Trends and clinico-epidemiological features of human rabies cases in Bangladesh 2006–2018

Abstract

Vaccinating dogs against rabies is an effective means of reducing human rabies. We subjected 1327 clinically diagnosed human rabies death and mass dog vaccination (MDV) data during 2006-2018 to quantify the impacts of MDV on human rabies incidence in Bangladesh and a subset of rabies death data (422) for clinico-epidemiological analysis. A positive and increasing trend of MDV (p = 0.01 and tau = 0.71) and a negative and declining trend (p < 0.001 and tau = −0.88) of human rabies cases (Correlation coefficient: −0.82) have been observed. Among 422 deaths, the majority (78%) of the victims sought treatment from traditional healers, and 12% received post-exposure prophylaxis (PEP). The mean incubation period of rabies in cases with exposure sites on the head & neck (35 days) was shorter than the upper limb (mean = 64 days, p = 0.02) and lower limb (mean = 89 days, p < 0.01). MDV has been found to be effective for reducing human rabies cases in Bangladesh. Creating awareness among the animal bite victims to stop reliance on traditional healers rather seeking PEP, addressing the role of traditional healers through awareness education programme with respect to the treatment of dog bites, ensuring availability of PEP, and continuing to scale up MDV may help to prevent human rabies deaths.Rabies is a zoonotic viral disease responsible for the death of approximately 59,000 people worldwide with more than 3.7 million disability-adjusted life years lost annually 1 . Due to acute progressive encephalitis, rabies is almost always fatal once clinical signs appear. The disease occurs predominantly in impoverished communities, in both rural and urban areas, and has been recognized for over 4000 years 2,3 . Rabies is present across all continents, except Antarctica with more than 95% of human fatalities happening in the areas of Asia and Africa, and approximately 40% of cases in the population are aged below 15 years. Although all warm-blooded animals are susceptible to rabies, domestic dogs are the main cause of rabies virus transmission to humans in up to 99% of cases in rabies-endemic regions 4 . Most cases of rabies are caused by the bite of an infected dog. The effect of rabies virus (RABV) exposure depends on a number of factors, including the gravity of the wound, the anatomical site of the bite on the body, the viral quantity and variant (genotype) inoculated into the wound(s) and the timeliness of post-exposure prophylaxis (PEP) 3 . The clinical manifestation of human rabies can appear in any of two forms: the widely perceived furious (classical or encephalitic) form or the paralytic (or dumb) form 5,6 . Each case of rabies has

Update on lyssaviruses and rabies: will past progress play as prologue in the near term towards future elimination?

“…Incubation periods range from less than a week to greater than a year (i.e. typically shorter, after bites to the head and neck), with most cases presenting within 4–6 weeks of exposure 41 . The few documented occurrences of exceptionally long incubation periods (i.e.…”

“…Fundamentally, as nearly all rabies cases occur after a bite, applied epidemiological data collection on the incidence of animal bite by age, sex, season, locality, species, etc., can be highly informative to public health policy creation in mitigating risks of disease occurrence by preventing and responding to exposures 2 , 41 , 58 , 74 , 86 , 91 , 92 , 95 , 191 . Applied appropriately with mass dog vaccination and human prophylaxis in a local, national, or regional One Health context saves lives and healthcare costs 2 , 96 .…”

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