Cost–benefit analysis of controlling rabies: prioritizing areas in rural setting of Maner: a cross sectional study

Background: Rabies being a preventable disease with no treatment available once onset starts but can be easily prevented by post-exposure among all animal bite victims. So it is essential to take the full course of vaccination for complete protection.Methods: The present study was a hospital based cross sectional study and was carried out in rural health training centre in Maner, Patna.Results: Our study included 340 patients who attended anti rabies clinic for post exposure prophylaxis. Among them 65% were children (<15 years) comprising mostly males (69%) and mostly of category III exposure. Direct cost of post exposure vaccination when compared with the cost of pre exposure prophylaxis is one-third (approx).Conclusions: Compliance to anti-rabies vaccination for post-exposure prophylaxis is still low and they are still at risk of developing rabies. Reasons being irregular supply of vaccine and immunoglobulin in government hospitals, loss of wages, forgotten dates, cost incurred to buy from outside and distance from the hospital if referred to other centre. Seeing the current scenario, planning and prioritizing areas to achieve our goal and lessen economic burden is need of the hour. We infer that pre exposure prophylaxis may be a cost effective strategy which can aid in the control and elimination of rabies in endemic settings.

Cost of rabies post exposure prophylaxis in different healthcare settings in six states of India

The expenditure for rabies postexposure prophylaxis (PEP) is substantial, especially for the poor who are affected the most. The present study was conducted to determine the cost incurred to a patient and the healthcare facility for providing PEP in different healthcare settings. A multicentric, health facility-based study was conducted from May 2017 to January 2018 in the six states involving 18 healthcare facilities. The study included 529 animal bite cases; most of them belonged to either category III (54.4%) or category II (43.1%) exposures and all of them received complete PEP. The total median cost incurred to the patients for complete PEP in the government health facility was INR 1400 (USD 22) and in private hospitals was INR 3685 (USD 58). The cost of PEP for the bite victims is considerable; therefore, it has to be provided free of charge at all healthcare facilities.

Economic Burden of Rabies: An Experience from a Tertiary Care Hospital in Kashmir, India

Background:Post-exposureprophylaxis(PEP) is the mainstay of prevention in suspected exposure to rabies virus.Exposedpatients are able to obtain anti-rabies vaccine in the anti-rabies clinicpro bono butthey have to pay forpassive immunization and cover otherassociated costs.Aim:To estimate and analyze the direct and indirect costs of rabies PEP.Methods: This study was conducted on 429 patients, who were exposed to bites from various animals and reported to Shri Mahraja Hari Singh Hospital (SMHS), an associated tertiary hospital of Government Medical College, Srinagar, Kashmir. Patient socio-demographic profile, details of animal bite exposure, the cost incurred for PEP wascollected. The data were analyzed using a descriptive statistic.Results: The study revealed a total median cost incurred on patients for receiving a PEP as 29.3 USD (United States Dollar), with an Inter-quartile Range (IQR) of 0.2 USD to 43.1USD. The direct median cost was 20.5 USD with an IQR of 6.2 USD to 29.4USD, while the indirect median cost was 20.3USD with an IQR of 13.5USD to 24.4USD.Conclusion:Post-exposure prophylaxis imposesa significant economic burden to bite victims especially those of low socio-economic strata for whom the cost issubstantial.Original ResearchArticle

Clinical safety profile of Premi-Rab a new indigenous equine rabies immunoglobulin for cat III animal bite victims at anti rabies clinic of a tertiary care hospital, Karnataka

Background: WHO guidelines recommend for treating Cat III animal bite victims with local infiltration of Equine Rabies Immunoglobulin (ERIG) into and around animal bite wounds followed by anti-rabies vaccine (ARV).The main reason for non-use of ERIGs by medical profession is the fear of anaphylaxis and laborious process. The present study was taken up with the objectives to assess the clinical safety of a new ERIG, describe sociodemographic profile of ERIG recipients and compliance to Intra Dermal Rabies Vaccine (IDRV), who reported to Anti Rabies Clinic (ARC) of Mandya Institute of Medical Sciences (MIMS), Mandya.Methods: Descriptive study at ARC, MIMS, Mandya for a period of one year. The data was collected using structured questionnaire. The data was entered into Microsoft excel and results were expressed using descriptive statistics.Results: The study revealed that cat III animal bite victims were 3400 (56.3%), of these only 545 (16.0%) opted for the new ERIG. Skin Sensitivity Test (SST) showed positive results in 17 (3.1%) cases. Among the ERIG recipients 28 (5.1%) had mild adverse reaction to ERIG. The compliance rate was 49.2% for all 4 doses of IDRV.Conclusions: 3.1% showed positive result to SST. 5.1% had mild adverse reaction to ERIG.

Analysis of 1019 cases with rabies exposure and prophylaxis / 中华实验和临床病毒学杂志

Objective@#To understand the prophylaxis of population exposed to rabies, and provide a basis for prevention and control of rabies.@*Methods@#The registration data of 1 019 cases with rabies exposure in Beijing Ditan Hospital Affiliated to Capital Medical University from Mar, 2017 to Feb, 2018 were analyzed using the descriptive epidemiologic method.@*Results@#Among the 1 019 cases of rabies exposure, the sex ratio of men to women was 0.90∶1, with the highest proportion of them were between 26 and 46 years of age old, accounting for 46.5%. Rabies exposure reached its peak (46.9%) between June and September. In addition, 63.3% of the injuries were caused by dogs and 36.7% by cats. Most of the wounds (55.1%) occurred in hands; and the second was lower limbs (26.6%). Most of the cases (60.7%) had grade II wounds; followed by grade III wounds (39.1%); 69.3% of the cases completed immunization with rabies vaccine. In grade III exposure, 73.7% of the patients were immunized with rabies immunoglobulin. Most of the persons of grade III exposure (73.7%) received inoculation with human rabies immunoglobulin (HRIG).@*Conclusions@#Measures to control rabies should be focused on the management of dogs and cats and the standardization of rabies post-exposure prophylaxis.

Analysis of the early immune effects of rabies vaccine combined with human rabies immunoglobulin / 中华实验和临床病毒学杂志

Objective@#To investigate the early immune effects of rabies vaccine combined with human rabies immunoglobulin (HRIG).@*Methods@#Rapid fluorescent focus inhibition test (RFFIT) was used to test the titers of rabies virus neutralizing antibodies (RVNA). The titers of RVNA of persons who had exposed to rabies at degree III on day 0, day 1, day 7, day 14 and day 45 were compared. The dynamic curves and seroconversion rates (SCR) of RVNA in persons of different genders, age and vaccine regimens (Essen and Zagreb) groups were analyzed.@*Results@#No significant differences of SCR among different genders, age and vaccine regimens groups were observed on the same day. SCR could be 100% on day14 in different groups. The dynamic curves of RVNA within the first 14 days showed the models of gradual rise, rapid rise and rapid decline.@*Conclusions@#The dynamic curves of RVNA within the first 14 days varied when rabies vaccines were used in combination with HRIG, and not all subjects were proved to be protected based on the RVNA detection within this period.

Create a new situation of rabies post-exposure prophylaxis in China / 中华实验和临床病毒学杂志

Post-exposure prophylaxis plays an important role in the continued decline of rabies epidemic in China. In the new era, significant progress has been made in the professional construction of rabies post-exposure prophylaxis; the theoretical and practical basis of subject setting has become mature gradually; related medical and biotechnology industries are developing rapidly; innovative research is synchronized with the international level and gradually approaching the leading level; the international and domestic influence is expanding day by day; the series of humanized service measures under standardized management meets the health needs of the people. The rabies post-exposure prophylaxis in China is stepping into the new situation.

A Case Study of Delayed Primary Suturing in Facial Injuries Following Animal Bites.

Aims: To evaluate the role of delayed primary suturing in prevention of sepsis and achieving better cosmetic appearance in animal bite injuries over the head and neck areas. Study Design: Prospective observational study. Place and Duration of Study: Department of Otorhinolaryngology at Govt. Medical College, Nanded, Maharasthra, (India) from a period of Jan 2009 to Dec 2013. Methodology: A prospective observational study of 70 cases of patients presented to us in the form of injury to head and neck area by animal bites. In all patients we followed the standard norm for delayed primary closure in form of: • Thorough wound toileting • Equine Rabies Immunoglobulin at the site of wound in all patients • Anti-Rabies vaccination • Daily dressing • Delayed primary suturing after 10 days All patients were routinely followed up and assessed for wound sepsis, cosmesis and function. Results: Among the animal bites, dog bite injuries were found to be most common facial injuries followed by swine and cat. In our study group of 70 patients which was dominated by males from second decade onwards showed a faint line of demarcation in sex distribution in children. Cosmetic outcome on comparing our study of delayed primary closure with Paschos NK et al. study healing by secondary intention, delayed primary suturing exhibited significantly better result with the mean score of (1.50) for VSS compared to healing by secondary intention group with mean score of (3.05) for VSS was recorded (p= 0.000) (95% CI 0.1516-0.1494). Conclusion: Delayed primary closure exhibited improved cosmetic appearance when compared with healing by secondary intention.

Epidemiological analysis on the open- patient cases of rabies admitted to CDC clinic of Fujian province in 2007 / 中国人兽共患病学报

To analyze the epidemiological factors of the open patient cases admitted to the clinic of Fujian CDC in 2007 for the purpose of prevention of rabies. The descriptive research methods in this study was used, including the gender, age, time admitted to out-patient department(OPD), level of exposure, treatment for the bitten wound, timeliness of inoculating rabies vaccine and therapy with human rabies immunoglobulins ,and the species of attacking animal . Data analysis showed that, in 2007, the OPD for dog injury of Fujian CDC had accepted 4128 cases bitten by dogs, among which children under 10 years old and adults of 21-41 years old constituted majority of cases who were bitten and injured by animals. The exposed cases which were sent to hospitals or OPD within 5 hours only 14.22%;while the percentage of cases received human rabies immunoglobulins was only 14.27%. However, the percentage of cases which were bitten and hurt by pet dogs was 64.27%. Those results indicate the need of strengthen people's knowledge and public education on rabies control and prevention, and the dog feeding management, includes cleaning of wound immediately after bitten by animals, especially the immediate use of rabies immunoglubulins and inoculation with rabies vaccine.

An Epidemiological Investigation on Post-exposure Prophylaxis after Biting by Dogs and Other Animals in the Rabies Endemic Area,Cixi City / 中国疫苗和免疫

Objective To better understand the treament effect of postexposure after biting by dogs and other animals in,Cixi city,and to provide evidence for rabies control.Methods The people,who were bitten by dogs and other animals,were investigated.All related information was collected such as the date and site of bite,animal species,postexposure treatment including vaccination and anti-rabies serum or human anti-rabies immune globulin.Results Total 21,504 cases had received the postexposure treatment from January to September in 2007.Among 21,504 people,95% were attributed to dog bites.62% of people had received the treatment within 12 hours after exposure.All people had received five doses of vaccine.Total 783 people had been administered anti-rabies serum.Furthermore,no sever side effect and rabies cases occurred among these people.Conclusions The injury caused by dogs was still a major potential factor to cause rabies in the rabies endemic area.The timely and correct postexposure treatment with good quality of vaccine could prevent from rabies.