Recent Research – February 2016

A round-up of recent research most relevant to GARC's mission.

Human Case Management

Caring for rabies patients in developing countries - the neglected importance of palliative care. Advice on how clinicians in resource-limited settings can make best use of essential drugs to assist rabies patients and their families. Furious rabies management should aim to alleviate thirst, anxiety and epileptic fits using infusions, diazepam or midazolam and antipyretic drugs. Respiratory failure must be avoided, especially if the family take the patient home alive.
 

Mass Dog Vaccination

Incentives Increase Participation in Mass Dog Rabies Vaccination Clinics and Methods of Coverage Estimation Are Assessed to Be Accurate. Incentives (dog collars and owner wristbands) effectively increased owner participation in mass dog rabies vaccination clinics and reduced vaccination costs-per-dog by $0.47. Survey techniques to determine coverage were also compared and vaccination coverage found to be below the 70% threshold for elimination.

Operational performance and analysis of two rabies vaccination campaigns in N'Djamena, Chad. Two consecutive mass dog vaccination campaigns in N'Djamena in 2012 and 2013 reached >70% coverage despite a dynamic and largely free-roaming dog population. Public awareness was found to be key and monthly reported rabies cases in dogs decreased by > 90% within one year.

Why has canine rabies remained endemic in the Kilosa district of Tanzania? Lessons learnt and the way forward. Despite knowledge about rabies, a KAP survey revealed that only 20.4 % of villagers knew how rabies is controlled in dogs and 71 % were not aware of dog vaccination campaigns, explaining the finding that only 24.4% of dog were vaccinated.

Vaccinate-assess-move method of mass canine rabies vaccination utilising mobile technology data collection in Ranchi, India Following a catch-vaccinate-release programme in Ranchi, India, a bespoke smartphone ‘Mission Rabies’ application was used to GPS capture the location of all vaccinated dogs and dogs sighted on post vaccination surveys. Where coverage was below 70 %, catching teams were re-deployed to vaccinate more dogs and increased the coverage achieved.

Factors associated with dog rabies immunisation status in Bamako, Mali. A cross-sectional survey in Bamako, Mali found that 45% of dogs were reported as vaccinated at least once, but less than half of these had a valid vaccination card. Dogs were mostly not vaccinated due to cost and the study concludes that vaccination should not cost more than 0.2 €. Overall, 24% of dogs had antibody titres ≥ 0.25 IU/ml, but all animals had titres ≥ 0.25 IU/ml after booster vaccination.

Heterogeneity in the spread and control of infectious disease: consequences for the elimination of canine rabies. Uneven vaccination coverage was found to have significantly delayed the elimination of canine rabies in the Visayas, Philippines, In contrast, relatively high human-mediated dog movements did not reduce elimination probability, but contribute to a reintroduction risk after elimination.

 

PEP provision

Worldwide rabies deaths prevention-A focus on the current inadequacies in postexposure prophylaxis of animal bite victims. Commentary suggesting that provision of modern PEP to remote areas of developing countries is needed to avert the bulk of human deaths from rabies.

Animal Bite and Deficiencies in Rabies Post-Exposure Prophylaxis in Tehran, Iran. The majority of cases had received only three of the 5 recommended PEP doses and where rabies immunoglobulin was indicated it was usually not, or only partially, delivered.

Pattern of animal bites and post exposure prophylaxis in rabies: A five year study in a tertiary care unit in Sri Lanka. There were 19 661 cases of animal exposure presented over 5 years, with 89% bites, and 37% major bites and 62% were major bites, a significant proportion from cats. PEP vaccine and REG costs totalled 24,795,888.00 Sri Lankan rupees (190,737.60US$) over the 5 years.

Current Status and Development of Vaccines and Other Biologics for Human Rabies Prevention. Timely and appropriate administration of modern biologics virtually assures survivorship, even after severe exposures to rabies, however this is often prohibitively costly. Development of recombinant, sub-unit and other novel methods are underway to improve the availability of safe, effective and more affordable rabies biologics.

 

Surveillance

Establishment of a Canine Rabies Burden in Haiti through the Implementation of a Novel Surveillance Program. In 2013, Haiti initiated a community-based animal rabies surveillance program of active community bite investigation and passive animal rabies investigation. Up to December 2014, 778 rabies suspect animals were 70 cases were lab-confirmed and an additional 36 cases clinically diagnosed, an 18-fold increase in reporting of rabid animals.

Evidence of two distinct phylogenetic lineages of dog rabies virus circulating in Cambodia. Analysis of 149 rabies virus complete sequences from Cambodia in 1998-2011. The Cambodian sequences fell mostly into clade SEA1 (also found in Thailand, Laos and Vietnam) and a few in SEA2 (also from Laos). The third clade SEA3 found in the region was not detected .in Cambodian isolates studies here.

Human Rabies in India: An Audit from a Rabies Diagnostic Laboratory. Retrospective analysis of clinical samples from 128 patients with suspected rabies, from 11 states in India, showed that antemortem confirmation of rabies by a combination of laboratory diagnostic assays (detection of viral RNA in CSF, skin and saliva, and neutralizing antibodies in CSF) could be achieved in 40.6%.

Rabies in a Dog Imported from Egypt with a Falsified Rabies Vaccination Certificate - Virginia, 2015 In June 2015, an adult female dog picked up from the streets of Cairo, Egypt, and shipped by a U.S. animal rescue organization to the US, with an intentionally falsified vaccination certificate was confirmed to have rabies.

Molecular and mathematical modeling analyses of inter-island transmission of rabies into a previously rabies-free island in the Philippines.Phylogenetic analysis and mathematical modeling demonstrate that there was a time lag of several months to a year between rabies introductions (into Tablas Island from Luzon) and initial case detection. Transmission chains following inter-island virus transmission were also observed, due to low vaccination coverages.

Epidemiology, Impact and Control of Rabies in Nepal: A Systematic Review. A review of literature and available national data revealed around 100 livestock and 10-100 human deaths per year are reported, with about 1,000 livestock and 35,000 humans reported to receive PEP, and serious underreporting likely. Rabies control efforts remained focalized, of short duration and not harmonized, with veterinary and human health authority coordination limited.

Surveillance of Canine Rabies in the Central African Republic: Impact on Human Health and Molecular Epidemiology Of 966 exposed persons, 632 received a post-exposure rabies vaccination and no rabies-related human deaths were confirmed. Of 82 samples from suspected rabid dogs tested, 69 were confirmed positive, most owned although unvaccinated. There was a strong spatiotemporal correlation between reported human exposures and detection of rabid dogs.