Rabies Prophylaxis Research Articles

Rabies in a child in Рenza region (clinical case)

Rabies is a dangerous viral disease characterized by severe damage to the brain and spinal cord. A clinical case of rabies in a 14-year-old teenager with a fatal outcome is presented. After the child's contact with a hedgehog was registered, post-exposure prophylaxis of rabies was not administered to the child. The complexity of timely diagnosis of rabies and the need for emergency prophylaxis of rabies after contact with wild animals are demonstrated.

Surgical Management of Pediatric Dog Bites: A Systematic Review and Treatment Guideline

IntroductionDog bites are a unique and unusual injury in children, associated with atypical bacterial species, high infection rates, and controversial surgical treatment. Expert recommendations currently guide management and no surgical evidence-based guidelines exist. We conducted a systematic review to answer three management questions: (1) What are the best practices for wound management? (2) In what circumstances should prophylactic antibiotics be administered? (3) In what circumstances should rabies prophylaxis be given? MethodsA structured review was performed using a keyword search querying “pediatric” “dog bite” “management”. Results were reported according to the PRISMA methodology. The quality of nonrandomized studies was evaluated according to Methodological Index for Non-Randomized Studies (MINORS). Qualitative analysis was performed. ResultsA total of 803 studies were identified and 53 studies were included in the final analysis. Current literature suggests that primary closure of bites which are well irrigated and sharply debrided within 8 h of injury, is not associated with increased infection. While dog bites are associated with an overall high rate of infection (6–25 %), routine antibiotic prophylaxis in low-risk wounds does not lower that risk. Postexposure prophylaxis for rabies is indicated for all dog bites where the rabies status of the dog cannot be determined, or the animal cannot be quarantined for 10 days. ConclusionHigh-quality evidence regarding the surgical management of pediatric dog bites is limited. Trial data have demonstrated improved outcomes in wound healing and infection rates with a focus on copious irrigation and diligent wound debridement, although independent validation is needed. Level of EvidenceLevel II – systematic review.

Post-exposure Rabies Prophylaxis in People Bitten by Warm-blooded Animals at the Epidemic Treatment Center of Kindia Regional Hospital, Guinea

Post-exposure Rabies Prophylaxis in People Bitten by Warm-blooded Animals at the Epidemic Treatment Center of Kindia Regional Hospital, Guinea

Assessing the immunogenicity of pre-exposure rabies prophylaxis and interchangeability of booster doses in a cohort of high-risk individuals

Assessing the immunogenicity of pre-exposure rabies prophylaxis and interchangeability of booster doses in a cohort of high-risk individuals

Safety and efficacy assessment of an mRNA rabies vaccine in dogs, rodents, and cynomolgus macaques

Rabies is a lethal disease caused by the rabies virus (RABV), which causes acute neurological infections in mammals, including human beings. We previously reported that an mRNA vaccine (LVRNA001) encoding the rabies virus’s glycoprotein induced strong protective immune responses to rabies in mice and dogs. Here, we further evaluate the safety of LVRNA001. First, we performed a confirmative efficacy study in dogs, which showed that LVRNA001 fully protected the animals from the virus, both pre- and post-infection. Moreover, using pre- and post-exposure prophylaxis murine models, we showed that LVRNA001, built from the CTN-1 strain, was able to protect against various representative RABV strains from the China I–VII clades. To evaluate the safety of the vaccine, chronic and reproductive toxicity studies were performed with cynomolgus macaques and rats, respectively. In a repeated-dose chronic toxicity study, vaccinated monkeys displayed no significant alterations in body weight, temperature, or hematological and biochemical markers. Lymphocyte subset measurement and histopathological examination showed that no toxicity was associated with the vaccine. The immunogenicity study in cynomolgus macaques demonstrated that LVRNA001 promoted the generation of neutralizing antibodies and Th1-biased immune response. Evaluation of reproductive toxicity in rats revealed that administration of LVRNA001 had no significant effects on fertility, maternal performance, reproductive processes, and postnatal outcomes. In conclusion, LVRNA001 can provide efficient protection against rabies virus infection in dogs and mice, and toxicity studies showed no significant vaccine-related adverse effects, suggesting that LVRNA001 is a promising and safe vaccine candidate for rabies prophylaxis and therapy.

Trauma surgical relevance of bite injuries by animals and humans

Bite injuries require differentiated treatment due to the deeply inoculated polymicrobial pathogen spectrum, possible concomitant injuries and pronounced soft tissue damage. Dog bites are the most common bite injuries but are less complicated to heal than human and cat bites. The location of the bite greatly depends on the age and the size of the bite victim as well as the type of bite perpetrator. In every case detection of the pathogen should be carried out to provide the best possible adapted treatment in the event of an exacerbation. The primary antibiotic treatment should be empirical with amoxicillin + clavulanic acid or ampicillin + sulbactam and, if necessary, adjusted according to the antibiogram. Depending on the findings, surgical treatment includes excision of the bite canal and acustomized wound debridement. It is important to check the vaccination status of those involved and if indicated, to carry out postexposure prophylaxis for tetanus and rabies.

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

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

Isolation and characterization of rabies monoclonal antibody charge variants.

Current postexposure prophylaxis of rabies includes vaccines, human rabies immunoglobulin (RIG), equine RIG, and recombinant monoclonal antibodies (mAb). In the manufacturing of rabies recombinant mAb, charge variants are the most common source of heterogeneity. Charge variants of rabies mAb were isolated by salt gradient cation exchange chromatography (CEX) to separate acidic and basic and main charge variants. Separated variants were further extensively characterized using orthogonal analytical techniques, which include secondary and tertiary structure determination by far and near ultraviolet circular dichroism spectroscopy. Charge and size heterogeneity were evaluated using CEX, isoelectric focusing (IEF), capillary-IEF, size exclusion chromatography, sodium dodecyl sulfate polyacrylamide gel electrophoresis, and western blotting. Antigen binding affinity was assessed by enzyme linked immuno-sorbent assay and rapid florescence foci inhibition test. Results from structural and physicochemical characterizations concluded that charge variants are formed due to posttranslational modification demonstrating that the charge heterogeneity, these charge variants did neither show any considerable physicochemical change nor affect its biological function. This study shows that charge variants are effective components of mAb and there is no need of deliberate removal, until biological functions of rabies mAb will get affected.

Management Strategies for Common Animal Bites in Pediatrics: A Narrative Review on the Latest Progress.

Animal bites are a common reason for children to visit primary care and emergency departments. Dog bites are the most prevalent, followed by cat bites at 20-30%. Other animals such as bats, monkeys, snakes, and rats collectively contribute less than 1% of cases. Hospitalization is necessary in only 4% of animal bite incidents. The main aim of this narrative review is to summarize the main protocols currently followed in pediatrics in cases involving the most common bites from different animal species. Analysis of the literature showed that the management of common animal bites in children presents a multifaceted challenge requiring a comprehensive understanding of the epidemiology, clinical presentation, and treatment modalities associated with each specific species. Effective wound management is paramount in reducing the risk of infection and promoting optimal healing outcomes. Additionally, tetanus vaccination status should be assessed and updated as necessary, and prophylactic antibiotics may be indicated in certain cases to prevent secondary infections. Furthermore, the role of rabies prophylaxis cannot be overstated, particularly in regions where rabies is endemic or following bites from high-risk animals. In addition to medical management, psychosocial support for both the child and their caregivers is integral to the overall care continuum. Future studies exploring the efficacy of novel treatment modalities, such as topical antimicrobial agents or advanced wound dressings, may offer new insights into optimizing wound healing and reducing the risk of complications.

The epidemiology and clinical features of post-exposure prophylaxis for rabies: A retrospective study of 9772 cases

BackgroundIn December 2015, the World Health Organization, the World Animal Health Organization, and the Food and Agriculture Organization of the United Nations convened the International Congress on the elimination of rabies in Geneva. How to use epidemiological factors of post-exposure prophylaxis to prevent rabies has become the focus of attention. ObjectiveTo analyze the epidemiological characteristics of 9772 patients with rabies in a four-year period in one hospital, to clarify the outbreak law of rabies and to explore the corresponding prevention and control strategies. MethodsThe epidemiological data of rabies patients were collected from the infectious disease reporting information management system of the hospital from July 2018 to June 2022. The distributional characteristics of 13 influencing factors were analyzed using the chi-square test and linear regression. ResultsThere was a significant correlation between the number of wounds and age, and the numbers of female and male patients were close. People over the age of 44 were more likely to get bites or scratches on their lower extremity (P<0.0001). There was a greater possibility for elderly people to be bitten by dogs (P<0.0001). Dogs preferred to bite or scratch lower limbs (P<0.0001), while cats upper limbs (P<0.0001). Upper limbs were more possibly attacked by animals at home (P<0.0001). There were significant correlations among exposure grade, wound treatment and number of wounds. Conclusions: Lower extremity protection is needed for the elderly and when encountering dogs, and more attention needs to be paid to the upper extremities when encountering cats and household pets, as well as pets that are cute but need to be protected from bites or scratches.

Current status of Rabies Prophylaxis in Dalaba (Republic of Guinea)

Current status of Rabies Prophylaxis in Dalaba (Republic of Guinea)

A prospective study on health seeking behaviour and post exposure prophylaxis received by animal bite victims at the anti-rabies clinic in a tertiary care centre of urban Bangalore.

Rabies is 100% preventable by administering early and complete post exposure prophylaxis (PEP). Animal bite victims must have the knowledge and attitude necessary to seek appropriate medical care at the earliest to receive the required PEP. The present study sought to ascertain the health-seeking behavior of animal bite victims, their knowledge and attitude regarding rabies prophylaxis, the PEP they received, and their level of compliance with the full course of anti-rabies vaccination. The study included animal bite cases that presented to the anti-rabies clinic and matched the eligibility criteria. All the required details were recorded using an internally validated structured questionnaire. All participants were followed up for six months to ensure their health conditions and compliance with the vaccination schedule. Out of 1058 respondents, 57.9% were adults, with 46.6% belonging to middle socioeconomic class. 91.1% of them were informed biting animals as dogs. Before arriving at the anti-rabies clinic, 93.3% of the study subjects washed their wounds, and 62.4% visited to another health facility. Rabies knowledge was inadequate among the study participants, only 54.8% being mindful about the disease and its prevention. The compliance with the full course of antirabies vaccination was found to be 77.9%. All subjects were healthy, confirming that PEP is safe and effective. Regular social and behavioral change communication (SBCC) needs to be implemented with regard to health-seeking behavior.

Awareness on Recent Guidelines for Rabies Prophylaxis among Healthcare Professionals in Rewa District, Madhya Pradesh, India: A Questionnaire-based Cross-sectional Study

Introduction: Rabies is a zoonotic disease that can be fatal and continues to impose a significant financial burden on developing countries. Recently, there have been advancements in the introduction of cell culture vaccines and immunoglobulin, as well as the approval of Intradermal (ID) schedules for vaccine administration. Aim: To assess the knowledge of doctors in Rewa District regarding the National Guidelines for Rabies Prophylaxis in 2019. Materials and Methods: A cross-sectional study was conducted, involving doctors from tertiary healthcare centres, district hospitals, and private practices. Data were collected over a period of one month from 206 doctors using a Google form, which included information about their field of practice and their knowledge of recent guidelines on Rabies prophylaxis. Data analysis was performed using the Chi-square test. Results: Out of the 206 doctors surveyed, 92 (44.7%) were male. A 56.7% of the doctors were aware of the regimen and dosage for ID administration of the Anti Rabies Vaccine, (ARV) and 44.6% were knowledgeable about the modification of PostExposure Prophylaxis (PEP) to Pre-Exposure Prophylaxis (PrEP) in the Essen regimen. Furthermore, 70.9% of the doctors were familiar with the dosage of Human Rabies Immunoglobulin (HRIG), while 42.7% knew how to manage animal bites in immunocompromised patients. Conclusion: The study revealed a lack of sufficient knowledge on various aspects of rabies management among the doctors surveyed. This underscores the need for reorientation programs and Continuing Medical Education (CMEs) training to be provided to doctors to enhance their knowledge of rabies and improve the effective management of animal bites.

Risk Reduction Strategies for Rabies Exposures and Prophylaxis in Children

Annually, 59,000 people die of rabies, the world’s oldest known infectious disease, globally. In the United States, canine rabies has been virtually eliminated but the risk of rabies due to wildlife, especially raccoons, skunks, and bats, has required post exposure prophylaxis (PEP) be administered to more than 60,000 patients annually1. In 2021, 5 people in the United States2 died of rabies mostly due to misinformation or improper treatment. Rabies post exposure prophylaxis consists of three steps, wound washing, administration of human rabies immune globulin (HRIG) and a full course of vaccine3. In 2022, Whitehouse4 published that there were 122 breakthrough rabies infections when PEP was given due to four factors: 1) deviations from core practice 2) delays in seeking health care 3) errors in administration of HRIG 4) comorbidities or immunosuppression. It is estimated that over 40% of PEP administration is given inappropriately. The publication,” Safety, and efficacy of rabies immunoglobulin in pediatric patients with suspected exposure”, Human Vaccines &amp; Immunotherapeutics, 17:7, 2090–20965, was the first study that prospectively reviewed the use of human rabies immune globulin 150 IU/ml in 30 pediatric patients ages 0.5–14.9 years old. Globally, 40% of people bitten by animals suspected of being infected with the rabies virus are children under the age of 15.6 This paper will look at risk reduction strategies that will include: Proper Identification of major rabies vectors Special risks associated with bat exposures in children Administration of human rabies immune globulin with volume considerations in children Special administration consideration for rabies vaccines “Just -in- time “Education for health care providers Illustrative cases will be used to demonstrate each of these strategies of risk as well as the strategies for risk reduction.

Fatal cases in pediatric patients after post-exposure prophylaxis for rabies: A report of two cases

Rationale: Rabies is a zoonotic disease with a high mortality, primarily transmitted through the bite of infected mammals, particularly dogs and cats. Despite being a well-known disease since ancient times, it continues to cause a significant number of human deaths worldwide, with approximately 65 000 fatalities reported annually. Patient concerns: We present two fatal cases of rabies in a 12-year- old immigrant boy and a 7-year-old boy. The first case was subject to a 24-hour delay in receiving appropriate medical attention and rabies preventive measures due to the lack of awareness among emergency hospital staff, leading to the administration of wound dressing only. The second case received timely rabies immunoglobulin administration; however, there was a 4-day delay in administering the fourth dose of the rabies vaccine, despite presenting evident symptoms of rabies. Diagnosis: Postmortem examination of brain samples from both patients confirmed the presence of rabies virus. Interventions: Post-exposure prophylaxis for rabies. Outcomes: Both patients were admitted to the hospital after the manifestation of rabies-related symptoms, with the 12-year-old child seeking medical care 47 days after the animal bite and the 7-year-old child seeking medical care 58 days after the exposure. Finally, the first patient died after 27 days and the second patient died after 40 days of hospitalization. Lessons: There is an urgent need for heightened awareness and education among both healthcare professionals and the public regarding the urgency of seeking immediate medical attention after potential rabies exposure. Timely recognition and initiation of post-exposure prophylaxis are pivotal in preventing the progression of the disease. Strengthening surveillance and reporting systems, coupled with continuous training for healthcare professionals, can contribute to early detection and management of rabies cases.

Public Health Protection Continuity of Operations During the Evacuation and Return to Community Phases of the Unprecedented Evacuation of Two-thirds of the Northwest Territories, Canada, 2023

Abstract Objective In August 2023, 68% (n=25,900) of the Northwest Territories, Canada, evacuated from wildfires, including the never previously evacuated capital, Yellowknife. Official evacuation orders extended from August 16 to September 6 for this region, impacting health protection services (HPS) in the Territory for remaining residents, and risks on return. Methods The Office of the Chief Public Health Officer (OCPHO) reviewed and implemented priorities over a three-day period prior to the evacuation order for time critical HPS to continue remotely or transfer to receiving jurisdictions. On return to community, OCPHO implemented processes for reviewing surveillance objectives to assess for impacts to affected populations. Results During evacuation, over 15 reports of animal exposures were assessed remotely for rabies prophylaxis. Individuals requiring sexually transmitted infection (STI) follow-up were referred to receiving jurisdictions. One patient with infectious tuberculosis was transferred to another province. Water plant operators were supported with new communication and out-of-Territory testing protocols. On return, enhanced surveillance included: respiratory viruses, STI and blood borne infections, gastrointestinal illness, and toxic drug supplies. Conclusions While some HPS continued to mitigate risks, future surveillance will assess the scale of impacts. Updates to continuity of operations plans need to include considerations for remote and local services.

Rabies exposure and prophylaxis among dog owners in Ogun State, Nigeria: a descriptive and categorical analysis of knowledge, attitudes and practices

Background: Rabies, a deadly viral human-animal disease, remains endemic in Nigeria. Identifying gaps in rabies knowledge, attitudes, and practices among dog owners in communities within Southwestern Nigeria remains a public health goal. This cross-sectional study investigated the knowledge of and attitudes to rabies exposure, prophylaxis and associated factors, and practices during rabies exposure and prophylaxis among dog owners in Ogun State, Nigeria. Methods: Using multistage sampling technique, 500 dog owners were randomly selected and interviewed with a pre-tested structured questionnaire. Data collected on their socio-demographics, knowledge of and attitudes to rabies exposure and prophylaxis, and practices during rabies exposure and prophylaxis were evaluated using descriptive and categorical analysis. Results: The majority of the respondents were female (53.0%; 265 respondents of 500 respondents), 32 years old (54.6%; 273 of 500), and had primary and secondary education (53.2%; 266 of 500 respondents). The majority (60.0%; 300 of 500 respondents) allowed their dogs to roam the streets, but only 120 (24.0%) had vaccinated their dogs up to date. Of the 500 respondents, 145 (29%) had experienced dog bites, but few (4.1%; 6 of 145) received rabies vaccine, and even fewer (2.8%; 4 of 145) completed the regimen. Proportions of respondents with knowledge, attitudes, and practices associated with higher rabies risks were 37.8%, 59.4%, and 97.6%, respectively. Age (P = 0.01), education (P = 0.04), short-term dog ownership (P = 0.01), and occupation (P = 0.01) were factors associated with their practices in relation to higher rabies risks. Conclusion: The knowledge, attitudes, and practices of dog owners towards rabies exposure portends a high risk. Public health interventions to achieve behavioural change, and the enforcement of dog vaccination and leash laws are highly recommended.

Expert consensus on pre-exposure rabies prophylaxis

Pre-exposure rabies prophylaxis, also known as immunoprophylaxis before exposure to rabies, refers to preventive rabies vaccination for individuals at risk of rabies infection before rabies exposure, which is one of the important strategies for rabies prevention. Pre-exposure rabies prophylaxis can reduce the risk of individual rabies and reduce the cost of post-exposure prophylaxis by establishing an immunologic barrier in advance and the memory immune response after the booster. In view of the current situation that clinicians in China have relatively insufficient knowledge of pre-exposure rabies prophylaxis, the Rabies Prevention and Control Committee of the Chinese Preventive Medicine Association and Animal Injury Treatment Branch of China Association for Disaster and Emergency Rescue Medicine organized domestic experts in relevant fields to write this expert consensus in accordance with the latest guidelines, expert consensus, and the latest clinical evidence. This consensus describes the concept and significance of pre-exposure rabies prophylaxis, immunization procedures and cost-effectiveness respectively, and puts forward recommendations on pre-exposure rabies prophylaxis strategies. It is hoped that this consensus can improve clinicians' understanding of pre-exposure rabies prophylaxis and increase the rate of pre-exposure rabies prophylaxis among people at high risk of exposure in China.

A 4 year retrospective study of facial dog bite injuries in patients reported to pediatric emergency, BPKIHS, Nepal.

Introduction: Dog bites facial injuries are a significant health care problem and their sequelae ranges from minor to fatal injuries.&#x0D; &#x0D; Objectives: To determine the incidence of facial dog bite injuries and to assess the outcome as well as presentation of facial injuries among the children reported to the pediatric emergency, BPKIHS, Nepal.&#x0D; &#x0D; Methodology: A study was conducted where the clinical records of children with facial dog bite injuries reported from 2015 to 2018, were assessed and analyzed.A proforma was designed to extract relevant clinical data from the case records. Information such as age, gender of the victims, anatomical site of the injury, interval between injury and presentation to the hospital, nature of injuries,profile(stray or pet)and immunization status the of dog ,outcome and complications were extracted.&#x0D; &#x0D; Results: The incidence of facial dog bite injuries has significantly increasedpointing maleschool going children injured predominantly(70%).Seventeen(81%) victims had presented within 24 hrs of injury whereas two(9.5%) patients had reported after 24 hours and 72 hours of the injury. Nineteen patients were treated on the same dayunder local anesthesia, one under general anesthesia where thorough wound lavage with meticulous reapproximation followed by suturing was done. Full recovery was evident in eighteen (86%) cases with primary wound closure whereas two (14%) patients had undergone healing with secondary intention.&#x0D; Conclusion: There is an increase in incidence of dog bite facial injuries among children in our tertiary health care centre. Satisfactory healing outcomes were achieved with a thorough wound lavage and primary closure of non-infected wounds under appropriate rabies prophylaxis and proper antibiotic regimen.

A Case of a Serum Sickness-Like Reaction After Postexposure Rabies Prophylaxis

BackgroundSerum sickness secondary to rabies postexposure prophylaxis is not well documented in the medical literature. Our case describes serum sickness after exposure to human-derived rabies immunoglobulin (HRIG) and three human diploid rabies vaccines (HDCV) in a young adult male. Case ReportA 30-year-old previously healthy male patient presented to the Emergency Department with complaints of fever, rash, and jaundice, and had a hospital course complicated by biliary stenosis likely secondary to reactive periportal lymphadenopathy. His initial laboratory values demonstrated obstructive jaundice and slightly elevated complement component 4 levels. These symptoms likely are due to the course of HRIG and HDCV vaccines the patient completed after being exposed to a rabies-positive bat in his home. The patient was hospitalized for 8 days, during which he underwent an endoscopic retrograde cholangiopancreatography with sphincterotomy and biliary stenting. He had one repeat hospitalization for acute blood loss anemia attributed to sphincterotomy, which did not require transfusion or further intervention. Liver biopsy showed cholestatic hepatitis. Why Should an Emergency Physician Be Aware of This?Medical literature describing serum sickness or a serum sickness-like reaction occurring from exposure to HRIG or HDCV is sparse despite the commonality of postexposure rabies prophylaxis in health care. It is important to educate practitioners on this potential complication and highlight next potential consultations and treatments.