Quantifying the risk of rabies in biting dogs in Haiti

Abstract

Rabies is a fatal viral disease typically transmitted through the bite of rabid animal. Domestic dogs cause over 99% of human rabies deaths. Over half of the world's population lives in a country where the canine rabies virus variant is endemic and dog bites are common. An estimated 29 million people worldwide receive post-bite vaccination after being exposed to animals suspected of rabies. Accurate and timely risk assessment of rabies in biting dogs is critical to ensure that rabies pep is administered to all persons with a suspected rabies exposure, while avoiding PEP administration in situations where rabies can be definitively ruled out. In this study, a logistic regression model was developed to quantify the risk of rabies in biting dogs, using data from Haiti's animal rabies surveillance program. Significant risk factors identified in the model were used to quantify the probability of rabies in biting dogs. The risk of rabies in a biting dog as assessed through Haiti's rabies surveillance program was highly elevated when the dog displayed hypersalivation (OR = 34.6, 95% CI 11.3-106.5) or paralysis (OR = 19.0, 95% CI 4.8-74.8) and when the dog was dead at the time of the assessment (OR = 20.7, 95% CI 6.7-63.7). Lack of prior rabies vaccination, biting 2 or more people, and if the dog was a puppy also increased the probability that a biting dog would have rabies. The model showed high sensitivity (100%) and specificity (97%) when examined using validation data. This model enables us to project the risk of rabies in biting dogs in Haiti shortly after the bite event and make provisional pep recommendations prior to laboratory testing or dog quarantine results. Application of this model may improve adherence to PEP for bite victims who can be educated on the quantitative risk of the exposure event. This model can also be used to reduce unnecessary PEP costs when the risk of rabies is determined as sufficiently low and the animal is available for observation. Rabies is an invariably fatal viral zoonosis typically transmitted through the bite of an infected animal 1. Globally, domestic dogs are responsible for over 99% of the 59,000 human rabies deaths estimated to occur each year 2,3. Over half of the world's population lives in a country where the canine rabies virus variant (CRVV) is endemic. Rabies is preventable with timely washing of the wound and administration of post-exposure prophylaxis (PEP), which consists of rabies immune globulin (RIG) and a series of four doses of vaccine over a 14-day period. It is estimated that over 29 million rabies vaccine doses are administered in canine rabies endemic countries each year, at a cost of 1.7 billion USD 2. The cost to treat a rabies exposure in most developing countries is in excess of one month's salary, a substantial financial burden for many bite victims 4-6. Furthermore, treatment typically requires four to five doctor visits, which is an additional financial and logistical burden. More than 29 million people worldwide receive post-bite rabies vaccination ea...

Patterns and Outcomes of dog bite injuries presenting to emergency department in a tertiary care hospital at Karachi

“…Amongst all animals, bites inflicted by dogs form the greatest burden on the healthcare resources and domesticated dogs are the topmost reason behind rabies spread. 9,10 In underdeveloped countries this burden is further increased because of the inaccessibility to the vaccine and its cost. 11 This study is compared to previous studies done in both developed and underdeveloped countries to identify different aspects of the problem and to explore the factors having potential to modify the magnitude of the issue.…”

Review of rabies in Nepal

“…Dogs are responsible for the spread of rabies, which is true in 95% of the cases in regions like Asia and Africa [ 25 ]. Dogs alone are responsible for 99% of disease transmission in rabies endemic regions [ 3 , 4 ]. But in nature, the transmission and maintenance of rabies occur in two interrelated cycles: the urban cycle, which involves domesticated and stray dogs; and a sylvatic cycle, that involves wildlife like foxes, wolves, jackals, mongoose, raccoons, skunks and bats [ 26 , 27 ].…”

“…This virus can infect all the animals of group Mammalia, but dogs have been considered as the major source of infection. 95% of the human cases of rabies are due to dog bites but the tally reaches 99% in the endemic regions [ 3 , 4 ]. However, a slight proportion of the disease in humans is also reported via wildlife such as foxes, wolves, jackals, mongoose, raccoons, skunks and bats, especially in developed countries that have successfully controlled domestic cases of rabies [ 5 , 6 ].…”

Revista de la Universidad del Zulia, Volumen 12, Número 33

“…Galán Torres (2012) recommends that the vaccination schedule should be unique, such recommendation in the country and the Puno region should be adopted in order to achieve more adequate coverage. However, the registration and/or notification of biting dogs it was quite irregular (figure 10), being controlled almost 100% (figure 11), contrary to what was reported in Haiti, where 50% of the dogs involved in a bite event are unknown (Ma et al, 2020); in addition, was reinforced with the sending of samples for the diagnosis of canine rabies as epidemiological surveillance, reaching an adequate percentage (Cediel et al, 2010;MINSA, 2006MINSA, , 2017Schneider et al, 1996) with the exception of the year 2019 where it declined a little (table 2 and figure 8), considering that adequate and fair investment in dog vaccination (despite the fact that in this case, the investment has been scarce) could bring down costs in medical treatment demonstrating the need for intersectoral coordination (Fitzpatrick et al, 2014;Hampson et al, 2015;Zinsstag et al, 2009).…”