Problems in human rabies post-exposure prophylaxis management

Tepsumethanon, Saowaluck; Tepsumethanon, Veera; Tantawichien, Thanphet; Suwansrinon, Kanitta; Wilde, Henry

doi:10.1016/j.tmaid.2006.07.001

Cited by 13 publications

(11 citation statements)

References 9 publications

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“…Each case had only one consultation for potential rabies exposure during the study period. Each clinician saw an average of 5.5 cases (median: four cases, range [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]. Most consultations occurred in district level hospitals (177/273, 65%) followed by 22% in BHU-I and 14% in regional hospitals.…”

Section: Resultsmentioning

confidence: 99%

“…Doctors had a median of only two years of experience, while clinical officers and heath assistants had a median of 21 and 19 years' experience respectively. Each clinician conducted a median of four consultations (range [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]. Doctors and health consultants conducted a similar proportion of consultations, 45 and 42% respectively, while clinical officers conducted only 13%.…”

Section: Discussionmentioning

confidence: 99%

“…Good clinical judgment is essential to prevent human rabies [17]. Other studies on clinician's knowledge and attitudes conducted in the USA showed an unsatisfactorily low level of compliance with national guidelines resulting in inappropriate PEP treatment [18][19][20].…”

mentioning

confidence: 99%

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Evaluation of post-exposure prophylaxis practices to improve the cost-effectiveness of rabies control in human cases potentially exposed to rabies in southern Bhutan

et al. 2020

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Evaluation of post-exposure prophylaxis practices to improve the cost-effectiveness of rabies control in human cases potentially exposed to rabies in southern Bhutan

et al. 2020

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“…23,24 In our study, appropriate postexposure prophylaxis was performed in 85.5% of cases, and was found to be inappropriate in 14.5% of cases. These errors were as follows: beginning vaccination before the observation time is completed in the vaccinated animal (41.4%), beginning vaccination before observation time is completed in the unvaccinated animal which is not suspected of having rabies (51.7%) and not administering human rabies immune globulin although the animal has escaped or been killed (6.9%).…”

Section: Discussionmentioning

confidence: 60%

Assessment of 200 pediatric patients exposed to rabies risk

2015

Arch Argent Pediat

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Background/Purpose: Rabies is still an important health problem particularly in underdeveloped or developing countries. In this study, the aim was to investigate demographic characteristics and vaccination schedules of cases suspected of having rabies and admitted to the Pediatric Emergency Clinic of our hospital, which serves as one of the Rabies Vaccination Centers in our province. Methods: In our study, medical records of 200 patients admitted to the Pediatric Emergency Clinic with suspicion of risk of contact with the rabies virus were retrospectively analyzed. Results: Of those 200 cases, rabies risk was found to be greater in the 5-9 year old group. There was a history of having been bitten by dogs in 68.5% of cases, cat scratch in 29.5%, and contact with other animals in 2%. While 76% of animals were stray animals, only 11% of them had an owner and had been vaccinated, and were under supervision. Rabies vaccination only had been administered to 42.5% of admitted patients, tetanus and rabies vaccination to 51.5%, tetanus; rabies vaccination and human rabies immune globulin were administered to 6%. Post-exposure prophylaxis was found to have been given as recommended to 83.5% of cases. Conclusion: Rabies remains an important public health problem in developing countries like ours. We consider that public awareness should be raised; local authorities should devote efforts to control stray animals and supervise such services, and updated guidance and training should be provided to the concerned health staff to reduce the risk of rabies.

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“…Clinical experience and good clinical judgment are essential to prevent human rabies [16]. Other studies on clinician’s knowledge and attitudes, conducted in the USA (Florida, Kentucky), showed an unsatisfactorily low level of compliance with national guidelines resulting in inappropriate PEP treatment [17-19].…”

Section: Discussionmentioning

confidence: 99%

Clinicians’ management of patients potentially exposed to rabies in high-risk areas in Bhutan: A cross-sectional study

Penjor

Marquetoux

Dorji

et al. 2018

Preprint

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23Background: Rabies is endemic in southern Bhutan, associated with 1-2 human deaths annually and 24 accounting for about 6% of annual national expenditure on essential medicines. A WHO-adapted 25 National Rabies Management Guidelines (NRMG) is available to aid clinicians in PEP prescription. An 26understanding of clinical practice in the evaluation of rabies risk in endemic areas could contribute to 27 improve clinicians' PEP decision-making. 28 Methods: A cross-sectional survey of clinicians was conducted in 13 health centers in high-rabies-risk 29 areas of Bhutan during February-March 2016. Data were collected from 273 patients examined by 50 30 clinicians. 31 Results: The majority (69%) of exposure was through dog bites. Half the patients were children under 18 32 years of age. Consultations were conducted by health assistants or clinical officers (55%), or by medical 33 doctors (45%), with a median age of clinicians of 31 years. Rabies vaccines were prescribed in 91% of 34 exposure cases. The overall agreement between clinician's rabies risk assessment and the NRMG for the 35 corresponding exposure was low (kappa =0.203, p<0.001). Clinicians were more likely to underestimate 36 the risk of exposure than overestimate it. Male health assistants were the most likely to make an 37 accurate risk assessment and female health assistants were the least likely. Clinicians from district or 38 regional hospitals were more likely to conduct accurate risk assessments compared to clinicians in Basic 39 Health Units (Odds Ratios of 7.8 and 17.6, respectively). 40 Conclusions: This study highlighted significant discrepancies between clinical practice and guideline 41 recommendations for rabies risk evaluation. Regular training about rabies risk assessment and PEP 42 prescription should target all categories of clinicians. An update of the NRMG with more specific 43 criterions for the prescription of RIG might contribute to increase the compliance, along with a regular 44 review of decision-making criteria to monitor adherence to the NRMG. 45Author summary 46 Human rabies remains an important public health threat in Bhutan, especially in southern regions where 47 canine rabies is endemic. The steady increase in number of patients reporting to hospitals following dog 48 bites means escalating costs of post-exposure prophylaxis for the country. We investigated attitudes and 49 practices of clinicians who manage patients with potential rabies exposure, in the endemic area. The risk 50 of rabies exposure in the study area is mostly associated with dog bites, involving children half the time. 51Rabies vaccines were prescribed in 9 out of 10 exposure cases, while immuno-globulins were rarely 52 prescribed. The study confirmed the perceived lack of compliance of clinicians with guideline 53 recommendations for assessing rabies risk. This results in under-estimating the rabies risk in potentially 54 risky exposures in high-rabies-risk areas. Our work underscore the importance of targeted training of 55 female health assistants, do...

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Problems in human rabies post-exposure prophylaxis management

Cited by 13 publications

References 9 publications

Evaluation of post-exposure prophylaxis practices to improve the cost-effectiveness of rabies control in human cases potentially exposed to rabies in southern Bhutan

Evaluation of post-exposure prophylaxis practices to improve the cost-effectiveness of rabies control in human cases potentially exposed to rabies in southern Bhutan

Assessment of 200 pediatric patients exposed to rabies risk

Clinicians’ management of patients potentially exposed to rabies in high-risk areas in Bhutan: A cross-sectional study

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