Prevention of Rabies by Application of Lytta vesicatoria (Ḏarārīḥ) in Persian Medicine Texts in Islamic Civilization

Rabies is one of the most lethal diseases in human history. From the past, various drugs have been used to prevent the contraction of the disease when being bitten by a rabid animal. An insect called Ḏarārīḥ (Lytta vesicatoria), although poisonous, has in some cases been medically used. Greeks and Romans have used venomousness of this insect to treat skin diseases, but it has not been used to prevent rabies. This is a summative qualitative content analysis that focused on Persian Medicine (PM) texts from 2th to 13th AH centuries. Literature was searched during centuries 4th to 13th AH, by using this key words: ذراریـح) Ḏarārīḥ), قنثاریـدس) Cantharis/cantharides), and ئشـفث Lytta vesicatoria and after extracting the data and analyzing them, the results were presented. In TPM texts, this insect was used to prevent rabies. This study has shown that the use of ḏarārīḥ (Lytta vesicatoria) in the prevention of rabies has been one of the innovations of the practitioners of Islamic civilization. The innovation proves that scholars in the period of Islamic civilization were not merely consumers or custodians of Roman, Greek, Indian, and Iranian knowledge, but added to it while preserving that knowledge.

Human exposure to rabies in Yemen: Incidence, trend, and mortality 2011-2017 (Preprint)

BACKGROUND Rabies remains a neglected disease and poorly controlled throughout the developing world, particularly Africa and Asia, where most human rabies deaths occur. OBJECTIVE This study aimed to describe the epidemiology of rabies, its trend, and its geographical distribution in Yemen METHODS Cumulative data from Rabies surveillance system for the period 2011 to 2017 was obtained from the National Rabies Control Program. The data included the number of persons bitten by a suspected animal, their gender and age, and the result of animal’s lab-test. Cases were defined as human victims bitten or injured by animals confirmed to be infected with rabies and received post exposure prophylaxis at any rabies control unit during 2011-2017 RESULTS During the period 2011-2017, a total of 76049 persons were bitten or injured by a suspected rabid animal. Of those, 21,927 (29%) were exposed to positively confirmed rabid animal and had PEP. Of all cases 68% were males and 32% were females. About 15% of cases were under five years, 41% aged 5-14 years, 28% aged 15-40 years, and 16% aged > 40 years. One third (36.8%) of reported cases were from Amanat Al Asimah followed by 32% from Ibb governorates, 12% from Dhamar, 8% from Al Hudaydah, 5% from Taizz, and 4% from Amran. The annual mean number of the cases exposed to positively confirmed rabid animal and had PEP was 3132. The annual incidence rate of exposure to positively confirmed rabid animal was 14 per 100,000 population. The annual mean number of deaths was 42 and the annual mean mortality rate was 2 per 1000,000 populations. CONCLUSIONS Rabies is still a worrying health problem in Yemen with a higher percentage among children and males. The annual incidence of exposure was 14 per 100,000 population. An electronic system should be introduced to improve reporting. It is important to have sufficient supply of vaccines and immunoglobulins in control units especially in the affected governorates. Education, communication and information campaigns about preventive measures targeting school-age populations are strongly recommended. Moreover, vaccination campaigns in the canine population to avoid animal-to-human transmission is necessary.

ONE HEALTH STRATEGIES FOR RABIES OUTBREAK CONTROL IN DOMPU, WEST NUSA TENGGARA, INDONESIA: RECOMMENDATIONS FOR EMERGENCY RESPONSE

Objective: Almost 1,315 cases of rabid animal bites and 9 fatal cases of human rabies were declared in February 2019 due to the outbreak of rabies in Dompu, West Nusa Tenggara (WNT), Indonesia, and this outbreak has affected more than 240,000 people. We report a recommendation for emergency response of one health strategies for rabies outbreak control in Dompu, WNT, Indonesia. Methods: We implemented the OH approach to expedite the management of outbreaks in Dompu. A meeting with the local government of Dompu district (GoD) was held after an outbreak report was released in February 2019. Furthermore, we encouraged the GoD to adopt OH to manage and control the outbreak. Results: In Indonesia, the concept is not clear but gradually developing. The burgeoning issues are tackled by GoD through some initiatives, but implementing OH is itself a challenge. We encourage GoD to focus on these gaps and prioritize the health issues for which the best suitable results can be achieved by OH approach. Conclusion: The OH approach accelerated the prevention of rabies outbreaks in Dompu. To effectively implement the OH approach, it is important to design a legal and institutional framework. In addition, it is essential to raise awareness among policy-makers, including political leadership and enhance the government’s regular budget for the OH approach.

A Phase 3, Randomized, Open-label, Noninferiority Trial Evaluating Anti-Rabies Monoclonal Antibody Cocktail (TwinrabTM) Against Human Rabies Immunoglobulin (HRIG)

Background Limited supply, cost and potential for severe adverse effects observed with the blood derived rabies immunoglobulin products has led to search for alternative therapies. This issue has been addressed by developing an anti-rabies monoclonal antibody cocktail. Methods This is a phase 3, randomized, open-label, noninferiority trial conducted in patients with World Health Organization (WHO) category III exposure with suspected rabid animal. Eligible patients were assigned to either the test arm, TwinrabTM (docaravimab and miromavimab) or the reference arm, human rabies immunoglobulin (HRIG; Imogam® Rabies-HT), in a ratio of 1:1. The primary endpoint was the comparison of responder rates between the 2 arms assessed as percentage of those with rabies virus neutralizing antibodies titers ≥0.5 IU/mL on day 14. Results A total of 308 patients were equally randomized into the 2 arms. In the per-protocol (PP) population, there were 90.21% responders in the TwinrabTM arm and 94.37% in the HRIG arm. The geometric mean of rapid fluorescent foci inhibition test titers in the PP on day 14 were 4.38 and 4.85 IU/mL, for the TwinrabTM and HRIG arms, respectively. There were no deaths or serious adverse events reported. Conclusions This study confirmed that TwinrabTM is noninferior to HRIG in terms of providing an unbroken window of protection up to day 84. This trial in healthy adults with WHO category III exposure from suspected rabid animal also establishes the safety of TwinrabTM in patients with 1 WHO approved vaccine regimen (Essen). Clinical Trials Registration CTRI/2017/07/009038.

Rhabdoviruses: Rabies and rabies-related lyssaviruses

The Rhabdoviridae are a large family of RNA viruses, two genera of which infect animals: the genus Lyssavirus contains rabies and rabies-related viruses that cause at least 55,000 deaths annually in Asia and Africa. The risks and problems posed by rabies and other lyssaviruses vary across the world. Viruses can penetrate broken skin and intact mucosae. Humans are usually infected when virus-laden saliva is inoculated through the skin by the bite of a rabid animal, usually a dog. Although the greatest threat to man is the persistent cycle of infection in stray dogs, several other terrestrial mammal species are reservoirs of infection. In the Americas, bat viruses and also classic type 1 rabies and insectivorous bats have become the principal vectors of infection to humans in the United States of America. Elsewhere in the world, there is increasing evidence of widespread rabies-related lyssavirus infection of bats.

New Rabies Vaccines for Use in Humans

Although vaccines are available, rabies still claims more than 55,000 human lives each year. In most cases, rabies vaccines are given to humans after their exposure to a rabid animal; pre-exposure vaccination is largely reserved for humans at high risk for contacts with the virus. Most cases of human rabies are transmitted by dogs. Dog rabies control by mass canine vaccination campaigns combined with intensive surveillance programs has led to a decline of human rabies in many countries but has been unsuccessful in others. Animal vaccination programs are also not suited to control human rabies caused by bat transmission, which is common in some Central American countries. Alternatively, or in addition, more widespread pre-exposure vaccination, especially in highly endemic remote areas, could be implemented. With the multiple dose regimens of current vaccines, pre-exposure vaccination is not cost effective for most countries and this warrants the development of new rabies vaccines, which are as safe as current vaccines, but achieve protective immunity after a single dose, and most importantly, are less costly. This chapter discusses novel rabies vaccines that are in late stage pre-clinical testing or have undergone clinical testing and their potential for replacing current vaccines.

Pattern of exposure among victims of suspected rabid animal attending anti-rabies clinic of tertiary care hospital

Background: Rabies, a neglected tropical disease, is vaccine preventable and occurs in more than 150 countries. It is almost always fatal. About 40% of deaths due to rabies occur in children under the age of 15 years. Objectives were to study the pattern of injury following exposure to canine bite, bear maul and rabid cow among the attendees of Antirabies clinic of SMHS hospital, Srinagar and to classify the type of exposure using WHO guidelines for initiation of post exposure prophylaxis.Methods: The study was conducted over a period of three months from 1st June 2016 to 31st August 2016, in Anti Rabies Clinic of Department of Community Medicine, Government Medical College, Srinagar. It was a descriptive Study and included all victims of canine bite and rabid cow. A total of 134 patients were received.Results: Most [83 (61.9%)] of the patients were males with mean age of 36.63 years. Legs were the most common [57 (43.2%)] site of exposure followed by hands [15 (11.2%)] and thigh [13 (9.7%)]. Contact with a rabid cow was present in 5 (3.7%). Class II exposure was most frequently encountered [83 (61.9%)]. Class III exposure was seen in 49 (36.6%). All patients who attended anti rabies clinic for post exposure prophylaxis received free Antirabies Vaccine. Combined Antirabies vaccine and immunoglobulin was received by 49 (36.6%).Conclusions: Dog bite related injuries happen frequently in Srinagar. There is proper post exposure prophylaxis in place in SMHS hospital. There is need for curbing the ever increasing dog population and enforcing rabies vaccination in dogs.

Assessment of knowledge regarding rabies and its prevention among the medical students of Government Medical College Rajnandgaon, Chhattisgarh, India

Background: Rabies is a fatal viral zoonotic disease. In India about 20,000 persons die of rabies annually. The aim of present study was to assess the knowledge regarding rabies and its prevention among the medical students.Methods: A cross-sectional study was conducted among183 medical students of Government Medical College Rajnandgaon, Chhattisgarh during August 2017 to September 2017 using a pre-tested questionnaire. Data was entered and analyzed by using descriptive statistics (frequency and percentage).Results: It was seen that majority (83.1%) of medical students knew about the viral cause of rabies, 93.4% knew the dog as most common reservoir of rabies and 91.8% knew the most common mode of rabies transmission by bites of rabid animal. About three fourth (74.3%) of medical students knew that hydrophobia as the symptom of rabies in human. About danger sites of animal bite and fatality of rabies was known by 81.4% and 68.8% of medical students, respectively. Only 45.9% of medical students knew the correct incubation period of rabies. Majority (72.7%) of students knew about the immediate wash of the wound with soap and water but only 42.1% knew about antiseptic use. Majority (71%) of students knew the correct site and only 43.7% knew the correct schedule of vaccination. Only 29% of medical students knew about indication of rabies immunoglobulin.Conclusions: There is a need to organize re-orientation programs and continuing medical education (CME) sessions on rabies and its prevention for medical students, at regular interval.

The Use of a Heterologous Anti-Rabies Immunoglobulin for Specific Prevention of Human Rabies

This paper reviews the problems of passive immunization of rabies. In the Russian Federation remains serious epizoot-epidemiological situation of rabies, characterized the increase of the number of disadvantaged settlements and the registration of the hydrophobia in the population. In these circumstances the only possibility to prevent the disease in humans who suffered from the bite of a rabid animal, is timely and appropriate the administration of modern anti-rabies drugs.