Recent Research - September 2015

Recent research findings (since July 2015) of relevance to GARC's mission and community

Surveillance

Reconciling surveillance systems with limited resources: an evaluation of passive surveillance for rabies in an endemic setting. Many countries do not have the resources to establish active surveillance systems for rabies. A scenario tree model based on data collected via questionnaires and interviews suggests that the sensitivity of passive surveillance can be 100% even at a low disease prevalence (0.1%) given a large enough sample size, in this case the entire population of Colombo City.

Epidemiological characteristics of human rabies in Henan province in China from 2005 to 2013. A total of 1022 rabies cases were reported from 2005 to 2013, with incidence remaining high after a 2007 peak. Most cases were males, often ages 40-65 and farmers. The wound treatment rate (12.2 %) and vaccination rate (2.6 %) of rabies cases after exposure were relatively low, while the rabies immunoglobulin utilization rate was only 2.8 %.

PEP

Local infiltration of rabies immunoglobulins without systemic intramuscular administration: An alternative cost effective approach for passive immunization against rabies. Current PEP recommendations demand large quantities of expensive RIG. This study restricted its use to local infiltration alone and avoided systemic intramuscular administration. A total of 269 category III patients bitten by suspect or confirmed rabid dogs/ animals were infiltrated with equine RIG in and around the wound (quantity was proportionate to the size and number of wounds irrespective of body weight). This was followed by regular intradermal rabies vaccination. On average 1.26ml of RIGs was required per patient, costing Rs.150 ($3), and in total 42 vials (5ml) of RIG were required compared to the 363 required using current recommendations. All the patients were followed for 9 months and were healthy and normal at the end of the observation period. The results should be confirmed with larger scale trials in other centers.

Human Cases and treatment

Human rabies in Zhejiang Province, China. 201 cases of human rabies were diagnosed in Zhejiang Province between 2007 and 2014, with annual incidence declining gradually. Male farmers and rural laborers were the groups most affected, almost always via dog bites. Less than half of cases (41.4%) sought wound treatment after exposure, and only 9.7% received PEP.

Evaluation of short-interfering RNAs treatment in experimental rabies due to wild-type virus. Treating mice with short-interfering RNAs targeting the nucleoprotein gene and also the brain immune response produced a reduction in the severity of the disease, but no impact on death rates. The study suggests that the use of pre-designed siRNA alone may not be useful in rabies treatment.

Education and Advocacy

Integrated health messaging for multiple neglected zoonoses: Approaches, challenges and opportunities in Morocco. A health messaging intervention, using powerpoint presentations for five zoonotic diseases including rabies was assessed. It identified  ways to improve public awareness, such as by using local pictures, conducting education in school settings, and piggy-backing on high-priority diseases like rabies. However it also found that information "overload" easily occurred when disease transmission pathways did not overlap.

Knowledge, attitudes and practices towards rabies: questionnaire survey in rural household heads of Gondar Zuria District, Ethiopia. A KAP survey showed that a over 99% of people were aware of rabies, most thought it was fatal and most identifed bites of dogs as the route of transmission. However, despite this, less than half of repondents mentioned the need for immediate treatment, or considered modern medicine as appropriate treatment. Only 30.7 % practiced washing of the wounds with water as first aid.

Wildlife Rabies

Spatio-temporal Use of Oral Rabies Vaccines in Fox Rabies Elimination Programmes in Europe. In Europe, the elimination of wildlife rabies using oral rabies vaccination of foxes for over 30 years has been a success, but with more than 10 different vaccines used in combination with varied distribution strategies.

Recognizing the Role of Skunks in Human and Animal Rabies Exposures in the Southwest. A "One Health" approach, uses surveillance data to show that even though most of the positive animals collected were bats, human and domestic animal exposures were primarily a result of interactions with rabid skunks. Wildlife and domestic animal and human exposures are associated and informative to one another.

Fluorescent antibody test, quantitative PCR pattern and clinical aspects of rabies virus strains isolated from main reservoirs in Brazil. RABV variants isolated from  dog, vampire bat, crab eating fox, marmoset, and Myotis bat hosts were  evaluated for replication rates and clinical infection in mice. spp. Virus replication was not correlated with clinical signs and evolution, but isolates from crab eating fox and marmoset had a longer evolution period and higher survival rates.