Risk Factors and Spatio-Temporal Patterns of Human Rabies Exposure in Northwestern Tigray, Ethiopia

Abstract

Background:Rabies is a neglected tropical disease, which is economically important with great public health concerns in developing countries including Ethiopia. Epidemiological information can play an important role in the control and prevention of rabies, though little is known about the status of the disease in many settings of Ethiopia. The present study aimed to investigate the risk factors and spatio-temporal patterns of human rabies exposure in Northwestern Tigray, Ethiopia.Methods:A prospective study was conducted from 01 January 2016 to 31 December 2016 (lapsed for one year) at Suhul general hospital, Northern Ethiopia. Data of human rabies exposure cases were collected using a pretested questionnaire that was prepared for individuals dog bite victims. Moreover, GPS coordinate of each exposure site was collected for spatio-temporal analysis using hand-held Garmin 64 GPS apparatus. Later, cluster of human rabies exposures were identified using Getis-Ord Gi* statistics.Results:In total, 368 human rabies exposure cases were collected during the study year. Age group of 5 to 14 years old were highly exposed (43.2%; 95% CI, 38.2–48.3). Greater number of human rabies exposures was registered in males (63%; 95% CI, 58.0–67.8) than females (37%; 95% CI, 32.1–42.0). Residents of rural (85.6%; 95% CI, 81.6–88.8) areas were at greater risk to rabies than urban residents (14.4%; 95% CI, 11.2–18.4). Higher proportion of human rabies exposures were caused by unprovoked (96.5%; 95% CI, 94.0–98.0) and unvaccinated (85.9%; 95% CI, 81.9–89.1) dogs. All rabies exposures were exclusively caused by dog bites and the majority of them (80.4%; 95% CI, 76.0–84.2) were caused by stray dogs. Results of spatio-temporal analysis showed that Asgede Tsimbla, Endaselassie and Laelay Adiyabo districts experienced the highest burden of rabies exposure; identified as hot spots. Strong peaks of human rabies exposure occurred between March and July months.Conclusion:The present study provided basic epidemiological information on the potential risk factors associated with human rabies exposure. Moreover, our findings provided basis for understanding the spatio-temporal patterns of human rabies in Northwestern Tigray districts for the first time.

Rabies mortality and morbidity associated with animal bites in Africa: a case for integrated rabies disease surveillance, prevention and control: a scoping review

“… 33 38 39 85 100 Dog vaccination coverage varied from 14.1% to 68.78%. 33 85 In Ethiopia and Zimbabwe, the dog vaccination decreased significantly across the study and also the health status of most dogs involved in biting was unknown. 39 100 Rabies prevention and control also depended on the seasonality.…”

“…16 17 20 21 The review of 20 studies across Africa has revealed that bite victims account for 91.9% (48 092 dog bites), cat bite for 2.9%, jackal bite for 0.8% and 4.41% for others (monkey, donkey, horse, rat, pig, rabbit, Honey badger, kudu, goat, cattle, eland and hyaena). [29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48] Mass vaccination of dogs as a key component of national rabies elimination programmes has been successful in eliminating dog-transmitted rabies in Europe, North and Latin America, and Japan. [49][50][51] By far, the most significant public health threat comes from RABV, and over 99% of all globally reported human cases are caused by exposure to unvaccinated dogs infected with canine RABV variant, mostly in Asia and Africa.…”

“…29 84 A total of 924 human rabies reported. 101 The incidence of human rabies exposure was reported to be 40 per 100 000 people in Ethiopia 33 ; annual estimated rabies incidence of 2.33 cases per 100 000 in humans 101 ; the incidence of human rabies exposure cases calculated per 100 000 people was 35.8, 63.0, 89.8 and 73.1 every year 91 1 year, January 2016-31 December 2016; 2 years, 2015-2017; 3 years, 2012-2015; 11 months, April 2009-March 2010 33 91 100 101 Ghana (Techiman municipality; eastern region of Ghana)…”

Policy Perspectives of Dog-Mediated Rabies Control in Resource-Limited Countries: The Ethiopian Situation

“…In rural areas, the preferential use of traditional/spiritual healers might also contribute to the reduced level of post-exposure prophylaxis (PEP) ( 14 ). Based on registered health records, the annual human rabies exposure rate (based on refined exposure risk assessment performed following rabies suspected animal bite) per 100,000 population has been estimated to range from zero to 40 ( 15 , 16 ). To account for underreporting, Beyene et al ( 17 ) conducted an extensive survey-based case search, also known as contact tracing.…”

Spatiotemporal distribution of COVID-19 during the first 7 months of the epidemic in Vietnam

“…It helps the decision-making to determine the allocation of limited medical and human resources and the preparedness for the infection control measures, especially for developing countries. Detection of disease clustering contributes to identification of risk factors for exposure [ 8 ] as well as identification of the signals of a pandemic [ 9 ]. Several previous studies using spatiotemporal analysis have contributed to decision-making during outbreaks of emerging infectious diseases such as severe acute respiratory syndrome (SARS) [ 10 ], Middle East respiratory syndrome [ 11 ], avian influenza A (H5N1) [ 12 ] and (H7N9) viruses [ 13 ] infections and COVID-19 [ 14 ].…”