Management Of Rabies Research Articles

The NF-κB pathway negatively regulates the replication of rabies virus by triggering inflammatory responses

Rabies, which is caused by the rabies virus (RABV), is a neurological disease of mammals, including humans. The disease is untreatable, as drugs and antibodies are prevented from entering brain tissue by the blood-brain barrier (BBB). However, it has been reported that BBB permeability can be enhanced in mice infected with a laboratory-attenuated strain of RABV, which is not the case in those infected with wild-type RABV. Moreover, it is not the RABV infection directly that enhances BBB, but rather the inflammatory molecules that are induced by the virus. Understanding the mechanism underlying the RABV-induced production of chemokines and cytokines is crucial for the prevention and management of rabies. In this study, we found that mice infected with the RABV challenge strain CVS11 showed significant inflammatory infiltration in the later stages of infection. At the cellular level, we confirmed that the NF-κB signaling pathway was activated following RABV infection, leading to significant upregulation of the expression of downstream chemokines and inflammatory factors (CCL2, CCL5, CXCL10, TNF-α, and IL-6). Surprisingly, the replication of RABV was upregulated when the NF-κB pathway was inhibited, and the levels of its downstream chemokines and inflammatory factors were reduced following treatment with the inhibitor JSH-23. This suggests that RABV infection activates the NF-κB pathway, which is then able to negatively regulate the replication of RABV. This pathway is therefore a potential target for drugs and other therapies in the treatment of rabies.

A cross-sectional study on knowledge of epidemiological determinants, prevention and management of rabies among MBBS interns of a tertiary health care center of central India

Background: According to World Health Organization (WHO), rabies is a vaccine-preventable, zoonotic, viral disease caused by Lyssavirus type 1. It causes 20,000 deaths annually in India. MBBS interns represent the physicians who will graduate and practice medicine from next year. Hence, keeping this in mind, the present study was carried out to assess the knowledge regarding epidemiological determinants, prevention and management of rabies among MBBS interns. Methods: A cross-sectional study was conducted between April 2023 to June 2023 among 200 MBBS interns of Indira Gandhi Government Medical College, Nagpur, Maharashtra. Data was collected by the self-administered, pre-designed, pre-structured questionnaire and was analysed using statistical package for the social sciences (SPSS) software version 25. Results: It was seen that the mean age of participants was 23.34 (±0.859) years. The majority of participants were males (51.5%). The majority (80%) of interns knew the correct causative agent of rabies, while only 40% knew the correct incubation period of rabies. The majority, that is 63.5%, 85.5% and 75% of interns, knew the correct route, site and schedule of post exposure prophylaxis (PEP) respectively. Only 26.5% interns knew the correct management of category I animal bites, while 74.5% and 89% knew the correct management of category II and category III animal bites, respectively. The mean total knowledge score among interns was 13.17±2.63. Conclusions: The study found that interns with experience in dealing with animal bite cases had significantly higher total knowledge scores. To improve knowledge, interactive animal bite case-dealing sessions and regular CMEs should be conducted.

One Health approach to the diagnosis and management of feline rabies: A case report from Ebonyi State, Nigeria

Abstract Rabies, a disease with an almost 100% fatality rate, continues to be endemic and neglected in Nigeria. This case report presents the rare confirmation of feline rabies in July 2022 in Ebonyi State, South Eastern Nigeria. Direct Fluorescent Antibody Test and Reverse-Transcription Polymerase Chain Reaction confirmed that the cat was infected with rabies a few weeks after it was obtained by the owner. The two cat-scratched victims (owner and another in-contact person) opted for unorthodox management with a local traditional healer without seeking conventional medical care. Further outbreak investigations into the incidents involved multiple observational visits and interviews with key informants revealed the existence of risk factors that could have facilitated the transmission of the disease. A one-health approach, which considers the interconnectedness of human, animal, and environmental health, is favourable to achieve sustainable rabies control and was used in outbreak response. Implementing active rabies surveillance, raising awareness about dog and cat vaccination, and discouraging unorthodox management is essential to control rabies within the community. Additionally, improving access to post-exposure prophylaxis is crucial in preventing rabies-related fatalities and achieving zero human rabies deaths by 2030. Information © The Authors 2024

Improving Government and Community Synergy in Rabies Control and Overcoming in Tomohon City: Study at the Health and Agriculture Department

Rabies, known as mad dog disease, is an acute infectious disease that can attack humans. To date, many people have been affected by rabies, including those in Tomohon City. This research was conducted to analyze the synergy between the government and the community in controlling rabies in Tomohon City. The research design used is qualitative. Research findings show that Tomohon City is one of the cities in Indonesia that is not yet free from rabies. The policies set by the Tomohon City Government have not been able to suppress rabies cases. Weak communication and coordination from related agencies and lack of community support are the main causes. The strategy that needs to be implemented is related to problem solving, the role of government and communication networks. Therefore, it is necessary to strengthen border area control over the traffic of animals that transmit rabies, carry out direct outreach and education to the public about the prevention, control and management of rabies, impose sanctions on market traders who still sell meat from animals that transmit rabies without health documents and increase cooperation and coordination between the Subdistrict Government, Subdistrict Government, and related Government Agencies as well as with the Community.

Prevalence and public health significance of rabies virus in bats in the North Region of Cameroon.

Rabies is a zoonotic disease of all warm-blooded animals including humans. There is a paucity of data on the status of rabies in wild animals in Cameroon and the disease is endemic in the country with dogs being the main source of transmission. Bat habitats are widespread in Cameroon, but there is limited information on the prevalence of rabies in bats, and their role of as potential reservoirs of rabies virus. A cross sectional study was carried out to estimate the prevalence and to assess risk factors of rabies virus in bats in the North Region of Cameroon. A total of 212 bats belonging to three families (Pteropodidae, Vespertilionidae and Molossidae) and 5 species were sampled in 7 localities in the North Region of Cameroon and were tested for rabies virus antigen using direct Immunofluorescence Test (IFA). Overall, 26.9% (57/212) of the bats collected showed an IFA positive reaction. The prevalence was significantly higher (P<0.05) in adult bats (33.3% (36/108)) compared to young individuals (20.2%; 21/104). The main risk factors identified in the study for human exposure to bats were gender (Male), religion (Christianity), localities (Babla and Lagdo), the practice of bat hunting, bat consumption, unawareness of bat rabies and cohabitation with bats in close proximity. The study revealed the first evidence of Lyssavirus in bats in Cameroon. This finding showed that bat rabies are real and represents a potential public health concern in communities with bat habitats in the North Region of Cameroon. Enhancing the level of public awareness and health education on the potential of bats as reservoirs of Lyssavirus in Cameroon as well as the integration of the "One Health" approach for effective management of animal and human rabies should be emphasized.

Human rabies encephalomyelitis in the background of rabies outbreak in animals in Gelephu, Bhutan, 2023: a case report

BackgroundRabies continues to pose significant public health challenges in many developing countries including Bhutan. A probable case of rabies was admitted to our hospital and its reporting led to the uncovering of an outbreak in domestic and wild animals. We discuss the challenges in the diagnosis and management of rabies in a resource-limited setting.Case presentationA 35-year-old male presented with intermittent fever, bilateral lower limb weakness that was rapidly progressive, urinary incontinence with episodes of palpitations and sweating. He had sustained a Category III bite on the right lower thigh with four bite marks, inflicted by a stray dog. He had received post-exposure prophylaxis with intra-dermal anti-rabies vaccine. On initial examination, the patient was in distress but cooperative for the interview. He had pulse rate ranging from 60 to 100/min with episodes of diaphoresis and palpitations, but with normal capillary blood glucose. In the lower limb, the muscle power was zero with absent tendon reflexes in the lower limb and impaired abdominal reflex below T10 level. He had hyperaesthesia below T8, hydrophobia, aerophobia and photophobia. He had multiple spontaneous fasciculations in both the thighs and right deltoid and these later involved the intercostal muscles, neck and face muscles. He had altered sensorium and desaturation for which he required mechanical ventilation. Polymerase chain reaction for rabies virus was negative in cerebrospinal fluid and saliva. Rabies virus neutralizing antibody was negative in cerebrospinal fluid but had high titres in the serum. He received Human Rabies Immunoglobulin after admission. He was managed in the intensive care unit and died 23 days later. After this case was notified, a rapid response team was deployed in the field, and uncovered rabies outbreak in animals in the locality.ConclusionsThis case called for a serious evaluation of the country’s efforts in achieving zero rabies deaths by 2030. The management of this case identified several critical areas of context-specific interventions in Bhutan. There is also an urgent need to improve diagnostic capabilities at the national reference laboratory and enhance the technical competencies of healthcare workers in the management of dog bite cases.Graphical

Guarding Against Rabies: The Power of Vaccination in Rabies Disease Management

Rabies, a lethal viral disease caused by the rabies virus, presents a critical public health challenge globally. The disease's etiology involves transmission through the bite or scratch of infected animals, primarily dogs, with the virus targeting the central nervous system and leading to devastating neurological symptoms. Early diagnosis is crucial but challenging due to the disease's non-specific initial manifestations. Vaccination strategies serve as the cornerstone of rabies prevention, encompassing pre-exposure prophylaxis for high-risk individuals and post-exposure prophylaxis for those bitten or scratched by potentially rabid animals. In this article we provide an in-depth exploration of vaccination therapy as a pivotal strategy in the deterrence and management of rabies. The evolution of rabies vaccines, particularly inactivated virus vaccines, is explored, underscoring their role in reducing human rabies cases. The article concludes by emphasizing the significance of continuous research to enhance vaccine effectiveness and promote a comprehensive approach to rabies prevention.

Raccoon densities across four land cover types in the southeastern United States

AbstractRaccoons (Procyon lotor) are the primary reservoir for rabies virus in eastern North America. Management of rabies in raccoons is achieved primarily with the use of oral rabies vaccination (ORV) and effective ORV bait densities are determined in part by the densities of raccoons. Decisions regarding ORV bait densities, however, are limited by an incomplete understanding of raccoon densities across the spectrum of landscapes they occupy. We carried out a mark‐recapture study of raccoons on the Savannah River Site in South Carolina, USA, from 2017–2019, to develop sex‐ and landscape‐specific raccoon density estimates across 4 rural land cover types in the southeastern United States: bottomland hardwood, riparian forest, isolated wetland, and upland pine (Pinus spp.). We captured 404 unique raccoons 773 times over the 3‐year trapping period. Estimated densities were 5.44 ± 0.37 (SE) animals/km2 in bottomland hardwood forest, 2.62 ± 0.32 animals/km2 in riparian forest, 2.19 ± 0.29 animals/km2 in isolated wetlands, and 2.14 ± 0.23 animals/km2 in upland pine. Densities were significantly higher in bottomland hardwood than all other land cover types, whereas densities among the remaining cover types were similar. These patterns are likely the result of landscape fragmentation and configuration, with riparian forests typically embedded in a matrix of less suitable cover types, leading to low densities despite presumably high resource availability. There were higher densities of males than females in every cover type except upland pine, where the sex ratio was balanced. Densities on our site were low compared to other rural areas, which likely results from the lack of human influence in terms of agriculture or development. The financial cost of baiting for ORV distribution may be reduced by considering the comparatively low densities of raccoons in these rural landscapes in the southeastern United States.

Temporal trend and high-risk areas of rabies occurrences in animals in Nepal from 2005 to 2018

Rabies is an important zoonosis in both the public and animal health domains. The occurrences of animal rabies have been continuously reported in Nepal. For the effective control and management of animal rabies, a better understanding of rabies epidemiology is essential. Therefore, the objectives of this study were to determine the spatial distribution and to describe the epidemiological characteristics of animal rabies occurrences in Nepal. Official reports of rabies occurrences from 2005 to 2018 were analyzed using the Global Moran’s Index and Local Moran’s Index. The study revealed an increasing trend in the later years of the study period after 2014 with occurrences clustered around the southern region of the country. For the overall period, the high—high clustering areas were mostly found in Dailekh and Kailali. In addition, different areas were visualized as high-risk areas in various years. This study identified the high-risk areas of rabies; thus, authorities and stakeholders can utilize this finding in enhancing the rabies control program in the country

Rabies Elimination in Rural Kenya: Need for Improved Availability of Human Vaccines, Awareness and Knowledge on Rabies and Its Management Among Healthcare Workers.

BackgroundIn Africa, rabies causes an estimated 24,000 human deaths annually. Mass dog vaccinations coupled with timely post-exposure prophylaxis (PEP) for dog-bite patients are the main interventions to eliminate human rabies deaths. A well-informed healthcare workforce and the availability and accessibility of rabies biologicals at health facilities are critical in reducing rabies deaths. We assessed awareness and knowledge regarding rabies and the management of rabies among healthcare workers, and PEP availability in rural eastern Kenya.MethodologyWe interviewed 73 healthcare workers from 42 healthcare units in 13 wards in Makueni and Kibwezi West sub-counties, Makueni County, Kenya in November 2018. Data on demographics, years of work experience, knowledge of rabies, management of bite and rabies patients, and availability of rabies biologicals were collected and analyzed.ResultsRabies PEP vaccines were available in only 5 (12%) of 42 health facilities. None of the health facilities had rabies immunoglobulins in stock at the time of the study. PEP was primarily administered intramuscularly, with only 11% (n = 8) of the healthcare workers and 17% (7/42) healthcare facilities aware of the dose-sparing intradermal route. Less than a quarter of the healthcare workers were aware of the World Health Organization categorization of bite wounds that guides the use of PEP. Eighteen percent (n = 13) of healthcare workers reported they would administer PEP for category I exposures even though PEP is not recommended for this category of exposure. Only one of six respondents with acute encephalitis consultation considered rabies as a differential diagnosis highlighting the low index of suspicion for rabies.ConclusionThe availability and use of PEP for rabies was sub-optimal. We identified two urgent needs to support rabies elimination programmes: improving availability and access to PEP; and targeted training of the healthcare workers to improve awareness on bite wound management, judicious use of PEP including appropriate risk assessment following bites and the use of the dose-sparing intradermal route in facilities seeing multiple bite patients. Global and domestic funding plan that address these gaps in the human health sector is needed for efficient rabies elimination in Africa.

Neuropathogenesis of Human Rabies

Rabies is an acute infection that occurs in the central nervous system caused by a virus from the Rhabdoviridae family and the Lyssavirus genus that can be transmitted by dogs, cats, monkeys, bats, civets, and wolves. The purpose of writing this literature review is to determine the definition, epidemiology, neuropathogenesis and the role of neurotransmitters, clinical features, diagnosis, and management of rabies. The method used in writing this journal is a literature review, using literature searching. Search the library using website-based search tools, namely Google and Google Scholar using the keywords Rabies, Human Rabies, and Neuropathogenesis of Human Rabies. Free full text English and Indonesian publications. The journals selected in this literature review are 12 journals published between 2015-2021. Rabies infection begins with the transfer of viral microorganisms into the bite wound through the saliva of an infected animal. Rabies virus receptors consist of nicotinic acetylcholine receptors, Neural cell adhesion molecules (NCAM), and Nerve Growth Factor (NGF). Virus replication occurs in skeletal muscle and spreads via motor or sensory nerves to the spinal cord and brain. The virus binds to the nicotinic acetylcholine receptor via the neuromuscular route. There are 3 neurotransmitters that play a role in the neuropathogenesis of rabies, namely acetylcholine, serotonin, and GABA.

Roles of traditional medicine and traditional healers for rabies prevention and potential impacts on post-exposure prophylaxis: A literature review.

IntroductionGlobally, traditional medicine is widely used to treat a variety of injuries and illnesses, including dog bites, and exposures that are risky for rabies. However, efficacy of most traditional remedies used for rabies prevention or treatment has not been demonstrated in controlled trials or proven in community-based surveys.MethodsSix databases were searched including the terms rabies, traditional treatment, traditional remedy, traditional therapy, traditional medicine, and medicinal treatment to review traditional remedies used in the prevention and treatment of rabies. In addition, published literature of rabies transmission dynamics was used to estimate statistical likelihood of dog bite victims developing rabies to provide clarity as to why traditional healers have a high apparent success rate when preventing death from rabies in victims bitten by suspected rabid dogs.ResultsLiterature review yielded 50 articles, including three controlled experiments, that described use of traditional remedies for rabies prevention and treatment. Traditional remedies for rabies ranged from plant- or animal-based products to spiritual rituals; however, only a few controlled mice trials were conducted, and none of these trials demonstrated efficacy in preventing or treating rabies. Risk of dying from rabies after a bite from a dog with unknown rabies status is low, 1.90% (0.05%-29.60%). Therefore, traditional healers had a 98.10% (70.40%-99.95%) apparent success rate in preventing death from suspected rabid dog bites despite inefficaciousness of herbal remedies.ConclusionThere was no universal plant species or route of administration that was consistently used for rabies prevention or treatment across countries. No traditional remedy was efficacious in the prevention or treatment of rabies in randomized controlled experiments. Understanding the cultural context under which traditional remedies are used may facilitate collaboration of traditional healers with the modern medical system to ensure timely and appropriate use of proven therapies for prevention and clinical management of rabies.

Community Empowerment for Prevention and Management of Rabies in Dogs in Carangsari Village, Petang District, Badung Regency, Bali, Indonesia

Rabies, which was first reported in Bali in 2008, is now endemic and cannot be eradicated properly due to many related factors. An important factor in successfully eradicating this disease on the island is the full involvement of the local community. Therefore, this study aims to determine the knowledge and attitudes of the local community in controlling rabies in three out of ten randomly selected villages from the Carangsari sub-district. Although the village was previously considered a red zone, the number of rabies cases reported has greatly decreased. In this observational study, a census of all surveyed household heads on how to handle rabies was used to ensure the sustainability of local communities to carry out good practices in dealing with the disease. Three local officers were selected from each village and trained in basic knowledge related to dog management, rabies control, and animal welfare. They were then asked to conduct a survey and practice their knowledge by better controlling the local community. The collected data were analyzed qualitatively and descriptively and presented in tabular form. In the selected villages, 234 households were found, but only 74 (32.1%) kept dogs, with a total of 153 consisting of 110 locals and 43 mixed/breed dogs. Most of the villagers surveyed have general knowledge about rabies management and the application of animal welfare principles, which will be beneficial for reducing disease in the area. Furthermore, villagers’ involvement is considered an important factor applicable in other places where rabies is still a problem. However, government funding for vaccines and relevant technical support is required.

Integrated Rabies Surveillance - Hunan Province, China, 2020.

The objective of this paper was to assess the epidemiology of rabies in Hunan Province, analyze the associated factors, understand the status of prevention and treatment after rabies exposure, evaluate the effectiveness of prevention and treatment, and provide a scientific basis for formulating effective prevention and control measures. The surveillance data of rabies in Hunan Province in 2020 were collected and analyzed by descriptive epidemiological method. In 2020, a total of 59 cases of rabies were reported in Hunan Province, with an incidence rate of 0.09/100,000. Overall, 42 cases (71.19%) were due to animal bites and 43 cases (72.88%) were of grade III. The proportion of hand and combined injury of hand was the highest (40.68%). A total of 603,261 cases of rabies exposure were reported from the rabies post-exposure prophylaxis (PEP) clinic in Hunan Province. Dogs were the main animal causing injuries, accounting for 74.21%. Only 83,418 (13.84%) of the animals had a clear immune history, and a total of 11 dog attacks were reported in Hunan Province. The average immunity rate of dogs in the whole province was 30.98%. In 2020, 554 dogs were sampled in the whole province; 20 of them were positive for a positivity rate of 3.61%. Rabies in Hunan Province in 2020 had a relatively low prevalence. Failure to treat wounds, immunoglobulin injections, and vaccination after exposure were the main causes of rabies. Therefore, post-exposure management of rabies should be further strengthened to reduce the risk of rabies for high-risk populations.

ASSESSMENT OF KNOWLEDGE REGARDING RABIES AND ITS PREVENTION AMONG THE MEDICAL STUDENTS OF GOVERNMENT MEDICAL COLLEGE, NALHAR, NUH

Introduction : Rabies is a viral zoonotic disease with 100% fatality. Being a 100% preventable disease, it becomes imperative that the health care professionals including students pursuing MBBS course have an appropriate knowledge about the animal bite and prevention of rabies and be better equipped to tackle the menace more efciently. This study has been done to assess the knowledge and level of awareness regarding transmission, clinical sign and symptom, preventive measures, post prophylaxis wound management and use of RIG among 2nd year MBBS students of Shaheed Hasan Khan Mewati Government Medical College, Nalhar, Nuh post awareness session in the form of didactic lecture. Material And Methods: An observational study was conducted among the 2nd year MBBS students of SHKM GMC, Nalhar, Nuh in September 2019. A total of 83 participants were included in the study. Data was collected using performed questionnaire and analyzed using percentage method. Results:It was seen that the majority(74.69%) of medical students knew about the most common method of transmission of rabies virus by bites of rabid animal. About 83.13% of medical students knew hydrophobia as the symptom of rabies in human. Only 21.68% of students were aware of the fact that bite wound should not be cauterized while 10.84% of students knew the correct site of administration of RIG. Conclusion : Our study found most of the students were aware of the mode of transmission and clinical symptoms of rabies but few could correctly mention the fact about cauterization and correct site of administration of RIG. It is recommended that continuing medical education (CME) sessions on prevention and management of rabies for medical students be conducted regularly for better patient handling and management.

Management of vampire bats and rabies: a precaution for rewilding projects in the Neotropics

Changes in animal population dynamics and community composition following species (re)introduction may have unanticipated consequences for a variety of downstream ecosystem processes, including infectious disease transmission. Due the lessons learned from ongoing projects, we present a novel approach on how to anticipate, monitor, and mitigate the vampire bats and rabies in rewilding projects. We pinpoint a series of precautions and the need for long-term monitoring of vampire bats and rabies responses to rewilding projects and highlighted the importance of multidisciplinary teams of scientist and managers focusing on prevention educational program of rabies risk transmitted by bats. In addition, monitoring the relative abundance of vampire bats, considering reproductive control by sterilization and oral vaccines that autonomously transfer among bats would reduce the probability, size and duration of rabies outbreaks. The rewilding assessment framework presented here responds to calls to better integrate the science and practice of rewilding and will help conservation practitioners and researchers to develop effective message framing strategies that minimize bats emerging infectious diseases and support biodiversity and its associated ecosystem services.

Healthcare utilization patterns and economic burden of animal bites: A cross-sectional study

Objective: To determine the healthcare utilization patterns and estimate the economic burden of animal bites in Golestan province, north part of Iran.Methods: This cross-sectional study was performed based on the data of 12 181 animal-bite patients from Golestan province who were referred to the rabies prophylaxis centers between March 2019 and March 2020. The study was a societal perspective, and all patients were investigated by census method. The micro-costing method with a bottom-up approach as well as the human capital approach were used to estimate the economic burden.Results: In our study, the economic burden caused by animal bites was estimated at $1 383 639 (275 354 672 060 Rials). The largest share of costs was related to direct healthcare costs, direct non-healthcare costs, and indirect costs accouting for 91%, 5%, and 4%, respectively. In addition, the average cost of a animal-bite patient was estimated at $113.5 (22 605 260 Rials) (The average cost of a case in type 2 and 3 exposures was $45 and $412.8, respectively). The largest share of direct healthcare costs was related to immunoglobulin, vaccine, and personnel expenses accounting for 61.3%, 19.8%, and 11.65%, respectively.Conclusions: Our study shows that animal bites in Golestan province, north of Iran impose a high economic burden on the communities, especially the healthcare system, which indicates the need to review management and control programs of animal bites and rabies based on animal-bite patterns of the area.

Pattern of Injuries among Dog Bite Victims in an Urban Area of Kancheepuram District, Tamilnadu

Introduction: Rabies is a fatal zoonotic disease caused by bite of an infected animal, dogs being the most common reservoir of the virus. India accounts about 59.9 % of rabies death in Asia. The site of bite, depth of the wound and health seeking behavior among the victims play a major role in the prevention and effective management of rabies&#x0D; Objectives: To study the pattern of injuries among dog bite victims in an urban area of Kancheepuram district, Tamilnadu.&#x0D; Methodology: A community based cross-sectional study was conducted among 120 victims who visited a tertiary care veterinary hospital followed by a dog bite. They were selected by convenient sampling method. Data collected was analyzed statistically using SPSS 25.0 version.&#x0D; Result: In this study, the most common site of bite was lower limbs (62.0%). Prevalence of bite by stray dogs was high (56.2 %). Immediate post - exposure prophylaxis with soap and water was practiced by 78.5 %. Around 82.6% knew that it is preventable&#x0D; Conclusion: Health education about rabies vaccination and appropriate management measures with intersectoral coordination and community participation needed to achieve the target of zero human death from dog mediated rabies by 2030.

Better Management of Rabies Using Innovative Statistical Tools

The aim of this paper is to illustrate how statistical tools can benefit healthcare policy makers specialised in the rabies management. Understanding the prevalence of such a disease is crucial for management teams. Seasonality may be a salient feature of data series provided by medical units, that is why the use of an innovative tool for seasonal adjustment is needed. For this paper, the data series (number of persons examined for rabies, by age and residency) were provided by one single health care unit – The National Institute of Infectious Diseases “Matei Bals”.

Defining New Pathways to Manage the Ongoing Emergence of Bat Rabies in Latin America.

Rabies transmitted by common vampire bats (Desmodus rotundus) has been known since the early 1900s but continues to expand geographically and in the range of species and environments affected. In this review, we present current knowledge of the epidemiology and management of rabies in D. rotundus and argue that it can be reasonably considered an emerging public health threat. We identify knowledge gaps related to the landscape determinants of the bat reservoir, reduction in bites on humans and livestock, and social barriers to prevention. We discuss how new technologies including autonomously-spreading vaccines and reproductive suppressants targeting bats might manage both rabies and undesirable growth of D. rotundus populations. Finally, we highlight widespread under-reporting of human and animal mortality and the scarcity of studies that quantify the efficacy of control measures such as bat culling. Collaborations between researchers and managers will be crucial to implement the next generation of rabies management in Latin America.