scholarly journals Economical way to decrease financial burden: anti rabies vaccines by intra dermal administration in developing countries

2020 ◽  
Vol 7 (4) ◽  
pp. 1419
Author(s):  
Prachi Kori ◽  
Manju Toppo ◽  
Seema Patel
Keyword(s):  
Developing Countries ◽  
Financial Burden ◽  
Care Facility ◽  
Health Care Facility ◽  
Cost Benefit ◽  
Post Exposure Prophylaxis ◽  
Dog Bite ◽  
Dermal Administration ◽  
Exposure Prophylaxis ◽  
Rabies Vaccination

Background: To prevent deaths due to rabies only remedy available is post exposure prophylaxis. The major constraint is affordability to anti-rabies vaccine for intramuscular administration or intra dermal administration as PEP. So, intra dermal anti rabies vaccination (IDRV) as recommended by WHO in developing countries like India, reduces the quantity and cost of vaccination, although in most of the health facilities still intra muscular anti rabies vaccination is preferred. Objective of our study is to assess the cost benefit of intra dermal anti rabies vaccination and to find out the demographic profile of patients attending ARV clinic.Methods: It is a hospital record-based study done after ethical committee approval, carried out in a tertiary health care facility, Hamidia hospital, Bhopal (M.P.), India.Results: Our study includes 4818 entries of dog bite cases in whom vaccination cost is found to be approximately Rs. 3,90,420 with Intra dermal administration and it reduces vaccine cost by 60-70% compared with mostly preferred intramuscular vaccination. Among them 31.47% were below 14 years of age and majority 75% were male. Category III bite cases are most common 83.6% and commonest site of dog bite was over the lower limb 68.73%.Conclusions: Intra dermal regimen is more cost beneficial compared to intra muscular regimen, which is thus more helpful to reduce financial burden in developing countries like India.

scholarly journals Cost Savings of Using Updated Thai Red Cross Intradermal Regimen in a High-Throughput Anti-Rabies Clinic in New Delhi, India

2019 ◽  
Vol 4 (1) ◽  
pp. 50 ◽  
Author(s):  
Bijit Kundu ◽  
Girish Meshram ◽  
Shrinath Bhargava ◽  
Omprakash Meena
Keyword(s):  
High Throughput ◽  
Financial Burden ◽  
Cost Savings ◽  
Red Cross ◽  
Post Exposure Prophylaxis ◽  
New Delhi ◽  
Before And After ◽  
Exposure Prophylaxis ◽  
The Cost ◽  
Rabies Vaccination

Replacement of the Essen intramuscular (EIM) by the updated Thai Red Cross intradermal (UTRCID) regimen for rabies post-exposure prophylaxis (PEP), in high-throughput hospitals of India, has been advocated since 2006 thanks to its cost-effectiveness. However, several anti-rabies clinics in India and other parts of the world have not initiated this switchover of regimens because of the paucity of financial literature, generated in realistic settings, regarding the same. We calculated the procurement costs of various items required for providing rabies vaccinations via the EIM regimen and UTRCID regimen, on an annual basis, a year before and after the switchover. From a healthcare provider’s perspective, the cost of vaccination per patient was calculated to be 5.60 USD for the EIM regimen and 2.40 USD for the UTRCID regimen. The switchover to the UTRCID regimen from the EIM regimen reduced the financial burden of the rabies vaccination by almost 60%. Procurement of vaccine vials contributed to the majority of the cost (>94%) in both of the regimens. Procurement of syringes with fixed needles contributed negligibly (<6%) to the financial burden in both the regimens. A policy to progressively switch over to the UTRCID regimen from the EIM in all high-throughput anti-rabies centers of India would dramatically reduce the economic burden of running a successful anti-rabies program.

scholarly journals A dog bite study in a dog rabies-affected area in South Africa

2020 ◽  
Vol 35 (1) ◽  
Author(s):  
Jacqueline Weyer ◽  
Chantel A. Le Roux ◽  
Charles Kajese ◽  
Lucy Fernandes
Keyword(s):  
Developing Countries ◽  
Temporal Distribution ◽  
Healthcare Facility ◽  
Post Exposure Prophylaxis ◽  
Dog Bite ◽  
Healthcare Facilities ◽  
Post Exposure ◽  
Direct Training ◽  
Using Data ◽  
Exposure Prophylaxis

Background: Rabies is an untreatable and highly fatal viral zoonosis. Despite the ability to control and prevent the disease, it is estimated that one person dies of rabies every 10 minutes in developing countries. However, the true burden of the disease remains undefined in most developing countries because of a lack of systematic surveillance. Dog bite data obtained from healthcare facilities where dog bite victims seek medical care may provide an additional source of information that can be used to inform the burden of disease and identify points for interventions for improved delivery of post-exposure prophylaxis (PEP) to prevent the disease.Methods: A descriptive epidemiological study was conducted using data obtained from dog bite registers and patient case files at a healthcare facility for a two year period (2015-2017).Results: The study reported frequency, demographics, source, geographic and temporal distribution of bite cases reported to a hospital serving a rabies-affected community. In addition, the post-exposure management of dog bite cases at this facility is described.Conclusion: Dog bites was not an infrequently reported at the healthcare facility, with up to 29 cases reported in a month during the study period. The affected population was defined and it is motivated that this information is useful for targeted health interventions. Findings related to the delivery of PEP may also be used to direct training and re-training of healthcare workers for improved delivery of PEP.

Pattern and Outcome of Dog Bite Injuries among Children-a Study in 200 Cases

2021 ◽  
pp. 1-5
Author(s):  
Md Waliur Rahman ◽  
◽  
Md Habibullah Sarkar ◽  
Samir Kumar Talukder ◽  
Md Joynal Abedin ◽  
...  
Keyword(s):  
Public Health ◽  
Health Problem ◽  
Public Health Problem ◽  
Hospital Treatment ◽  
Post Exposure Prophylaxis ◽  
Dog Bite ◽  
Post Exposure ◽  
Dog Bites ◽  
Exposure Prophylaxis ◽  
Bite Injuries

Introduction: Dog bites in humans are a major public health problem. Globally, millions of people are bitten by dogs but most of the fatal cases occur in children. Dog bites in human are a serious public health problem and have been well documented worldwide. As rabies is not a notifiable disease in Bangladesh and most deaths occur in rural areas where surveillance is poor. Objectives: To determine the pattern of dog bite injuries and associated health problems among children. Methods: The study was an observational retrospective study carried out at the Dept. of General Surgery, Chuadanga Sadar Hospital, Chuadanga, Bangladesh. The study reviewed the clinical data of patients managed for dog bite related injuries and rabies over a four and half year period between January 2016 and June 2020. A proforma was designed to extract relevant clinical data from the case records. Information extracted included the age, sex of the victims, site of the bite, time of presentation in the hospital, pre-hospital treatment, hospital treatment including post-exposure prophylaxis and complication. Results: In all, 200 cases of dog bite injuries were managed constituting 0.89% of the total consultations; 5 (2.5%) had rabies. Most of the victims were aged 6-12 years (55.0%) and majority (67.0%) was boys. Eighty two percent of the victims presented within 24hrs of the injury. 92 (46.0%) had WHO grade 3 dog bite injury at presentation and the lower limb was the commonest (56.0%) bite site. Use of herbal preparation was the most common pre-hospital treatment 60%. Although 95.0% received anti-rabies vaccine, only 55.5% of them completed the vaccination schedule. The case fatality rate for dog bite was 5.0%. The 5 that died all presented late, had no post exposure prophylaxis and died within 24 hours of admission. Conclusion: There is need for public enlightenment on dangers associated with dog bites and also for the government to ensure vaccination for cost of post exposure prophylaxis treatment for children free of cost

scholarly journals Traveller exposures to animals: a GeoSentinel analysis

2020 ◽  
Vol 27 (7) ◽  
Author(s):  
Michael P Muehlenbein ◽  
Kristina M Angelo ◽  
Patricia Schlagenhauf ◽  
Lin Chen ◽  
Martin P Grobusch ◽  
...  
Keyword(s):  
Mammalian Species ◽  
Wild Animal ◽  
Post Exposure Prophylaxis ◽  
Behavioral Modification ◽  
Surveillance Network ◽  
Domestic Species ◽  
Wide Range ◽  
Animal Bites ◽  
Exposure Prophylaxis ◽  
Rabies Vaccination

Abstract Background Human coexistence with other animals can result in both intentional and unintentional contact with a variety of mammalian and non-mammalian species. International travellers are at risk for such encounters; travellers risk injury, infection and possibly death from domestic and wild animal bites, scratches, licks and other exposures. The aim of the present analysis was to understand the diversity and distribution of animal-related exposures among international travellers. Methods Data from January 2007 through December 2018 from the GeoSentinel Surveillance Network were reviewed. Records were included if the exposure was non-migration travel with a diagnosis of an animal (dog, cat, monkey, snake or other) bite or other exposure (non-bite); records were excluded if the region of exposure was not ascertainable or if another, unrelated acute diagnosis was reported. Results A total of 6470 animal exposures (bite or non-bite) were included. The majority (71%) occurred in Asia. Travellers to 167 countries had at least one report of an animal bite or non-bite exposure. The majority (76%) involved dogs, monkeys and cats, although a wide range of wild and domestic species were involved. Almost two-thirds (62.6%) of 4395 travellers with information available did not report a pretravel consultation with a healthcare provider. Conclusions Minimizing bites and other animal exposures requires education (particularly during pretravel consultations) and behavioral modification. These should be supplemented by the use of pre-exposure rabies vaccination for travellers to high-risk countries (especially to those with limited access to rabies immunoglobulin), as well as encouragement of timely (in-country) post-exposure prophylaxis for rabies and Macacine alphaherpesvirus 1 (herpesvirus B) when warranted.

Paralytic rabies: An acute flaccid myelitis after inadequate post exposure prophylaxis

2019 ◽  
Vol 49 (4) ◽  
pp. 301-302
Author(s):  
Ashok Kumar Pannu ◽  
Raichur Vijay Kumar ◽  
Deeksha Vijaykumar ◽  
Lakshmi Priya ◽  
Harpreet Singh ◽  
...  
Keyword(s):  
Post Exposure Prophylaxis ◽  
Middle Aged ◽  
Post Exposure ◽  
Acute Flaccid Myelitis ◽  
Clinical Syndromes ◽  
Exposure Prophylaxis ◽  
Rabies Vaccination

Rabies has two distinct clinical syndromes, encephalitic (or ‘furious’) and paralytic (or ‘dumb’). The paralytic form presents as acute flaccid myelitis and is more common in patients who received post-exposure anti-rabies vaccination without rabies immunoglobulins. We have recently had the opportunity to manage a middle-aged man presenting as ‘dumb’ paralytic rabies.

scholarly journals “As long as the patient tells you it was a dog that bit him, why do you need to know more?” A qualitative study of how healthcare workers apply clinical guidelines to treat dog bite injuries in selected hospitals in Uganda

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0254650
Author(s):  
Stevens Kisaka ◽  
Fredrick E. Makumbi ◽  
Samuel Majalija ◽  
Alexander Kagaha ◽  
S. M. Thumbi
Keyword(s):  
Clinical Guidelines ◽  
Clinical Management ◽  
Health Workers ◽  
Post Exposure Prophylaxis ◽  
Dog Bite ◽  
Dog Bites ◽  
Rabies Control ◽  
Exposure Prophylaxis ◽  
Control And Management ◽  
Bite Injuries

Dog-mediated rabies is on the increase in Uganda despite the availability of post-exposure prophylaxis (PEP). PEP procedures are expounded in the Uganda Clinical Guidelines (UCG) of 2016. We assessed adherence by health workers to UCG while managing dog bites in two PEP centers and obtained insights into motivations of their practices. Using qualitative methods, we observed the health worker-patient encounters, reviewed medical records, and interviewed 14 health workers that were involved in managing dog bite injuries. We used deductive thematic analysis to identify codes in themes developed from UCG. We found that much of the history of the bites was taken, but it was neither verified nor written down on the patient’s file. Classification of wounds was inaccurate and ancillary laboratory assessments like culture and sensitivity tests were not conducted in all cases. Although antibiotics were given for both treatment and prophylactic purposes, the prescription was based on availability and affordability, not UCG recommendations. Rabies immunoglobulin (RIG) was not administered to deserving patients due to unavailability and high costs to the patient. Anti-rabies vaccine (ARV) was prescribed indiscriminately and some health workers attributed this to pressure from patients. Health education regarding prevention of dog bites was not given to patients due to time constraints on the side of the providers as a result of high caseloads at the emergency departments. Challenges to adherence to guidelines were identified as frequent ARV stock outs; inadequate cooperation among health facilities; and insufficient knowledge and skills on how injuries and rabies should be managed. We conclude that clinical management of dog bites is not fully in line with UCG. We argue that adoption of an integrated bite case management and cost-saving strategies as well as continuing medical education programs on rabies control and management could improve the clinical management of dog bites.

scholarly journals Safety and immunogenicity of intradermal rabies vaccination for post exposure prophylaxis

2016 ◽  
pp. 692-696
Author(s):  
Ravish Hardanahalli ◽  
Rachana Annadani ◽  
Madhusudana Shampur ◽  
Veena Vijayashankar ◽  
Ashwath Doddabele ◽  
...  
Keyword(s):  
Post Exposure Prophylaxis ◽  
Post Exposure ◽  
Exposure Prophylaxis ◽  
Rabies Vaccination

scholarly journals Compliance to anti-rabies vaccination in post-exposure prophylaxis

2015 ◽  
Vol 59 (1) ◽  
pp. 58 ◽  
Author(s):  
RavishHaradanahalli Shankaraiah ◽  
RachanaAnnadani Rajashekar ◽  
Vijayashankar Veena ◽  
Ashwath NarayanaDoddabele Hanumanthaiah
Keyword(s):  
Post Exposure Prophylaxis ◽  
Post Exposure ◽  
Exposure Prophylaxis ◽  
Rabies Vaccination

scholarly journals Epidemiological and clinical profile of dog bitten children and side effects of anti rabies vaccine

2019 ◽  
Vol 6 (4) ◽  
pp. 1491
Author(s):  
P. Ramkumar ◽  
S. Balamurugan
Keyword(s):  
Side Effects ◽  
Rabies Vaccine ◽  
Clinical Profile ◽  
Post Exposure Prophylaxis ◽  
Dog Bite ◽  
Stray Dogs ◽  
Post Exposure ◽  
Systemic Side Effects ◽  
Local Side ◽  
Rabies Vaccination

Background: Rabies is one of the commonest zoonotic diseases due to Lyssa virus. Rabies is a 100% fatal disease. Understanding the epidemiological and clinical profile of the victims helps in the prevention of dog bite. But rabies is 100% preventable by pre and post exposure prophylaxis vaccination. Evaluation of side effects of anti-rabies vaccine (ARV) is helpful in the pre and post exposure prophylaxis.Methods: Authors did a descriptive study of 1450 dog-bitten children. Using the pro-forma, authors interviewed the parents, examined the children. Using W.H.O classification, authors classified the dog bite wounds. Anti-rabies vaccination was administered to category 2 dog bite wounded children. Side effects of vaccination are recorded.Results: Out of 1450 children, significantly more number of boys (67%) in the age group of 10-12 years (31%), from class IV socioeconomic category (52%), nuclear families (80%), sustained category III dog bite (52%) in the lower limb (48%) by unvaccinated (82%) stray dogs (60%) while playing or walking (52%) in the street (60%) during night (72%). Purified Vero cell culture rabies vaccine is having rare mild local side effects (2%), rare mild systemic side effects (4.16%) and very rare systemic allergic reaction (0.14%) but no major side effects.Conclusions: Dog bites can be prevented by not allowing the children to play or walk alone in the street especially during night. The severity of wound can be minimized by wearing fully covered extremities. Vaccination of dogs and population control of stray dogs will reduce rabies. There were no major side-effects or adverse events following vaccination (AEFI) with anti-rabies vaccination. Rare mild local side effects and very rare mild systemic side effects may happen.

scholarly journals To study the treatment compliance among the animal bite patients attending anti rabies clinic in a tertiary care hospital, Solapur

2017 ◽  
Vol 4 (9) ◽  
pp. 3394 ◽  
Author(s):  
Dhananjaya Chinthapatlu Desaiah ◽  
Lokesh Kabbalu Chikkegowda ◽  
Swetha Chandru ◽  
Santhosh Munipapanna
Keyword(s):  
Interpersonal Communication ◽  
Tertiary Care ◽  
Treatment Compliance ◽  
Vaccination Schedule ◽  
Study Data ◽  
Post Exposure Prophylaxis ◽  
Care Hospital ◽  
Fourth Dose ◽  
Exposure Prophylaxis ◽  
Rabies Vaccination

Background: Rabies is 100% fatal zoonotic disease. In India majority of the disease is caused by bite of dogs, whereas bite of several other animals like cats, donkeys, monkeys, pigs, jackals and wolves can cause rabies. Post exposure prophylaxis (PEP) effectively prevents the occurrence of rabies in the exposed person. Hence the current study is done to know the treatment compliance among the patients attending Anti rabies clinic.Methods: It is hospital based longitudinal study. Data was collected through personal interview from January 1st 2013 to December 31st 2013 and clinical examination was done. All patients were registered and were given first dose of ARV at the time of registration and advised to take all the remaining doses as per schedule. Data regarding their compliance for completion of vaccination schedule was analyzed. Statistical analysis was done by using simple proportions and percentages.Results: Out of 7205 patients, 5343 (74.15%) patients completed second dose, 5021 (69.68%) patients completed third dose and 2998 (41.6%) patients completed fourth dose of intradermal schedule of rabies vaccination and anti-rabies immunoglobulins were advised for 1536 patients among them 1180 (76.82%) patients took immunoglobulins.Conclusions: Most of the patients are not completing ARV intradermal schedule. Hence the animal bite patients should be motivated effectively through health education by interpersonal communication at the time of initiation of vaccination course about timely and complete administration of anti - rabies vaccination to attain the goal of Rabies free India. 

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