Human Rabies Research Articles

Prediction of the size and spatial distribution of free-roaming dog populations in urban areas of Nepal

A factor constraining the elimination of dog-mediated human rabies is limited information on the size and spatial distribution of free-roaming dog populations (FRDPs). The aim of this study was to develop a statistical model to predict the size of free-roaming dog populations and the spatial distribution of free-roaming dogs in urban areas of Nepal, based on real-world dog census data from the Himalayan Animal Rescue Trust (HART) and Animal Nepal. Candidate explanatory variables included proximity to roads, building density, specific building types, human population density and normalised difference vegetation index (NDVI). A multivariable Poisson point process model was developed to estimate dog population size in four study locations in urban Nepal, with building density and distance from nearest retail food establishment or lodgings as explanatory variables. The proposed model accurately predicted, within a 95 % confidence interval, the surveyed FRDP size and spatial distribution for all four study locations. This model is proposed for further testing and refinement in other locations as a decision-support tool alongside observational dog population size estimates, to inform dog health and public health initiatives including rabies elimination efforts to support the ‘zero by 30′ global mission.

Rabies in Pakistan: Policies and recommendations

AbstractRabies, commonly referred to as the endemic disease of the impoverished in Pakistan, remains a significant public health concern. Globally, it contributes to over 55,000 fatalities annually, with 31,000 cases reported in Asia, predominantly among children. In Karachi, the yearly occurrence of rabies ranges between 7 and 9.8 cases per million individuals. However, the actual burden is likely underestimated due to underreporting. Key challenges in Pakistan include limited awareness and increasing dog bite incidents. To address this, comprehensive educational programs focusing on proper wound care, the ineffectiveness of homemade remedies, the importance of early medical intervention, and the administration of vaccines and post‐exposure prophylaxis are imperative. Implementing a One Health model, encompassing mass vaccination, cost‐effective treatments, training on intradermal vaccine administration, accurate data collection, and community awareness initiatives, is essential for rabies control. This article aims to provide policymakers and scholars with valuable insights into the primary factors and challenges of controlling endemic human rabies in Pakistan and proposes effective strategies for its control, with the ultimate goal of achieving rabies‐free status by 2030.

Study on immune persistence of the CTN-1V strain rabies vaccine in humans

This study is a single-arm, single-center phase IV clinical trial on a rabies vaccine that has been marketed in China. The Vero cells and CTN-1V strain are used in the rabies vaccine product. The purpose of this study was to investigate the safety, immunogenicity and immune persistence of this product. One hundred and forty-nine participants were enrolled to the study, all of whom were included in the safety analysis set (SS), among which 116 participants were included in the protocol analysis set (PPS), One hundred and fifteen participants were included in the 6-month immune persistence analysis set (IPS6) and 111 in the 12-month immune persistence analysis set IPS12. Results showed that: 1) In the SS analysis set, adverse reactions were mainly pyrexia and pain at the vaccination site, the severity of which were mostly grade 1, and concentrated in 0–3 days after vaccination. No grade 3 or above adverse events and serious adverse events (SAE) related to the experimental vaccine were observed. 2) In the PPS analysis set, the antibody positive conversion rate reached 100% at 14 days after full immunization of the pre-immunized negative population; The antibody geometric mean titer (GMT) (95% CI) was 14.82 (13.00, 16.90). 3) The positive rate of serum neutralizing antibody was 93.91 % and the GMT at 1.58 IU/ml at 6 months after full immunization. The positive rate of neutralizing antibody was 85.59 % and GMT at 1.30 IU/ml at 12 months after immunization. Our results show that the human rabies vaccine with the CTN-1V strain and Vero cells as matrix had good safety, immunogenicity and immune persistence in our study.

Retraction: Case of human rabies despite post-exposure prophylaxis (PEP) and complete recovery after intrathecal rabies immunoglobulin (RIG)

Retraction: Case of human rabies despite post-exposure prophylaxis (PEP) and complete recovery after intrathecal rabies immunoglobulin (RIG)

Real-world evidence of rabies post-exposure prophylaxis in Serbia: Nation-wide observational study (2017–2019)

BackgroundRabies remains a deadly zoonotic disease, primarily prevalent in Eastern European countries, with a significant global burden in Asia and Africa. Post-exposure prophylaxis (PEP) is critical to prevent clinical rabies. Serbia, a country with a relatively low animal rabies incidence, has been implementing a 4-dose Essen PEP regimen for 13 years. This real-world study aimed to assess the effectiveness of the 4-dose Essen regimen, considering demographic and clinical factors, after WHO Category III exposure. MethodThe study included 601 patients who received the 4-dose Essen PEP and 79 who received an additional 5th dose. ResultsAge emerged as a critical factor influencing seroconversion rates after the 4-dose regimen, with older individuals exhibiting lower RVNA titers. Logistic regression indicated a 3.18% decrease in seroconversion odds for each added year of age. The Cox proportional hazards mixed model highlighted age-related risks, with age groups 45–60 and 75–92 at the highest risk of non-seroconversion. Human Rabies Immune Globulin (HRIG) administration was associated with lower RVNA values after the 4-dose regimen, suggesting interference with vaccine immunogenicity among people who received larger doses of HRIG. ConclusionsThis study provides valuable real-world evidence for rabies PEP in a non-homogeneous population with potential comorbidities. The results underscore the importance of optimizing PEP strategies, particularly in older individuals, and reconsidering HRIG dosing to improve seroconversion rates.

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

Modeling of Human Rabies Cases in Brazil in Different Future Global Warming Scenarios.

Bat species have been observed to have the potential to expand their distribution in response to climate change, thereby influencing shifts in the spatial distribution and population dynamics of human rabies cases. In this study, we applied an ensemble niche modeling approach to project climatic suitability under different future global warming scenarios for human rabies cases in Brazil, and assessed the impact on the probability of emergence of new cases. We obtained notification records of human rabies cases in all Brazilian cities from January 2001 to August 2023, as reported by the State and Municipal Health Departments. The current and future climate data were sourced from a digital repository on the WorldClim website. The future bioclimatic variables provided were downscaled climate projections from CMIP6 (a global model ensemble) and extracted from the regionalized climate model HadGEM3-GC31-LL for three future socioeconomic scenarios over four periods (2021-2100). Seven statistical algorithms (MAXENT, MARS, RF, FDA, CTA, GAM, and GLM) were selected for modeling human rabies. Temperature seasonality was the bioclimatic variable with the highest relative contribution to both current and future consensus models. Future scenario modeling for human rabies indicated a trend of changes in the areas of occurrence, maintaining the current pace of global warming, population growth, socioeconomic instability, and the loss of natural areas. In Brazil, there are areas with a higher likelihood of climatic factors contributing to the emergence of cases. When assessing future scenarios, a change in the local climatic suitability is observed that may lead to a reduction or increase in cases, depending on the region.

Dog ecology and rabies knowledge, attitude and practice (KAP) in the Northern Communal Areas of Namibia.

In 2021, a comprehensive dog demographic questionnaire combined with a KAP survey were conducted in the northern communal areas (NCAs) of Namibia with the aim of gaining a better understanding of dog populations, owner behaviour, and knowledge, attitudes and practices (KAP) relating to rabies. The survey of 3,726 households across the eight regions of the NCAs provided insights that will inform interventions in order to improve human rabies prevention and Namibia's dog rabies control strategy. The results showed a relatively low average human/dog ratio (HDR) of 5.4:1 indicating a surprisingly high dog population of at least 272,000 dogs in the NCAs, 93% of which appear to be owned but are free-roaming. Data analysis revealed opportunities but also highlighted needs for improvements in rabies surveillance and mass dog vaccinations. Although knowledge, attitude, and practice scores towards epidemiologic and clinical aspects, human rabies prevention, and dog rabies vaccination were deemed to be acceptable, the survey nevertheless revealed deficiencies in certain aspects in some of the population. Interestingly, data seemed to indicate relatively high dog bite incidences per 100,000 people, ranging between 262 and 1,369 and a certain number of unreported human rabies cases. Despite the very high number of dogs, only 50% of dog-owning households reported having vaccinated their dogs. In order to address these issues, the planning, announcement, and implementation of mass dog vaccination campaigns needs to be adapted to achieve adequate vaccination coverage. Another focus needs to be on rabies awareness and education if Namibia is to be significantly contributing to the global goal of "Zero by 30".

Human dog-mediated rabies in the Circle of Kati, Mali: An epidemiological situation analysis and the stakeholder’s knowledge regarding rabies and the One Health approach

Background and Aim: Human dog-transmitted rabies remains a serious public health issue in Mali despite efforts to mitigate it. Indeed, several stakeholders have implemented multiple initiatives for years. However, there is still a lack of cooperation among stakeholders. This study was conducted to capture situational data on rabies and One Health practices among key actors involved in the fight against rabies in Mali. Materials and Methods: Data from veterinary and medical services were collected for analysis. Data collection was based on a review of technical documents (epidemiology of rabies in animals and humans and activities conducted to tackle the disease) and stakeholder interviews (awareness of rabies and the One Health approach). Results: With regard to the epidemiological situation, the findings revealed unsatisfactory vaccination coverage in dogs and low suspected sample collection for laboratory diagnosis. In addition, only half of the exposed individuals received complete post-exposure prophylaxis. A survey carried out by experts in the fields of animal health, human health, and the environment indicated that only 22.47% were well aware of rabies and had never heard of the One Health approach. Overall, there was no significant association between knowledge and participant sector of origin (p > 0.05), highlighting the need for operationalization of the One Health approach in Mali. Conclusion: Therefore, an integrated national action plan for rabies control should be developed with a particular focus on capacity building, particularly in the area of the One Health core competencies. Keywords: epidemiology, multisectoral engagement, One Health, Public Health priority zoonoses, Stakeholders.

ANALYSIS OF KNOWLEDGE AND ATTITUDE AGAINST RABIES IN DENBANTAS VILLAGE TABANAN

Rabies is a zoonotic disease and it is well known to the general public that rabies can be transmitted to humans through the bite of an infected animal. The signs raised by rabies in dogs and humans are divided into two, namely furious and paralysis. The purpose of this study was to determine the relationship between the knowledge and attitudes of villagers infected with rabies towards its mitigation in Tabanan Regency. The study design was an observational design. The number of respondents in this study was all families who were raising dogs in Banjar Tuakilang Baleran and Banjar Celagi, Denbantas Village, Tabanan District, Tabanan Regency, Bali. The analysis used in this study is Chi square analysis to determine the relationship between two variables on the basis of testing the difference in the proportion value of the observation value with the expected value. In p value, a value of 0.489 was obtained in Banjar Tuakilang Baleran and a value of 0.500 in Banjar Celagi, the value was > 0.05. Based on the results of this description, it can be decided that there is no relationship between knowledge and attitudes towards rabies virus control. The conclusion of the study showed that the knowledge factor with public attitudes had no effect on the control of the rabies virus. Suggestions for the community, especially in Banjar Tuakilang Baleran and Celagi, Denbantas Village, Tabanan District, Tabanan Regency can maintain and improve knowledge and attitudes related to rabies.

Human Rabies Treatment-From Palliation to Promise.

Rabies encephalitis has plagued humankind for thousands of years. In developed countries, access to preventive care, both pre-exposure and post-exposure, has significantly reduced the burden of suffering and disease. However, around the world, rabies remains a neglected tropical disease, largely due to uncontrolled dog rabies, and tens of thousands perish each year. Currently, the standard of care for management of rabies encephalitis is palliation. Heroic attempts to treat human rabies patients over the last few decades have yielded glimpses into our understanding of pathophysiology, opening the door to the development of new antiviral therapies and modalities of treatment. Researchers continue to investigate new compounds and approaches to therapy, yet there remain real challenges given the complexity of the disease. We explore and review some of the promising therapies on the horizon in pursuit of a salvage treatment for rabies.

Chukotka as a Portal for the Rabies Introduction into Kamchatka (Systematic Review)

The aim of this review was to assess the peculiarities of distribution and epidemiological risk of rabies in the extreme northeast of Asia. The systematic review was prepared through synthesizing publications on rabies over 1860–2022 (n=22) and previously unpublished data for 2009–2023. From the late 19th century until the 1980s, rabies epizootics were consistently observed in Chukotka and Kamchatka. A correlation was found between the time of occurrence of rabies in those territories with a lag period of 1–2 years (r=0.349; p=0.054). In 2009–2023, 24 animal rabies cases were confirmed in Chukotka; rabies has not been registered in Kamchatka since 1981. Until 1982, 5 confirmed human rabies cases were described in Chukotka, as well as 4 lethal cases presumably due to rabies (Chukotka – 3, Kamchatka – 1). The similarity of the spatial distribution of epizootics in different periods of time was established. Rabies was detected mainly in the area of the permanent polar fox (Vulpes lagopus) habitation, in the coastal tundra from the mouth of the Kolyma River to the Anadyr Gulf. Outside this territory (the valleys of the Anadyr and Penzhina Rivers, the Kamchatka Peninsula), rabies was reported in red foxes (Vulpes vulpes). At present, the importance of the polar fox in the spread of rabies in Chukotka has decreased, while the significance of the red fox has increased substantially. Due to vaccination, rabies among dogs is recorded sporadically. Rabies virus isolates from Chukotka belong to the Arctic genetic lineage (Arctic-3 group), which has a circumpolar distribution. The possibility of independent circulation of the rabies virus in the Kamchatka Peninsula is doubtful because of the limited size of the red fox population. Based on the mapping, possible directions for the introduction of rabies to Kamchatka from Chukotka have been identified. Barrier oral rabies vaccination of foxes is recommended during the years of high abundance of red and polar foxes in Chukotka.

Epidemiological Characteristics of Human Rabies in Urban and Suburban Districts in Shanghai, 2006–2021

Objective: Rabies is a vaccine-preventable, viral zoonotic disease caused by a lyssavirus. This study was aimed at analyzing the epidemiological characteristics of human rabies in Shanghai to provide valuable information to support accurate prevention and control. Methods: Individual-level data on human rabies and dog bites/attacks in Shanghai were collected from 2006 to 2021. Demographic characteristics, spatial and seasonal patterns, and correlations were analyzed to explore the epidemiological profiles. Infection risk was predicted with a Bayesian aggression model. Results: A total of 43 human rabies cases were registered in Shanghai in 2006–2021; the annual average incidence rate was 0.01/100000. Males and residents at ages of 10 to 19 years and over 50 years had an elevated risk of rabies. All cases were reported in suburban districts and peaked in July. The body parts most frequently injured by dogs were the hands (48.84%). The fatality rate was 100%. Most cases (86.05%) were not treated after exposure. A total of 310 dog bites/attacks were reported and significantly correlated with the number of cases (P=0.010). The predicted risk of human rabies was higher in suburban than urban areas. Conclusion: The incidence of human rabies in Shanghai was relatively low; nevertheless, risk still existed, particularly in suburban areas.

Usefulness of minimally invasive autopsy in the diagnosis of arboviruses to increase the sensitivity of the Epidemiological Surveillance System in Ceará, Brazil.

To create a protocol for performing minimally invasive autopsies (MIA) in detecting deaths from arboviruses and report preliminary data from its application in Ceará state, Brazil. Training was provided to medical pathologists on MIA. A protocol was established for performing MIA, defining criteria for sample collection, storage methods, and diagnoses to be carried out according to the type of biological sample; 43 MIAs were performed in three months. Of these, 21 (48.8%) arrived at the Death Verification Service (SVO) with arboviruses as a diagnostic hypothesis, and seven (16.3%) were confirmed (six chikungunya cases and one dengue case); cases of COVID-19 (n = 9), tuberculosis (n = 5), meningitis (n = 4), cryptococcosis (n = 1), Creutzfeldt-Jakob disease (n = 1), breast cancer (n = 1), and human rabies (n = 1) were also confirmed. The protocol implemented enabled identification of a larger number of suspected arbovirus-related deaths, as well as confirmation of other diseases of interest for surveillance. A protocol was developed to perform minimally invasive autopsies (MIAs) in Death Verification Services (SVO), capable of expanding the system's capacity to identify a greater number of deaths suspected to be due to arboviruses. The experience suggests that in-service trained health professionals are able to perform MIA, and that use of this technique in SVOs has been shown to be capable of increasing the system's sensitivity in detecting deaths of interest to public health. Trained professionals will be able to collect biological material in hospitals, through MIA, in cases of interest for health surveillance and when family members do not allow a complete conventional autopsy to be performed.

The struggle in the attempt to eliminate dog-mediated human rabies in Nigeria by 2030: a retrospective study from 2020 to 2023

The struggle in the attempt to eliminate dog-mediated human rabies in Nigeria by 2030: a retrospective study from 2020 to 2023

Evaluation of Animal Birth Control Program in an Urban Area of North Kerala

Background: India contributes to 36% of global rabies-related deaths, according to the World Health Organization. To address the issue of increased number of stray dog exposures, the Kerala Government initiated a comprehensive plan that includes an intensive animal birth control (ABC) program along with antirabies vaccination. This study was conducted with the objective of evaluating the implementation of the ABC program in the corporation area of Kozhikode district. Materials and Methods: Evaluation of the ABC program was performed based on the Standard Operating Procedures proposed by the Animal Welfare Board of India. The program was evaluated using input–output analysis. Results: The input indicators included the infrastructure, workforce, equipment, and logistics for the conduct of the program. As per a survey conducted in Kozhikode Municipal Corporation in 2018, there were 13,182 ± 1612 stray dogs. The program includes sterilization and vaccination, as well as pet dog licensing and microchipping services. Even though a remarkable reduction in animal exposures is not seen in corporation area, not much cases of human rabies were reported. Conclusion: A single ABC clinic catering to a large population may not be enough to meet the increasing stray dog population. Achievements gained by the program may be diluted due to insufficient workforce and procedures. Sustained coverage of ABC programs to some extent can solve the frequent shortages of vaccines and hence the increased dependence on PEP which is overburdening the health system. The program may be expanded to rural areas also.

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 & 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.

A debate on elimination of dog-mediated human rabies in developing countries by 2030

Abstract Rabies is a vaccine-preventable viral disease that affects over 150 countries and territories worldwide. This neglected disease is almost always fatal once clinical signs manifest and is thus responsible for approximately 59,000 annual deaths. Due to globalization, rabies continues to be seen as a disease of developing countries and more emphasis, both nationally and internationally, is put on fighting infectious diseases that also affect economically developed countries. Even though the elimination of dog-mediated rabies in Europe and North America has proved the possibility of its eradication, rabies is still a persistent public health concern in low- and middle-income countries. It is believed that the interplay of sustainable investment strategies and rabies education, through developed countries, could positively affect the cooperation of culturally diverse regions and could help garner coordinated action from different areas affected by dog-mediated rabies. Breaking the rabies transmission cycle requires a comprehensive approach that includes increased vaccination efforts, improved surveillance and control of wildlife populations, and public education and awareness. More global effort must be put into these efforts to effectively combat the spread of rabies and protect public health. We herein examine various strategies and innovative financing methods for eliminating dog-mediated human rabies from the developing world to achieve the World Health Organization’s (WHO) goal of zero rabies deaths by 2030.

A Notable Increase in Human Rabies Mortality After Ten Years in Iran in 2022: A Case Series Study

Rabies virus is responsible for 60000 deaths annually worldwide, and over 95% of all human rabies deaths occur in developing countries. In Iran, the annual number of animal bites is 180 per 100000 people, and rabies control programs focus more on post-exposure prophylaxis (PEP). In this study, the data on people whose death was caused by rabies were obtained from the WHO Collaborating Center (CC) for Reference and Research on Rabies (Pasteur Institute of Iran) from 2011 to 2022. Data analysis showed a remarkable increase in human rabies mortality rate after 10 years in Iran in 2022, with 14 cases. Then, the causes were investigated despite prevention measures. The increase in human rabies cases in Iran indicates that the currently used control methods are insufficient. Controlling the population of stray dogs, sterilization, and vaccination coverage of 70% are the most essential and basic steps in preventing rabies.