Abstract
BackgroundRabies is a highly fatal disease transmitted through the bite of a rabid animal. Human deaths can be prevented by prompt administering of rabies vaccine and rabies immunoglobulin following the exposure. An assessment of community knowledge, awareness and practices on rabies is important during outbreak to understand their preparedness and target educational messages and response activities by the rapid response team.MethodsA rabies outbreak has occurred in Rangjung town, eastern Bhutan on 4 October 2016. A rapid response team was activated to investigate outbreak and to establish a control program. A community-based questionnaire survey was conducted from 20 to 21 October 2016 to assess the community knowledge of rabies to guide outbreak preparedness and also target educational messages and response activities by the RRT.ResultsA total of 67 respondents were interviewed, of which 61% were female and 39% male. All the respondents have heard of rabies (100%), have knowledge on source of rabies (dog) and its mode of transmission in animals and humans. Most (61%) respondents were aware and also indicated that they would wash the animal bite wound with soap and water and seek medical care on the same day of exposure (100%). Majority (94%) of the respondents have indicated that they would report to the government agencies if they see any suspected rabid dogs in the community and suggested various control measures for dog population management and rabies in Rangjung including neutering procedure and mass dog vaccination. Although only few (10%) of the respondents households owned dogs and cats, but 50% of them have indicated that their dogs were allowed to roam outside the home premises posing risk of contracting rabies through rabid dog bites.ConclusionsAlthough this study indicates a high level of knowledge and awareness on rabies among the community, there exists some knowledge gaps about rabies and therefore, an awareness education should be focused on the source of rabies and rabies virus transmission route to reduce public concern on nonexposure events thereby reducing the cost on unnecessary postexposure treatment.
Highlights
Rabies is a highly fatal disease transmitted through the bite of a rabid animal
A case of rabies was suspected if an animal demonstrate change in behavior and become very excitable, aggression, excessive salivation, biting unusual objects like sticks and stones, aimless movement, and paralysis in case of dog and cat, and excessive salivation, behavioral changes, vocalization, aggression, hyperesthesia, paralysis, coma and death in case of cattle; a case of rabies was confirmed if the brain tissue samples tested positive to rabies virus by rapid antigen detection test (BioNote) and fluorescent antibody test (FAT) [8]
3 person were bitten by confirmed rabid dogs in Rangjung during recent outbreak and all have received complete post-exposure prophylaxis (PEP) course including human rabies immunoglobulin
Summary
Rabies is a highly fatal disease transmitted through the bite of a rabid animal. Human deaths can be prevented by prompt administering of rabies vaccine and rabies immunoglobulin following the exposure. In Bhutan, rabies is endemic in southern parts of the country that borders with India and results in sporadic deaths of domestic animals and humans following rabid dog bites [4, 5]. A case of rabies was suspected if an animal demonstrate change in behavior and become very excitable, aggression, excessive salivation, biting unusual objects like sticks and stones, aimless movement, and paralysis in case of dog and cat, and excessive salivation, behavioral changes, vocalization (bellowing), aggression, hyperesthesia, paralysis, coma and death in case of cattle; a case of rabies was confirmed if the brain tissue samples tested positive to rabies virus by rapid antigen detection test (BioNote) and fluorescent antibody test (FAT) [8]. The RRT had implemented the control measures including: tracing, capture and euthanasia of suspected rabies dogs, collection of brain tissue samples and conduct of laboratory test; zoosanitary measures (safe disposal of carcasses through burial); an emergency vaccination of susceptible dogs and cats to create immune buffer; active surveillance; and awareness education to the general public and the students. All the bite victims have received post exposure treatment including wound washing with soap and water/antiseptic dressing; infiltration of human rabies immunoglobulin (HRIGs) around the bite site and received complete course of WHO recommended intradermal rabies vaccine (purified chick embryo cell vaccine (PCECV) - Rabipur) on day 0, 3, 7 and 28 as per the rabies postexposure treatment guideline
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