Determinants of delay in initiating post-exposure prophylaxis for rabies prevention among animal bite cases: Hospital based study

Joseph, Jessy; Sangeetha, N; Khan, Amir Maroof; Rajoura, O P

doi:10.1016/j.vaccine.2013.10.067

Cited by 42 publications

(47 citation statements)

References 21 publications

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“…This is consistent with other studies where persons exposed to rabies did not receive the full course of rabies PEP treatment and often delayed starting the prophylactic treatment [4, 12, 21]. The low rabies PEP completion rates could be attributed to factors like the high cost of obtaining PEP, long distances to health facilities, multiple referrals, unavailability of rabies PEP in government health facilities among others [1].…”

Section: Discussionsupporting

confidence: 87%

“…Other public health concerns following animal-bites include the risk of sepsis of bite wounds, psychological trauma and high cost of seeking PEP for the bite victims [10–12]. Human mortality from canine rabies is estimated at 60,000 annually worldwide, with about 56% of the cases occurring in Asia and 43.6% in Africa, mostly in rural areas [8, 13, 14].…”

Section: Introductionmentioning

confidence: 99%

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Epidemiology and surveillance of human animal-bite injuries and rabies post-exposure prophylaxis, in selected counties in Kenya, 2011–2016

Ngugi

Maza²,

Omolo

et al. 2018

BMC Public Health

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BackgroundHuman animal-bite injuries are a serious public health problem due to associated risk for rabies virus exposure. Animal-bite injuries especially dog bites are useful indicators for assessing the risk of rabies virus transmission and need for rabies post exposure prophylaxis (PEP). Understanding the epidemiology and surveillance of animal bites and rabies post-exposure prophylaxis is critical in implementing Kenya’s national rabies elimination strategy. We aimed to describe the incidence of human animal-bite injuries, patient/biting animal characteristics, uptake of rabies PEP and factors associated with animal bite incidents.MethodsWe reviewed animal bite records from outpatient and anti-rabies vaccine (ARV) registers of 17 health facilities from five counties. An animal bite was defined as an entry of an animal bite of the class mammal including humans in registers in a person of any age from January 2011 to December 2016. We collected demographic and information on PEP uptake. We calculated descriptive statistics, odds ratios (OR) and 95% confidence interval (CI) to examine factors associated with being an animal bite case-patient. We also calculated incidence of animal bites using health facility catchment population for year 2016 as the denominator.ResultsWe analyzed 7307 records. The median age was 22 years (IQR = 31 years); there were 4019 (55%) male and age < 15 years were 2607 (37%). Dogs accounted for 6720 (93%) of bites of which 78% were owned free-roaming dogs. Of the 5674 (88%) cases that received rabies PEP, 2247 (40%) got at least three-doses. The median time from bite to seeking medical care was 2 days (IQR = 4 days). Being bitten on the head/face (OR = 5.8; CI: 3.3–10.2); being bitten by owned free-roaming dog (OR = 1.7; CI: 1.5–1.9) and being male (OR = 1.4; CI: 1.3–1.5) were significantly associated with being an animal-bite case-patient. Being male, being bitten on head/face and being bitten by owned free-roaming dog remained independently associated with being an animal bite case-patient at multivariable logistic regression. Bite-incidence was 289 bites /100,000 persons among all counties.ConclusionPreventing dog bites would most effectively reduce bite injuries by improving public health education among children below 15 years, encouraging early PEP initiation and completion, development and implementation of responsible dog ownership and animal behaviour educational programmes as well as improving human and veterinary health linkages.Electronic supplementary materialThe online version of this article (10.1186/s12889-018-5888-5) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 87%

Section: Introductionmentioning

confidence: 99%

Epidemiology and surveillance of human animal-bite injuries and rabies post-exposure prophylaxis, in selected counties in Kenya, 2011–2016

Ngugi

Maza²,

Omolo

et al. 2018

BMC Public Health

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“…In a study by Khazaei et al [19], animal bites were likewise most often observed in males (71.8%) [19]. Further, a study carried out in France reported the sex ratio of animal bites (male-to-female) to be 1.98 [20], and a study by Joseph et al [14] confirmed this result. This correlation is consistent with the results of the present study.…”

Section: Discussionmentioning

confidence: 88%

“…A semi-structured questionnaire was used for collecting information regarding the interval between exposure and the initiation of anti-rabies PEP, the socioeconomic status of the family, the bite site on the body, and other risk factors associated with the delay in the initiation of the vaccine. For the purpose of this study, a delay in the initiation of anti-rabies PEP was defined as the initiation of PEP ≥48 hours after the animal bite [14]. Since the scope of this study was limited to individuals who sought treatment at the Rabies Treatment Center, it is possible that our study excluded some individuals who were bitten but did not seek treatment.…”

Section: Methodsmentioning

confidence: 99%

Epidemiology of Animal Bites and Factors Associated With Delays in Initiating Post-exposure Prophylaxis for Rabies Prevention Among Animal Bite Cases: A Population-based Study

Esmaeilzadeh¹,

Rajabi²,

Vahedi³

et al. 2017

J Prev Med Public Health

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ObjectivesOne way to prevent deaths due to rabies is the timely utilization of post-exposure prophylaxis (PEP). Therefore, in addition to an understanding of the epidemiological distribution of animal bites, it is necessary to explore the factors leading to delays in PEP initiation.MethodsThis cross-sectional study was conducted in Iran in 2011, and included 7097 cases of animal bites recorded at the Rabies Treatment Center of the Shiraz University of Medical Sciences using the census method. Logistic regression was used to identify factors associated with delays in PEP.ResultsAmong the patients studied, 5387 (75.9%) were males. The prevalence of animal bites in Fars province was 154.4 per 100 000 people. Dogs were the most frequent source of exposure (67.1%), and the most common bitten part of the body was the hands (45.5%). A delay in the initiation of PEP was found among 6.8% of the studied subjects. This delay was more likely in housewives (odds ratio [OR], 4.66; 95% confidence interval [CI], 2.12 to 10.23) and less likely in people with deep wounds (OR, 0.65; 95% CI, 0.43 to 0.97).ConclusionsAlthough all animal bite victims received complete PEP, in some cases, there were delays. Further, the type of animal involved, the depth of the bite, and the patient’s occupation were the major factors associated with a delay in the initiation of PEP for rabies prevention.

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“…Unfortunately, because many do not have access to proper medical care, whether for financial or logistical reasons, or may not recognize a potential RABV exposure, prompt administration of rabies PEP to at-risk individuals is not always achieved (4). In these cases RABV enters the brain, clinical rabies develops and the infected individuals almost invariably die.…”

Section: Introductionmentioning

confidence: 99%

Pre- and post-exposure safety and efficacy of attenuated rabies virus vaccines are enhanced by their expression of IFNγ

2015

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Consistent with evidence of a strong correlation between interferon gamma (IFNγ) production and rabies virus (RABV) clearance from the CNS, we recently demonstrated that engineering a pathogenic RABV to express IFNγ highly attenuates the virus. Reasoning that IFNγ expression by RABV vaccines would enhance their safety and efficacy, we reverse-engineered two proven vaccine vectors, GAS and GASGAS, to express murine IFNγ. Mortality and morbidity were monitored during suckling mice infection, immunize/challenge experiments and mixed intracranial infections. We demonstrate that GASγ and GASγGAS are significantly attenuated in suckling mice compared to the GASGAS vaccine. GASγ better protects mice from lethal DRV4 RABV infection in both pre- and post-exposure experiments compared to GASGAS. Finally, GASγGAS reduces post-infection neurological sequelae, compared to control, during mixed intracranial infection with DRV4. These data show IFNγ expression by a vaccine vector can enhance its safety while increasing its efficacy as pre- and post-exposure treatment.

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Determinants of delay in initiating post-exposure prophylaxis for rabies prevention among animal bite cases: Hospital based study

Cited by 42 publications

References 21 publications

Epidemiology and surveillance of human animal-bite injuries and rabies post-exposure prophylaxis, in selected counties in Kenya, 2011–2016

Epidemiology and surveillance of human animal-bite injuries and rabies post-exposure prophylaxis, in selected counties in Kenya, 2011–2016

Epidemiology of Animal Bites and Factors Associated With Delays in Initiating Post-exposure Prophylaxis for Rabies Prevention Among Animal Bite Cases: A Population-based Study

Pre- and post-exposure safety and efficacy of attenuated rabies virus vaccines are enhanced by their expression of IFNγ

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