Human Rabies Cases Research Articles

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.

Trends and Clinico-Epidemiological Features of Human Rabies Cases in Bangladesh, 2006–2018

Background: Vaccinating dogs against rabies is an effective means of reducing human rabies. Methods: We analyzed 1,327 clinically diagnosed human rabies deaths and mass dog vaccination (MDV) data during 2006–2018 to quantify the impacts of MDV on human rabies incidence in Bangladesh and a subset of rabies death data (n = 422) for clinico-epidemiological analysis. Results: We found a positive and increasing trend of dog population vaccination (P = .01 and τ = 0.71) and a negative and declining trend (P < .001 and τ = −0.88) of human rabies cases (correlation coefficient, −0.82). Among 422 human rabies death cases, most victims (78%) sought treatment from traditional healers, and 12% received postexposure prophylaxis (PEP). The mean incubation period of rabies cases with exposure sites on the head and neck (35 days) was shorter than the upper limb (mean, 64 days; P = .02) and lower limb (mean, 89 days; P < .01). MDV is effective for reducing human rabies cases in Bangladesh. Conclusions: Creating awareness among the animal bite victims to stop relying on traditional healers rather seeking PEP, addressing the role of traditional healers through an awareness education program in respect to the treatment of dog bites, ensuring availability of PEP, and continuing to scale up MDV can help prevent human rabies deaths.Funding: NoneDisclosures: None

Regional and age difference of human rabies prevalence of the past fourteen years in China

ObjectiveThe aim of this study is to describe the epidemiological characteristics about regional and age difference of human rabies in the past fourteen years in China, and provide a reliable epidemiology basis for further control and prevention of human rabies. MethodsThe database of “China Public Health Science Data Center” affiliated Chinese CDC was searched with the key words of “rabies” or “epidemiology” or “morbidity” or “mortality” from 2004 to 2018 and the corresponding data about human rabies cases was collected referred to regional and age difference for describing the epidemiological characteristics of human rabies. ResultsIn this study, a total of nearly 26,315 rabies cases (1754 ± 253) and 25,691 rabies-related deaths (1712 ± 255) (Mean ± SE) were reported, and a decreasing trend about the morbidity and mortality of human rabies existed from 0.2039 and 0.2039 (1/100,000) in 2004 to 0.0304 and 0.0295 in 2018. Otherwise, regional difference of human rabies prevalence significantly existed, and juvenile and middle-aged population especially in 50–60 years old were more easily attacked and infected with rabies (all p < 0.05). ConclusionThis study proved that human rabies still is a major public health problem in China though a decreasing trend about the morbidity and mortality of human rabies existed in the past fourteen years.

Prevention of human rabies: a challenge for the European Union and the European Economic Area.

Rabies is enzootic in over one hundred countries worldwide. In the European Union/European Economic Area (EU/EEA), the vast majority of human rabies cases are travellers bitten by dogs in rabies-enzootic countries, mostly in Asia and Africa. Thus, EU/EEA travellers visiting rabies enzootic countries should be aware of the risk of being infected with the rabies virus when having physical contact with mammals. They should consider pre-exposure vaccination following criteria recommended by the World Health Organization and if unvaccinated, immediately seek medical attention in case of bites or scratches from mammals. As the majority of the EU/EEA countries are free from rabies in mammals, elimination of the disease (no enzootic circulation of the virus and low number of imported cases) has been achieved by 2020. However, illegal import of potentially infected animals, mainly dogs, poses a risk to public health and might threaten the elimination goal. Additionally, newly recognised bat lyssaviruses represent a potential emerging threat as the rabies vaccine may not confer protective immunity. To support preparedness activities in EU/EEA countries, guidance for the assessment and the management of the public health risk related to rabies but also other lyssaviruses, should be developed.

Lessons learnt from measures taken to prevent rabies introduction and spread into a long rabies free territory (case study of the Irkutsk Oblast)

Rabies is endemic on the considerable part of the Russian Federation, and it is associated with current natural outbreaks of the infection. The highest animal morbidity rates are reported in the central and southern regions of the European part of Russia and in the southern part of Western Siberia. The Irkutsk Oblast is among the few regions of our country, which are rabies free for several decades. The research was aimed at the analysis of factors aiding to the maintenance of the rabies free status of the region. Retrospective study of archive and previously published reports on human and animal rabies cases in the Irkutsk Oblast starting from 1954 was performed. Epidemics of urban rabies ceased in the region in 1970s. Sporadic rabies cases in dogs, reported in 1976 and later, could be imported or could result from the infection from bats. Diagnostic errors were also possible. Rabies is reported in foxes in the Subjects bordering the Irkutsk Oblast: Krasnoyarsk Krai and Republic of Buryatia. It is supposed that in case of the infection introduction the forest-steppe agricultural areas near the Angara River are likely to be affected due to high population of foxes. Relative geographic isolation of the Irkutsk Oblast favors to the long animal rabies freedom of this territory. The vast area of mountain taiga with low fox population serves as an ecological barrier. In 2007–2009 and in 2019, barrier oral vaccination was carried out along the border with the Krasnoyarsk Krai and on the west coast of Baikal Lake. Measures for anti-rabies vaccination of dogs and cats were intensified. Active virological monitoring is performed on a regular basis. The paper demonstrates cartograms of fox and wolf population density along with designation of sites, where oral vaccination of wild carnivores was performed.

Epidemiological aspects of human exposure cases to rabies by in the central west region of Tunisia

Abstract Introduction Rabies is a major public health problem in several countries in the South and East of the Mediterranean and in the Middle East. The objectives of this study were to describe the epidemiological profile of human exposures to rabies by a dog, as well as the profile of aggressive dogs during a period of 15 years in a region in the central west region of Tunisia. Methods We have included all cases of human exposure to a dog, reported between 2004 and 2018 in the Kasserine area. The source of the data was the directorate of primary health care in Kasserine. Results A total of 41,850 human exposure cases to a dog have been reported over the fifteen year study period with an annual average of 1937.5 cases. Among them, 29,062 cases (69.4%) were attacked by a bite. The crude incidence of dog bite cases was 441 per 100,000 population. The vaccination status of attacking dogs was unknown in 15.4% of the cases (n = 6423). Among all attacking dogs with a known vaccination status (n = 35427), 45.2% were vaccinated (n = 16017) and 54.7% (n = 19392) were unvaccinated. A significant increase in human exposure cases to dogs was noted from 2004 to 2018 (β = 11.7, p = &amp;lt;10-3). The number of exposures by an unknown dog or a known unvaccinated dog increased significantly (β = 28.02; p = &amp;lt;10-3 and b = 69.9, p = &amp;lt;10-3; respectively). However, the number of cases attacked by a known vaccinated dog decreased significantly (β = -86.4, p = &amp;lt;10-3). During the study period, five cases of human rabies were identified in the study area. Conclusions In Tunisia, human exposure to rabies by a dog has been on the rise. It could be linked to the period of popular and political movement that the country is going through. Key messages In this study, human exposures cases to rabies by unvaccinated dog is significantly increasing. It is crucial to strengthen appropriate preventive measures, such as mass vaccination and dog castration programs.

The World Rabies Day 2020: Collaborate and Vaccinate

Rabies constantly kills 59,000 people annually, mostly in Asia and Africa. Rabies, which is responsible for 99% of human rabies cases, is totally preventable by standard vaccinations. In 2015, a global call for action was made by the WHO, OIE, FAO, and GARC to join forces toward the elimination of dog-transmitted human rabies by the year 2030. All the tools and protocols to reach that target are readily available, and the feasibility of dog rabies elimination has been proven. Countries should drive the changes needed to engage into this global movement. Certainly, countries in the EMR require taking more critical steps to reach the rabies elimination target by 2030. The international awareness campaign of the WRD is an excellent occasion to assess challenges and opportunities toward rabies elimination.

Epidemiology of human rabies in South Africa, 2008 - 2018.

Human rabies cases continue to be reported annually in South Africa (SA). Previous investigations have shown the association between the occurrence of human rabies cases and dog rabies cases in the country. To describe the epidemiology of laboratory-confirmed human rabies cases in SA for the period 2008 - 2018. A retrospective document review of laboratory-confirmed human rabies cases for the period 2008 - 2018 was performed using a case register and related documentation available from the National Institute for Communicable Diseases. A total of 105 human rabies cases were laboratory confirmed from 2008 to 2018, with cases reported from all the provinces of SA except the Western Cape. Children and adolescents were most affected by the disease during the study period. In almost half of the cases, medical intervention was not sought after exposure. When victims did seek healthcare, deviations from post-exposure prophylaxis protocols were reported in some cases. The epidemiological trends of human rabies cases reported in SA for the period 2008 - 2018 remained largely the same as in previous reports. Dog-mediated rabies remains the main source of human rabies in SA.

Evaluating the role of surgical sterilisation in canine rabies control: A systematic review of impact and outcomes.

Current recommendations for the elimination of canine-mediated human rabies focus on mass dog vaccination as the most feasible and cost-effective strategy. However, attempts to control rabies are often combined with canine surgical sterilisation programmes. The added value of sterilisation is widely debated. A systematic review was undertaken to compare the outcomes and impact of vaccination and sterilisation programmes with vaccination only programmes. A systematic search of three electronic databases (CAB s, Medline and Global Health) and grey literature was performed. From 8696 abstracts found, 5554 unique studies were identified, and 16 studies met the inclusion criteria. Eight described vaccination only programmes and eight described vaccination and sterilisation programmes. Indicators of impact measured were dog bites and/or doses of post-exposure prophylaxis administered; numbers of dog and/or human rabies cases; dog population demographic changes; changes in health and welfare of dogs, and indicators related to human behaviour change. The studies were contextually very diverse, programmes being implemented were complex, and there was variation in measurement and reporting of key indicators. Therefore, it was difficult to compare the two types of intervention, and impossible to make an evaluation of the role of sterilisation, using this evidence. Given the large number of vaccination and sterilisation programmes conducted globally, the lack of studies available for review highlights a gap in data collection or reporting, essential for impact assessment. There are several knowledge gaps concerning the impact of the sterilisation component alone, as well as subsequent effects on rabies transmission and control. Prospective studies comparing the outcomes and impact of the two interventions would be required in order to establish any additional contribution of sterilisation, as well as the underlying mechanisms driving any changes. In the absence of such evidence, the priority for rabies control objectives should be implementation of mass vaccination, as currently recommended by the World Health Organisation.

Updates on the development of vaccines and therapeutic options against rabies

Even though rabies has been claiming more than 50,000 deaths annually worldwide, it is considered as a vaccine-preventable viral disease. More than 95 % of the total human rabies cases are caused by dogs. During the initial stage of infection, affected individuals usually show weakess at the bitten extremities and the virus can ultimately travel to the brain causing neurological signs. In attenuated (inactivated) form, the currently in use vaccines have been recommended by WHO for the prevention (i.e. pre-exposure prophylaxis, PrEP) and treatment (i.e. post-exposure prophylaxis, PEP) regime againstthe rabies virus (RABV). However, given that they normally require refrigeration and are costly, there have been discussions revolving around potential development of newer, safer and cheaper alternative that can perform better and more convenient than the ones that are currently in use. The current review aims to explore general characteristics of RABV before looking into potential candidates of vaccines that have been studied. Further studies on the pathogenic mechanism of RABV and therapeutic approaches are still required to prevent the deathly infection following clinical manifestation. In sum, integrated interventional strategy emphasizing human health and animal health is essential and requires collaboration between health authorities and the public.

ONE HEALTH STRATEGIES FOR RABIES OUTBREAK CONTROL IN DOMPU, WEST NUSA TENGGARA, INDONESIA: RECOMMENDATIONS FOR EMERGENCY RESPONSE

Objective: Almost 1,315 cases of rabid animal bites and 9 fatal cases of human rabies were declared in February 2019 due to the outbreak of rabies in Dompu, West Nusa Tenggara (WNT), Indonesia, and this outbreak has affected more than 240,000 people. We report a recommendation for emergency response of one health strategies for rabies outbreak control in Dompu, WNT, Indonesia.&#x0D; Methods: We implemented the OH approach to expedite the management of outbreaks in Dompu. A meeting with the local government of Dompu district (GoD) was held after an outbreak report was released in February 2019. Furthermore, we encouraged the GoD to adopt OH to manage and control the outbreak.&#x0D; Results: In Indonesia, the concept is not clear but gradually developing. The burgeoning issues are tackled by GoD through some initiatives, but implementing OH is itself a challenge. We encourage GoD to focus on these gaps and prioritize the health issues for which the best suitable results can be achieved by OH approach.&#x0D; Conclusion: The OH approach accelerated the prevention of rabies outbreaks in Dompu. To effectively implement the OH approach, it is important to design a legal and institutional framework. In addition, it is essential to raise awareness among policy-makers, including political leadership and enhance the government’s regular budget for the OH approach.

An economic case study of the control of dog-mediated rabies by an animal welfare organisation in Jaipur, India

A global strategic plan for the elimination of dog-mediated human rabies deaths by 2030 was announced in 2018. The cost-effectiveness of annual mass dog vaccination programmes, as a control and elimination method, has been advocated on many occasions. Complementary methods, such as animal birth control (ABC) activities, have received less attention. This paper provides a case-study of a programme operated by Help in Suffering (HIS) in Jaipur, India from 1994/95 until 2016/17 comprising both ABC and additional vaccination-only activities. The availability of cost data alongside information on dog numbers, dog bites and human rabies cases provided an exceptionally detailed and unique retrospective dataset recording actual events and expenditures. Updated to 2016/17 prices, the total cost of the programme was 658,744 USD. Since 2007/2008, activity costs have been separated and returned costs of 10.78 USD per dog, both sterilised and vaccinated, and 1.86 USD per dog, vaccinated only. Over the course of the programme, the number of disability-adjusted life years (DALYs) due to premature death and the distress associated with dog bites was estimated to be 36,246 fewer than would have been expected if HIS had not been operating, based on a counterfactual scenario using pre-intervention values. Linking the DALY figure to the cost of the activities undertaken by HIS yields a cost of 26 USD per DALY averted. Discounted at 3%, the DALYs averted equate to 16,587 at a cost of 40 USD per DALY averted. Both cases make it a very cost-effective intervention, in relation to the threshold of investing one year’s gross domestic product (GDP) per DALY averted (1981 USD in 2016/17). The monetary benefit from fewer dog bites and clinical human rabies cases requiring treatment amounted to 5.62 million USD after discounting, which, if attributed to Help in Suffering, yields a monetary benefit-cost ratio of 8.5. Thus, the potential monetary benefits greatly outweigh the programme costs, even without considering the DALYs averted. If a modest notional monetary value of one year’s GDP is assigned to represent the human capital or production value of DALYs averted, the discounted societal economic benefit reaches 38.48 million USD and implies a benefit-cost ratio of 58.4. These economic analyses demonstrate that ABC activities in combination with additional vaccination efforts can be a cost-effective control measure for dog-mediated human rabies.

Retrospective Evaluation of Implementation of Long-Term Forecast on Spatial Spread of Rabies in the Asian Part of Russia

Objective:To evaluate the historical long-term forecast of the spatial spread of rabies in Siberia and Far East and to characterize modern approaches to spatial forecasting. The concept of spatial spread of rabies in the Asian part of Russia, developed in the 80s of the twentieth century, is subjected to critical analysis based on information on rabies registration for 1881–1980 and zoogeographic data. At that time, 5 rabies enzootic regions were identified, and the most probable directions of further exportation of infection suggested. At first, a review of published data on human and animal rabies cases for the period of 1985–2019 was undertaken (including reference publications). Data on cases of rabies among humans and animals were selected for which geographical coordinates could be determined. Mapping was performed using GIS (QGIS 3.12.0 software and “Natural Earth” and “OpenStreetMap” electronic maps). Comparison of maps for different time periods demonstrated that rabies incidence was recorded mainly within the previously identified risk areas. However, the occurrence of human disease in different regions did not always correspond to the intensity of epizootics and the predicted risk. Next, in an attempt to correct the prognosis of the spatiotemporal rabies spread, we reviewed publications that incorporated virus genetic data along with GIS technology and modeling application. The distribution of the three major rabies virus lineages (“steppe”, “Arctiс-like”, “Arctic”) corresponded to the regions that were previously identified. The spread of fox rabies (the “steppe” rabies virus lineage) in the north-east direction was described. In several instances, rabies outbreaks in southern Siberia and Far East were associated with cross-border movement of the virus from Kazakhstan, Mongolia and China. Data on the speed of the epizootic waves, pathways, and natural barriers for virus spread are discussed. The correction of the forecast for rabies virus circulation and spread is important for the development of control strategies in the region, including oral vaccination of wildlife virus reservoirs.

Factors associated with mobile phone ownership and potential use for rabies vaccination campaigns in southern Malawi

BackgroundRabies is a fatal but preventable viral disease, which causes an estimated 59 000 human deaths globally every year. The vast majority of human rabies cases are attributable to bites from infected domestic dogs and consequently control of rabies in the dog population through mass vaccination campaigns is considered the most effective method of eliminating the disease. Achieving the WHO target of 70% vaccination coverage has proven challenging in low-resource settings such as Sub Saharan Africa, and lack of public awareness about rabies vaccination campaigns is a major barrier to their success. In this study we surveyed communities in three districts in Southern Malawi to assess the extent of and socio-economic factors associated with mobile phone ownership and explore the attitudes of communities towards the use of short message service (SMS) to inform them of upcoming rabies vaccination clinics.MethodsThis study was carried out between 1 October–3 December 2018 during the post-vaccination assessment of the annual dog rabies campaign in Blantyre, Zomba and Chiradzulu districts, Malawi. 1882 questionnaires were administered to households in 90 vaccination zones. The surveys gathered data on mobile phone ownership and use, and barriers to mobile phone access. A multivariable regression model was used to understand factors related to mobile phone ownership.ResultsMost survey respondents owned or had use of a mobile phone, however there was evidence of an inequality of access, with higher education level, living in Blantyre district and being male positively associated with mobile phone ownership. The principal barrier to mobile phone ownership was the cost of the phone itself. Basic feature phones were most common and few owned smartphones. SMS was commonly used and the main reason for not using SMS was illiteracy. Attitudes to receiving SMS reminders about future rabies vaccination campaigns were positive.ConclusionsThe study showed a majority of those surveyed have the use of a mobile phone and most mobile phone owners indicated they would like to receive SMS messages about future rabies vaccination campaigns. This study provides insight into the feasibility of distributing information about rabies vaccination campaigns using mobile phones in Malawi.

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

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

The impact of anthropogenic and environmental factors on human rabies cases in China.

Human rabies is a public health problem in Asia, especially in less-developed regions where the disease is under-reported because of a lack of epidemiological surveillance. To address this gap, we collected data on human rabies in Yunnan Province, China, between 2005 and 2016. Using statistical mapping techniques, we correlated the occurrence of human rabies to environmental (elevation, precipitation, normalized difference vegetation index [NDVI], temperature and distance to the nearest main rivers) and anthropogenic (human and dog population density, distance to the nearest main roads and gross domestic product [GDP]) factors. We used a performance score, the average area under the receiver operator characteristic curve (0.88), to validate our risk model. Using this model, we found that environmental factors were more strongly associated with human rabies occurrence than anthropogenic factors. Areas with elevation below 2000metres, GDP per capita between $750 and $4500/year and NDVI below 0.07 were associated with greater risk of human rabies. Rabies control in China should specifically target these areas.

Characterization of the Th17 profile immune response in cases of human rabies transmitted by dogs and its interference in the disease pathogenesis.

The Th17 profile immune response is influenced by the presence of cytokines such as IL-1, IL-6, TGF-β, IL-17, and IL-23. We sought to characterize the Th17 profile in CNS samples from human rabies cases transmitted by dogs and examine its possible influence on disease pathogenesis. We observed a high expression of TGF-β, followed by IL-23, IL-17 and IL-6, and a low expression of IL-1β and IFN-γ. Those results suggest the participation of Th17 in rabies virus neuroinfection transmitted by dogs. IL-23 probably plays a role in maintaining the Th17 profile, but it can also interfere with the establishment of the Th1 profile and viral clearance.

Epidemiology of human exposure to rabies in Nunavik: incidence, the role of dog bites and their context, and victim profiles

BackgroundIn Nunavik, Arctic rabies is still endemic due to a spillover from wildlife to dogs. The prevention of human exposure and the management of potential exposure is a significant public health concern in this region.MethodsThis study retrospectively describes cases of potential exposure to rabies in humans as reported to the Nunavik Public Health Board through their registry of reported cases. We used multi-correspondence analysis as well as univariable and multivariable regression models to test for differences between children and adults in reported cases, and to examine the contexts of exposure to dogs and dog attacks.ResultsFrom 2008 to 2017, 320 cases of potential exposure to rabies were reported, 92% of which were linked to dogs. The annual incidence rate was 2.5 per 1000 people. The incidence increased significantly during the study period, although the reasons for this are unclear. Fifteen cases of exposure were with rabid animals, mostly dogs (9 of 15). No human cases of rabies occurred thanks to adequate medical case management. Two specific profiles for potential exposure to rabies were identified based on age and gender. The first was children (< 15 y/o), male or female, who were more likely to be exposed through playing with dogs and were more often injured in the head and/or neck. The second was young male adults (aged 15 to 34 y/o), who were more involved with wildlife than other age groups and mostly injured in the upper limbs and as a result of a reaction by the animal.ConclusionRabies is a real public health threat in Nunavik. Potential human exposure needs to be prevented, and prevention measures should be tailored to the two risk profiles identified based on age, gender and animal species involved.

Responses to the Risk of Canine and Human Rabies in the City of Sibut, Central African Republic

In Sibut (CAR), the increase in bites by stray dogs and two cases of human rabies alerted health authorities in 2019. The answers were the vaccinations of humans and of dog (780 dogs). Among the 127 humans bitten and identified, 87% received a first injection of post-exposure prophylaxis. The drop-out between the first and third doses was 41%. Communication on rabies and the provision of vaccines and serums to the population are necessary, but difficult to achieve in the crisis conditions of the country.

Trends and clinico-epidemiological features of human rabies cases in Bangladesh 2006\u20132018

Vaccinating dogs against rabies is an effective means of reducing human rabies. We subjected 1327 clinically diagnosed human rabies death and mass dog vaccination (MDV) data during 2006–2018 to quantify the impacts of MDV on human rabies incidence in Bangladesh and a subset of rabies death data (422) for clinico-epidemiological analysis. A positive and increasing trend of MDV (p = 0.01 and tau = 0.71) and a negative and declining trend (p < 0.001 and tau = −0.88) of human rabies cases (Correlation coefficient: −0.82) have been observed. Among 422 deaths, the majority (78%) of the victims sought treatment from traditional healers, and 12% received post-exposure prophylaxis (PEP). The mean incubation period of rabies in cases with exposure sites on the head & neck (35 days) was shorter than the upper limb (mean = 64 days, p = 0.02) and lower limb (mean = 89 days, p < 0.01). MDV has been found to be effective for reducing human rabies cases in Bangladesh. Creating awareness among the animal bite victims to stop reliance on traditional healers rather seeking PEP, addressing the role of traditional healers through awareness education programme with respect to the treatment of dog bites, ensuring availability of PEP, and continuing to scale up MDV may help to prevent human rabies deaths.