Burden Of Rabies Research Articles

Controlling rabies epidemics in Nepal with limited resources: optimal control theory approach

In many developing countries, including Nepal, rabies epidemics constitute a serious public health concern, partly because of limited resources for proper implementation of control measures. In this study, we develop an extended model by incorporating various controls into the transmission dynamics model with both dog and jackal vectors. We apply the optimal control theory on the developed model system to identify optimal control strategy for mitigating rabies burden in Nepal with limited resources. Among the potential control strategies, human vaccination, dog vaccination, dog culling, dog sterilization, and jackal vaccination, considered in this study, our results show that a combination of dog vaccination and dog culling is the most effective strategy to control rabies in Nepal. Our optimal control solutions provide the strategy for optimal implementation of these controls to suppress rabies prevalence among dogs and jackals of Nepal using a minimum cost associated with controls. We found that given limited resources, implementing controls in a time-dependent manner with a higher level at the beginning of the outbreaks and reducing them during later part of the epidemics can provide maximum benefits.

Patterns and distribution of human exposed to rabies in Yemen, 2011–2018

Background: Rabies is a hidden health threat in developing countries. It has the highest case–fatality rate close to100%. In Yemen, Despite National Rabies Control Program (NRCP) has established since 1989, the true burden of human rabies in Yemen still not clear. The aims of this study were to describe the patterns and distribution of human exposed cases to rabies and to make necessary recommendations for improvement. Methods and materials: Soft and hard copies of the cumulative data from NRCP were obtained from 26 control units distributed in 15 governorates from January 2011 to December 2018. WHO case definition for human exposure to rabies was used .Data were analyzed using Microsoft Excel and Epi-info 7.2. Results: During eight years 2011–2018, a total of 89,590 possible exposure cases that bitten by a suspected rabid animal were reported, of them (29%) 25,574 exposed to positively confirmed rabid animal and have Post Exposure Prophylaxis (PEP), from those possible exposure cases (0.4%) 347 have human rabies and died. (68%) of exposed cases were males and (40%) were among age group of (4–15 years). More than (52%) of exposed cases were from three rural governorates Ibb, Dhamar, and Al–Hudaydah (32%, 12%, 8%) respectively. The overall incidence of person that exposed to rabies and have post exposure prophylaxis PEP was 17 per 100, 000, and the overall incidence of deaths 2 per 1000, 000. The highest incidence of exposed cases that have PEP was in 2014 with 16 per 100.000. The overall mean value of vaccines and immunoglobulins were (14425, 3481) respectively. The lowest quantity of vaccines was in 2016 with 3788 doses, and the lowest quantity of immunoglobulins was zero vials in 2017. Conclusion: Rabies is still a neglected public health problem in Yemen. Strengthening rabies surveillance to ensure proper reporting and secure availability and affordability of vaccines and immunoglobulins are crucial. Increasing community awareness on rabies at high risk areas and integrated effort of health and agriculture sector to control rabies among animals are recommended.

Economic burden of rabies and its impact in Bangladesh through a One Health approach

Economic burden of rabies and its impact in Bangladesh through a One Health approach

Policy Perspectives of Dog-Mediated Rabies Control in Resource-Limited Countries: The Ethiopian Situation.

One Health disease-control programs are believed to be most effective when implemented within the population transmitting the disease. The World Health Organization (WHO) and partners have targeted the elimination of dog-mediated human rabies by 2030 primarily through mass dog vaccination. Mass vaccination, however, has been constrained by financial resource limitations. The current owner-charged dog vaccination strategy, used in most resource-limited countries like Ethiopia, has not reached the minimum coverage required to build population immunity. Dog vaccination is non-existing in most rural areas of Ethiopia, and coverage is <20% in urban areas. Although the health and economic benefits of rabies elimination outweigh the costs, the direct beneficiaries (public in general) and those who bear the costs (dog owners) are not necessarily the same. In this perspective paper, we aggregate evidence on the socioeconomic burden of rabies in Ethiopia as well as the implications for potential opportunities to control the disease and possibilities to obtain the required funding sources for evidence-based interventions in the control of rabies in Ethiopia.

Assessment of the current rabies situation and its management in epidemic areas of southern Ethiopia

Rabies infection is almost always a 100% lethal viral disease in all mammals, including humans. Although more than 60,000 people worldwide are preventable, 2,700 people in Ethiopia die of fatal human rabies annually. The aim of this study was to generate strategic information on the extent of the burden of rabies and major response strategies in place, only to overcome and bring attention to the management of rabies outbreaks. The cross - sectional case - based study design was used to discuss the disease areas of the Southern Nations, Nationalities, and Peoples ' Regional States of Ethiopia. Data analysis revealed a total of 16 fatal human rabies and 287 suspected rabies exposures. The highest attack rate of 116.3 cases per 100,000 human subjects was reported in Tembaro woreda. As a result, 48 animal deaths of rabies have been reported, while cattle (28) have been more affected than other animal species. The lack of dog immunization, lack of community awareness of dog management, and inaccessibility and inefficiency of anti - rabies vaccines were major risk factors associated with the spread of rabies exposure between humans and animals. In conclusion, this study has clearly shown that both the existence and the high magnitude of fatal human and animal rabies are significant in the area. Multidisciplinary approach interventions to increase community awareness of dog vaccination, effective and immediate treatment of exposed individuals is recommended as a method of disease control and prevention

RABIES IMMUNOGLOBULIN: Brief history and recent experiences in Côte d'Ivoire

BackgroundRabies is a fatal viral zoonosis mainly transmitted via dog bites. The estimated 59′000 annual deaths caused by the disease are preventable through correct and timely administration of post-exposure prophylaxis (PEP). PEP should be initiated as soon as possible after an exposure to a rabies suspected animal and consists of a course of active vaccinations and administration of rabies immunoglobulin (RIG) in case of severe exposure. However, RIG is not accessible in most rabies endemic countries and its impact on survival in combination with modern vaccines and its cost-effectiveness is unclear. We examined the effect of equine RIG (eRIG) in a field-trial in Côte d'Ivoire, a developing country with low but chronic rabies burden and persistent lack of RIG, similar to a majority of rabies endemic countries attempting elimination of the disease. MethodsData from 3367 patients attending anti-rabies centers (Centres Anti-Rabiques, CARs) of the National Institute for Public Hygiene (Institut National d'Hygiène Publique, INHP) in the departments of Bouaké and San Pédro in Côte d'Ivoire was prospectively collected between April 2016 and March 2018. We identified 1594 patients at risk of rabies infection as eligible for RIG administration. Depending on local availability of eRIG and vaccination protocol applied, PEP consisted of active immunization only (non-eRIG group, n = 1145) or active and passive immunization (eRIG group, n = 449). Patients were followed-up by phone interviews at least 15 months after their exposure to assess for rabies suspected deaths. ResultsFollow-up data was available for 641 patients in the non-eRIG group (56%) and 242 in the eRIG group (54%). Three suspected or possible rabies deaths occurred in each of the two groups, corresponding to a possible rabies mortality of 1.2% (95% CI 0.3–3.6%) in the eRIG group and 0.5% (95% CI 0.1–1.4%) in the non-eRIG group. The difference in proportions was small and not statistically significant (0.7%, p = 0.21). Deaths in both groups were associated with treatment delay after exposure and non-compliance to PEP protocol. No death occurred after correct and timely active immunization independent of eRIG administration. ConclusionThe provision of eRIG did not lead to a measurable reduction of rabies burden in our study population. This underlines that improved access to active vaccines will be effective in reducing rabies deaths even if access to eRIG remains difficult in developing countries. A possible benefit of eRIG administration for severely exposed patients cannot be excluded based on these results.

Burden of rabies in Mali

Rabies is the most dreaded neglected zoonosis worldwide. It affects mostly developing countries with limited access to post-exposure prophylaxis and a low coverage of dog vaccination. ObjectiveThis study estimates the burden of human rabies in Mali from the extrapolation of animal bite surveillance, mostly dogs, in the region of Sikasso and the District of Bamako in 2016 and 2017. Material and methodsMonte Carlo simulations of a series of interconnected probabilities were used to estimate the burden of rabies. The data was collected from cross-sectional surveys of 8775 households of which 4172 were in the District of Bamako and 4603 in the region of Sikasso. Further data was collected in health centres and from the respective veterinary services. ResultsWe estimate that in the year 2016 133 [95% Confidence Interval (95%CI) 87-186] people died and that 5’366 [95%CI 3’510-7’504] years of life (YLL) were lost and in 2017 et 136 [95%CI 96-181] people died and that 5530 [IC 95% 3’913-7’377] YLLs were lost. The loss of income was estimated at 3.2 million USD [95%CI 2,1-4,5] en 2016, and 3,3 million USD [95%CI 2,3-4,4] in 2017. This represents the highest financial loss from rabies, followed by the cost of postexposure prophylaxis (PEP) of 86’848 $USD and 89’371 $ USD respectively. From the whole cost of rabies in Mali, 92% of the cost in 2016 and 94% of those in 2017 were attributable to premature mortality and the cost of help seeking. The proportion of cost of PEP was 3% in 2016 and 2017 of the total cost of disease. The cost related to dog vaccination changed from 3% to 1% in the same time period. ConclusionThis study shows that despite the possibility of preventing human rabies by PEP, its burden remains important in Malian communities. Rabies control by mass vaccination of dogs is hardly done and access to PEP is difficult. However, Rabies elimination by mass vaccination of dogs has been demonstrated to be feasible. Hence a coordinated regional effort between countries by funding dog mass vaccination and full access to PEP can eliminate rabies in West Africa.

Rabies surveillance-response in Mali in the past 18 years and requirements for the future

ContextRabies is endemic in Mali, but little is known about the distribution of rabies and its surveillance across the country. Documenting the evolution of rabies and the problems related to surveillance is useful to facilitate elimination of human rabies by 2030. MethodData collected at the Central Veterinary Laboratory (LCV) from 1999 to 2017 and through the surveillance system functioning at household, health and veterinary structure levels, as established by the Global Vaccine Alliance funded project on the burden of rabies, between 2016 and 2017 in Bamako and the Sikasso region were used in this study. All data on animals examined for rabies by the direct fluorescence antibody test (DFA) during the specified time period were summarized, and the proportion of rabies positive tested among animals suspected of rabies was estimated. From the number of dogs tested positive for rabies, a cumulative incidence was estimated for the total canine population. The number of positive tested samples was divided by the product of the estimated canine population and number of years (18). In addition, the number of human rabies cases was analyzed to estimate a cumulative incidence. ResultsAmong all animal samples suspected for rabies, 93.2% [95% CI 90.6–95.3] were positive by the DFA test. From the 486 included animal samples, 94.7% [95% CI 92.3–96.5] were domestic dogs with 90.9% [95% CI 87.9–93.3] positive, which stands out as the main reservoir of rabies in Mali. Cats, cattle, sheep and donkeys also tested positive using the DFA test. The cumulative incidence of canine rabies was estimated at 0.371 [95% CI: 0.336–0.408] / 10′000 dogs. The highest incidence was observed in Bamako, the capital of Mali, with a cumulative incidence of 2.242 [95% CI: 2.001–2.504] / 10′000 dogs, followed by Koulikoro with 0.335 [95% CI: 0.258–0.429] / 10′000 dogs. For other areas far from LCV, the cumulative incidence was low, with zero in Kidal. Nationally reported cases of human rabies declined in recent years with an average of 12.6 [95% CI: 8.7–16.5] deaths per year. This result gives an annual incidence of 0.1047 [0.0742–0.1352] / 100′000 inhabitants. ConclusionOver the past 18 years, rabies is endemically stable in Mali despite the decrease in reported human cases. The disparity among regions in number of samples tested indicates a low level of clinical and laboratory surveillance and likely a high level of underreporting. Dogs play the main role in rabies transmission in Mali. Monitoring of and decisions for post-exposure prophylaxis (PEP) includes other animals (cats, cattle, and monkeys) involved in transmission. Mali should develop a national rabies strategy to include better communication between the public health and animal health sectors, strengthening of laboratory surveillance capacity, mass vaccination of dogs and guaranteed access to PEP.

Short communication on the use of a free rabies hotline service in Chad

As part of the activities of a project to estimate burden of rabies and vaccine demand in Chad, funded by the GAVI Alliance, we set up a free hotline service to guide the population and related public services in the event of an animal bite. This short communication presents the data collected on use of the hotline and describes the value of such a mobile phone service. Flyers, posters and radio advertisements distributed information on the hotline. Not every conversation was systematically registered, but we gathered information from 345 calls in total, including caller location and reason for the call as well as the advice and recommendation given. Although more calls were received from urban zones, the hotline was also accessed from rural locations. More than half of the calls came from the public followed by about 1/3 of calls from health workers and 10% of calls from veterinary workers. Background information on the animal bites mirror results from previous studies, especially the alarming lack of access to health and veterinary facilities in the country. Based on network provider information on incoming and outgoing calls, we estimate that on average 11 queries were handled per day. The hotline enabled the study team to give guidance to the public and to health and veterinary professionals and to monitor vaccine stock in the study areas of the project.

Seroconversion after three doses of intramuscular rabies vaccine as a post-exposure treatment

Rabies is still threatening half of the world’s population with the global burden of canine rabies being estimated as 59,000 human deaths, annually. With no cure existing for clinical rabies, post-exposure prophylaxis (PEP) is the only certain means to save lives of the exposed people. In Iran, bite incidences exceed 180,000 per year, where all victims receive 5 vaccine doses for PEP, conforming to the Essen regimen. More than two-thirds of the exposed individuals stop receiving treatments after day 7, for the reason of being exposed to a non-rabid dog or cat. According to the national standard protocols, these individuals should re-start a complete 5-dose PEP course upon the re-exposure. New WHO recommendations based on scientific data is encouraging revisions to the existing prophylaxis programs. In order to know if an incomplete Essen regimen can provide adequate immunity, in the present study, 5 groups of individuals who had only received 3 first doses of the Essen regimen within the previous 1, 3, 6, 12 and 24 months were examined for immunity against rabies. Our results indicated sufficient anti-rabies neutralizing antibody in all individuals, before and after receiving two standard booster doses (i.e. days 0 and 3). This might also suggest the adequacy of the 3 first doses of vaccination, as a one-week long post-exposure vaccination program.

Fighting Dog-Mediated Rabies in Namibia-Implementation of a Rabies Elimination Program in the Northern Communal Areas.

The major part of the global burden of dog-mediated rabies falls on Africa and Asia, where still an estimated 60,000 people die of the disease annually. Like in many African countries, dog-mediated rabies is a major public health concern in Namibia, costing the country an estimated 242 human deaths during the past two decades, in particular in the Northern Communal Areas (NCAs). Consequently, under the “One Health” concept, the Namibian government adopted a National Rabies Control Strategy in 2015, which strives to contribute to the global goal of ending dog-mediated human rabies deaths by 2030. A key component of this strategy was the implementation a dog rabies elimination program in the NCAs in 2016, being designed as a stepwise regional rollout strategy by building on experience gained in a pilot project area. The area of implementation covers approximately 263,376 km2 and 64 constituencies, with around 1.2 million inhabitants and estimated 93,000 dogs.

Reorienting rabies research and practice: Lessons from India

In this article, we reflect on the institutional and everyday realities of people-street dog relations in India to develop a case for decolonised approaches to rabies and other zoonoses. Dog-mediated rabies in Asia and Africa continues be a major concern in transnational public health agendas despite extensive research and knowledge on its prevention. In India, which carries 35% of the global rabies burden and has large street dog populations, One Health-oriented dog population management programmes have been central to the control of this zoonotic disease. Yet, rabies continues to be a significant problem in the country. In this article, we address this impasse in rabies research and practice through investigations of interactions between people, policy, and street dogs. Drawing primarily on field and archival research in Chennai city, we track how street dogs are perceived by people, explore how these animals have come into interface with (public) health concerns over time, and examine the biosocial conditions that frame people-dog conflict (and thereby rabies). These analyses create a picture of the multidimensional character of people-dog relations to offer new insights on why One Health-oriented rabies initiatives have not borne out their full promise. In effect, the article makes a case for a shift in public health orientations—away from intervening on these animals as vectors to be managed, and towards enabling multispecies habitats. This, we argue, requires the decolonisation of approaches to dog-mediated rabies, and expanded conceptions of ‘healthy more-than-human publics’. In conclusion, the article chalks out broader implications for public health approaches to zoonoses in a world marked by mutual risk and vulnerability that cuts across human and nonhuman animals.

Phylodynamics reveals extinction-recolonization dynamics underpin apparently endemic vampire bat rabies in Costa Rica.

Variation in disease incidence in wildlife is often assumed to reflect environmental or demographic changes acting on an endemic pathogen. However, apparent endemicity might instead arise from spatial processes that are challenging to identify from traditional data sources including time series and field studies. Here, we analysed longitudinal sequence data collected from rabies virus outbreaks over 14 years in Costa Rica, a Central American country that has recorded continuous vampire bat-transmitted rabies outbreaks in humans and livestock since 1985. We identified five phylogenetically distinct lineages which shared most recent common ancestors with viruses from North and South America. Bayesian phylogeographic reconstructions supported bidirectional viral dispersals involving countries to the north and south of Costa Rica at different time points. Within Costa Rica, viruses showed little contemporaneous spatial overlap and no lineage was detected across all years of surveillance. Statistical models suggested that lineage disappearances were more likely to be explained by viral extinctions than undetected viral circulation. Our results highlight the importance of international viral dispersal for shaping the burden of rabies in Costa Rica, suggest a Central American corridor of rabies virus invasions between continents, and show that apparent disease endemicity may arise through recurrent pathogen extinctions and reinvasions which can be readily detected in relatively small datasets by joining phylodynamic and modelling approaches.

Rabies knowledge and practices among human and veterinary health workers in Chad

To prevent human rabies deaths close communication between the veterinary and human health sector is needed for timely and adequate treatment after a bite exposure. Good practice treatment and efficient One Health communication depends heavily on the knowledge and practices (KP) of both human health and veterinary workers. We have evaluated the level of KP of both these sectors during a one-day joint training program to kick start a large scale rabies burden and vaccine demand study in selected regions of Chad. Participants were evaluated through a questionnaire before and after training to get insight into the basic knowledge of rabies and the improvement of this knowledge after the training session.In addition to 20 questions on rabies derived from the educational platform of the Global Alliance for Rabies Control, the questionnaires included a pre-training knowledge self-evaluation and a post-training evaluation of the course. Overall 247 workshop participants with varied level of educational background responded to at least one questionnaire. Around 75% of respondents were from the human health sector and 20% from the veterinary sector.Knowledge level did not differ significantly between the two sectors nor between rural or urban working backgrounds. Respondents with a university degree scored significantly higher in pre-and post-training questionnaire compared to respondents with high school level degree or lower. Knowledge was also dependent on study region and sex of the respondent. In general, the importance of a One Health approaches, such as vaccination of dogs to prevent human rabies, is well understood in both sectors. Regarding treatment, many participants did not know the adequate number of doses required for a full course of PEP, but through the training, this knowledge improved. Detailed knowledge of atypical transmission routes and pathophysiology (neurotropism of the virus) was generally lacking and did not significantly improve through the training.The study revealed considerable deficiencies and challenges in the knowledge level of both veterinary and human health workers in Chad. Rabies control programs need to anticipate these challenges to implementation and provide sufficient time and funds for training workshops and follow-up.

Estimation of the incidence of animal rabies in Punjab, India.

BackgroundRabies is a devastating zoonotic disease of mammals that causes encephalitis and death. It is endemic in India, with an estimated annual 20,000 human deaths (one-third of the global rabies burden). The magnitude of animal rabies incidence is unknown.MethodsIn four sub-districts of Punjab, India, we monitored canine and livestock populations from August 15, 2016 to August 14, 2017. Demographic, clinical and rabies diagnostic laboratory (RDL) data were collected from suspected cases of rabies. The annual incidence rate / 10,000 animal years at risk (95% CI) in each sub-district was estimated for each species.ResultsDuring 2016–2017, a total of 41 suspected rabies cases were detected in the four selected sub-districts in Punjab. Laboratory confirmed rabies (LCR) incidence was 2.03/10,000 dog years (0.69, 5.96) and 2.71/10,000 dog years (1.14, 6.43) in stray and pet dogs, respectively. The LCR incidence in farmed buffalo and cattle was 0.19/10,000 buffalo years (0.07, 0.57) and 0.23/10,000 cattle years (0.06, 0.88), respectively. The LCR incidence amongst equine was 4.28/10,000 equine years (0.48, 38.10). Stray cattle rabies incidence in the selected sub-districts was 9.49/10,000 cattle years (3.51, 25.67). If similar enhanced surveillance for rabies was conducted state-wide, we estimate that 98 (34–294) buffalo, 18 (2–156) equine, 56 (15–214) farmed cattle, 96 (35–259) stray cattle, 128 (54–303) pet dogs and 62 (21–182) stray dogs would be expected to be confirmed with rabies in Punjab annually.ConclusionThese results indicate that rabies incidence in animals, particularly in dogs and stray cattle, is much higher than previously suspected. We recommend that statewide enhanced disease surveillance should be conducted to obtain more accurate estimates of rabies incidence in Punjab to facilitate better control of this important disease.

Ecological and Epidemiological Findings Associated with Zoonotic Rabies Outbreaks and Control in Moshi, Tanzania, 2017-2018.

Approximately 1500 people die annually due to rabies in the United Republic of Tanzania. Moshi, in the Kilimanjaro Region, reported sporadic cases of human rabies between 2017 and 2018. In response and following a One Health approach, we implemented surveillance, monitoring, as well as a mass vaccinations of domestic pets concurrently in >150 villages, achieving a 74.5% vaccination coverage (n = 29, 885 dogs and cats) by September 2018. As of April 2019, no single human or animal case has been recorded. We have observed a disparity between awareness and knowledge levels of community members on rabies epidemiology. Self-adherence to protective rabies vaccination in animals was poor due to the challenges of costs and distances to vaccination centers, among others. Incidence of dog bites was high and only a fraction (65%) of dog bite victims (humans) received post-exposure prophylaxis. A high proportion of unvaccinated dogs and cats and the relative intense interactions with wild dog species at interfaces were the risk factors for seropositivity to rabies virus infection in dogs. A percentage of the previously vaccinated dogs remained unimmunized and some unvaccinated dogs were seropositive. Evidence of community engagement and multi-coordinated implementation of One Health in Moshi serves as an example of best practice in tackling zoonotic diseases using multi-level government efforts. The district-level establishment of the One Health rapid response team (OHRRT), implementation of a carefully structured routine vaccination campaign, improved health education, and the implementation of barriers between domestic animals and wildlife at the interfaces are necessary to reduce the burden of rabies in Moshi and communities with similar profiles.

Economic Burden of Rabies: An Experience from a Tertiary Care Hospital in Kashmir, India

Background: Post-exposure prophylaxis (PEP) is the mainstay of prevention in suspected exposure to rabies virus. Exposed patients are able to obtain anti-rabies vaccine in the anti-rabies clinic pro bono but they have to pay for passive immunization and cover other associated costs.&#x0D; Aim: To estimate and analyze the direct and indirect costs of rabies PEP.&#x0D; Methods: This study was conducted on 429 patients, who were exposed to bites from various animals and reported to Shri Mahraja Hari Singh Hospital (SMHS), an associated tertiary hospital of Government Medical College, Srinagar, Kashmir. Patient socio-demographic profile, details of animal bite exposure, the cost incurred for PEP was collected. The data were analyzed using a descriptive statistic.&#x0D; Results: The study revealed a total median cost incurred on patients for receiving a PEP as 29.3 USD (United States Dollar), with an Inter-quartile Range (IQR) of 0.2 USD to 43.1USD. The direct median cost was 20.5 USD with an IQR of 6.2 USD to 29.4USD, while the indirect median cost was 20.3USD with an IQR of 13.5USD to 24.4USD.&#x0D; Conclusion: Post-exposure prophylaxis imposes a significant economic burden to bite victims especially those of low socio-economic strata for whom the cost is substantial.

Priority areas for conservation of Old World vultures.

The prosperity and well‐being of human societies relies on healthy ecosystems and the services they provide. However, the biodiversity crisis is undermining ecosystems services and functions. Vultures are among the most imperiled taxonomic groups on Earth, yet they have a fundamental ecosystem function. These obligate scavengers rapidly consume large amounts of carrion and human waste, a service that may aid in both disease prevention and control of mammalian scavengers, including feral dogs, which in turn threaten humans. We combined information about the distribution of all 15 vulture species found in Europe, Asia, and Africa with their threats and used detailed expert knowledge on threat intensity to prioritize critical areas for conserving vultures in Africa and Eurasia. Threats we identified included poisoning, mortality due to collision with wind energy infrastructures, and other anthropogenic activities related to human land use and influence. Areas important for vulture conservation were concentrated in southern and eastern Africa, South Asia, and the Iberian Peninsula, and over 80% of these areas were unprotected. Some vulture species required larger areas for protection than others. Finally, countries that had the largest share of all identified important priority areas for vulture conservation were those with the largest expenditures related to rabies burden (e.g., India, China, and Myanmar). Vulture populations have declined markedly in most of these countries. Restoring healthy vulture populations through targeted actions in the priority areas we identified may help restore the ecosystem services vultures provide, including sanitation and potentially prevention of diseases, such as rabies, a heavy burden afflicting fragile societies. Our findings may guide stakeholders to prioritize actions where they are needed most in order to achieve international goals for biodiversity conservation and sustainable development.

Rabies post-exposure prophylaxis initiation and adherence among patients in Vietnam, 2014–2016

BackgroundAdhering to post-exposure prophylaxis (PEP): wound treatment, vaccine, and rabies immunoglobulin (RIG) is a crucial step in preventing rabies mortality. When PEP is widely available, a lack of adherence to the recommended treatment guidelines can also lead to death. Our objective was to understand characteristics associated with adherence to the vaccine regimen and RIG in Vietnam. MethodsWe obtained individual-level data on PEP adherence from registries at 10 sites located in five provinces. From these registries, we extracted epidemiologic characteristics of patients including the timing of PEP initiation and completion. We used descriptive analyses and logistic regression to examine patient characteristics associated with initiation and completion of RIG and vaccine. Based on reported rabies mortality, the government defined provincial rabies burden as medium-burden (<5 and >2 deaths) and high-burden (≥5 deaths). ResultsDuring 2014–2016, 15,646 patients received PEP in our study. Among 14,296 vaccinated patients, only 41.4% (5847) completed their five-dose intramuscular (IM) injections and 81.6% (133) of patients completed their eight-dose intradermal (ID) injections. Approximately 26% of patients received RIG. Patient characteristics associated with vaccine completion were females (44%), <15 years of age (44%), category 1 exposure (68%, bite location on leg (46%), bite from bat (56%), bite from a healthy animal (45%), high-burden province (86%), and district preventive center (49%). Disparities were revealed among provinces, with high-burden provinces having highest (86%) and lowest (7%) vaccine completion rates. Conclusions and relevanceVietnam has made tremendous progress towards reducing the burden of rabies. However, despite the wide availability of PEP, we found relatively low rates of vaccine completion. Our findings suggest provider training and patient education is needed to ensure appropriate treatment is completed. Moreover, our data suggest changes to information reported through the national surveillance system for monitoring good clinical practice for rabies prevention and control.

Updated estimation of the Burden of Rabies in Dogs and Humans in Cambodia using Spatial Bayesian Regression Modelling.

Updated estimation of the Burden of Rabies in Dogs and Humans in Cambodia using Spatial Bayesian Regression Modelling.