scholarly journals Epidemiological Analysis of the Effectiveness of Rabies Post-Exposure Prophylaxis in the Russian Federation (2001–2018)

2021 ◽  
Vol 20 (4) ◽  
pp. 57-67
Author(s):  
D. N. Nashatyreva ◽  
A. D. Botvinkin ◽  
E. M. Poleshchuk ◽  
G. N. Sidorov ◽  
N. V. Rudakov
Keyword(s):  
Failure Rate ◽  
Russian Federation ◽  
Human Rabies ◽  
Post Exposure Prophylaxis ◽  
Post Exposure ◽  
Source Of Infection ◽  
Comparison Groups ◽  
The Russian Federation ◽  
Exposure Prophylaxis ◽  
The Relationship

Relevance. Post-exposure prophylaxis (PEP) is the most effective method for reducing the morbidity and mortality of human rabies. Since 2000, in Russia, domestically produced cultural purified and concentrated rabies vaccine (COCAV) and equine immunoglobulin (AIG) are used as the main drugs for PEP.Aims. To assess the epidemiological effectiveness of post-exposure rabies prophylaxis and possible causes of failure in the Russian Federation in 2001–2018.Materials & methods. A comprehensive retrospective epidemiological study of 167 cases of rabies in humans and PEP statistics in the Russian Federation was carried out. To test the hypotheses about the relationship between PEP failures and risk factors, namely (gender, age, place of residence of the sick, nature of the injuries received, source of infection), two main comparison groups were formed: «vaccinated» (n = 28) and «not vaccinated» (n = 139). In addition, we compared the groups who received PEP correctly and those vaccinated with violations of instructions. The failure rate was assessed in relation to the total number of vaccinated and the number of vaccinated after contact with rabid animals.Results. During the analyzed period, the incidence of human rabies decreased from 0.015 to 0.0013 per 100 thousand population. Of the patients, 83.2% did not receive PEP (did not apply, vaccinations were not prescribed, refused). In the group «vaccinated» in 53.6% (n = 15), the schemes of PEP prescribing and administering were violated, including in 35.7% (n = 10) of cases AIG was not administered. The rest 46.4% (n = 13), received vaccinations in accordance with the instructions. Before the end of the vaccination course, 85.7% (n = 24) fell ill; the rest fell ill with an incubation period of more than three months. Only one person received AIG and all 6 vaccine injections. The group «vaccinated» differed from the group «not vaccinated» by a higher frequency of category III injuries (χ2 = 9.99, p = 0.019) and injuries caused by wild animals, especially wolves (χ2 = 22.24, p < 0.001).Conclusions. Among people who developed rabies in 2001–2018, 16.8% received PEP. The proportion of the number of cases and the total number of those who received PEP was 1: 240.0 thousand. The failure rate of PEP after contact with rabid animals was 0.03% (excluding the nature of the contact and the animal species). More than 70% of all failures are associated with wolf and fox bites, more than 85% with category III injuries.

scholarly journals Post-exposure prophylaxis vaccination rate and risk factors of human rabies in mainland China: a meta-analysis

2018 ◽  
Vol 147 ◽  
Author(s):  
D. L. Wang ◽  
X. F. Zhang ◽  
H. Jin ◽  
X. Q. Cheng ◽  
C. X. Duan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Rural Areas ◽  
Meta Analysis ◽  
Mainland China ◽  
Vaccination Rate ◽  
Human Rabies ◽  
Post Exposure Prophylaxis ◽  
Eastern Region ◽  
Post Exposure ◽  
Exposure Prophylaxis

AbstractRabies is one of the major public health problems in China, and the mortality rate of rabies remains the highest among all notifiable infectious diseases. A meta-analysis was conducted to investigate the post-exposure prophylaxis (PEP) vaccination rate and risk factors for human rabies in mainland China. The PubMed, Web of Science, Chinese National Knowledge Infrastructure, Chinese Science and Technology Periodical and Wanfang databases were searched for articles on rabies vaccination status (published between 2007 and 2017). In total, 10 174 human rabies cases from 136 studies were included in this meta-analysis. Approximately 97.2% (95% confidence interval (CI) 95.1–98.7%) of rabies cases occurred in rural areas and 72.6% (95% CI 70.0–75.1%) occurred in farmers. Overall, the vaccination rate in the reported human rabies cases was 15.4% (95% CI 13.7–17.4%). However, among vaccinated individuals, 85.5% (95% CI 79.8%–83.4%) did not complete the vaccination regimen. In a subgroup analysis, the PEP vaccination rate in the eastern region (18.8%, 95% CI 15.9–22.1%) was higher than that in the western region (13.3%, 95% CI 11.1–15.8%) and this rate decreased after 2007. Approximately 68.9% (95% CI 63.6–73.8%) of rabies cases experienced category-III exposures, but their PEP vaccination rate was 27.0% (95% CI 14.4–44.9%) and only 6.1% (95% CI 4.4–8.4%) received rabies immunoglobulin. Together, these results suggested that the PEP vaccination rate among human rabies cases was low in mainland China. Therefore, standardised treatment and vaccination programs of dog bites need to be further strengthened, particularly in rural areas.

scholarly journals Human rabies post-exposure prophylaxis relative to the disease epidemiological status

2019 ◽  
Vol 24 (1) ◽  
pp. 315-322 ◽  
Author(s):  
Bruno Fonseca Martins da Costa Andrade ◽  
Taísa Santos de Melo Andrade ◽  
Luzia Helena Queiroz
Keyword(s):  
Rabies Vaccine ◽  
Human Rabies ◽  
Post Exposure Prophylaxis ◽  
Post Exposure ◽  
Paulo State ◽  
Technical Manual ◽  
Prophylactic Measures ◽  
Exposure Prophylaxis ◽  
Main City ◽  
Technical Recommendations

Abstract This study evaluated the prophylactic measures adopted after attacks by dogs and cats in the main city of Northwester São Paulo State, based on the technical manual for post-exposure treatment, considering the not controlled (1990-1996) and controlled (1997-2010) rabies status. A retrospective analysis was done using the data from the SINAN records (W64-CID10) between 1990 and 2010. In most cases, the accidents were mild (76.9%), and biting animals were healthy (75.4%); therefore, no treatment was needed in 53.3% of the cases. In 64.6% of cases, the prescribed PEP treatment was inappropriate. The most indicated PEP treatments consisted of vaccine and RIG (43.4%), and either three doses of mouse brain vaccine or two doses of cell culture vaccine (76.5%), during the not controlled and controlled rabies periods, respectively. The treatment was more appropriate and followed the technical recommendations during controlled rabies periods compared to not controlled (p < 0.0001) periods. However, excessive application of RIG and rabies vaccine was observed in both periods.

scholarly journals Human rabies post exposure prophylaxis at the Pasteur Institute of Dakar, Senegal: trends and risk factors

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Mamadou Korka Diallo ◽  
Alpha Oumar Diallo ◽  
Anta Dicko ◽  
Vincent Richard ◽  
Emmanuelle Espié
Keyword(s):  
Risk Factors ◽  
Human Rabies ◽  
Post Exposure Prophylaxis ◽  
Pasteur Institute ◽  
Post Exposure ◽  
Exposure Prophylaxis

Recurrent Temporary Paralysis Reported After Human Rabies Post-Exposure Prophylaxis

2014 ◽  
Vol 62 (3) ◽  
pp. 222-227 ◽  
Author(s):  
V. M. Dato ◽  
E. R. Campagnolo ◽  
D. U. Shah ◽  
M. J. Bellush ◽  
C. E. Rupprecht
Keyword(s):  
Human Rabies ◽  
Post Exposure Prophylaxis ◽  
Post Exposure ◽  
Exposure Prophylaxis

Problems in human rabies post-exposure prophylaxis management

2007 ◽  
Vol 5 (3) ◽  
pp. 189-193 ◽  
Author(s):  
Saowaluck Tepsumethanon ◽  
Veera Tepsumethanon ◽  
Thanphet Tantawichien ◽  
Kanitta Suwansrinon ◽  
Henry Wilde
Keyword(s):  
Human Rabies ◽  
Post Exposure Prophylaxis ◽  
Post Exposure ◽  
Exposure Prophylaxis

scholarly journals How geographic access to care shapes disease burden: the current impact of post-exposure prophylaxis and potential for expanded access to prevent human rabies deaths in Madagascar

2020 ◽  
Author(s):  
Malavika Rajeev ◽  
Hélène Guis ◽  
Glenn Edosoa ◽  
Chantal Hanitriniaina ◽  
Anjasoa Randrianarijaona ◽  
...  
Keyword(s):  
Rabies Vaccine ◽  
Human Rabies ◽  
Post Exposure Prophylaxis ◽  
Travel Times ◽  
Middle Income ◽  
Geographic Access ◽  
Post Exposure ◽  
Canine Rabies ◽  
Middle Income Countries ◽  
Exposure Prophylaxis

AbstractBackgroundPost-exposure prophylaxis (PEP) is highly effective at preventing human rabies deaths, however access to PEP is limited in many rabies endemic countries. The 2018 decision by Gavi to add human rabies vaccine to its investment portfolio should expand PEP availability and reduce rabies deaths. We explore how geographic access to PEP impacts the rabies burden in Madagascar and the potential benefits of improved provisioning.Methodology & Principal FindingsWe use travel times to the closest clinic providing PEP (N=31) as a proxy for access. We find that travel times strongly predict reported bite incidence across the country. Using resulting estimates in an adapted decision tree framework we extrapolate rabies deaths and reporting and find that geographic access to PEP shapes burden sub-nationally. We estimate 960 human rabies deaths annually (95% Prediction Intervals (PI):790 - 1120), with PEP averting an additional 800 deaths (95% PI: 800 (95% PI: 640 - 970) each year. Under these assumptions, we find that expanding PEP to one clinic per district could reduce deaths by 19%, but even with all major health centers provisioning PEP (1733 additional clinics), we still expect substantial rabies mortality. Our quantitative estimates are most sensitive to assumptions of underlying rabies exposure incidence, but qualitative patterns of the impacts of travel times and expanded PEP access are robust.Conclusions & SignificancePEP is effective at preventing rabies deaths, and in the absence of strong surveillance, targeting underserved populations may be the most equitable way to provision PEP. Our framework could be used to guide PEP expansion and improve targeting of interventions in similar endemic settings where PEP access is geographically restricted. While better PEP access should save many lives, improved outreach and surveillance is needed and if rolled out with Gavi investment could catalyze progress towards achieving zero rabies deaths.Author SummaryCanine rabies causes an estimated 60,000 deaths each year across the world, primarily in low- and middle-income countries where people have limited access to both human vaccines (post-exposure prophylaxis or PEP) and dog rabies vaccines. Given that we have the tools to prevent rabies deaths, a global target has been set to eliminate deaths due to canine rabies by 2030, and recently, Gavi, a multilateral organization that aims to improve access to vaccines in the poorest countries, added human rabies vaccine to it’s portfolio. In this study, we estimated reported bite incidence in relation to travel times to clinics provisioning PEP, and extrapolate human rabies deaths in Madagascar. We find that PEP currently averts around 800 deaths each year, but that the burden remains high (1000 deaths/ year), particularly in remote, hard-to-reach areas. We show that expanding PEP availability to more clinics could significantly reduce rabies deaths in Madagascar, but our results suggest that expansion alone will not eliminate deaths. Combining PEP expansion with outreach, surveillance, and mass dog vaccination programs will be necessary to move Madagascar, and other Low- and Middle-Income countries, forward on the path to rabies elimination.

scholarly journals Purified chick embryo cell rabies vaccine: economical multisite intradermal regimen for post-exposure prophylaxis

1987 ◽  
Vol 99 (3) ◽  
pp. 755-765 ◽  
Author(s):  
Pravan Suntharasamai ◽  
M. J. Warrell ◽  
Chaisin Viravan ◽  
Pornthep Chanthavanich ◽  
Sornchai Looareesuwan ◽  
...  
Keyword(s):  
Chick Embryo ◽  
Embryo Cell ◽  
Rabies Vaccine ◽  
Human Rabies ◽  
Post Exposure Prophylaxis ◽  
Protective Efficiency ◽  
Vaccine Regimen ◽  
Post Exposure ◽  
Chick Embryo Cell ◽  
Exposure Prophylaxis

SUMMARYThe standard six-dose intramuscular (i.m.) rabies post-exposure vaccine regimen using a new purified chick embryo cell (PCEC) vaccine was compared with two economical multisite intradermal (i.d.) PCEC regimens, a multisite i.m. PCEC schedule and a subcutaneous regimen using a suckling mouse brain (SMB) rabies vaccine manufactured in Thailand. The neutralizing antibody results for the four-site and eight-site i.d. and the standard i.m. PCEC regimens were similar over 3 months. A three-site i.m. PCEC regimen had no advantage. The SMB vaccine gave the lowest antibody levels. Human rabies immune globulin therapy significantly increased the GMT of all groups on day 7, unlike equine antirabies serum (EARS). Both antisera suppressed antibody responses to PCEC on days 14 and 28. Three generalized reactions probably related to EARS were the only serious side effects. An eight-site i.d. PCEC vaccine regimen proved as immunogenic as the routine i.m. schedule and, if implemented as post-exposure prophylaxis, would be the cheapest widely available tissue culture vaccine regimen. The protective efficiency should now be tested in patients bitten by rabid animals.

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