Animal Bites Research Articles

Public health preparedness, syndromic surveillance, and response during the largest religious gathering at the Catholic pilgrimage center of Velankanni in South India: 2016.

The dynamicity and mobility of the population in a mass gathering setting pose a challenge to traditional disease surveillance methods and strain the local health services. Velankanni is one of the most sacred Christian pilgrimage places located in Nagapattinam, Tamil Nadu, India. We participated in the Velankanni festival to describe the public health preparedness, surveillance, and response activities carried out during the festival. This was a cross-sectional study. We reviewed the national and international guidelines and published literature and discussed with the key stakeholders. We developed a checklist to observe public health preparedness activities. We facilitated the staff and monitored the activities by the implementers. We established the syndromic surveillance in the designated locations of the event and used tracker software to capture the data. Emergency medical teams were formed with trained health personnel to respond to medical emergencies. The team monitored all the public health activities. There are 59 primary care public health facilities and nine ambulatory Mobile Medical Units, with 160 medical officers available at the site. Of the 16,169 persons who attended the medical camps, 9863 (61%) were males and 8408 (52%) were aged 15-44. Acute diarrheal disease was the most frequent of the reported syndromes, followed by injuries, acute febrile illness, and animal bites. There was no outbreak of any disease either identified or reported. Our findings suggest that risk assessments should be used, and establishing an Incident Command Center is vital for executing command and control mechanisms during mass gatherings.

Rise in rabies cases in Jammu region: A problem that requires urgent attention.

Rabies is a fatal zoonotic disease that is endemic in India. Both forms of rabies, namely, encephalitic and furious, invariably lead to coma and death. Lack of awareness is the most critical barrier in accessing timely post-exposure prophylaxis that can prevent the progression to clinical disease. To report the case series of fourteen clinically suspected rabies cases. We followed a retrospective study design. Data were collected from the Anti Rabies Section of Government Medical College, Jammu, which is a tertiary care hospital of Jammu Division. We collected data of all patients over a period of three years, from 2017 to 2020, who were diagnosed as cases of clinically suspected rabies on the basis of classic signs and symptoms and who finally succumbed to the disease. Descriptive statistics was used to describe the results of the study. In the present description, the mean age of the patients was 31 ± 18.6 years. Out of 14 suspected cases, 9 had not received any post-exposure prophylaxis-neither vaccine nor serum-and instead visited spiritual faith healers. The remaining patients had history of either incomplete, unknown, or incorrect vaccination status. Median duration of presentation of symptoms after dog bite was 42 days, with a range of 15-180 days. Mean survival of patients after presentation of symptoms was around 1.8 days. Low level of awareness resulted in non-seeking of health-care services after animal bites.

ВЕРОЯТНОСТЬ ИНФЕКЦИОННОГО ПРОЦЕССА RABIES У ЛЮДЕЙ В РЕГИОНЕ СО СЛОЖНОЙ ЭПИЗООТИЧЕСКОЙ ОБСТАНОВКОЙ ПО БЕШЕНСТВУ

The aim of the study was to establish the relationship between cases of animal rabies and cases of people seeking medical help after bites of synanthropic and wild animals in various geographical areas of the Saratov Region. An analysis of the number of people who sought medical help for animal bites in the right-bank Districts of the Saratov Region in 2022 showed that the largest number of people sought medical help after traumatic contacts with animals in Balashovsky (272 people), Volsky (213 people), Rtishchevsky Districts (126 people), and in the left-bank Districts of the Region, the largest number of people sought medical help after traumatic contacts with animals in Balakovsky, Pugachevsky and Krasnokutsky Districts of the Region, which amounted to 580, 167 and 82 people, respectively. The lea-ding positions in the number of people injured by animal bites during the period under review are occupied by the city of Saratov – 2,342 people, as well as the city of Engels and the Engels District of the Region – 1,037 people. Having analyzed the number of people injured by animals with established rabies in the Saratov Region in 2022, it was found that the largest number of people were injured in Saratov (11 people). In Dergachevsky – 9 people, in Rtishchevsky and Sovetsky Districts – 8 people, respectively. An analysis of the number of cases of rabies in animals of different species in the region in 2022 showed that the lea-ding positions among the recorded cases of rabies were occupied by dogs (16 cases), cats (14 cases), and wild animals (9 cases). The probability of infection of the population with the rabies virus during traumatic contact with an animal is 0.066. In conditions of stationary trouble in the Region over a long period of time, the contagiousness index is 2.1, which indicates an extremely high danger and probability of rabies among the population of the Region.

The Veterinarian’s Role in Biocontainment Research Animal Facilities and Prevention of Spread of Pathogens: A Case of Nigeria and South Africa

Infections acquired in research laboratories and unintentional pathogen escapes from breaches in biocontainment pose risks to humans and the environment, necessitating the need for effective biosafety and biosecurity management frameworks in biocontainment research animal facilities (BRAFs). We examine key biosafety issues associated with BRAFs, including inadequate decontamination procedures for wastewater and experimental samples, handling high biosafety level pathogens in lower-level laboratories, risks of animal bites and sharps injuries, contamination of bedding and enrichment materials, and improper management and transportation of biohazard samples. Additionally, we discuss the role of veterinarians in research animal facilities and the challenges they encounter in maintaining biocontainment standards. We emphasise the importance of routine monitoring of effluent water to detect possible disease outbreaks. We recommend a thorough investigation of disease outbreaks to identify potential sources of pathogen release from BRAFs, which could serve as hotspots for future disease outbreaks. Findings from such investigations will inform the development of policies aimed at safeguarding human populations from future pandemics and preventing BRAFs from becoming sources of infectious disease outbreaks.

An Analytical Study of the Number of Communicable Diseases and Health Institutions in Iraq using Two-Way Analysis of Variance, Friedman and Scheffe Tests

In this research paper, data were analyzed from Environmental Statistics in Iraq (Health Indicators for 2019)/ Central Statistical Organization /Iraqi Ministry of Planning. The data represents the number of health institutions distributed across all governorates of Iraq (government hospitals, private hospitals, popular clinics, specialized health centers (dental, chest, allergy, asthma, other specialties), primary health care centers (main and subsidiary), other health institutions (insurance clinics). health care, health homes), training health center, family medicine health center, family planning center, central health laboratories, forensic medicine, blood bank). In addition to other data representing the number of infections with communicable diseases in Iraq (polio, acute flaccid paralysis, whooping cough, measles, German measles, mumps, congenital tetanus, adult tetanus, hydatid cysts, typhoid, malaria, schistosomiasis, bacillus dysentery, rabies, Diphtheria, chicken pox, hemorrhagic fever, Malta fever, pneumonia, cholera, scabies, cutaneous leishmaniasis, black fever, animal bites, meningitis of all kinds, bird flu, swine flu). It was determined whether there are significant differences in the number of health institutions in terms of their distribution across all governorates of Iraq, or not. Also, is there a significant difference in the number of infections with communicable diseases in all governorates of Iraq or not? If there is a significant difference in the number of health institutions or the number of infections with communicable diseases, whichever number is higher. The study included the total number of health institutions in Iraq, as well as the total number of communicable diseases of various types in all governorates of Iraq. The results were obtained by applying the Friedman test, in addition to two-way analysis of variance, as well as the Scheffé test.

Treatment seeking behaviour and compliance regarding Anti-rabies vaccine among animal bite patients in Anti-rabies clinic, at District Hospital Amritsar, Punjab

Treatment seeking behaviour and compliance regarding Anti-rabies vaccine among animal bite patients in Anti-rabies clinic, at District Hospital Amritsar, Punjab

Lyssa: Goddess, Drug, Illness and Shield in Hellenic Antiquity.

The aim of this historical review is to present the beliefs of the ancient Greeks related to lyssa and how the mythology surrounding this disease was created. In Greek antiquity Lyssa was a secondary goddess, a personification of a zoonotic disease which could be transmitted after an animal bite. Also named hydrophobia, the illness lyssa presented with an acute loss of mental stability, offensive frenzy and madness, and fear of water in the patient, who was seen to be possessed by a daemon as a divine punishment. In the Trojan War, lyssa was seen as a drug to Greek warriors, to demonstrate unreal power during battle. Homer was the first to refer to the hound of Orion, who was the greatest ancient Greek hunter. The hound, named Sirius, as a carrier of lyssa, was used as a bio-weapon to inflict death among the Trojans. Soranus of Ephesus and Galen gave descriptions of the disease, and proposed a sponge soaked with various herbal drugs as a therapeutic measure. The Greco-Roman physician Caelius Aurelianus noted that ancient Greeks knew about lyssa, and was the first to suggest that this was a neuro-disease. Lyssa was a figure in Greek Tragedy, depicted as a young female with a dog-like crown, related to Erinyes and Maniae. CONCLUSION: Lyssa was noted as a disease in Hellenic literature more than 2500 years ago. It was used as a bio-weapon to inflict madness. This vignette reveals Lyssa within a historical framework for the reader to understand the disease's origins.

Incidence of animal bite and risk for rabies in Kaduna State, Nigeria – public health implication

This study focused on the incidence of animal bite (n=50) reported in Kaduna State, Nigeria, between January and April 2024, focusing on factors such as the type of biting animal, sex of the victims, geographical distribution, temporal trends, and the nature of the bites. The data were sourced from weekly reports submitted by Area Veterinary Officers to the Department of Veterinary and Livestock Services and were supplemented with rabies test results from the National Veterinary Research Institute (NVRI), Vom, Plateau State. Results revealed that dogs were responsible for 96% of the biting incidents, while cats accounted for 4%. Male victims were more frequently bitten, and the highest incidence was reported in Kaduna Central (Zone 2) with 44% and Zaria being the lowest (12%). Most incidents occurred in February (38%) and March (34%). Provoked bites constituted 52% of the cases, and 86% of the dogs involved were not vaccinated against rabies. Rabies test results showed that 94% were negative, while 6% tested positive, all of which were reported in Kaduna South (Zone 3). A significant association (p=0.034) between senatorial zones and rabies test results was observed, indicating a need for targeted public health interventions in specific zones. The study underscores the need for improving vaccination coverage and implementing educational campaigns to mitigate risk of rabies and reduce the incidence of animal bites. Enhanced public health strategies, community engagement and one health approach should be implemented to address the multifaceted challenges posed by dog bites and rabies in Kaduna State.

Postpartum Bilateral Nerve Palsy: A Harbinger for Preeclampsia?

Objective: To report a case of postpartum bilateral facial weakness that preceded the diagnosis of preeclampsia. Introduction: Bell’s palsy is a neuromuscular disorder that can cause paralysis or weakness of the face. It is the most common cause of unilateral facial weakness; however, bilateral weakness is rare. Bell’s palsy is one of the most common neuromuscular disorders observed in pregnancy, though the link between the two is not entirely clear. Proposed etiologies include reactivation of human herpes viruses, immune mediated inflammatory demyelination of the facial nerve, and microangiopathy as a result of systemic hypertension. There have been several case reports and studies suggesting a correlation between preeclampsia and Bell’s palsy. We present a rare case of postpartum bilateral Bell’s palsy in the setting of preeclampsia. Design: Case report. Results: Our patient is a 24 year-old G6P4116 Caucasian woman with no significant past medical history who presented with bilateral facial weakness and headache. She was postpartum day four from a spontaneous vaginal delivery of dichorionic diamniotic twins at 35 weeks at an outside hospital. She denied any elevated blood pressures during her pregnancy. Initially, on postpartum day two she had reported a severe headache that initially affected her occipital region bilaterally before migrating to her ears and forehead. At this time the patient was normotensive and was discharged home on analgesics. On postpartum day three, she returned to another emergency department with a worsening, severe headache. She was sent home with a diagnosis of anxiety. On postpartum day four, her symptoms persisted and she came to the emergency department at our facility. During our initial evaluation, her blood pressure was 170/98. She was admitted for severe preeclampsia and given IV magnesium and nifedipine. However, her headache persisted and she developed bilateral facial weakness, neck pain, and swelling. She reported that she was unable to move her face and had difficulty smiling. Her face was expressionless. She denied nausea, vomiting, dysphagia, double vision, gait disturbances, hearing loss, fever, shortness of breath, numbness, or tingling. She denied recent travel, sick contacts, or animal or tick bites. She was evaluated by neurology and her initial physical exam revealed intact cranial nerves, though the patient appeared to have difficulty squeezing her eyes shut and smiling. Periorbital edema was noted. Facial symmetry and sensation were intact bilaterally. She had difficulty saying the letter “P.” Her MRIs of both brain and cervical spine, chest x-ray, and lumbar puncture were all normal. Our working diagnoses included bilateral Bell’s palsy, Guillain-Barré and Miller-Fischer syndromes. The antibody panel drawn for Miller-Fischer syndrome subsequently resulted as negative. Our patient received three days of IVIG and was discharged on a week supply of prednisone 60mg with a taper thereafter. At discharge, she had severe bilateral facial droop. She was unable to puff out her cheeks or raise her eyebrows. Neurology recommended outpatient follow up. One month after discharge she had residual right sided facial droop, but the deficits of the left side of her face had mostly resolved. Discussion: Current literature suggests a correlation between preeclampsia and Bell’s palsy. There is some thought that elevated blood pressure leads to facial nerve compression secondary to edema or microemboli. One report suggested that the onset of Bell’s palsy antepartum or postpartum may be a predictor of preeclampsia. An English language PUBMED search revealed six case reports on bilateral Bell’s palsy in either the pregnant or postpartum state. Cases reported occurred in either the third trimester or within the first week postpartum. This was consistent with the onset of our patient’s symptoms during her first week postpartum. In one case, neurological symptoms preceded preeclampsia. Our patient complained of headaches and neck pain prior to having elevated blood pressures. Three of these cases included twin gestations, as did our case. Outcomes varied, with some patients seeing complete resolution of symptoms within weeks to others having recurring symptoms over a year. Providers should consider the relationship between preeclampsia and Bell’s palsy when treating pregnant or postpartum patients with new onset neurological symptoms. Pregnant and postpartum patients are at greater than three times increased risk for Bell’s palsy and have more severe symptoms and longer recovery times compared to the average population. It is important that obstetricians and gynecologists assess for signs of preeclampsia in pregnant or postpartum patients with concerns for Bell’s palsy, as well as refer patients for a complete neurological workup. Ultimately, more research is needed to further understand the relationship between preeclampsia and Bell’s palsy.

Postpartum Bilateral Nerve Palsy: A Harbinger for Preeclampsia?

Objective: To report a case of postpartum bilateral facial weakness that preceded the diagnosis of preeclampsia. Introduction: Bell’s palsy is a neuromuscular disorder that can cause paralysis or weakness of the face. It is the most common cause of unilateral facial weakness; however, bilateral weakness is rare. Bell’s palsy is one of the most common neuromuscular disorders observed in pregnancy, though the link between the two is not entirely clear. Proposed etiologies include reactivation of human herpes viruses, immune mediated inflammatory demyelination of the facial nerve, and microangiopathy as a result of systemic hypertension. There have been several case reports and studies suggesting a correlation between preeclampsia and Bell’s palsy. We present a rare case of postpartum bilateral Bell’s palsy in the setting of preeclampsia. Design: Case report. Results: Our patient is a 24 year-old G6P4116 Caucasian woman with no significant past medical history who presented with bilateral facial weakness and headache. She was postpartum day four from a spontaneous vaginal delivery of dichorionic diamniotic twins at 35 weeks at an outside hospital. She denied any elevated blood pressures during her pregnancy. Initially, on postpartum day two she had reported a severe headache that initially affected her occipital region bilaterally before migrating to her ears and forehead. At this time the patient was normotensive and was discharged home on analgesics. On postpartum day three, she returned to another emergency department with a worsening, severe headache. She was sent home with a diagnosis of anxiety. On postpartum day four, her symptoms persisted and she came to the emergency department at our facility. During our initial evaluation, her blood pressure was 170/98. She was admitted for severe preeclampsia and given IV magnesium and nifedipine. However, her headache persisted and she developed bilateral facial weakness, neck pain, and swelling. She reported that she was unable to move her face and had difficulty smiling. Her face was expressionless. She denied nausea, vomiting, dysphagia, double vision, gait disturbances, hearing loss, fever, shortness of breath, numbness, or tingling. She denied recent travel, sick contacts, or animal or tick bites. She was evaluated by neurology and her initial physical exam revealed intact cranial nerves, though the patient appeared to have difficulty squeezing her eyes shut and smiling. Periorbital edema was noted. Facial symmetry and sensation were intact bilaterally. She had difficulty saying the letter “P.” Her MRIs of both brain and cervical spine, chest x-ray, and lumbar puncture were all normal. Our working diagnoses included bilateral Bell’s palsy, Guillain-Barré and Miller-Fischer syndromes. The antibody panel drawn for Miller-Fischer syndrome subsequently resulted as negative. Our patient received three days of IVIG and was discharged on a week supply of prednisone 60mg with a taper thereafter. At discharge, she had severe bilateral facial droop. She was unable to puff out her cheeks or raise her eyebrows. Neurology recommended outpatient follow up. One month after discharge she had residual right sided facial droop, but the deficits of the left side of her face had mostly resolved. Discussion: Current literature suggests a correlation between preeclampsia and Bell’s palsy. There is some thought that elevated blood pressure leads to facial nerve compression secondary to edema or microemboli. One report suggested that the onset of Bell’s palsy antepartum or postpartum may be a predictor of preeclampsia. An English language PUBMED search revealed six case reports on bilateral Bell’s palsy in either the pregnant or postpartum state. Cases reported occurred in either the third trimester or within the first week postpartum. This was consistent with the onset of our patient’s symptoms during her first week postpartum. In one case, neurological symptoms preceded preeclampsia. Our patient complained of headaches and neck pain prior to having elevated blood pressures. Three of these cases included twin gestations, as did our case. Outcomes varied, with some patients seeing complete resolution of symptoms within weeks to others having recurring symptoms over a year. Providers should consider the relationship between preeclampsia and Bell’s palsy when treating pregnant or postpartum patients with new onset neurological symptoms. Pregnant and postpartum patients are at greater than three times increased risk for Bell’s palsy and have more severe symptoms and longer recovery times compared to the average population. It is important that obstetricians and gynecologists assess for signs of preeclampsia in pregnant or postpartum patients with concerns for Bell’s palsy, as well as refer patients for a complete neurological workup. Ultimately, more research is needed to further understand the relationship between preeclampsia and Bell’s palsy.

Effect of telephone reminders on adherence to anti-rabies vaccine amongst animal bite patients in North India: A randomised, single-blind, parallel-group, single-centre, interventional superiority trial

ObjectivesRabies is a highly infectious viral zoonotic disease of the central nervous system with a near 100% fatality rate. Vaccine adherence is an integral part of achieving effective treatment. India accounts for 27% of the global deaths from rabies yearly. Rabid dog bites are responsible for 99% of these deaths. This study aimed to assess the effect of reminder calls on compliance with the anti-rabies vaccine among animal bite patients. MethodsAn interventional, randomised, single-blinded, parallel-group, single-centre study was conducted at the Anti Rabies Clinic, Rajindra Hospital, Government Medical College, Patiala, a city located in Punjab, India, with a population of approximately 19 lakhs. A sample of 400 patients was enrolled and divided into two groups by lottery method. After obtaining written and informed consent from patients, data were collected using a validated pre-tested, semi-structured proforma. The intervention group received reminder calls before each dose. At the end of the study, complete information regarding compliance was obtained from both groups and analysed. ResultsThe median age group of the animal bite patients was 21-40 years, with most being male (69.50%). Most of the bites were on the lower extremities (64.0%), followed by the upper extremities (29.0%) and the face (3.25%). Out of 153 patients who delayed the dose, 137 (89.54%) delayed a single dose. The 4th dose on the 28th day was the most frequently delayed dose (75.16%). Reminder calls increased the vaccine compliance rate from 53.5% in the non-intervention group to 70% in the intervention group (adjusted odds ratio=2.28; P=0.0002). There was no effect of gender, area, educational qualification, or marital status on the compliance. ConclusionsReminder calls were found to have significant effect on the adherence to the anti-rabies vaccine. This simple, cost-effective, and patient-friendly intervention must be integrated within the health care system to ensure timely and complete administration of the anti-rabies vaccine to reduce the risk of rabies.

Adherence to treatment in patients with animal bites in a hospital of Colombia

BackgroundThe treatment of animal bite wounds includes both local management and prophylactic use of oral antibiotics. However, the effectiveness of the latter in our population is inconclusive. This research aims to identify the relationship between adherence to antibiotic treatment and the infection rate after an animal bite. MethodsA prospective cohort study was conducted in a tertiary hospital in Colombia. All patients who had suffered animal bites were included in this study. T-tests and chi-square tests were used to evaluate the results. Subgroup analysis was performed, and the risk ratio was calculated with a 95 % confidence interval. ResultsA total of 227 patients were included, of whom 56.4 % were male, with an average age of 22 years, and 43.6 % were female. Canine bites accounted for 90.3 % of the cases, with the hand being the most frequently affected anatomical area. Beta-lactam antibiotics with beta-lactamase inhibitors were the most commonly used (53 %). Adherence to antibiotic treatment was observed in 63 % of the patients. Signs and symptoms of infection occurred in 44 % of cases, while suture dehiscence occurred in only 3 %. ConclusionsWhile adherence to treatment is acceptable, infection occurs at a high percentage. The adherence rate to antibiotic treatment in dog bites is high; however, the use of antibiotics remains controversial, as healthcare professionals do not adequately adhere to national guidelines.

Prevalence Study and Overview of Rabies in the Province of Ouarzazate-Morocco

Background: Rabies is a cosmopolitan anthropozoonosis for which humans are accidental victims. In Morocco, rabies is an endemic disease, with new cases of human rabies reported every year. The aim of our study is to analyze the epidemiological aspects of rabies in the province of Ouarzazate. Materials and Methods: This is a retrospective study using records available at the Ouarzazate Municipal Hygiene Office. It includes 1,759 cases of exposure to animal bites between 2016 and 2019. Results: We identified 1,759 cases of animal bites during the period of 4 years of study, representing an average annual exposure rate of 190/100,000 inhabitants. Most cases were rural (65%). The median age of bitten cases was 28 years, with people under 15 years of age exposed in 32% of cases. Males predominate, with 61.3% of cases. Dogs are the main animal aggressors at 47.8%, followed by cats at 33%. The upper limbs are the preferred sites of aggression (89.2%). Exposure was grade III in 76.8% of cases. Lesions were multiple in 52.1% and superficial in 62.6%. No cases of human rabies have been recorded since 2001, despite 20 cases being exposed to a biologically confirmed rabid animal during our study. Conclusion: Rabies remains a public health concern in the province of Ouarzazate, despite the presence of a national rabies control program. Effective control of this zoonosis requires strengthening education and community engagement, as well as close collaboration between animal health and human health sectors for integrated management of bite cases.

Frequency of workplace incidents and injuries in veterinarians, veterinary nurses and veterinary students and measures to control these.

Veterinarians, veterinary nurses and veterinary students work and train in a variety of environments and are exposed to a wide range of hazards. (1) To compare the rate of health and safety incidents and injuries between veterinarians, veterinary nurses and veterinary students. (2) To investigate the health and safety hazard controls present in Australian veterinary workplaces. A cross-sectional study, using an online questionnaire. Anonymous links to the questionnaire were disseminated to Australian veterinarians, veterinary nurses and veterinary students. A total of 494 veterinarians, 484 veterinary nurses and 212 veterinary students completed the survey. Incidents and injuries were common, particularly sharps-related injuries and animal bites. Australian veterinary nurses and veterinarians experienced the studied incidents at similar rates to each other. Veterinary students experienced some incidents and injuries at rates higher than both veterinarians and veterinary nurses, including heatstroke, hypothermia, sunburn, electric shock, loss of consciousness, being rammed or pushed over by an animal and farm equipment injuries. Of the workplace hazard controls reported, first aid boxes were most commonly present, and safety meetings occurred least commonly. Veterinary nurses received Q fever and rabies vaccines much less frequently than veterinarians and veterinary students. This study demonstrated that improvements need to be made to the occupational health and safety standards in the Australian veterinary sector. Veterinarians and veterinary nurses had suboptimal rates of access to many of the required and critical workplace health and safety controls. Improvements to the standard of health and safety training of veterinary students are indicated, given their higher rates of certain incidents and injury.

Rabies Vaccine for Prophylaxis and Treatment of Rabies: A Narrative Review.

Rabies, a millennia-old viral infection transmitted through animal bites, poses a lethal threat to humans, with a historic fatality rate of 100% if left untreated. Louis Pasteur's introduction of the rabies vaccine in1885 marked a turning point in the battle against rabies, preventing numerous cases. The purpose of this paper is to review the historical development, current challenges, and future prospects of rabies vaccination and treatment, with emphasis on the importance of continued research and collaborative efforts in the quest to eradicate this deadly infection. Historical vaccine development progressed from inactivated to live-attenuated forms, with modern recombinant techniques showing promise. The preventive measures at present primarily involve vaccination, but challenges persist, such as differing safety profiles and immunogenicity among vaccine types.Pre-exposure prophylaxis with a three-dose vaccine series is crucial, especially in high-risk scenarios.Post-exposure prophylaxis combines human rabies immunoglobulin and inactivated rabies virus vaccine. The quest for the next generation of vaccines explores genetically modified and viral vector-based approaches; emerging treatments include gene therapy, virus-like particles, and monoclonal antibodies, offering hope for improved outcomes. Economic barriers to post-exposure prophylaxis, limited education, and awareness challenge rabies control. Cost-effective solutions and comprehensive awareness campaigns are vital for the successful eradication of rabies. More research and collaborative endeavors remain pivotal in the ongoing journey to eradicate rabies, one of the deadliest infectious diseases known to humans, if not met with prophylactic measures.

Post-Exposure Rabies Vaccine Compliance and Reasons for Non-Adherence - A Mixed Method Study in Puducherry

Background: Among the people who die annually of rabies worldwide, the majority either did not receive post-exposure prophylaxis (PEP), or received PEP after substantial delays or were administered PEP according to schedules that deviated from WHO recommendations. This study focuses on post-exposure rabies vaccine compliance and on the reasons for non-adherence. Methods: A mixed-method study was done among people exposed to animal bite who visited a PHC during January to December 2022.The participant list was taken from the register maintained at PHC and the data was collected by semi-structured questionnaire followed by in-depth interview. Results: The major cause for noncompliance with the ARV vaccination was failure to remember ARV schedule (52.4%), followed by lack of awareness of animal bite (19.6%) poor knowledge of ARV completion (16.2%), lack of time and access (9.4%) and choice of native treatment (2.4%). On multivariate analysis of the factors influencing rabies vaccine compliance, age, area of residence and socio-economic status were found to be statistically significant. Conclusion: The study results highlight the importance of imparting health education to increase vaccine compliance to prevent rabies.

Rabies encephalitis following Post Exposure prophylaxis (PEP) is becoming an evolving problem in Bangladesh

Rabies is one of the oldest and deadliest disease in the world and causes a significant number of deaths. Over 95 % of all human deaths from rabies occur in Asia and Africa. Bangladesh is endemic to rabies. Since the National Rabies Elimination Program was successfully implemented in 2010, Bangladesh has achieved considerable strides in preventing human mortality from rabies. Rabies post-exposure prophylaxis (PEP) is widely used and very effective. However, occasional incidences of rabies in individuals who have initiated or completed PEP have been documented. In this observational cohort study, a total of 45 clinically diagnosed rabies patients, irrespective of age and gender, from 33 different districts of Bangladesh were studied. A detailed clinico-demographic profile, including post-exposure prophylaxis received before the development of rabies, was recorded. RT-PCR for rabies was done on the saliva samples of all patients. An MRI, EEG, and CSF viral panel was also done for patients who were RT-PCR negative. From January 2022 to June 2023, 45 clinically diagnosed rabies cases were admitted to IDH. Two of them were PCR-positive. The median age of the patients was 11 years (IQR 5–40 years). 37 (82.2 %) were males. Dogs were the most commonly accused animal (86.5 %). The median time from exposure to the development of rabies symptoms was 37 days (IQR 22–60 days, range 07–240 days). The median duration of illness was 5 days (IQR: 3–7 days). All of the patients had severe exposure. Only 5 (11 %) patients received complete WHO-recommended post-exposure prophylaxis (PEP). 20 (45 %) patients received only the rabies vaccine (incomplete PEP) without a wound wash or RIG. All the patients received supportive management. In addition to that, three patients were given intrathecal RIG at 40 U/kg/dose for two doses seven days apart. Out of three patients, two survived for more than two months. One patient is still alive after six months with significant morbidity. There is no cure for rabies; however, appropriate animal bite management by trained medical personnel with WHO-recommended PEP is the only way to achieve the goal of a rabies-free world.

Bat Bites and Rabies PEP in the Croatian Reference Centre for Rabies 1995-2020.

Seroprevalence of lyssaviruses in certain bat species has been proven in the Republic of Croatia, but there have been no confirmed positive bat brain isolates or human fatalities associated with bat injuries/bites. The study included a retrospective analysis of bat injuries/bites, post-exposure prophylaxis (PEP) and geographic distribution of bat injuries in persons examined at the Zagreb Antirabies Clinic, the Croatian Reference Centre for Rabies. In the period 1995-2020, we examined a total of 21,910 patients due to animal injuries, of which 71 cases were bat-related (0.32%). Of the above number of patients, 4574 received rabies PEP (20.87%). However, for bat injuries, the proportion of patients receiving PEP was significantly higher: 66 out of 71 patients (92.95%). Of these, 33 received only the rabies vaccine, while the other 33 patients received the vaccine with human rabies immunoglobulin (HRIG). In five cases, PEP was not administered, as there was no indication for treatment. Thirty-five of the injured patients were biologists or biology students (49.29%). The bat species was confirmed in only one of the exposure cases. This was a serotine bat (Eptesicus serotinus), a known carrier of Lyssavirus hamburg. The results showed that the bat bites were rather sporadic compared to other human injuries caused by animal bites. All bat injuries should be treated as if they were caused by a rabid animal, and according to WHO recommendations. People who come into contact with bats should be strongly advised to be vaccinated against rabies. Entering bat habitats should be done with caution and in accordance with current recommendations, and nationwide surveillance should be carried out by competent institutions and in close collaboration between bat experts, epidemiologists and rabies experts.

Animal and human bites: Navigating evaluation and care.

Patients who have experienced animal or human bites may present for care in a number of settings with a variety of injuries requiring different approaches to treatment and management. Because animal and human bites range in severity and can result in a host of sequelae, their evaluation and management can be complex. In caring for patients with an animal or human bite, NPs must consider the many factors relevant to such an injury.

Animal and human bites: Navigating evaluation and care.

Animal and human bites: Navigating evaluation and care.