scholarly journals Sedation-Paralysis as Cornerstone on Rabies Management (Milwaukee Protocol)

2022 ◽  
Author(s):  
Ali Jabbari ◽  
Behnaz Khodabakhshi ◽  
Shabnam Tabasi
Keyword(s):  
Intensive Care ◽  
Cardiac Rhythm ◽  
Antiviral Agents ◽  
Disease Onset ◽  
Care Patient ◽  
Post Exposure Prophylaxis ◽  
Motor Disorders ◽  
Dog Bite ◽  
The Central Nervous System ◽  
Exposure Prophylaxis

Rabies is a viral infection involving the central nervous system that is almost always fatal without proper post exposure prophylaxis. Here, we present a 38 years-old male with dog-bite and late attention whom, managed in intensive care unit. After 21 days, the disease progressed to serious neurologic and hemodynamic damage including motor disorders and imbalance in blood pressure and cardiac rhythm. Clinical management of the patient consisted of antiviral agents (Amantadine and Ribavirin), neuroprotection, sedation-paralysis and supportive care. Patient was survived 43 days from the clinical disease onset. Although our patient died in spite of intensive care, advances in the use of sedation-paralysis and early prescription of antiviral agents raised hopes that it may eventually be possible to save rabies patients.

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 “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 Epidemiological Aspect of Dog Bite and Response of The Dog Bite Victims Attending Vaccination Centre of Sadar Hospital, Sirajganj

KYAMC Journal ◽  
2019 ◽  
Vol 9 (4) ◽  
pp. 148-152
Author(s):  
Ahmed Nawsher Alam ◽  
Mahmuda Siddiqua ◽  
Asma Siddiqua ◽  
Nasreen Akther ◽  
Moushumi Sarker ◽  
...  
Keyword(s):  
Rural Areas ◽  
Public Health Problem ◽  
Education Level ◽  
Post Exposure Prophylaxis ◽  
Dog Bite ◽  
Primary Level ◽  
Epidemiological Aspect ◽  
Low Education ◽  
Knowledge And Attitude ◽  
Exposure Prophylaxis

Background: Rabies is a public health problem in Bangladesh, with poorer people and children being mainly affected. Objectives: The aim of this study was to investigate the behaviours of dog bite victims following a bite and to assess the knowledge and attitude about rabies among dog bite victims. Materials and Methods: A crosssectional type of descriptive study was designed where individual people who came to the vaccination centre from the month of April 2015 to July 2015 for post-exposure prophylaxis were considered. They were interviewed and followed during subsequent visits until they had received their final dose of vaccination. Result: Among the victims, males 60.9% were more common than females 39.1% and most of them were children aged below 20 years 51 %, mostly from rural areas 69.3%, had very little primary 46.1% or no education 24.7%. Victims were bitten mostly at their legs 89.3%. In response to question regarding what happens following dog bite, 49% couldn't say anything, and 46% mentioned hydrophobia. Most of them (87%) know that rabies can be transmitted from dogs to humans; 68.4% had no idea that rabies can be prevented in dogs. Though 82.3% bite victims didn't know that rabies in humans can be prevented before a dog bite, 77.7% knew that rabies can be prevented after a dog bite. Use of soap and water was found lowest 13.1% among those who had education upto primary level and highest 53.9% in graduates. Conclusion: This study showed that most victims didn't take any washing measures before visiting to hospital which is one of the most important measures recommended by WHO and it was found mostly who had low education level. It also observed that knowledge gap about rabies among the dog bite victims decreased with increased education level. KYAMC Journal Vol. 9, No.-4, January 2019, Page 148-152

scholarly journals A Retrospective Study on Dog Bite Associated Rabies in Human and the Use of Post-exposure Prophylaxis in Nepal during 2008 to 2017

2021 ◽  
Vol 11 (2) ◽  
pp. 181-186
Author(s):  
Pushkar Pal ◽  
Hiroshi Shimoda ◽  
Rajendra Bashyal ◽  
Adisorn Yawongsa ◽  
Theera Rukkwamsuk
Keyword(s):  
Population Management ◽  
Human Rabies ◽  
Post Exposure Prophylaxis ◽  
Dog Bite ◽  
Stray Dogs ◽  
Post Exposure ◽  
Dog Bites ◽  
Stray Dog ◽  
The Government ◽  
Exposure Prophylaxis

A 10-year (2008-2017) retrospective canine-mediated human rabies epidemiology was studied to assess the burden of rabies in Nepal. To this end, the number of dog bites, the use of post-exposure prophylaxis (PEP), and human death records from 2008 to 2017 were retrieved from Sukraraj Tropical Hospital, Kathmandu, Nepal. The findings revealed that the number of human rabies occurrences was consistent with minor fluctuations throughout the study period. There were 252,297 dog bite cases in humans recorded between 2008 and 2017. Every month, 2,102 people were bitten by mostly stray dogs. There was a gradual increase in PEP use throughout 10 years. On average, 36,995 PEP dosages were used per year for stray dog bites. The PEP consumption and the number of human deaths were negatively correlated. A total of 482 human rabies deaths were recorded in Nepal during the study period. On average, 49 people died of canine-mediated rabies each year. Although there was an increase in the use of PEP, the number of human deaths and street dog bites recorded were still high. The high mortality due to rabies could then be attributed to the flawed surveillance system and stray dog population management, and not merely the lack of PEP services. Hence, it is recommended that the government agencies and other concerned stakeholders should organize mass vaccination and population management program for stray dogs in order to reduce the country’s rabies burden.

scholarly journals Fatal case of human rabies imported to Italy from India highlights the importance of adequate post-exposure prophylaxis, October 2011

2012 ◽  
Vol 17 (19) ◽  
Author(s):  
P De Benedictis ◽  
G Perboni ◽  
C Gentili ◽  
L Gaetti ◽  
F Zaffanella ◽  
...  
Keyword(s):  
Intensive Care ◽  
Fatal Case ◽  
Human Rabies ◽  
Post Exposure Prophylaxis ◽  
Intensive Care Treatment ◽  
Post Mortem ◽  
Post Exposure ◽  
Acute Encephalitis ◽  
History Of ◽  
Exposure Prophylaxis

In October 2011, an Indian man resident in Italy was admitted to a hospital in Mantua, Italy with symptoms of acute encephalitis. Due to a recent history of bite by a suspected rabid dog in India, where he had received incomplete post-exposure treatment, rabies was suspected. The patient died after 22 days of intensive care treatment and rabies was confirmed post mortem. This report stresses the need of appropriate post-exposure prophylaxis in rabies-endemic countries.

scholarly journals Suspected dog bite associated HIV horizontal transmission in Swaziland

2013 ◽  
Vol 5 (1) ◽  
Author(s):  
Ganizani Mlawanda
Keyword(s):  
Hepatitis C ◽  
Hepatitis B ◽  
Hiv Transmission ◽  
Horizontal Transmission ◽  
Rapid Test ◽  
Post Exposure Prophylaxis ◽  
Dog Bite ◽  
Dog Bites ◽  
Second Victim ◽  
Exposure Prophylaxis

Background: Dog bites may lead to transmission of bacteria and viruses over and above tetanus and rabies. Theoretically human immunodeficiency virus (HIV), Hepatitis B and Hepatitis C may be transmitted after dog bites where transfer of blood from one victim to another occur in clinical practice HIV, Hepatitis B and Hepatitis C are not considered when making treatment decisions, nor adequate patient history taken to consider all potential risks after dog bites in succession.Objective: To present case of suspected HIV transmission after dog bites in close succession involving two HIV sero-discordant victims.Management and outcome: HIV rapid test and/or HIV Ribonucleic acid (RNA) polymerasechain reaction (PCR) results for the victim(s) at presentation and a month later.Results: Two night patrol guards presented to casualty after dog bites in close succession by the same dog. They were managed according to the dog bite protocol. Thinking out of the box, the first victim was found to be HIV positive by rapid test whilst the second victim was negative based on both HIV rapid test and HIV RNA PCR. One month after the dogbites, a case of HIV sero-conversion was confirmed in the second victim despite post-exposure prophylaxis (PEP).Discussion: Although an isolated case, shouldn’t clinicians re-think the significance of HIV transmission after animal bites where there is repeated blood exposure in several people insuccession?Conclusion: Clinicians should be aware of the potential of HIV, Hepatitis B and C transmission, when faced with dog bites in succession. 

Management of Rabies Prophylaxis for Potential Bat Exposures in a Level III Neonatal Intensive Care Unit

2016 ◽  
Vol 38 (4) ◽  
pp. 483-485
Author(s):  
Ann L. Bailey ◽  
Rachel D. Quick ◽  
Joanne Dixon ◽  
Sarmistha B. Hauger
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Preterm Infants ◽  
Neonatal Intensive Care ◽  
Post Exposure Prophylaxis ◽  
Post Vaccination ◽  
Potential Exposure ◽  
Post Exposure ◽  
Exposure Prophylaxis

This report describes the unique challenges of managing potential exposure to bats in a neonatal intensive care unit. The outcome demonstrates that rabies post-exposure prophylaxis can be safely administered to preterm infants with evidence that preterm infants are able to develop adequate titers post vaccination.Infect Control Hosp Epidemiol 2017;38:483–485

scholarly journals The Diagnosis, Clinical Course, Treatment, and Prevention of the Rabies Virus

2021 ◽  
Author(s):  
Jaida Hopkins ◽  
Samantha Sweck ◽  
Sean Richards
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Central Nervous System Infection ◽  
Post Exposure Prophylaxis ◽  
Behavior Changes ◽  
Success Rates ◽  
Treatment And Prevention ◽  
The Central Nervous System ◽  
Exposure Prophylaxis ◽  
Therapy Success

Rabies, despite available vaccines, causes approximately 55,000 deaths every year. Diagnosing relies on noting physical behaviors such as hydrophobia, vomiting, fever, behavior changes, paralysis, and consciousness, as well as, using several methodologies to molecularly detect the presence of the virus. RABV often enters through a bite wound given that it is transmissible through saliva. Infection spreads from muscle fibers into the peripheral nervous system traveling to the central nervous system. Infection of the central nervous system can lead to encephalitis (furious rabies) or acute flaccid paralysis (paralytic rabies). Treatment relies heavily on the time of exposure. If the patient is diagnosed prior to being symptomatic, post-exposure prophylaxis (PEP) can be administered. However, once the patient has begun displaying symptoms, therapy success rates sharply decline. Prevention includes vaccinating during both pre- and post-exposures, as well as utilizing Stepwise Approach towards Rabies Elimination (SARE) to aid impoverished countries in declining their rabies mortality rates.

scholarly journals THE IMPORTANCE OF RIVER VIRUS CONTROL, IT’S GEOGRAPHICAL DISTRIBUTION, BIOLOGICAL CYCLE, PATHOGENESIS AND PROPHYLATIC MEASURES: A REVIEW.

2019 ◽  
Vol 16 (31) ◽  
pp. 133-146
Author(s):  
Thiago Willame Barbosa ALVES ◽  
Francisco Patricio de ANDRADE JÚNIOR ◽  
Vanessa Santos de Arruda BARBOSA
Keyword(s):  
Geographical Distribution ◽  
International Health ◽  
Post Exposure Prophylaxis ◽  
Biological Cycle ◽  
Zoonotic Infection ◽  
Worldwide Distribution ◽  
Prophylactic Measures ◽  
The Central Nervous System ◽  
Review Study ◽  
Exposure Prophylaxis

The rabies is a zoonotic infection that attacks the central nervous system, being caused by a virus of RNA belonging to the Lyssavirus genus. The present study aimed to gather information about the importance of rabies virus (VR) control, correlating with its geographical distribution, biological cycle, pathogenesis and prophylactic measures. This is a review study in which the databases Medline/Pubmed, Lilacs, Scielo, Science Direct, thesis and dissertation bank of public universities and the national and international health committees were used. We analyzed 105 materials, of which 52 were included in this study, those that did not have relevant aspects about the proposed theme, were excluded. Rabies has a worldwide distribution, where its mortality reaches almost 100%. Therefore, permanent surveillance of the different components of the RV transmission chain is essential, in addition vaccination of domestic animals (dogs and cats) and post-exposure prophylaxis should be well performed to promote better prevention against this virus and to prevent possible development of this disease.

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.

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