Investigation of Canine-Mediated Human Rabies Death, Haiti, 2015

Abstract

In Haiti, an investigation occurred after the death of a 4-year-old girl with suspected rabies. With tips provided by community members, the investigation led to the identification of 2 probable rabies-related deaths and 16 persons bitten by rabid dogs, 75% of which chose postexposure prophylaxis. Community engagement can bolster rabies control.

Human death from suspected rabid dog bite in Zamfara State, Nigeria

“…After the victim was bitten, it took almost two months before the onset of clinical signs while death ensued within 10 days following the noticeable symptoms. The incubation period observed in this case is consistent with 1-3 months previously stated by the World Health Organization, and also coincides with the results of other studies (World Health Organization, 2013;Wallace et al, 2016;Ahmad et al, 2017;Qi et al, 2018;Tran et al, 2018). Preceding reports have indicated a shorter incubation period in cases with category III exposure site on the upper limb (Wallace et al, 2016;Qi et al, 2018).…”

“…Hence, this case can basically be classified as probable rabies. The recognized clinical signs and course of the illness in this case were similar to the previously reported exposures describing rabies in humans who died after being bitten by a suspected rabid dog (Wallace et al, 2016;Tran et al, 2018). Although the surveillance of rabies in humans has not been well carried out in Nigeria, the first documented rabies case in Zamfara State was detected in a sheep that had been bitten by an aggressive stray dog (Ahmad et al, 2017).…”

“…This incident occurred in a rural area at the peak of the farming season, during which outdoor activities of the farmers increased, leading to an enhanced chance of contact with the stray dog and potential exposure to rabies. Previous studies support this view, which showed that most human rabies-related deaths are being recorded from rural communities (Wallace et al, 2016;Tarantola et al, 2017;Qi et al, 2018;Tran et al, 2018). However, access to highly effective intervention such as timely PEP, has been considered challenging especially in rabies-endemic developing countries, where most exposures occur in rural areas (Tarantola et al, 2017).…”

“…In Africa, maximal number of human rabies deaths is documented amongst underprivileged agrarian people and children (Singh et al, 2017). Financial obstacles associated with transportation to the authorized healthcare facility and treatment, absence of local medical unit and trained personnel have been identified as barriers to seeking medical care after a rabies exposure in remote areas (Tran et al, 2018). Therefore, for better treatment of dog bites and surveillance of rabies, "rabies response centers" should be established in rural areas across Nigeria.…”

Rabies vaccine initiation and adherence among animal-bite patients in Haiti, 2015

“…Haiti is one of the last remaining countries in the Western Hemisphere with endemic canine rabies [ 1 , 12 – 16 ]. From 2009–2012, an average of four canine and seven human rabies cases were reported by Haiti’s national surveillance system (NSS), however, studies have shown these reports underestimate the true burden of rabies [ 1 , 13 – 15 , 17 ]. One community-based surveillance program with active bite-case investigation, which was operated in three Haitian communes, detected more rabid animals than reported for the entire country by NSS [ 13 ].…”