Abstract
BackgroundRabies is a disease that still exists in developing countries and leads to more fatalities than other zoonotic diseases. Our study aimed to describe the profile of human exposures to animals over fifteen years and to assess the post-exposure prophylaxis (PEP) practices in the governorate of Kasserine (Tunisia) on pre- and post-revolution (2011).MethodsWe carried out a descriptive study using surveillance data from a region in Central-West Tunisia. All humans exposed to animals, residents in Kasserine Governorate and declared to the regional directorate of primary health care (RDPH) from January 1st, 2004 to December 31st, 2018 were included.ResultsA total of 45,564 cases of human exposures to animals were reported over the fifteen-year period of the study with an annual average of 3089.2 ± 403.1. The standardized incidence rate (SIR) of human exposures to animals was 694 per year per 100,000 inhabitants (inh).The most listed offending animal was the dog (91.3%) and the most reported type of exposure was bites (63.7%). The trend in human exposures to animals increased significantly over time. The number of exposures by vaccinated dogs decreased significantly and by unvaccinated and stray dogs increased steeply. When comparing pre-and post-revolution periods, the yearly average of animal exposures post-2011 was significantly greater than the average prior to 2011 (3200 ± 278.5 vs 2952.8 ± 483) (p < 0.001). The yearly average of animal bites post-2011 was significantly greater than the average prior to 2011 (2260.5 ± 372.1 vs 1609.8 ± 217.9) (p < 0.001). The average number of vaccine doses per animal exposure was 2.4. Concerning PEP protocols, protocol A (2 and 3 doses) was indicated in 79% of animal exposures cases. From 2004 to 2018, a downward trend was noted for protocol A (r = − 0.29, p < 0.001) and an upward trend for protocol B (3 and 5 doses) (r = 0.687, p < 0.001). During our study period, 5 fatal cases of human rabies were declared.ConclusionRabies remains a major public health problem in Tunisia. The political dynamics had an impact on the health care system and rabies control. Preventive measures should be applied adequately to decrease the burden of this disease.
Highlights
Rabies is a disease that still exists in developing countries and leads to more fatalities than other zoonotic diseases
Our study aimed to describe the epidemiological profile of human exposures to animals over fifteen years and to assess the post-exposure prophylaxis (PEP) practices in the governorate of Kasserine (Tunisia) pre- and post-revolution
Characteristics and incidence of human exposures to animals A total of 45,563 cases of human exposures to animals were reported over the fifteen-year period of the study with an annual average of 3089.22 ± 403.10 cases
Summary
Rabies is a disease that still exists in developing countries and leads to more fatalities than other zoonotic diseases. Rabies is a disease of antiquity, still existing, and leading to more fatalities than any other zoonotic diseases [3, 4]. Over 95% of human deaths result from virus transmission through rabid dog bites [8] It is a preventable disease through pets vaccination, adequate management of bite wounds, timely post-exposure prophylaxis (PEP) and public health interventions to control stray animals [9]. The complete eradication of rabies is a public health challenge This is due to the nature of causal agent living in a wide variety of hosts on the one hand and to the status of the disease as neglected in the other hand [10]. The lack of information on the endemicity and burden of the disease contributed in part to hinder the elimination of this fatal disease [6]
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