Rabies Elimination in Rural Kenya: Need for Improved Availability of Human Vaccines, Awareness and Knowledge on Rabies and Its Management Among Healthcare Workers

Abstract

BackgroundIn Africa, rabies causes an estimated 24,000 human deaths annually. Mass dog vaccinations coupled with timely post-exposure prophylaxis (PEP) for dog-bite patients are the main interventions to eliminate human rabies deaths. A well-informed healthcare workforce and the availability and accessibility of rabies biologicals at health facilities are critical in reducing rabies deaths. We assessed awareness and knowledge regarding rabies and the management of rabies among healthcare workers, and PEP availability in rural eastern Kenya.MethodologyWe interviewed 73 healthcare workers from 42 healthcare units in 13 wards in Makueni and Kibwezi West sub-counties, Makueni County, Kenya in November 2018. Data on demographics, years of work experience, knowledge of rabies, management of bite and rabies patients, and availability of rabies biologicals were collected and analyzed.ResultsRabies PEP vaccines were available in only 5 (12%) of 42 health facilities. None of the health facilities had rabies immunoglobulins in stock at the time of the study. PEP was primarily administered intramuscularly, with only 11% (n = 8) of the healthcare workers and 17% (7/42) healthcare facilities aware of the dose-sparing intradermal route. Less than a quarter of the healthcare workers were aware of the World Health Organization categorization of bite wounds that guides the use of PEP. Eighteen percent (n = 13) of healthcare workers reported they would administer PEP for category I exposures even though PEP is not recommended for this category of exposure. Only one of six respondents with acute encephalitis consultation considered rabies as a differential diagnosis highlighting the low index of suspicion for rabies.ConclusionThe availability and use of PEP for rabies was sub-optimal. We identified two urgent needs to support rabies elimination programmes: improving availability and access to PEP; and targeted training of the healthcare workers to improve awareness on bite wound management, judicious use of PEP including appropriate risk assessment following bites and the use of the dose-sparing intradermal route in facilities seeing multiple bite patients. Global and domestic funding plan that address these gaps in the human health sector is needed for efficient rabies elimination in Africa.

Spatial accessibility and inequality analysis of rabies-exposed patients to rabies post-exposure prophylaxis clinics in Guangzhou City, China

“…A previous study showed most dogs in rural areas roamed freely and were not required registration, posing a significant risk of infection and transmission of rabies [ 5 ]. In addition, people in rural areas had weak awareness of rabies prevention [ 40 – 42 ].Previous studies showed rural areas in China were still the main source of rabies transmission, and improving the awareness of rabies prevention in rural areas is still one of the main measures to eliminate human rabies [ 8 , 43 , 44 ].…”

A review of human dog‐bite injuries in Kitui South subcounty, Kenya (2017–2021)

“…6,7 Rabies is considered to be endemic in Kenya, with an estimated 523 human deaths (95% confidence interval [CI] 134-1100) annually; hence, dog bites are an important public health risk. 8 Although there is a dearth of information on the global estimates of dog-bite incidence, studies suggest that tens of millions suffer from dog-bite injuries, causing deaths in an estimated 59,000 individuals annually. 9 In the United States, approximately 4.5 million dog bites take place annually, while an estimated 1870 bites per 100,000 population occur annually in the UK.…”

“…Dogs are responsible for the transmission of zoonoses, particularly rabies virus, where they account for more than 99% of human rabies cases and approximately 22,000 people die annually of rabies in Africa alone 6,7 . Rabies is considered to be endemic in Kenya, with an estimated 523 human deaths (95% confidence interval [CI] 134–1100) annually; hence, dog bites are an important public health risk 8 …”

“… 6 , 7 Rabies is considered to be endemic in Kenya, with an estimated 523 human deaths (95% confidence interval [CI] 134–1100) annually; hence, dog bites are an important public health risk. 8 …”

Geographic Distribution of Rabies Virus and Genomic Sequence Alignment of Wild and Vaccine Strains, Kenya

“…Kenya has a >100-year history of rabies; the first case was reported in 1912 ( 23 ). Despite successful control efforts in the past, the disease has remained endemic because of challenges in sustaining vaccination programs ( 24 , 25 ). The number of human deaths attributable to rabies in Kenya is unknown ( 23 ), but some studies report estimates of >2,000 per year and others as low as 523 ( 26 , 27 ); the highest incidences have been reported in western and eastern Kenya ( 23 ).…”