Rabies post-exposure healthcare-seeking behaviors and perceptions: Results from a knowledge, attitudes, and practices survey, Uganda, 2013

Background Rabies is a viral disease of animals and people causing fatal encephalomyelitis if left untreated. Although effective pre- and post-exposure vaccines exist, they are not widely available in many endemic countries within Africa. Since many individuals in these countries remain at risk of infection, post-exposure healthcare-seeking behaviors are crucial in preventing infection and warrant examination. Methodology A rabies knowledge, attitudes, and practices survey was conducted at 24 geographically diverse sites in Uganda during 2013 to capture information on knowledge concerning the disease, response to potential exposure events, and vaccination practices. Characteristics of the surveyed population and of the canine-bite victim sub-population were described. Post-exposure healthcare-seeking behaviors of canine-bite victims were examined and compared to the related healthcare-seeking attitudes of non-bite victim respondents. Wealth scores were calculated for each household, rabies knowledge was scored for each non-bitten survey respondent, and rabies exposure risk was scored for each bite victim. Logistic regression was used to determine the independent associations between different variables and healthcare-seeking behaviors among canine-bite victims as well as attitudes of non-bitten study respondents. Results A total of 798 households were interviewed, capturing 100 canine-bite victims and a bite incidence of 2.3 per 100 person-years. Over half of bite victims actively sought medical treatment (56%), though very few received rabies post-exposure prophylaxis (3%). Bite victims who did not know or report the closest location where PEP could be received were less likely to seek medical care (p = 0.05). Respondents who did not report having been bitten by a dog with higher knowledge scores were more likely to respond that they would both seek medical care (p = 0.00) and receive PEP (p = 0.06) after a potential rabies exposure event. Conclusions There was varying discordance between what respondents who did not report having been bitten by a dog said they would do if bitten by a dog when compared to the behaviors exhibited by canine-bite victims captured in the KAP survey. Bite victims seldom elected to wash their wound or receive PEP. Having lower rabies knowledge was a barrier to theoretically seeking care and receiving PEP among not bitten respondents, indicating a need for effective and robust educational programs in the country.

Shared Odds of Borrelia and Rabies Virus Exposure in Serbia

Lyme borreliosis (LB) is the most common tick-borne disease in Serbia and other European countries. Rabies is a fatal zoonosis distributed worldwide and is caused by the rabies virus. Professionals at risk of rabies—including veterinarians, hunters, communal service workers, and forestry workers—overlap with some professions at a higher risk of exposure to tick bites and tick-borne pathogen infections. We hypothesized that individuals identified by the public health system as at risk of rabies virus infection, and consequently vaccinated against rabies virus, also share a higher likelihood of Borrelia exposure. To test our hypothesis, a case-control study was carried out during 2019 in Serbia to determine the seroprevalence of anti-Borrelia antibodies in two case groups (individuals at risk and vaccinated against rabies virus) and a control group (individuals without risk of rabies). Individuals vaccinated against rabies following either “pre-exposure protocol” (PrEP, n = 58) or “post-exposure protocol” (PEP, n = 42) were considered as rabies risk groups and healthy blood donors (n = 30) as the control group. The results showed higher Borrelia seroprevalence in PrEP (17.2%; 10/58) and PEP (19.0%; 8/42) groups compared with the control group (6.67%; 2/30). Furthermore, odds ratio (OR) analysis showed that risk of rabies (in either the PrEP (OR = 2.91) or PEP (OR = 3.29) groups) is associated with increased odds of being seropositive to Borrelia. However, the difference in Borrelia seroprevalence between groups was not statistically significant (Chi-square (χ²) test p > 0.05). The shared odds of LB and rabies exposure found in this study suggest that, in countries where both diseases occur, the common citizen can be at risk of both diseases when in a risky habitat. These findings are important to guide physicians in targeting high-risk groups, and diagnose LB, and to guide decision-makers in targeting control and prevention measures for both infections in risk areas.

Vaccine-Preventable Disease

This chapter discusses disease entities that are vaccine preventable. Diseases not likely to be seen by physicians because of near eradication include diphtheria, tetanus, polio, and rabies. However, suspected rabies exposure is common, and initiating post-exposure prophylaxis is essential to preventing rabies. Clearly, other diseases that vaccines have reduced but not eliminated, such as pertussis, hepatitis A, hepatitis B, rotavirus, varicella/zoster, pneumococcal disease, meningococcal disease, influenza, respiratory syncytial virus, and tuberculosis, will be encountered. Haemophilus influenzae type b disease may also rarely be seen. There is great potential for physicians to never see a case of measles, mumps, and rubella, but because clusters of parents have chosen to not vaccinate their children, sporadic outbreaks will continue to occur.

High time to prioritize rabies prevention—a new paradigm

Almost 500 patients consulted a GeoSentinel clinic annually for post-exposure prophylaxis after a potential rabies exposure as compared to approximately 20 for hepatitis A and 40 for typhoid fever. Travellers’ response after potential rabies exposure is alarmingly inadequate. Thus, rabies pre-exposure prophylaxis should now become the #1 travel vaccine intervention.

Assessment of the current rabies situation and its management in epidemic areas of southern Ethiopia

Rabies infection is almost always a 100% lethal viral disease in all mammals, including humans. Although more than 60,000 people worldwide are preventable, 2,700 people in Ethiopia die of fatal human rabies annually. The aim of this study was to generate strategic information on the extent of the burden of rabies and major response strategies in place, only to overcome and bring attention to the management of rabies outbreaks. The cross - sectional case - based study design was used to discuss the disease areas of the Southern Nations, Nationalities, and Peoples ' Regional States of Ethiopia. Data analysis revealed a total of 16 fatal human rabies and 287 suspected rabies exposures. The highest attack rate of 116.3 cases per 100,000 human subjects was reported in Tembaro woreda. As a result, 48 animal deaths of rabies have been reported, while cattle (28) have been more affected than other animal species. The lack of dog immunization, lack of community awareness of dog management, and inaccessibility and inefficiency of anti - rabies vaccines were major risk factors associated with the spread of rabies exposure between humans and animals. In conclusion, this study has clearly shown that both the existence and the high magnitude of fatal human and animal rabies are significant in the area. Multidisciplinary approach interventions to increase community awareness of dog vaccination, effective and immediate treatment of exposed individuals is recommended as a method of disease control and prevention

Experiences of people affected by rabies in Ethekwini district in the province of Kwazulu-Natal, South Africa

Background: South Africa is one of the countries in Africa adversely affected by rabies, a notifiable disease which can be fatal. Fatalities can be prevented if health care is sought timeously and people are educated about the disease. The Province of Kwa- Zulu-Natal, in particular, has had rabies outbreaks in the past which have led to loss of many lives and devastation of entire families. Objective: The aim of the study was to explore the experiences of people affected by rabies in the eThekwini district of Kwa- Zulu-Natal, South Africa. Methods: The study was guided by a qualitative, exploratory, descriptive design. The sample was purposively selected, and a semi-structured interview was used to collect data from people affected by rabies in the eThekwini district. Data saturation was reached after 12 participants were interviewed. Data was analysed by using Tesch’s eight steps of thematic analysis. Results: The themes included family stability and support structures, exposure to risk factors and risky practices, factors that hindered participants from seeking health care assistance, limited knowledge about rabies and the effects of rabies. Conclusion: It was evident that participants experienced many challenges during their rabies exposure. Individuals, who were directly affected by rabies through contact with rabid animals, were expected to take responsibility for their own lives. Keywords: Rabies; South Africa; qualitative research.