Abstract
BackgroundThousands of human deaths from rabies occur annually despite the availability of effective vaccines following exposure, and for disease control in the animal reservoir. Our aim was to assess risk factors associated with exposure and to determine why human deaths from endemic canine rabies still occur.Methods and FindingsContact tracing was used to gather data on rabies exposures, post-exposure prophylaxis (PEP) delivered and deaths in two rural districts in northwestern Tanzania from 2002 to 2006. Data on risk factors and the propensity to seek and complete courses of PEP was collected using questionnaires. Exposures varied from 6–141/100,000 per year. Risk of exposure to rabies was greater in an area with agropastoralist communities (and larger domestic dog populations) than an area with pastoralist communities. Children were at greater risk than adults of being exposed to rabies and of developing clinical signs. PEP dramatically reduced the risk of developing rabies (odds ratio [OR] 17.33, 95% confidence interval [CI] 6.39–60.83) and when PEP was not delivered the risks were higher in the pastoralist than the agro-pastoralist area (OR 6.12, 95% CI 2.60–14.58). Low socioeconomic class and distance to medical facilities lengthened delays before PEP delivery. Over 20% of rabies-exposed individuals did not seek medical treatment and were not documented in official records and <65% received PEP. Animal bite injury records were an accurate indicator of rabies exposure incidence.ConclusionsInsufficient knowledge about rabies dangers and prevention, particularly prompt PEP, but also wound management, was the main cause of rabies deaths. Education, particularly in poor and marginalized communities, but also for medical and veterinary workers, would prevent future deaths.
Highlights
Rabies is an acute viral infection which causes horrifying neurological symptoms that inevitably result in death
Modern cell culture vaccines used in combination with rabies immunoglobulins are virtually 100% effective in preventing human deaths if administered promptly to rabies-exposed patients following appropriate wound management [3] and mass vaccination of domestic dogs has successfully eliminated or controlled domestic dog rabies in many parts of the world [4,5]
It is inexcusable that an estimated 55,000 human deaths from rabies occur annually [6], of which over 99% are in developing countries where the disease is endemic in domestic dog populations [7]
Summary
Rabies is an acute viral infection which causes horrifying neurological symptoms that inevitably result in death. It is inexcusable that an estimated 55,000 human deaths from rabies occur annually [6], of which over 99% are in developing countries where the disease is endemic in domestic dog populations [7]. Hospital studies further suggest that clinical diagnosis of human rabies may be hindered by confusion with common neurological syndromes, such as cerebral malaria [8]. These and other studies on rabies incidence and exposure risk rely on bite victims reporting to hospital, yet not all rabies-exposed individuals seek medical attention. Thousands of human deaths from rabies occur annually despite the availability of effective vaccines following exposure, and for disease control in the animal reservoir. Our aim was to assess risk factors associated with exposure and to determine why human deaths from endemic canine rabies still occur
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