Recent Research - April 2018

Advocacy / Policy

Estimating the burden of rabies in Ethiopia by tracing dog bite victims. 655 animal bite cases were traced to their communities and further victims identified. Annual suspected rabid dog exposures were estimated per evaluated urban, rural highland and rural lowland district at, respectively, 135, 101 and 86 bites, which led, respectively, to about 1, 4 and 3 deaths per 100,000 population. Average costs per completed PET were 23, 31 and 40 USD, which was significantly higher in rural districts. Extrapolation of the district results to the national level indicated an annual estimate of approximately 3,000 human deaths resulting in about 194,000 DALYs per year and 97,000 exposed persons requiring on average 2 million USD treatment costs per year countrywide.

Rabies in the Americas: 1998-2014. This paper presents longitudinal data for 21 LAC countries on dog vaccination, PEP and rabies surveillance.  Dog and human rabies have decreased significantly, but differences in human and dog rabies incidence rates and dog vaccination rates were shown between low, middle and high-income countries. At the peak, over 50 million dogs were vaccinated annually in national campaigns in the countries represented. On average, over 2 million doses of human vaccine were applied annually. In the most recent survey, only 37% of countries reported that they had sufficient financial resources to meet the program objectives. The data show a sufficient and sustained effort of the LAC countries in the area of dog vaccination and provide understanding of the baseline effort required to reduce dog-mediated rabies incidence.

 

Diagnosis and surveillance

Evaluation of Monoclonal Antibody-Based Direct, Rapid Immunohistochemical Test for Rabies Diagnosis. The dRIT test has a worldwide promising application, particularly in developing countries. However, no commercial conjugated antibody is available to meet the laboratory demand. We describe here the production of a monoclonal antibody (MAb) against rabies virus (RABV) N protein and its use as a biotinylated conjugate in a dRIT. Results showed that the dRIT had 100% specificity (95% CI 0.93-1.00) and 96.49% sensitivity (95% CI 0.88-1.00) as compared with the gold standard FAT. It therefore provides a simple, economical alternative to FAT.

Application and Comparative Evaluation of FAT, dRIT and RT-PCR Tests for the Detection of Rabies Virus Antigen or Nucleic Acid in Brain Samples of Animals Suspected of Rabies in India. DFA, dRIT and RT-PCR diagnostic tests were compared on 257 brain samples, including decomposed samples. The results confirm 100% corroboration between DFA and dRIT, buttress the applicability of dRIT in the simple and rapid diagnosis of rabies in animals, and reaffirm the suitability of RT-PCR for samples unfit for testing either by DFA or dRIT.

Rabies surveillance in the United States during 2016. During 2016, 50 states and Puerto Rico reported 4,910 rabid animals to the CDC of which 4,487 (91.4%) involved wildlife. Relative contributions by the major animal groups were as follows: 1,646 (33.5%) bats, 1,403 (28.6%) raccoons, 1,031 (21.0%) skunks, 313 (6.4%) foxes, 257 (5.2%) cats, 70 (1.4%) cattle, and 58 (1.2%) dogs. There was a 4.6% decrease in the number of samples submitted for testing in 2016, compared with 2015. No human rabies deaths were reported in 2016. Laboratory testing of animals suspected to be rabid remains a critical public health function and continues to be a cost-effective method to directly influence human rabies postexposure prophylaxis recommendations

Potential Confounding of Diagnosis of Rabies in Patients with Recent Receipt of Intravenous Immune Globulin. This report describes six patients who were tested for rabies by CDC and who met CSTE criteria for confirmed human rabies and four patients who were found to have serum RLNAs despite having not been vaccinated for rabies. None of these 10 patients received a rabies diagnosis; rather, they were considered to have been passively immunized against rabies through recent receipt of intravenous immune globulin (IVIG).

PEP

Management of dog bites by frontline service providers in primary healthcare facilities in the Greater Accra Region of Ghana, 2014-2015. 57.8% of 232 frontline service providers were correct in that the rabies virus is the causative agent of rabies, 39.2% attributed it to a dog bite, 2.6% did not know the cause, and one person attributed it to the herpes virus. Only 15.5% knew the incubation period in dogs and the period required to observe for signs of a rabies infection. 42.2% of the did not know how to administer RIG. Of the facilities visited, 76% did not have the rabies vaccines and 44% did not know where to get rabies vaccines from. Most of the service providers (87.9%; 204/232) had never reported either a dog bite or a suspected case of rabies.

Rabies Vaccine Hesitancy and Deaths Among Pregnant and Breastfeeding Women - Vietnam, 2015-2016.During 2015-2016, among 169 cases reported in Vietnam, two probable cases of rabies were reported in breastfeeding mothers and four in pregnant women, all of whom had been bitten by dogs. All six patients died. Three of the four pregnant women had cesarean deliveries. In each case, families reported the patient's fear of risk to the fetus or breastfed child as the primary barrier to receiving PEP.

Education

A rabies lesson improves rabies knowledge amongst primary school children in Zomba, Malawi. Knowledge and attitudes towards rabies were assessed by a questionnaire before a primary school lesson, immediately after the lesson and 9 weeks later to assess the impact the lesson had on school children's knowledge and attitudes, and also in children who were exposed to a mass dog vaccination programme but did not receive the lesson. Knowledge of rabies and how to be safe around dogs increased following the lesson, and knowledge remained higher than baseline 9 weeks after the lesson. Knowledge was greater amongst school children who had received the lesson compared to those who had not indicating that the lesson itself was critical in improving knowledge.

Mass Dog vaccination

Impact of community-delivered SMS alerts on dog-owner participation during a mass rabies vaccination campaign, Haiti 2017. To improve awareness among dog owners, 600,000 text messages were sent to phones in two Haitian communes to remind dog owners to attend dog vaccination campaigns. A post-campaign household survey was conducted to assess dog owner's perception of the text messages and the impact. 91.9% of text-receiving dog owners indicated the text was helpful. In central point campaign areas, there was 73.1% attendance among those who received the text vs 36.4% among those who did not. In areas incorporating door-to-door vaccination over multiple days there was no significant impact of receiving a text.

Qualitative Evaluation of the Five-Year 'Red Collar' Campaign to End Inhumane Culling of Dogs as a Method of Rabies Control. To end the inhumane culling of dogs in response to rabies, World Animal Protection launched 'Red Collar'; a five-year campaign (2011-2016) that worked with governments to promote the implementation of mass dog vaccination for rabies control. We present the findings from a qualitative evaluation of 'Red Collar', conducted both regionally and with national focus on Bangladesh, China, Indonesia, the Philippines and Zanzibar, Tanzania, based on semi-structured interviews and written contributions from stakeholders. The campaign successfully generated momentum for implementation of mass dog vaccination by targeted governments and lessons learned were established.

Epidemiology in wildlife

The spread and evolution of rabies virus: conquering new frontiers. Robust surveillance efforts combined with diagnostics and disease modelling are now providing insights into the epidemiology and evolution of rabies virus. The immune status of the host, the nature of exposure and strain differences all clearly influence infection and transmission dynamics. This review focusses on rabies in wildlife, synthesize current knowledge in the rapidly advancing fields of rabies virus epidemiology and evolution, and advocate for multidisciplinary approaches to advance our understanding of this disease.