Human Rabies Cases Research Articles

The urgency of resuming disrupted dog rabies vaccination campaigns: a modeling and cost-effectiveness analysis

Dog vaccination is a cost-effective approach to preventing human rabies deaths. In Haiti, the last nation-wide dog vaccination campaign occurred in 2018. We estimated the number of human lives that could be saved by resuming dog vaccination in 2021 compared to 2022 and compared the cost-effectiveness of these two scenarios. We modified a previously published rabies transmission and economic model to estimate trends in dog and human rabies cases in Haiti from 2005 to 2025, with varying assumptions about when dog vaccinations resume. We compared model outputs to surveillance data on human rabies deaths from 2005 to 2020 and animal rabies cases from 2018 to 2020. Model predictions and surveillance data both suggest a 5- to 8-fold increase in animal rabies cases occurred in Haiti’s capital city between Fall 2019 and Fall 2020. Restarting dog vaccination in Haiti in 2021 compared to 2022 could save 285 human lives and prevent 6541 human rabies exposures over a five-year period. It may also decrease program costs due to reduced need for human post-exposure prophylaxis. These results show that interruptions in dog vaccination campaigns before elimination is achieved can lead to significant human rabies epidemics if not promptly resumed.

Evolution of Rabies in South America and Inter-Species Dynamics (2009-2018).

Rabies is listed as one of the World Health Organisation’s (WHO) Neglected Tropical Diseases Worldwide, with a significant impact in South America. This paper explores the dynamics of rabies cases in humans, pets (dogs and cats), livestock and wildlife (bats in particular) in South America during the period 2009–2018. The data used in this study were derived from the two main databases for rabies in South America: the OIE-WAHIS from the World Organisation for Animal Health (OIE) and PANAFTOSA’s Regional Information System for the Epidemiological Surveillance of Rabies (SIRVERA). Being a neglected disease with possible underreporting in some areas, the reported rabies cases may not always represent the real disease burden. The analysis focuses on the evolution of the number of cases in time and their spatial distribution, as well as on the main source of infections in humans, determined by laboratory assays of the antigenic variant or through epidemiological investigations. Additionally, Generalised Linear Mixed Models (GLMM) were used to evaluate the risk factors associated with the occurrence of human cases. Our results show that the highest impact of the disease in terms of number of cases was reported on livestock, while the overall number of cases (in animals and humans) progressively decreased along the study period. The spatial distribution of rabies in livestock showed two main clusters in the north-western (mainly Colombia) and in the south-eastern part of the affected area (Brazil), and a third smaller cluster in Peru. A cluster in dogs was observed in Bolivia. Out of the 192 human cases reported during the study period, 70% of them were transmitted by bats. The number of human cases reported during the study period were significantly associated with the number of rabies cases reported in livestock, pets and wildlife. Despite the overall decreasing case report rate, the disease still represents a major animal and public health concern in South America, and new strategies for compiling systematic information, networking and education are needed, as well as the education and training of veterinary staff.

Rabies surveillance in the United States during 2019.

To provide epidemiological information on animal and human cases of rabies occurring in the United States during 2019 and summaries of 2019 rabies surveillance for Canada and Mexico. All animals submitted for laboratory diagnosis of rabies in the United States during 2019. State and territorial public health departments and USDA Wildlife Services provided data on animals submitted for rabies testing in the United States during 2019. Data were analyzed temporally and geographically to assess trends in domestic and wildlife rabies cases. During 2019, 53 jurisdictions submitted 97,523 animal samples for rabies testing, of which 94,770 (97.2%) had a conclusive (positive or negative) test result. Of these, 4,690 tested positive for rabies, representing a 5.3% decrease from the 4,951 cases reported in 2018. Texas (n = 565 [12.0%]), New York (391 [8.3%]), Virginia (385 [8.2%]), North Carolina (315 [6.7%]), California (276 [5.9%]), and Maryland (269 [5.7%]) together accounted for almost half of all animal rabies cases reported in 2019. Of the total reported rabid animals, 4,305 (91.8%) were wildlife, with raccoons (n = 1,545 [32.9%]), bats (1,387 [29.6%]), skunks (915 [19.5%]), and foxes (361 [7.7%]) as the primary species confirmed with rabies. Rabid cats (n = 245 [5.2%]) and dogs (66 [1.4%]) accounted for > 80% of rabies cases involving domestic animals in 2019. No human rabies cases were reported in 2019. The overall number of animal rabies cases decreased from 2018 to 2019. Laboratory diagnosis of rabies in animals is critical to ensure that human rabies postexposure prophylaxis is administered judiciously.

Mathematical modelling and phylodynamics for the study of dog rabies dynamics and control: A scoping review.

BackgroundRabies is a fatal yet vaccine-preventable disease. In the last two decades, domestic dog populations have been shown to constitute the predominant reservoir of rabies in developing countries, causing 99% of human rabies cases. Despite substantial control efforts, dog rabies is still widely endemic and is spreading across previously rabies-free areas. Developing a detailed understanding of dog rabies dynamics and the impact of vaccination is essential to optimize existing control strategies and developing new ones. In this scoping review, we aimed at disentangling the respective contributions of mathematical models and phylodynamic approaches to advancing the understanding of rabies dynamics and control in domestic dog populations. We also addressed the methodological limitations of both approaches and the remaining issues related to studying rabies spread and how this could be applied to rabies control.Methodology/principal findingsWe reviewed how mathematical modelling of disease dynamics and phylodynamics have been developed and used to characterize dog rabies dynamics and control. Through a detailed search of the PubMed, Web of Science, and Scopus databases, we identified a total of n = 59 relevant studies using mathematical models (n = 30), phylodynamic inference (n = 22) and interdisciplinary approaches (n = 7). We found that despite often relying on scarce rabies epidemiological data, mathematical models investigated multiple aspects of rabies dynamics and control. These models confirmed the overwhelming efficacy of massive dog vaccination campaigns in all settings and unraveled the role of dog population structure and frequent introductions in dog rabies maintenance. Phylodynamic approaches successfully disentangled the evolutionary and environmental determinants of rabies dispersal and consistently reported support for the role of reintroduction events and human-mediated transportation over long distances in the maintenance of rabies in endemic areas. Potential biases in data collection still need to be properly accounted for in most of these analyses. Finally, interdisciplinary studies were determined to provide the most comprehensive assessments through hypothesis generation and testing. They also represent new avenues, especially concerning the reconstruction of local transmission chains or clusters through data integration.Conclusions/significanceDespite advances in rabies knowledge, substantial uncertainty remains regarding the mechanisms of local spread, the role of wildlife in dog rabies maintenance, and the impact of community behavior on the efficacy of control strategies including vaccination of dogs. Future integrative approaches that use phylodynamic analyses and mechanistic models within a single framework could take full advantage of not only viral sequences but also additional epidemiological information as well as dog ecology data to refine our understanding of rabies spread and control. This would represent a significant improvement on past studies and a promising opportunity for canine rabies research in the frame of the One Health concept that aims to achieve better public health outcomes through cross-sector collaboration.

An Evaluation of the Rabies Surveillance in Southern Vietnam.

Introduction: Rabies is endemic in Vietnam and has been a statutory notifiable infectious disease since 1998. We, herein, assessed the performance of rabies surveillance in Southern Vietnam and identified areas for improvement.Materials and Methods: We analyzed data on human rabies cases reported during 1991–2018. We adapted guidelines from the U.S. Centers for Disease Control and Prevention to evaluate attributes of surveillance. Between June and November 2018, we interviewed a total of 145 staff from hospitals, preventive medicine centers, and animal health offices at provincial and district levels in five southern provinces.Results: Between 2009 and 2018, an average of nine cases of human rabies (range: 4–20 cases) was reported annually in Southern Vietnam, representing an incidence of 2.7 cases per 10 million population. The highest incidence was observed in 2018 (5.5 cases per 10 million population). Survey data suggested that only 24% (13/53) of participants agreed that the monthly report template was easy to complete and that 42% (23/55) indicated that the change from the paper-based to the electronic case notification systems was easy. Only 7% (2/29) of human rabies cases were reported timely, and 65% (13/20) successfully collected specimens. Approximately 39% (56/144) of staff were aware of turning surveillance data into prevention activities, and 21% (31/145) witnessed data used for strategic program decision making.Conclusions: Although rabies surveillance was quite simple, flexible, and accepted in southern Vietnam, simplifying the report forms, training staff, and improving the timeliness of reporting and data usage are highly recommended for a better implementation of rabies surveillance.

Domestic dog demographics and estimates of canine vaccination coverage in a rural area of Zambia for the elimination of rabies.

BackgroundAn estimated 75% or more of the human rabies cases in Africa occur in rural settings, which underscores the importance of rabies control in these areas. Understanding dog demographics can help design strategies for rabies control and plan and conduct canine mass vaccination campaigns effectively in African countries.Methodology/Principal findingsA cross-sectional survey was conducted to investigate domestic dog demographics in Kalambabakali, in the rural Mazabuka District of Zambia. The population of ownerless dogs and the total achievable vaccination coverage among the total dog population was estimated using the capture-recapture-based Bayesian model by conducting a canine mass vaccination campaign. This study revealed that 29% of the domestic dog population was under one year old, and 57.7% of those were under three months old and thus were not eligible for the canine rabies vaccination in Zambia. The population growth was estimated at 15% per annum based on the cross-sectional household survey. The population of ownerless dogs was estimated to be small, with an ownerless-to-owned-dog ratio of 0.01–0.06 in the target zones. The achieved overall vaccination coverage from the first mass vaccination was estimated 19.8–51.6%. This low coverage was principally attributed to the owners’ lack of information, unavailability, and dog-handling difficulties. The follow-up mass vaccination campaign achieved an overall coverage of 54.8–76.2%.Conclusions/SignificanceThis paper indicates the potential for controlling canine rabies through mass vaccination in rural Zambia. Rabies education and responsible dog ownership are required to achieve high and sustainable vaccination coverage. Our findings also propose including puppies below three months old in the target population for rabies vaccination and emphasize that securing an annual enforcement of canine mass vaccination that reaches 70% coverage in the dog population is necessary to maintain protective herd immunity.

Current issues and gaps in the implementation of rabies prevention in Ukraine in recent decades

Ukraine remains the only country in Europe where rabies is widespread among animals and humans. Annually there are about 1,600 rabies cases in animals in Ukraine and sporadic cases in humans have been registered despite the conducting of preventive measures. Therefore, the aim of the study was to inspect the failures in rabies prevention, indicate the top reasons for human cases and highlights the risk of animal attacks in view of their species and geographical distribution in Ukraine during 1996–2020. The following archival state materials were used for analysis: from the Ministry of Health of Ukraine and from the annual reports of oblast departments of the State Service of Ukraine for Food Safety and Consumer Protection. In general, more than 84,000 people (187.4 per 100,000 of the population) were affected by bites or harmful contact with animals every year, among them, 2,155 people were victims of rabid animals. Post-exposure prophylaxis (PEP) was prescribed annually, on average, for 21,434 patients (25.5% of all victims). Most people were attacked by cats and dogs that had owners (71.5%). The frequency of the proportion of the risk of attacks by rabid dogs on humans was (1:124), from cats (1:25), wild animals (1:7), and farm animals (1:2), but the largest general proportion of animal attacks on people was from dogs – 838,635 attacks (77.7%). Thus, due to the permanently higher level of contact with people, attacks by dogs remains more dangerous. Geographically attacks on humans by domestic carnivores were observed most commonly in the east part of Ukraine due to the high urbanization of the region and the high density of the human population. A large number of attacks by foxes was observed in the west part of Ukraine due to the larger area of forests and fields. During the last 25 years, there have been 63 human rabies cases. The main sources of rabies were dogs (24 cases) and cats (22 cases). The main causes of development of rabies were: failure to receive the PEP due to the absence of a visit to a hospital after an attack of an animal (n = 38), failures in prescribing PEP (n = 15), failure of PEP (n = 10). In conclusion, the gaps in the control measures against rabies are the lack of agreed coordination of inter-sectoral links, the lack of significant efforts to raise public awareness and the lack of funding for prophylaxis programmes for humans and animals. Our future research will be aimed at modelling the transmission of rabies from the pet population to humans.

Research trends in rabies vaccine in the last three decades: a bibliometric analysis of global perspective

ABSTRACT Introduction Rabies is an infectious zoonotic viral disease which mainly occurs in Africa and Asia. Dogs are predominantly responsible for rabies transmission contributing up to 99% of all human rabies cases. Rabies is a vaccine preventable disease in both animals and humans. Objective This study aimed to quantify and characterize the scientific literature and identify the top most cited studies in rabies vaccine research (RVR) from 1991 to 2020. Methods The data used in this study were downloaded from Web of Science Core Collection (WoSCC), Science Citation Index-Expanded (SCI-E) database. Network visualization analysis was performed using VOSviewer software. Results A total of 1,042 papers (article: n = 986, 94.6%, review: n = 56, 5.4%) were included in this study. These have been cited 17,390 times with an average citation per paper was 16.69 times. The most frequent publication year was 2019 (n = 75, 7.2%). More than 55% studies were published from the United State of America (USA) (n = 380, 36.5%), France (n = 128, 12.3%), and China (n = 97, 9.3%). The most studied Web of Science (WoS) category was immunology (n = 344, 33%). The most prolific author in RVR was Rupprecht CE (n = 55, 5.3%). ‘Vaccine’ was the leading journal (n = 218, 20.9%). Rabies was the most widely used keyword. Conclusion Abundant literature has been published on RVR in developed countries. This study might provide a reference to understand the current and future research trends in RVR. In developing countries research collaboration and co-operation among institutes and researchers needs to be strengthened with developed countries.

Feasibility and Effectiveness Studies with Oral Vaccination of Free-Roaming Dogs against Rabies in Thailand.

(1) Background: Thailand has made significant progress in reducing the number of human and animal rabies cases. However, control and elimination of the last remaining pockets of dog-mediated rabies have shown to be burdensome, predominantly as a result of the large numbers of free-roaming dogs without an owner that cannot be restrained without special efforts and therefore remain unvaccinated. To reach these dogs, the feasibility, and benefits of oral rabies vaccination (ORV) as a complementary tool has been examined under field conditions. (2) Methods: ORV of dogs was tested in five study areas of four provinces in Thailand. In these areas, sites with free-roaming dogs were identified with the support of local municipal workers and dog caretakers. ORV teams visited each of five study areas and distributed rabies vaccine (SPBN GASGAS) in three bait formats that were offered to the dogs using a hand-out and retrieval model. The three bait types tested included: egg-flavored baits, egg-flavored baits pasted with commercially available cat liquid snack, and boiled-intestine baits. A dog offered a vaccine bait was considered vaccinated when the discarded sachet was perforated or if a dog chewed vaccine bait at least 5 times before it swallowed the bait, including the sachet. (3) Results: A total of 2444 free-roaming dogs considered inaccessible for parenteral vaccination were identified at 338 sites. As not all dogs were approachable, 79.0% were offered a bait; of these dogs, 91.6% accepted the bait and subsequently 83.0% were considered successfully vaccinated. (4) Conclusion: Overall, 65.6% of the free-roaming dogs at these sites were successfully vaccinated by the oral route. Such a significant increase of the vaccination coverage of the free-roaming dog population could interrupt the rabies transmission cycle and offers a unique opportunity to reach the goal to eliminate dog-mediated human rabies in Thailand by 2030.

Findings from the initial Stepwise Approach to Rabies Elimination (SARE) Assessment in China, 2019.

In 2015, China and other member states of the United Nations adopted the goal of eliminating dog-mediated rabies by 2030. China has made substantial progress in reducing dog-mediated human rabies since peaking with more than 3,300 reported cases in 2007. To further improve coordination and planning, the Chinese Center for Disease Control and Prevention, in collaboration with the United States Centers for Disease Control and Prevention, conducted a Stepwise Approach towards Rabies Elimination (SARE) assessment in March 2019. Assessment goals included outlining progress and identifying activities critical for eliminating dog-mediated rabies. Participants representing national, provincial and local human and animal health sectors in China used the SARE assessment tool to answer 115 questions about the current dog-mediated rabies control and prevention programs in China. The established surveillance system for human rabies cases and availability of post-exposure prophylaxis were identified as strengths. Low dog vaccination coverage and limited laboratory confirmation of rabid dogs were identified gaps, resulting in an overall score of 1.5 on a scale of 0 to 5. Participants outlined steps to increase cross-sectoral information sharing, improve surveillance for dog rabies, increase dog vaccination coverage, and increase laboratory capacity to diagnose rabies at the provincial level. All assessment participants committed to strengthening cross-sector collaboration using a One Health approach to achieve dog-mediated human rabies elimination by 2030.

Cost-effectiveness of the national dog rabies prevention and control program in Mexico, 1990-2015.

BackgroundRabies is a viral zoonosis that imposes a substantial disease and economic burden in many developing countries. Dogs are the primary source of rabies transmission; eliminating dog rabies reduces the risk of exposure in humans significantly. Through mass annual dog rabies vaccination campaigns, the national program of rabies control in Mexico progressively reduced rabies cases in dogs and humans since 1990. In 2019, the World Health Organization validated Mexico for eliminating rabies as a public health problem. Using a governmental perspective, we retrospectively assessed the economic costs, effectiveness, and cost-effectiveness of the national program of rabies control in Mexico, 1990–2015.MethodologyCombining various data sources, including administrative records, national statistics, and scientific literature, we retrospectively compared the current scenario of annual dog vaccination campaigns and post-exposure prophylaxis (PEP) with a counterfactual scenario without an annual dog vaccination campaign but including PEP. The counterfactual scenario was estimated using a mathematical model of dog rabies transmission (RabiesEcon). We performed a thorough sensitivity analysis of the main results.Principal findingsResults suggest that in 1990 through 2015, the national dog rabies vaccination program in Mexico prevented about 13,000 human rabies deaths, at an incremental cost (MXN 2015) of $4,700 million (USD 300 million). We estimated an average cost of $360,000 (USD 23,000) per human rabies death averted, $6,500 (USD 410) per additional year-of-life, and $3,000 (USD 190) per dog rabies death averted. Results were robust to several counterfactual scenarios, including high and low rabies transmission scenarios and various assumptions about potential costs without mass dog rabies vaccination campaigns.ConclusionsAnnual dog rabies vaccination campaigns have eliminated the transmission of dog-to-dog rabies and dog-mediated human rabies deaths in Mexico. According to World Health Organization standards, our results show that the national program of rabies control in Mexico has been highly cost-effective.

Situation of Rabies in Ethiopia: A Five-Year Retrospective Study of Human Rabies in Addis Ababa and the Surrounding Regions.

Objective The study objective was to estimate the burden of human rabies in Ethiopia from 2015–2019. Study Design. A descriptive study design was applied to measure the size of the problem. Method Retrospective data were used from the Ethiopian Public Health Institute rabies case record book that was registered between 2015 to 2019. Result Eighty-seven (87) cases of human rabies were diagnosed clinically in the Ethiopian Public Health Institute over the period of five years (2015–2019) with 100% case fatality. Of these, 83 (95.4%) cases were attributed to dog bites, whereas 1 (1.1%) to a cat and 3 (3.4%) to wild animals. The fatalities were from Oromia (n = 51 (58.6%), 13 (14.9%) were from Amhara, 15 (17.2%) were from Addis Ababa, and 8 (9.2%) from the Southern region. All referred cases had no record of immunization against rabies except eight. Ineffective postexposure treatment was the reason for 5 (5.7%) deaths. Out of 1,652 brain samples of different animals, mainly dogs, submitted for examination, 1,122 (68%) were found to be positive for rabies by the FAT. Dog bites were more common among males than females. The number of dog bite victims who had visited the EPHI counseling office and recommended to take postexposure prophylaxis against rabies both from Addis Ababa and the surrounding areas were 9,592 and 4,192, respectively. Out of these, 5,708 were males and 3,884 females for the capital Addis Ababa. Similarly, 2,439 males and 1,753 females account for areas surrounding Addis Ababa. Among those exposed from Addis Ababa, 1,079 (11.2%) were in the age group less than five, 1696 (17.7%) were in the age group 6–13, and 6,817 (71.1%) in the age group 14 and greater. Victims from outside of the capital Addis Ababa account for 644 (15.4%) for the age group less than 5 years, 964 (23%) for the age group 6–13 and, 2,584 (61.6%) for the age group 14 and greater. Conclusion Mechanisms must be sought to reduce the cost of PEP and means of obtaining funds so as to initiate timely treatment for rabies exposed individuals of low socioeconomic status. Besides prevention, strategies should focus on public education and strict dog population control.

Temporal and spatial distributions of animal and human rabies cases during 2012 and 2018, in Tunisia.

Rabies is one of the most important zoonosis in Tunisia. In the last 6 years, a dramatic increase in the number of cases in animals had raised concern about the transmission dynamics of rabies and the effectiveness of established control measures. For a better understanding of the epidemiological features of rabies in Tunisia, data on animal and human rabies cases and post‐exposure prophylaxis (PEP) protocol, for the period from 2012 to 2018, were analysed to describe the spatial and the temporal distributions of the disease and to guide targeted rabies control measures. Thus, the analysed data have shown that 2,642 animal and 25 human rabies cases were recorded between 2012 and 2018; only few case numbers were reported in wildlife. Time‐related distribution showed that the incidence of dog rabies increases over the period of study, from 24,8/100,000 dog population in 2012 to 35,2/100,000 dog population in 2018. Dog seems to be the main reservoir of rabies as it accounted for more than 59% of the animal confirmed cases and the source for more than 80% of the human confirmed cases. Geographical distribution of animal rabies cases revealed the presence of clusters in the North and the Center of Tunisia; only a little number of animal cases were reported in the South. In contrast, the overall human rabies incidence was 0.03 per 100,000 population, during the period of the study. We have found that the incidence of human rabies increases by 13.6% from 2012 to 2015 and drops steadily by 23.41% over the second period (2015 to 2018). A high number of PEP was recorded during the 7‐year period, with an average of 360 PEP per 100,000 inhabitants per year. Spatial analysis revealed the presence of clusters of PEP in the Northern and Central governorates. The present study pointed out the need to review the control strategy of rabies in Tunisia and conduct further studies on dog population to provide the basis for a new and efficacious policy of interventions and control program for rabies.

Clinical aspects of human rabies in the state of Ceará, Brazil: an overview of 63 cases.

INTRODUCTION Rabies is considered one of the most relevant public health problems owing to its high fatality rate and the high number of deaths worldwide. METHODS We included patients with human rabies who attended a reference hospital in the state of Ceará during 1976-2019. RESULTS Data were available for 63 out of 171 (36.8%) patients. Of these patients, 48 (76.2%) were attacked by dogs. In recent years, wild animals have been the most common aggressor species (marmosets and bats). Only 39 (70%) patients were initially correctly suspected with rabies. Bites were the most frequent exposure (56; 96%), most commonly on the hands (21; 42%) and the head (9; 18.4%). Only 14 (22%) patients had sought medical assistance before the onset of symptoms, and only one completed post-exposure prophylaxis. The most prevalent signs and symptoms included aggressiveness/irritability (50; 79.4%), fever (42; 66.7%), sore throat/dysphagia (40; 63.5%), and myalgia (28; 44.4%). Hydrophobia was present in 17 patients (22.0%). CONCLUSIONS Most cases of human rabies in Ceará occurred due to the failure to seek medical assistance and/or the failure of the health system in initiating early post-exposure prophylaxis. There is a need for specific information and education campaigns focusing on the cycle of sylvatic rabies as well as prevention measures. Health professionals should undergo refresher training courses on the signs and symptoms of rabies and on the specific epidemiological features of the disease in Brazil.

Epidemic Characteristics of Human Rabies - China, 2016-2020.

IntroductionThe epidemiological characteristics of human rabies in China in 2016–2020 were analyzed in order to provide the scientific basis for the formulation of the prevention and control policy of rabies at next stage.MethodsThe data of China’s National Notifiable Disease Reporting System (NNDRS) from 2016 to 2020 were collected and analyzed by using a descriptive epidemiology method.ResultsA total of 2,074 cases of human rabies were reported from 2016–2020 in China, there were year over year decreases in total number of cases. Human rabies appeared throughout the year, among which the highest in incidence happened from August to October, while March and December months were months in which the epidemic was weakest.ConclusionThough decreases were observed for human rabies in China, further steps should be taken to maintain these results. Management should be strengthened and the immunity of dogs should be prioritized to control this situation from the source. In addition, all reported cases should be monitored and reported to achieve the accurate prevention and control.

Assessing Impacting Factors of Dog Owners' Adoption of Dog Vaccination Against Rabies: A Cross-sectional Survey in Rural Areas - Guangxi Zhuang Autonomous Region, China, 2021.

What is already known about this topic?Rabies is fatal while preventable. More than 99% of human rabies cases were caused by dog bites worldwide. Mass dog vaccination could interrupt dog-mediated rabies if achieving and maintaining a minimum coverage rate of 70%.What does this report contribute?The results of this study show that roughly 23.7% of households owned dogs in Guangxi Zhuang Autonomous Region, China but only about 19.1% of these households reported having their dogs vaccinated. Possible positive factors were injury history of dog bites, awareness of the necessity, and policy help for the costs of dog vaccination, but negative factors were negative attitude and inaccessibility.What are the implications for public health practices?Much more effort should be made to improve dog vaccination coverage in rural areas in Guangxi Zhuang Autonomous Region, China. Well-designed free mass vaccination campaigns with more accessibility and awareness campaigns are important to improve coverage.

Using geostatistics to better understand the epidemiology of animal rabies in Morocco: what is the contribution of the predictive value?

This study aims to characterize the spatial distribution of animal rabies in Morocco in order to provide appropriate control approaches. Descriptive analyses of the epidemiological data show that the number of reported canine rabies cases greatly underestimates the true incidence of the disease. Underreporting subsequently affects the coherence of its spatial distribution. To perform accurate geographic distribution mapping of the disease based on interpolation methods, a data set was created using data between 2000 and 2018 to compare the derived disease cases with known true values in order to identify disease clusters. The subsequent interpolation was conducted using Ordinary Kriging regression methods and the semi variogram to focus on short distances and reduce uncertainty. The estimated clusters of rabies were evaluated using a cross validation step which revealed predicted cases close to the true values. To improve the precision of analysis, the authors displayed georeferenced dog and human rabies cases reported during the last three years, demonstrating reliable results that correspond to the estimated cluster areas similar to the true disease incidence on the field. This work highlights a strong correlation between infrastructure projects (i.e. railways, roads, facilities) and rabies epizootics for several specific locations. This study is the first attempt to use geostatistics to build upon the understanding of animal rabies in Morocco and shed light on the most appropriate strategies to sustainably reduce and mitigate the risk of rabies. There has been little literature on the use of kriging methods in animal health research. Thus, this study also aimed to explore a novel method in the veterinary sciences to establish kriging as a valid and coherent analysis tool to identify the extent to which the geostatistic area can objectively support understanding on animal rabies and saw it as being highly instrumental in coping with gaps in the data.

Application of the GARC Data Logger-a custom-developed data collection device-to capture and monitor mass dog vaccination campaigns in Namibia.

Domestic dogs are responsible for 99% of all cases of human rabies and thus, mass dog vaccination has been demonstrated to be the most effective approach towards the elimination of dog-mediated human rabies. Namibia demonstrated the feasibility of this approach by applying government-led strategic rabies vaccination campaigns to reduce both human and dog rabies incidences in the Northern Communal Areas of Namibia since 2016. The lessons learnt using paper-based form for data capturing and management of mass dog vaccination campaign during the pilot and roll out phase of the project (2016–2018) led to the implementation of a simple and accurate data collection tool in the second phase (2019–2022) of the rabies elimination program. In this paper, we describe the implementation of such custom-developed vaccination tracking device, i.e. the Global Alliance for Rabies Control (GARC) Data Logger (GDL), and the integration of the collected data into a website-based rabies surveillance system (Rabies Epidemiological Bulletin—REB) during 2019 and 2020 campaigns. A total of 10,037 dogs and 520 cats were vaccinated during the 2019 campaign and 13,219 dogs and 1,044 cats during the 2020 campaign. The vaccination data were recorded with the GDL and visualized via REB. Subsequent GIS-analysis using gridded population data revealed a suboptimal vaccination coverage in the great majority of grid cells (82%) with a vaccination coverage below 50%. Spatial regression analysis identified the number of schools, estimated human density, and adult dog population were associated with the vaccination performance. However, there was an inverse correlation to human densities. Nonetheless, the use of the GDL improved data capturing and monitoring capacity of the campaign, enabling the Namibian government to improve strategies for the vaccination of at-risk areas towards achieving adequate vaccination coverage which would effectively break the transmission of rabies.

Epidemiological study of human rabies cases in Bangladesh through verbal autopsy

Identification of risk factors is crucial to find ways to reduce rabies deaths. We investigated the hospital records of rabies deceased through contact tracing of the relatives of the victims using enhanced verbal autopsies (VA) to identify why the people had to die from rabies in recent years in Bangladesh. Patients whose deaths were confirmed by physicians based on the history of animal exposure and clinical signs were taken into account for VA. Socio-demographic profile of the deceased, animal exposure, nature of the wound, and history of post-exposure prophylaxis (PEP) data were obtained and analysed. The study found 256 cases in which the cause of death was attributed to rabies, most of the victims were male (71.88%), resided in the rural community (80.47%), dependent (49.22%), and children below the age of 15 years (47.27%). Dogs were the single most responsible (81.64%); however, cats (12.11%), jackals (3.91%) and mongoose (2.34%) were also found accountable for rabies incidence (P < 0.05). Significantly, limbs were the most common (67.97%) site of exposure, and the shortest incubation period was identified in the case of bites to head and face (P < 0.05). The majority (86.72%) of the deceased did not receive any PEP; whereas, 66.80% sought treatment from traditional healers. Among the deceased (13.28%, n = 34) who had received PEP, only 8.82% of them completed the full course of the vaccination regimen (P < 0.01); however, none of them had history of taking rabies immunoglobulin (RIG). The study recommends extensive public health awareness programs in the rural community and establishing methods to improve healthcare-seeking behaviours, including receiving PEP instead of visiting traditional healers. Moreover, the availability and accessibility of PEP in the government hospital facilities are desirable, and laboratory-based surveillance with compatible rapid data reporting may be incorporated in the existing policy.

Quantifying and mapping theburden of human and animal rabies in Iraq.

Rabies was first reported in ancient Iraqi civilizations, yet it remains a poorly quantified and important public health threat in the region. Efforts to control rabies in Iraq including dog population control, and vaccination of livestock and dogs, have increased since 2010. Officially reported data on human rabies, dog bites, and animal rabies cases between 2012 and 2017 are analysed here to assess the effect of existing control efforts, to inform future strategies, and to highlight gaps in surveillance and reporting. The results of molecular characterization of 32 viruses from animal cases from throughout Iraq are presented, to improve the understanding of rabies dynamics in the animal reservoir. Although annual numbers of reported human cases were lower in the period between 2012 and 2017 than prior to 2010, human cases continue. There was a distinct gender and age bias among human cases with nine cases in males for every one female and twice as many cases in children than adults. Spatial clustering analysis and phylogenetic evidence suggests rabies is endemic throughout the country, with no regional variation in risk, but better surveillance and reporting is required to underpin control strategies.