et de ses banlieues. -La creation des services veterinaires publics dans toutes les communes d'Abidjan et ses banlieues. -La vaccination des animaux domestiques et I' abattage des animaux errants

Rabies: Post Exposure Treatment and Cost Implications in Uganda

"Rabies is a viral zoonotic disease of warm blooded animals including humans. It is among the earliest recorded infections of man dating back to abouth 30th century BC. The word ""rabies"" comes from the Indian Sanksrit work ""rabbath"" which means ""to do violence"". In Uganda; laboratory confirmation of rabies was first documented 1936 in a sample taken from the West Nile region. This was follwed by mass vaccination of dogs and cats; stray dog elimination and movement control which led to a decline of animal rabies for which rabies Post Exposure Treatment (PET) is given. About 4;000 people receive PET annually."

La cinetique des anticorps antirabiques chez 20 personnes avec le vaccin de cellules renales de foetus de bovin

La Cote d'Ivoire etant une zone de grande endemicite de la rage avec des souches sauvages entretenues par une importante population de chiens errants; toutes les vaccinations doivent etre soumises a un controle systematique des anticorps antirabiques. La vaccination de 20 personnes faite avec le vaccin de cellules renales de foetus de bovin de l'Institut Pasteur; donne une couverture satisfaisante