Rabies knowledge and practices among human and veterinary health workers in Chad
Nodjimbadem MbaipagoRolande MindekemAssandi OussiguéréRonelngar MoyengarKemdongarti NaïssengarAlladoumngar MadjadinanJakob ZinsstagMonique Léchenne
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After a short overview of the present and past epidemiological situation regarding animal and human rabies in Eurasia, the general characteristics of the disease are described in each vector. Three main rabies cycles are presently established in Eurasia: in dogs, wild carnivores and insectivorous bats. Because of the strong barrier that exists between species-adapted rabies viruses and various potential hosts, these cycles are quite independent. They are perceived in many countries in Eurasia not to have a significant impact on animal health or the rural economy in general; the loss of dogs (or cattle) is not a priority animal health issue at the national level. Wildlife rabies has almost been eliminated in Western Eurasia by oral vaccination campaigns. Bats do not represent a real threat for a well informed public. Rabies is thus essentially a public health issue. Human rabies of canine origin has continued unabated for centuries in Eastern Eurasia, despite the Pasteur treatment and subsequent improvements of rabies post-exposure prophylaxis and biological products. Dog rabies, which is the main source of human contamination, remains practically uncontrolled. The Ministries of Health of all infected countries of Eurasia should focus their attention on canine rabies first, as it incurs endless expenses for treating humans that have been exposed to dog bites. These Ministries should use the competence of Veterinary Services and all other national bodies involved in dog rabies control, and contribute all necessary resources to support them to control this reservoir. This goal seems achievable in less than five years in a country, provided that cost-shared and well-planed mass canine oral vaccination campaigns are organised and coordinated at the regional and international levels. The conditions for the success of such campaigns are presented.
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Veterinary public health
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More than 75% of emerging infectious diseases and 60% of known human infectious diseases are transmitted from animals. Among these zoonoses, rabies is of utmost public health significance due to its lethality. The multi-faceted nature of zoonotic disease complicates control and prevention and thus, a multi-sectoral One Health Approach could be a better strategy to cope with rabies. Up until now, rabies prevention and control programs are conducted utilizing mass vaccination of domestic and community dogs and cats, and mass awareness programs. However, the burden of rabies has not been reduced as these approaches have failed to include all stakeholders (human, animal, and environmental health sectors) in disease management programs. The aim of this review is to highlight why and how One Health Approach would be the most effective way to control rabies in low- and middle-income countries (LMICs) like Nepal.
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Rabies causes approximately 59 000 human deaths worldwide annually. A global target of zero human deaths from dog-mediated rabies has been set for 2030, and large-scale control programs are now advocated. However, there is limited surveillance and guidance on how rabies surveillance can be improved to increase the detection of rabid animals or to guide the management of rabies control programmes once elimination has been achieved or when its approached. Challenges to rabies elimination were investigated by undertaking detailed epidemiological studies collecting data from 2010/2011 to 2022; and enhancing surveillance using Integrated Bite Case Management (IBCM) across different settings in Tanzania from 2018 to 2022. In 24 districts, local government health and veterinary workers were trained to collect data through implementing IBCM, comprising risk assessments of bite patients by health workers and investigations of suspected rabid animals by livestock field officers. In addition, contact tracing was used to identify rabid animals, human rabies exposures and deaths, with additional whole-genome sequencing of viruses from rabies positive samples in 13 districts of Lindi and Mtwara region, including Pemba Island. From these data, transmission chains were probabilistically inferred, estimated case detection, quantified the public health burden in terms of numbers of rabies exposures, animal rabies cases, human rabies deaths and evaluated the impact and cost-effectiveness of a One Health approach to rabies surveillance and control. Reporting of bite patients at high risk of rabies exposure increased following the introduction of IBCM. Between 2011 and 2019, 688 probable exposures were identified in Southeast Tanzania, including 47 rabies deaths. Of 549 probable animal rabies cases identified: 303 were domestic dogs (55.2%) and 221 jackals (40.3%). Dog-to-dog transmission accounted for 40.1% of inferred transmission events, and wildlife-to-wildlife transmission accounted for approximately 32.6%, with the remainder from cross-species transmission. On Pemba Island, five transmission chains circulated from 2010. Rabid dogs, human exposures and deaths declined following the introduction and improved implementation of dog vaccination campaigns, and these transmission chains were eliminated by May 2014. In 2016 two introductions of dog rabies cases to the island that seeded re-emergence were identified. The ensuing outbreak was eliminated by October 2018 through reinstated island-wide dog vaccination. While post-exposure vaccines were highly cost-effective ($256 per death averted), their accessibility was limited and only dog vaccination interrupted transmission. A combined One Health approach rapidly eliminated rabies, was highly cost-effective ($1657 per death averted) and saved 20-130 families from rabid dog bites annually. Overall, IBCM greatly improved rabies detection and can be used to monitor the impact of mass dog ii vaccinations. In Tanzania domestic dogs appear to be the critical reservoir host of rabies, even in settings with evidence of wildlife transmission. Dog vaccination suppressed rabies in both dog and wildlife populations and reduced both public health and conservation risks. A One Health approach underpinned by dog vaccination and post exposure prophylaxes to animal bite patients is an efficient, cost-effective, equitable and feasible approach to rabies elimination, but needs scaling up across connected populations to sustain the benefits of elimination, as seen on Pemba, and for similar progress to be achieved elsewhere.
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Rabies vaccine
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Rabies is a devastating zoonotic disease of mammals that causes encephalitis and death. It is endemic in India, with an estimated annual 20,000 human deaths (one-third of the global rabies burden). The magnitude of animal rabies incidence is unknown.In four sub-districts of Punjab, India, we monitored canine and livestock populations from August 15, 2016 to August 14, 2017. Demographic, clinical and rabies diagnostic laboratory (RDL) data were collected from suspected cases of rabies. The annual incidence rate / 10,000 animal years at risk (95% CI) in each sub-district was estimated for each species.During 2016-2017, a total of 41 suspected rabies cases were detected in the four selected sub-districts in Punjab. Laboratory confirmed rabies (LCR) incidence was 2.03/10,000 dog years (0.69, 5.96) and 2.71/10,000 dog years (1.14, 6.43) in stray and pet dogs, respectively. The LCR incidence in farmed buffalo and cattle was 0.19/10,000 buffalo years (0.07, 0.57) and 0.23/10,000 cattle years (0.06, 0.88), respectively. The LCR incidence amongst equine was 4.28/10,000 equine years (0.48, 38.10). Stray cattle rabies incidence in the selected sub-districts was 9.49/10,000 cattle years (3.51, 25.67). If similar enhanced surveillance for rabies was conducted state-wide, we estimate that 98 (34-294) buffalo, 18 (2-156) equine, 56 (15-214) farmed cattle, 96 (35-259) stray cattle, 128 (54-303) pet dogs and 62 (21-182) stray dogs would be expected to be confirmed with rabies in Punjab annually.These results indicate that rabies incidence in animals, particularly in dogs and stray cattle, is much higher than previously suspected. We recommend that statewide enhanced disease surveillance should be conducted to obtain more accurate estimates of rabies incidence in Punjab to facilitate better control of this important disease.
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Rabies, being a fatal, viral, zoonotic and vaccine-preventable disease, requires a holistic and team approach by all trained professionals working in the various aspects of public health maintenance. The one Health concept is founded on the awareness of the many benefits of controlling pathogens at the human-animal-environmental interface. Questionnaires were administered to the public and health personnel across the seventeen local government areas of Plateau Stateto collect information on factors that bothers on the public’s perception of rabies occurrence and control. These factors have been reported in previous and more recent studies to contribute to rabies in the state. They include the level of awareness of rabies and its control by the public, dog ownership and management practices, routine vaccination of dogs against rabies, reporting dog bites and suspected rabies cases to designated health authorities and role of the health personnel in rabies control. The information and data collected were analyzed using Microsoft Excel 2016. The study period spanned from 1998 – 2007. The findings of this study led to the conclusion that the creation of a one Health Initiative will stimulate a successful and sustainable control of rabies in the state.Keywords: Nigeria, One health, Plateau state, Rabies, Vaccine-preventable
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Rabies is a worldwide zoonosis caused by a lyssavirus, with many host species acting as reservoirs for infection. The epidemiology of rabies has changed over recent years, as this disease has been brought under control or eliminated in many terrestrial animal species in Europe and North America. A large number of Lyssavirus variants have now been characterised, and their distribution and animal hosts have become known. However, new lyssaviruses have been isolated from bats, prompting scientists to question the efficacy of the existing human and veterinary vaccines against these new strains. The epidemiology of bat rabies should be fully explored, so that the precise risks to the health of humans and domestic and wild carnivores may be determined and methods of preventing the disease among people who handle bats can be discovered. Rabies is still a significant public health problem, particularly in areas where canine rabies is still endemic, such as countries in Africa and Asia.
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Abstract: The control of rabies, where successful, is built on a One Health paradigm. In many instances, the control of human disease rests on programs designed to limit canine rabies. Early rabies programs were not only One Health based but simultaneously helped define, develop and operationalize the concept of One Health. The development of rabies control programs in the United States will be examined with a particular emphasis on the development of different elements of the One Health paradigm. A review of One Health based, creative approaches used by the early rabies programs and how these programs provided a template for other creative zoonotic and non-zoonotic control programs will be described. Selected other successful rabies control programs globally will be described and their One Health based strategies highlighted. The human-animal-wildlife interface resulting in the transmission of rabies to humans will also be described with a special emphasis on the incursion of wildlife rabies in North America. Finally, strategies for the prevention of over 55,000 human deaths a year globally from rabies will be assessed from One Health based perspective and the central role of intradisciplinary approaches appraised.
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According to the World Health Organization (WHO), rabies is one of the 18 neglected tropical diseases, together with dengue, leprosy, and trachoma, among others. Despite being a vaccine-preventable disease, the latest estimate of annual human rabies mortality from a 2015 study is as high as 59,000 throughout 150 countries. In human rabies, more than 95% of the cases are due to dog bites, making the elimination of canine rabies a global priority by fighting the disease at its animal source. World Health Organization (WHO), World Organization for Animal Health (OIE), Food and Agriculture Organization (FAO) of the United Nations, and the Global Alliance for Rabies Control (GARC) have warranted the One Health framework with the objective of complete eradication of dog-related human rabies by the year 2030. In an effort to rationalise the One Health approach, this scoping review found 17 studies on assessing the effectiveness of control interventions of human and canine rabies. Different strategies were implemented based on the endemicity of rabies in a particular country. Overall, the combined strategies using the One Health approach, which allows effective participation and communication between different agencies, have shown promising results in reducing rabies cases. These strategies will hopefully realise the goal in the Global Strategic Plan to achieve zero canine-mediated human rabies death by the year 2030.
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Neglected Tropical Diseases
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