Behavioral and structural barriers to accessing human post-exposure prophylaxis and other preventive practices in Arequipa, Peru, during a canine rabies epidemic
Abstract:A canine rabies epidemic started in early 2015 in Arequipa, Peru and the rabies virus continues to circulate in the dog population. Some city residents who suffer dog bites do not seek care or do not complete indicated post-exposure prophylaxis (PEP) regimens, increasing the risk of human rabies. The objectives of our study are to qualitatively assess knowledge about rabies, and preventive practices, such as rabies vaccine administration, following a dog bite. We conduct eight focus group discussions in peri-u… Show more
“…the number of dogs at risk, the quantity of vaccine doses needed, the determination of producers to meet rising demands, the opportunity costs of local vs. regional sources of biologics, long-term sources of support, etc. ), as do other unresolved topics 1 , 157 , 194 , 195 . Nevertheless, these are just anticipated nuances of a plan well in motion, and, as finer-grained program plans for GEHRD evolve, countries will grapple with these and other broader debates, such as a dependence upon external sources of modern biologics vs. a very clear need for self-sustainability ( https://www.dawn.com/news/1526311/pakistan-to-become-self-sufficient-in-four-antisera-by-june ).…”
Section: Remaining Issuesmentioning
confidence: 95%
“…As may be obvious from a cursorial examination of the more specialized aspects of the inarguable progress in rabies diagnostics and biologics, there is a certain skewedness towards technical approaches in disease problem-solving, with much less of a focus on more anthropological, economic, political, or societal concerns for introspection 163 , 195 . Without the inclusion of these arenas beyond mere “lip service”, transdisciplinary boundaries persist, preventing an ultimate understanding of why a given program may fail 164 .…”
Rabies is an ancient, much-feared, and neglected infectious disease. Caused by pathogens in the family Rhabdoviridae, genus Lyssavirus, and distributed globally, this viral zoonosis results in tens of thousands of human fatalities and millions of exposures annually. All mammals are believed susceptible, but only certain taxa act as reservoirs. Dependence upon direct routing to, replication within, and passage from the central nervous system serves as a basic viral strategy for perpetuation. By a combination of stealth and subversion, lyssaviruses are quintessential neurotropic agents and cause an acute, progressive encephalitis. No treatment exists, so prevention is the key. Although not a disease considered for eradication, something of a modern rebirth has been occurring within the field as of late with regard to detection, prevention, and management as well as applied research. For example, within the past decade, new lyssaviruses have been characterized; sensitive and specific diagnostics have been optimized; pure, potent, safe, and efficacious human biologics have improved human prophylaxis; regional efforts have controlled canine rabies by mass immunization; wildlife rabies has been controlled by oral rabies vaccination over large geographic areas in Europe and North America; and debate has resumed over the controversial topic of therapy. Based upon such progress to date, there are certain expectations for the next 10 years. These include pathogen discovery, to uncover additional lyssaviruses in the Old World; laboratory-based surveillance enhancement by simplified, rapid testing; anti-viral drug appearance, based upon an improved appreciation of viral pathobiology and host response; and improvements to canine rabies elimination regionally throughout Africa, Asia, and the Americas by application of the best technical, organizational, economic, and socio-political practices. Significantly, anticipated Gavi support will enable improved access of human rabies vaccines in lesser developed countries at a national level, with integrated bite management, dose-sparing regimens, and a 1 week vaccination schedule.
“…the number of dogs at risk, the quantity of vaccine doses needed, the determination of producers to meet rising demands, the opportunity costs of local vs. regional sources of biologics, long-term sources of support, etc. ), as do other unresolved topics 1 , 157 , 194 , 195 . Nevertheless, these are just anticipated nuances of a plan well in motion, and, as finer-grained program plans for GEHRD evolve, countries will grapple with these and other broader debates, such as a dependence upon external sources of modern biologics vs. a very clear need for self-sustainability ( https://www.dawn.com/news/1526311/pakistan-to-become-self-sufficient-in-four-antisera-by-june ).…”
Section: Remaining Issuesmentioning
confidence: 95%
“…As may be obvious from a cursorial examination of the more specialized aspects of the inarguable progress in rabies diagnostics and biologics, there is a certain skewedness towards technical approaches in disease problem-solving, with much less of a focus on more anthropological, economic, political, or societal concerns for introspection 163 , 195 . Without the inclusion of these arenas beyond mere “lip service”, transdisciplinary boundaries persist, preventing an ultimate understanding of why a given program may fail 164 .…”
Rabies is an ancient, much-feared, and neglected infectious disease. Caused by pathogens in the family Rhabdoviridae, genus Lyssavirus, and distributed globally, this viral zoonosis results in tens of thousands of human fatalities and millions of exposures annually. All mammals are believed susceptible, but only certain taxa act as reservoirs. Dependence upon direct routing to, replication within, and passage from the central nervous system serves as a basic viral strategy for perpetuation. By a combination of stealth and subversion, lyssaviruses are quintessential neurotropic agents and cause an acute, progressive encephalitis. No treatment exists, so prevention is the key. Although not a disease considered for eradication, something of a modern rebirth has been occurring within the field as of late with regard to detection, prevention, and management as well as applied research. For example, within the past decade, new lyssaviruses have been characterized; sensitive and specific diagnostics have been optimized; pure, potent, safe, and efficacious human biologics have improved human prophylaxis; regional efforts have controlled canine rabies by mass immunization; wildlife rabies has been controlled by oral rabies vaccination over large geographic areas in Europe and North America; and debate has resumed over the controversial topic of therapy. Based upon such progress to date, there are certain expectations for the next 10 years. These include pathogen discovery, to uncover additional lyssaviruses in the Old World; laboratory-based surveillance enhancement by simplified, rapid testing; anti-viral drug appearance, based upon an improved appreciation of viral pathobiology and host response; and improvements to canine rabies elimination regionally throughout Africa, Asia, and the Americas by application of the best technical, organizational, economic, and socio-political practices. Significantly, anticipated Gavi support will enable improved access of human rabies vaccines in lesser developed countries at a national level, with integrated bite management, dose-sparing regimens, and a 1 week vaccination schedule.
“…In recent years, innovative methods have emerged that map contextual data about a behavior (including field observations; interviews and focus groups with participants, stakeholders, and experts; and existing quantitative evidence and prior literature) to specific behavioral economics principles to uncover novel insights about barriers and facilitators that can inform intervention design. These methods and approaches have been widely used in a variety of global health settings and programmatic domains 32,33,35,36 and in previous work on food choices and human nutrition. [37][38][39][40] Because the provision of MNP is an active intervention that requires multiple steps, sustained action over time, and the translation of intentions into behavior, behavioral economics may offer novel insights into low adherence to MNP use despite its availability and promotion.…”
Section: Behavioral Economics and Intervention Designmentioning
Negative experiences with health care providers or inconvenience at the time that micronutrient powder (MNP) use is initiated may discourage future MNP use. n Mental models about nutrition can shape intentions to use MNP, and having too many choices can confuse caregivers. n A single negative experience with MNP can form strong memories and discourage caregivers from giving MNP.
“…While such programs, driven particularly with foreign assistance, offer the potential for major impact, they are not sustainable without local support. Focusing primarily upon recent literature from the past 5 years [ 1 – 5 , 6 •, 7 – 14 , 15 •, 16 – 24 , 25 •, 26 – 30 , 31 •, 32 •, 33 •, 34 – 51 , 52 •, 53 , 54 •, 55 – 62 , 63 ••, 64 – 66 , 67 •, 68 , 69 ••, 70 – 83 , 84 •, 85 , 86 •, 87 •, 88 ••, 89 , 90 •, 91 – 93 , 94 ••, 95 – 100 ], the objective of this communication is to provide an update on rabies in the tropics (narrowly defined as those geographic regions between the Tropic of Cancer and the Tropic of Capricorn) and progress in human and animal case reduction towards the goal of “Zero by Thirty” (ZBT). Fig.…”
Purpose of Review
Rabies is an ancient yet still neglected tropical disease (NTD). This review focuses upon highlights of recent research and peer-reviewed communications on the underestimated tropical burden of disease and its management due to the complicated dynamics of virulent viral species, diverse mammalian reservoirs, and tens of millions of exposed humans and animals – and how laboratory-based surveillance at each level informs upon pathogen spread and risks of transmission, for targeted prevention and control.
Recent Findings
While both human and rabies animal cases in enzootic areas over the past 5 years were reported to PAHO/WHO and OIE by member countries, still there is a huge gap between these “official” data and the need for enhanced surveillance efforts to meet global program goals.
Summary
A review of the complex aspects of rabies perpetuation in human, domestic animal, and wildlife communities, coupled with a high fatality rate despite the existence of efficacious biologics (but no therapeutics), warrants the need for a One Health approach toward detection via improved laboratory-based surveillance, with focal management at the viral source. More effective methods to prevent the spread of rabies from enzootic to free zones are needed.
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