Burden Of Rabies Research Articles

Patterns of animal rabies in the Nizhny Novgorod region of Russia (2012-2022): the analysis of risk factors.

Animal rabies is a viral disease that poses a significant threat to domestic and wild animal populations, with devastating consequences for animal health and human life. Understanding and assessing the risk factors associated with the transmission and persistence of the rabies virus in wild and domestic animal populations is crucial for developing effective strategies to control and mitigate cases. Studies of the spatial and temporal distribution of rabies cases in the Nizhny Novgorod region during 2012-2022 provided epidemiological evidence of the circulation of infection between animals in the presence of vaccination. Among the wild animals in the area, red foxes play a major role in the spread of rabies, accounting for 96.4% of all wild animal cases. We used spatiotemporal cluster analysis and a negative binomial regression algorithm to study the relationships between animal rabies burden by municipality and a series of environmental and sociodemographic factors. The spatiotemporal cluster analysis suggests the concentration of wild animal rabies cases in the areas of high fox population density and insufficient vaccination rates. The regression models showed satisfactory performance in explaining the observed distribution of rabies in different animals (R 2 = 0.71, 0.76, and 0.79 in the models for wild, domestic and all animals respectively), with rabies vaccination coverage and fox population density being among the main risk factors. We believe that this study can provide valuable information for a better understanding of the geographical and temporal patterns of rabies distribution in different animal species, and will provide a basis for the development of density-dependent planning of vaccination campaigns.

Rabies control costs at the provincial level: Who should pay more, the community or the government?

Background and Aim: Rabies is a zoonotic disease that persists endemic in numerous countries worldwide. In Vietnam, the main sources of rabies are dogs and cats, and they caused 76 human deaths annually by 2017–2021. Long An province has recently experienced an increasing burden of rabies, with seven fatal cases reported in the past 5 years. Various rabies control measures have been implemented in this province, including mass vaccination of the animal population, post-vaccination monitoring, diagnostic testing of suspected rabid dogs, dog bite investigation, animal management, pre-exposure treatment, post-exposure treatment (PET), and awareness programs. This study aimed to estimate the cost of rabies control measures for animals and humans in Long An province in 2022. Materials and Methods: An economic model was developed to estimate the costs of rabies control under two scenarios, with and without external financial support from the private sector. Inputs for the model included data from published literature, publicly available reports on rabies, government data, expert opinions, and a pilot study conducted in Vietnam. Results: The total annual costs of rabies control, with or without external support, were estimated to be VND 62.62 and 62.77 billion (equivalent to USD 2.67 and 2.68 million), respectively. The highest proportion of costs was related to PET in humans (84.50% and 84.30%), followed by the cost of mass vaccination paid by animal owners (14.28% and 13.90%). Most of the expenses were paid by the private sector (98.87% and 98.98%) rather than the public sector (1.14% and 1.20%). Conclusion: This study described a transparent and reproducible method for estimating the economic costs of rabies control at the provincial level. The economic model developed showed that control of rabies by mass vaccination is more cost-effective than using PET to prevent human death. The model can be applied to future economic analyses of rabies control in other provinces of Vietnam and other rabies-endemic countries. Keywords: animals, control measures, deterministic economic model, humans, rabies.

Contribution of artificial intelligence for understanding animal rabies epidemiology in Morocco: What are the perspectives of an innovative and predictive approaches?

Rabies is a major zoonotic disease legally notifiable in Morocco and elsewhere. Given the burden of rabies and its impact on public health, several national control programs have been implemented since 1986, without achieving their expected objectives.The aim of this study was to design a predictive analysis of rabies in Morocco. The expected outcome was the construction of probabilistic diagrams that can guide actions for the integrated control of this disease, involving all stakeholders, in the country. Such modeling is an essential step in operational epidemiology to optimize expenditure of public funds allocated to the integrated strategy for fighting this disease.The methodology employed combined the use of geospatial analysis tools (kriging) and artificial intelligence models (Machine Learning). In order to investigate the link between the risk of rabies within a territorial municipality (commune) and its socio-economic situation, the following data were analyzed: (1) health data: reported animal cases of rabies between 2004 and 2021 and data obtained through the ArcGIS kriging tool (Geospatial data); (2) demographic and socio-economic data. We compared several Machine Learning models. Of these, the “Imbalanced-Xgboost” model associated with kriging yielded the best results. After optimizing this model, we mapped our results for better visualization.The obtained results complement and consolidate previous study in this field with greater accuracy, showing a strong correlation between a commune's socio-economic status, its geographical location and its risk level of rabies. From this, 399 out of the 1546 communes have been identified as high-risk areas, accounting for 25.8% of the total number of communes. Under this risk-based approach, the results of these analyses make it practical to take targeted decisions for rabies prevention and control, as well as canine population control, in a territorial commune according to its risk level. Such an approach allows obvious optimized distribution of financial resources and adaptation of the control actions to be taken.The study highlights also the importance of using innovative technologies to refine epidemiological approaches and fill gaps in field data. Through this study, we hope to contribute to eradication of rabies in Morocco by providing reliable data and practical recommendations for control actions against rabies.

Assessment of the burden of rabies in one health approach control program in Ketapang District Indonesia: Using zDALY

BackgroundKetapang District, located in West Kalimantan, is a region where rabies is endemic. The first human death from rabies was reported in 2014 and the problem persists to this day. In response, the government has implemented the one health approach to control rabies since 2017. This study aimed to assess the disease burden of rabies control using zDALY metrics. MethodsThe zoonotic burden for human and animal was measured by developing Zoonotic Disability-Adjusted Life Years (zDALY), which combines DALY and local values of animals and their products, considering animal morbidity and mortality due to the disease (Animal Loss Equivalent/ALE). Data were gathered through interviews with victims or their families, dog owners, and secondary data from the Animal Husbandry Service, and the District Health Office. ResultsBefore implementing the one health approach, the zDALY value was 1,561.22 person-years (the zDALY rate: 109.53 years/100,000 people). After the intervention, the zDALY value was 1,808.86 person-years (the zDALY rate: 86.62 years/100,000 people). ConclusionsThis reduction in the zDaly rate indicates that rabies control through the one health approach in Ketapang District was effective in alleviating the disease burden caused by rabies.

IJCM_413A: A cross sectional study to find out status of post exposure prophylaxis among animal bite cases in Raipur city Chhattisgarh.

Background: Rabies is a viral zoonosis that occurs in more than 100 countries and territories Although a number of carnivores and bat species serve as natural reservoirs, rabies in dogs is the source of 99% human infections and poses a potential threat to more than 3.3 billion people. In humans, rabies is highly fatal once clinical symptoms have developed. According to the World Health Organization, human rabies can be prevented completely by proper post exposure prophylaxis. In India alone, 20,000 deaths (i.e., about 2/100,000 population at risk) and 2 million bites, mostly by dogs, are estimated to occur annually. India has 36% global and 65% Asian rabies burden in terms of cases. Local treatment of wounds is of maximal value when applied immediately after exposure (within minutes if possible). Animal experiments have shown that local wound treatment can reduce the chances of developing rabies by up to 80%. Objectives: To find out the status of post exposure prophylaxis and associated factors among animal bite cases in Raipur city Chhattisgarh. Methodology: Type of study: A community based cross sectional survey Conducted at: Raipur District. Duration of study: Over a period of 3 months (November 2023- January 2024). Study Subjects: General Population. Inclusion criteria: General population, Raipur. Exclusion Criteria: 1) Patients who do not give consent. 2)Unconscious Very ill patients or patients with Mental illness. Results: Total of 1124 participants 41 had animal bite, 63.41% were males and 36.59% were females. Among the biting animals 83% were dogs, while cats were 15% and 2% were monkeys. Out of 41 cases 90.24% had Category II bite while 9.75% had Category III bite. 33 out of 41 i.e. 80.48% victims took Anti Rabies vaccine, while rest 19.52% preferred treatment from traditional healer. Conclusion: Majority of animal bite were of dog bite and were classified under Category II. Improved awareness, forestalling animal rabies, and better access to affordable and potent human rabies vaccines are essential for the elimination of human rabies.

Rabies incidence and burden in three cities of Cameroon (2004–2013)

Rabies is a fatal disease occurring worldwide and especially in almost all the countries in Asia and Africa including Cameroon. Though animal and human rabies is prevalent in Cameroon, the epidemiology and socio-economic burden of the disease in the country is not known. Therefore, a 10-year (October 2004–April 2013) retrospective study on the incidence of animal and human rabies and its burden in Garoua, Ngaoundéré and Yaoundé in Cameroon was carried out. Records of human cases were extracted from the database of the regional hospitals, and animal cases from the databases of Centre Pasteur and National Veterinary Laboratory. The burden of the disease was assessed through the estimation of costs linked to preventive measures (vaccination), corrective procedures (Post Exposure Treatment), Disability-Adjusted Life Year (DALY) and overall societal cost of the disease. Overall, 56 rabies-suspected human deaths, corresponding to an incidence of 0.02 ± 0.00 ‱ and Animal Rabies Incidence (ARI) of 0.37 ± 0.00 % among 1844 suspected animal cases were recorded. The economic loss due to preventive measures of 326,046 ± 28,130.85 USD, related to corrective procedures of 806,741.25 ± 2,466.08 USD, and DALY of 1690.28 ± 4.76 years were estimated. This is the first study that highlights the enormous socio-economic burden associated with animal and human rabies in endemic parts of Cameroon and emphasizes on enhancing rabies eradication strategy focusing on the One Health approach.

Multiple animal bite injuries in a child: a case report

Animal bites are a leading cause of injury among children, of which dog bites contribute significantly to the burden of Rabies in the world. This was a case report of a 7-year-old migrant girl child who was admitted to the casualty as a victim of multiple stray dog bite injuries. The child presented with multiple and extensive lesions all over the body. Trauma related to animal bites cause not just physical pain and suffering but also emotional stress and carries the risk of Rabies which is a highly fatal disease. Prompt management of the case with post exposure prophylaxis against Rabies needs to be done immediately, along with wound management to ensure good treatment results and patient outcome. This report presents the case of a child who sustained multiple stray dog bite injuries all over the body. Patient was followed up for one month, showed good wound healing and recovery.

Epidemiology of suspected rabies cases in Ethiopia: 2018–2022

Rabies is a zoonotic disease affecting both public health and the livestock industry in Ethiopia. However, there is limited national-level information on the extent of the disease. Therefore, we studied the national burden and distribution of Rabies on both humans and animals. We conducted a retrospective descriptive study on rabies by obtaining five years (2018–2022) data from the Ethiopian Public Health Institute (EPHI) and the Ministry of Agriculture. We analyzed the incidence, mortalities, temporal and spatial patterns. Microsoft Excel and ArcGIS version 10.2 were used for descriptive and spatial analysis respectively. A total of 37,989 Rabies suspected human exposure cases and 297 deaths were reported with a mean annual number of 7,598 human exposure cases and 59 deaths. The exposure case and mortality incidence rates were 6 and 0.05 per 100,000 populations respectively. Suspected human exposure cases significantly increased from 5,217 (2018) to 11,298 (2022) at a rate of 2.2. In the same period, 2,094 animal suspected rabies cases and 1,682 deaths were reported predominantly in dogs (71.2%), followed by cattle (27.8%) and other domestic animals (1%). There is high rabies suspected human exposure cases at national level. Suspected rabid dogs were the major source of infection in humans. There were gaps in the reporting of animal cases and low dog vaccination coverage. Hence, it is important to strengthen One Health collaboration to enhance surveillance, information sharing, and diagnostic capacity and improve mass dog vaccination coverage.

Consequences of geographical accessibility to post-exposure treatment for rabies and snakebite in Africa: a mini review.

Rabies and snakebite envenoming are two zoonotic neglected tropical diseases (NTDs) transmitted to humans by animal bites, causing each year around 179,000 deaths and are most prevalent in Asia and Africa. Improving geographical accessibility to treatment is crucial in reducing the time from bite to treatment. This mini review aims to identify and synthesize recent studies on the consequences of distance and travel time on the victims of these diseases in African countries, in order to discuss potential joint approaches for health system strengthening targeting both diseases. A literature review was conducted separately for each disease using Pubmed, Google Scholar, and snowball searching. Eligible studies, published between 2017 and 2022, had to discuss any aspect linked to geographical accessibility to treatments for either disease in Africa. Twenty-two articles (8 on snakebite and 14 on rabies) were eligible for data extraction. No study targeted both diseases. Identified consequences of low accessibility to treatment were classified into 6 categories: (1) Delay to treatment; (2) Outcome; (3) Financial impacts; (4) Under-reporting; (5) Compliance to treatment, and (6) Visits to traditional healers. Geographical access to treatment significantly influences the burden of rabies and snakebite in Africa. In line with WHO's call for integrating approaches among NTDs, there are opportunities to model disease hotspots, assess population coverage, and optimize geographic access to care for both diseases, possibly jointly. This could enhance the management of these NTDs and contribute to achieving the global snakebite and rabies roadmaps by 2030.

Incorporating environmental heterogeneity and observation effort to predict host distribution and viral spillover from a bat reservoir.

Predicting the spatial occurrence of wildlife is a major challenge for ecology and management. In Latin America, limited knowledge of the number and locations of vampire bat roosts precludes informed allocation of measures intended to prevent rabies spillover to humans and livestock. We inferred the spatial distribution of vampire bat roosts while accounting for observation effort and environmental effects by fitting a log Gaussian Cox process model to the locations of 563 roosts in three regions of Peru. Our model explained 45% of the variance in the observed roost distribution and identified environmental drivers of roost establishment. When correcting for uneven observation effort, our model estimated a total of 2340 roosts, indicating that undetected roosts (76%) exceed known roosts (24%) by threefold. Predicted hotspots of undetected roosts in rabies-free areas revealed high-risk areas for future viral incursions. Using the predicted roost distribution to inform a spatial model of rabies spillover to livestock identified areas with disproportionate underreporting and indicated a higher rabies burden than previously recognized. We provide a transferrable approach to infer the distribution of a mostly unobserved bat reservoir that can inform strategies to prevent the re-emergence of an important zoonosis.

Measuring the impact of an integrated bite case management program on the detection of canine rabies cases in Vietnam.

Dog-mediated rabies is enzootic in Vietnam, resulting in at least 70 reported human deaths and 500,000 human rabies exposures annually. In 2016, an integrated bite cases management (IBCM) based surveillance program was developed to improve knowledge of the dog-mediated rabies burden in Phu Tho Province of Vietnam. The Vietnam Animal Rabies Surveillance Program (VARSP) was established in four stages: (1) Laboratory development, (2) Training of community One Health workers, (3) Paper-based-reporting (VARSP 1.0), and (4) Electronic case reporting (VARSP 2.0). Investigation and diagnostic data collected from March 2016 to December 2019 were compared with historical records of animal rabies cases dating back to January 2012. A risk analysis was conducted to evaluate the probability of a rabies exposure resulting in death after a dog bite, based on data collected over the course of an IBCM investigation. Prior to the implementation of VARSP, between 2012 and 2015, there was an average of one rabies investigation per year, resulting in two confirmed and two probable animal rabies cases. During the 46 months that VARSP was operational (2016 - 2019), 1048 animal investigations were conducted, which identified 79 (8%) laboratory-confirmed rabies cases and 233 (22%) clinically-confirmed(probable) cases. VARSP produced a 78-fold increase in annual animal rabies case detection (one cases detected per year pre-VARSP vs 78 cases per year under VARSP). The risk of succumbing to rabies for bite victims of apparently healthy dogs available for home quarantine, was three deaths for every 10,000 untreated exposures. A pilot IBCM model used in Phu Tho Province showed promising results for improving rabies surveillance, with a 26-fold increase in annual case detection after implementation of a One Health model. The risk for a person bitten by an apparently healthy dog to develop rabies in the absence of rabies PEP was very low, which supports the WHO recommendations to delay PEP for this category of bite victims, when trained animal assessors are available and routinely communicate with the medical sector. Recent adoption of an electronic IBCM system is likely to expedite adoption of VARSP 2.0 to other Provinces and improve accuracy of field decisions and data collection.

India’s sustaining challenges to combat rabies elimination: a comprehensive review

Rabies is one of the fatal zoonotic diseases wreaking havoc on humanity since antiquity. India continues to suffer the greatest rabies burden of any country, both in terms of annual human deaths and disability-adjusted life years. While modern rabies management emphasizes the importance of achieving zoonotic disease control and prevention through a One Health approach, the disease remains challenging as its persistence is invariably multifaceted. Therefore, it is imperative to examine the enduring reasons for the increasing incidence of rabies in India. Between 2012- 2022, a systematic search of scientific publications, popular search engines like Google, as well as in the grey literature regarding rabies was carried out. Since rabies elimination boils down to addressing the reasons, it is first seen related to the large and unvaccinated stray dog population, where 97% of cases are by dog bites. A second finding is that many bite victims resorted to indigenous treatment practices due to insufficient awareness and knowledge about the disease. Incomplete treatment practices also led to some deaths, especially because rabies vaccines are not affordable or accessible to poverty-stricken populations. Rarely, vaccine failures were caused by a lack of vaccine potency, a wound type, or ineffective administration methods. Even with all these data incorporated, there was no information on prevalence/incidence estimates of dog bites in recent years through national data. Therefore, without intensified surveillance, sustained political commitment, enormous mobilization of resources, and rabies education, the epidemic waves of this fatal disease will continue in India.

Rabies post-exposure prophylaxis delivery to ensure treatment efficacy and increase compliance

ObjectivesSince rabies is lethal once symptoms appear, its prevention including community awareness, mass dog vaccination and post-exposure prophylaxis (PEP) is crucial. Although safe and potent rabies vaccines have long been available, the global rabies burden is still high and access to adequately-delivered PEP remains challenging. Here we offer healthcare providers up-to-date, simple, exhaustive, visual guidance on how to perform PEP steps correctly. ProtocolPEP consists of 1) washing the wound with water and soap for 15 min, 2) assessing the need for rabies biologicals based on specific criteria; 3) administering, if required, rabies immunoglobulin or monoclonal antibodies deep in and around all wounds; 4) starting, if necessary, the WHO-recommended intradermal 1-week vaccination regimen; 5) informing patients adequately throughout the PEP process to increase compliance and avoid dangerous misconceptions about animal bite treatment and rabies risk. DiscussionThe intradermal 1-week vaccination regimen recommended by WHO is as safe as other regimens but carries important cost-, dose- and time-sparing benefits. As fundamental as the correct administration of rabies biologicals is clear doctor-patient communication and sharing of up-to-date knowledge among healthcare professionals. ConclusionsThis resource will help ensuring that no life is lost to rabies, an incurable yet preventable disease.

Global burden, trends, and predictions of rabies: an analysis from the Global Burden of Disease Study 1990–2019 and projections for 2030

Global burden, trends, and predictions of rabies: an analysis from the Global Burden of Disease Study 1990–2019 and projections for 2030

Evaluation of country infrastructure as an indirect measure of dog-mediated human rabies deaths.

Rabies is a neglected disease, primarily due to poor detection stemming from limited surveillance and diagnostic capabilities in most countries. As a result, there is limited ability to monitor and evaluate country, regional, and global progress towards the WHO goal of eliminating human rabies deaths by 2030. There is a need for a low-cost, readily reproducible method of estimating rabies burden and elimination capacity in endemic countries. Publicly available economic, environmental, political, social, public health, and One Health indicators were evaluated to identify variables with strong correlation to country-level rabies burden estimates. A novel index was developed to estimate infrastructural rabies elimination capacity and annual case-burden for dog-mediated rabies virus variant (DMRVV) endemic countries. Five country-level indicators with superior explanatory value represent the novel "STOP-R index:" (1) literacy rate, (2) infant mortality rate, (3) electricity access, (4) political stability, and (5) presence/severity of natural hazards. Based on the STOP-R index, 40,111 (95% CI 25,854-74,344) global human rabies deaths are estimated to occur in 2022 among DMRVV-endemic countries and are projected to decrease to 32,349 (95% CI 21,110-57,019) in 2030. The STOP-R index offers a unique means of addressing the data gap and monitoring progress towards eliminating dog-mediated human rabies deaths. Results presented here suggest that factors external to rabies programs influence the successes of rabies elimination, and it is now possible to identify countries exceeding or lagging in expected rabies control and elimination progress based on country infrastructure.

Modelling modifiable factors associated with the probability of human rabies deaths among self-reported victims of dog bites in Abuja, Nigeria.

Canine-mediated rabies kills tens of thousands of people annually in lesser-developed communities of Asia, Africa, and the Americas, primarily through bites from infected dogs. Multiple rabies outbreaks have been associated with human deaths in Nigeria. However, the lack of quality data on human rabies hinders advocacy and resource allocation for effective prevention and control. We obtained 20 years of dog bite surveillance data across 19 major hospitals in Abuja, incorporating modifiable and environmental covariates. To overcome the challenge of missing information, we used a Bayesian approach with expert-solicited prior information to jointly model missing covariate data and the additive effects of the covariates on the predicted probability of human death after rabies virus exposure. Only 1155 cases of dog bites were recorded throughout the study period, out of which 4.2% (N = 49) died of rabies. The odds for risk of human death were predicted to decrease among individuals who were bitten by owned dogs compared to those bitten by free-roaming dogs. Similarly, there was a predicted decrease in the probability of human death among victims bitten by vaccinated dogs compared to those bitten by unvaccinated dogs. The odds for the risk of human death after bitten individuals received rabies prophylaxis were predicted to decrease compared to no prophylaxis. We demonstrate the practical application of a regularised Bayesian approach to model sparse dog bite surveillance data to uncover risk factors for human rabies, with broader applications in other endemic rabies settings with similar profiles. The low reporting observed in this study underscores the need for community engagement and investment in surveillance to increase data availability. Better data on bite cases will help to estimate the burden of rabies in Nigeria and would be important to plan effective prevention and control of this disease.

Using Integrated Bite Case Management to estimate the burden of rabies and evaluate surveillance in Oriental Mindoro, Philippines.

Despite national elimination efforts, dog-mediated rabies remains endemic in the Philippines. Free provision of post-exposure prophylaxis (PEP) through the widespread establishment of Animal Bite Treatment Centers (ABTCs) has improved accessibility; however, the resulting upsurge in PEP demand is not sustainable, and human rabies deaths continue. Dog vaccination coverage also remains inadequate, and it is unclear whether surveillance is effective. Here, we used Integrated Bite Case Management (IBCM) to collect enhanced rabies surveillance data in Oriental Mindoro Province over a 3-year period (2020-2022). Adapting a probabilistic decision tree model, we estimated the burden of rabies, evaluated surveillance performance, and analyzed the costs and benefits of current rabies prevention and control practices in the province. The incidence of bite patients receiving PEP was high in Oriental Mindoro Province (1,246/100,000 persons/year), though < 3% of presenting patients were deemed high-risk for rabies exposure (24/100,000 persons/year). Using a decision tree model, we estimated that around 73.8% of probable rabies-exposed patients sought PEP (95% Prediction Interval, PrI: 59.4%-81.1%) and that routine surveillance confirmed < 2% of circulating animal rabies cases, whereas IBCM resulted in a nearly fourfold increase in case detection. Furthermore, we estimated that an average of 560 (95% PrI 217-1,090) dogs may develop rabies annually in the province, equating to 3-5 cases per 1,000 dogs per year. On average, 20 to 43 human deaths were averted by PEP each year in Oriental Mindoro at an annual cost of $582,110 USD (i.e., $51.44 USD per person) or $20,190 USD (95% PrI $11,565-79,400) per death averted. While current practices for PEP provisioning in the Philippines have improved access, a large proportion of people exposed to rabies (> 26%, 95% PrI 18.8%-40.1%) are still not seeking healthcare. Integrating an intersectoral surveillance system, such as IBCM, into national policy could greatly improve case detection if well implemented, with further benefits extending to guidance for PEP administration, potentially reducing unnecessary expenditure on PEP, and situational awareness to inform control of rabies through mass dog vaccination.

Global burden of rabies in 204 countries and territories, from 1990 to 2019: results from the Global Burden of Disease Study 2019

ObjectivesRabies is an acute lethal infectious disease caused by a lyssavirus infection. In 2018, the World Health Organization proposed a global strategic plan to end human rabies deaths by 2030. However, systematic studies on the global rabies disease burden and epidemiological trends are scarce. MethodsWe extracted the disease burden and epidemiological data of rabies worldwide in the preceding 30 years from the Global Burden of Disease Study 2019 and performed a comprehensive analysis. ResultsIn 2019, the incident cases of rabies worldwide were 14,075.51 (95% uncertainty interval: 6124.33-21,618.11), and the number of deaths was 13,743.44 (95% uncertainty interval: 6019.13-17,938.53), both of which were lower than that in 1990. With the improvement of the sociodemographic index, the incident cases, the number of deaths, age-standardized incidence rate, age-standardized incidence death rate, and disability-adjusted life years of rabies all showed downward trends. Adolescents and adults aged <50 years represented the majority of rabies cases worldwide. ConclusionThe global disease burden of rabies has declined over the past 30 years. Furthermore, the disease burden of rabies was closely related to the sociodemographic index level.

Knowledge, attitude and practice related to rabies among residents of Amhara region, Ethiopia

BackgroundRabies is an important viral zoonotic disease with high fatality rate and economic losses. The impact of rabies is considerably high in Asia and Africa. The study was designed to assess the community’s rabies knowledge, attitude and practice (KAP) and their determinants in Amhara region, Ethiopia. MethodsThe study was done based on a questionnaire survey of 899 participants in towns and rural districts of Amhara region. Multistage cluster sampling procedure was used to select participants. Quantitative score was generated for KAP and the scores were dichotomized as adequate and inadequate knowledge, desirable and undesirable attitude, and good and poor practice. Descriptive statics and mixed effect logistic regression considering kebele and villages as a random effect was used to see the association of predictor variables towards adequate knowledge, desirable attitude and good practice. ResultsAbout 61%, 72% and 45% of the respondents have adequate knowledge, desirable attitude and good practice scores, respectively. Almost all (99%) of the respondents rightly claimed that rabies is transmitted through bite of dogs. Majority of the participants (76.8%) strongly agree that rabies is an important zoonotic disease that can threaten the lives of humans and animals. Only 8% of the respondents had a practice of washing and rinsing dog bite wounds for the prevention of rabies. Female participants were less likely to have adequate knowledge than males (OR = 0.58, 95% CI = 0.35–0.96). Respondents in urban areas were more likely to have desirable attitude than rural residents (OR = 12.4, CI = 1.38–11.67). ConclusionThe study showed that participants have good knowledge and attitude towards rabies but poor rabies prevention and control practices. The community public health education should focus on translation of these good knowledge and favorable attitude into practices that effectively reduces rabies burden.

General insights on obstacles to dog vaccination in Chad on community and institutional level.

Domestic dogs are responsible for 95% of all human rabies cases worldwide and continue to be the main reservoir for this fatal virus in African and Asian countries. Interrupting the spread of the disease in the domestic dog population is therefore necessary for long-term, sustainable rabies control. Chad has been recognized as a rabies-endemic country since 1961, but no national control strategy is in place to date and dog vaccination coverage is very low. This qualitative, descriptive study aims to describe the main barriers to dog vaccination on both the community and the institutional level from a socio-anthropological point of view in Chad. The study was embedded in an overall project conducted from 2016 to 2018, to determine rabies burden and vaccine demand in West and Central Africa, funded by GAVI, the vaccine alliance. Data collection was conducted on the occasion of the project's closing workshops with stakeholders organized between August to September 2018 in the four (4) project areas: Logone Occidental, Ouaddaï, Hadjer Lamis and Chari Baguirmi. We conducted interviews and focus group discussions (FGD) among veterinary officers and dog owners. Participants were selected purposively based on their place of residence (dog owners) or work place (veterinary officers) and their previous contact with the project through reporting (dog owner) or management (veterinary officers) of a suspect dog rabies case. In each region, one FGD was organized with dog owners, and one FGD with heads of veterinary posts. At the end of the FGDs, a few participants were randomly selected for interviews. In addition, in each region an interview was conducted with the head of the livestock sector, the chief district medical officers and the head of a civil society association. The identified barriers to dog vaccination access are grouped into three main aspects: the economic, the socio-cultural and the institutional level. Economic constraints encountered relate to the cost of the vaccine itself and the expenses for transporting the dogs to the vaccination site. The cultural belief that the vaccine will have an impact on the therapeutic properties of dog meat for consumers (observed in Southern Chad), and the fact that dogs are considered impure animals in Muslim faith, which prohibits handling of dogs, are obstacles identified on the sociocultural level. At the institutional level, the unavailability of vaccines in veterinary services, the lack of communication about the law on dog vaccination, the absence of rabies in the training curricula of veterinary agents, and the lack of intersectoral collaboration limit vaccination coverage. In order to improve vaccination coverage and rabies surveillance with a view to eradicate rabies by 2030, communication strategies that are adapted to the context and that take cultural obstacles into account must be put in place in a synergy of interdisciplinary action. In addition, factors such as affordability, geographical access and availability of dog rabies vaccines needs to be addressed throughout the country. Although our study design did not allow a detailed analysis of obstacles related to socio-economic level, gender and age the broad insights gained can provide general guidance for future interventions in Chad and similar countries.