A retrospective evaluation of bites at risk of rabies transmission across 7 years: The need to improve surveillance and reporting systems for rabies elimination

Abstract

The vast majority of rabies deaths occur in developing countries and rural areas. Due to the absence of surveillance and the lack of reliable information, many endemic countries are not able to assess their rabies burden and implement appropriate solutions. This study reports the incidence of animal bites considered at risk of rabies transmission, along with rates and determinants of the adherence to post-exposure prophylaxis (PEP) between 2008 and 2014 in Dodoma Region, Tanzania. A retrospective analysis of rabid animal bites considered at risk of rabies transmission at Dodoma Regional Referral Hospital (DRRH) during 2008–2014 was conducted. Data were collected from the registers of patients presenting to the hospital because of a potential rabies exposure. The patients were assessed by a trained health worker and each bite was considered as “at risk of rabies” based on the victim’s description of the event. Overall, 10,771 patients coming from Dodoma Region attended DRRH because of a bite from a suspected rabid animal, giving a mean incidence of 74 bites at risk of rabies transmission per 100,000 persons per year. Overall, only 46.0% of people exposed received a complete course of PEP and 61.6% attended the clinic within 48 hours after the bite. Multivariate analysis shows that people age >15 years, residence in rural areas and occurrence during the rainy season were independently associated to delayed access to care. Male gender, age below 15 years. and bites occurring during the dry season were associated with completion of PEP. In this area with a high rate of at-risk bites, several factors—mainly related to health care access and to the affordability and delivery of rabies vaccines—still need to be addressed in order to reduce gender and social inequalities in rabies prevention and control. Further efforts are required to establish an efficient rabies surveillance system in Dodoma Region.

Animal Contact and Rabies Prophylaxis Experience: Evaluation of 625 Pediatric Cases

“…In a study by Krzowska-Firych et al comprising 519 pediatric patients, a larger number of patients applied from urban regions similar to our study (13). However, in the literature, contacts have been reported to be more vastly seen in the countryside (5). We are of the opinion that this situation is a result of the growing number of dogs on streets in cities, and hence, animal control is harder and, in the countryside, public awareness is low and there is not sufficient number of cases that apply to hospital after animal contact.…”

“…Most of the mortalities occur in developing countries where rabies control is inadequate and insufficient. Limited access to rabies vaccination and specific immunoglobulins constitutes a crucial problem (5). Moreover, 80% of the mortalities involve those living in the countryside, and 40% of the patients are under the age of 15.…”

The Story of Post-exposure Rabies Prophylaxis at the Pediatric Emergency Department

“…8,15,22 Dog bites are common in the eastern part of the country and in many developing countries. 15,23 In developed countries, wild animals are the common reasons of potentially rabid animal contacts. Although rodents are not considered sources of human transmission, prophylaxis is applied to victims of events involving rodents in some countries.…”

“…Most of the exposures were caused by stray cats and dogs (61.4%) as it is in other countries. [22][23][24] The rate of immunized animals in Turkey and in our city is less than what is required; nevertheless, these animals have owners which is crucial in rabies prevention. 22 The type of exposure is the most significant determinant of hospital applications and the categorization of the wound determines the treatment approach.…”

Trends and spatial distribution of animal bites and vaccination status among victims and the animal population, Uganda: A veterinary surveillance system analysis, 2013 – 2017

“…Rabies is transmitted primarily through bites from an infected rabid animal; however, it can also be transmitted from licks or scratches from an infected rabid animal or, rarely, through transplantation of tissues or organs from an infected individual (4–6). Rabies occurs on all continents except Antarctica, with most cases reported in Africa and Asia (7,8). Almost all cases of human rabies are due to bites from infected dogs (7).…”