Global & Disaster Medicine

Archive for the ‘Rabies’ Category

Malaysia: The death toll from rabies outbreak in the Serian district has increased to five people after a 52-year-old man succumbed to the virus at the Sarawak General Hospital

Malaysian Digest

  • Tinding Limbang was pronounced dead at 10.43pm.
  • Tinding was admitted to the hospital for weak limbs, numbness and backache on July 11.

 

 


Rabies Fears in Bangladesh: At least 66 people including, six children and five women, were bitten by stray dogs in different areas of Manikganj town in one day yesterday.

Daily Star

  • They were given treatment and anti-rabies vaccines at Manikganj Sadar Hospital.

 


Rabies in Borneo: 2 siblings, aged four and six – from Kampung Paun Rimu Bakong, passed away on Tuesday while a third child remains in critical condition.

Borneo Post

“…..The girl was confirmed positive for contracting the rabies virus following laboratory tests on June 30.
She started having fever on June 23 and was brought to Serian Hospital, but was treated as outpatient then.
However, her condition worsened as she started showing changes in behaviour, getting aggressive and exhibiting signs of hydrophobia.
On June 28, she had seizures at home and was rushed to SGH by her parents. It is reported that she was bitten by a dog about a month before the symptoms appeared……”

Map of the world

 


Bataan province: Three persons die after being bitten by rabid dogs

Manila Bulletin

 


CDC assisting investigation of dead bat found in packaged salad

CDC

FDA

Experts from the Centers for Disease Control and Prevention (CDC) are working with the Florida Department of Health and the U.S. Food and Drug Administration (FDA) to support an investigation of a dead bat that was found in a packaged salad purchased from a grocery store in Florida. Two people in Florida reported eating some of the salad before the bat was found. The bat was sent to the CDC rabies lab for laboratory testing because bats in the United States sometimes have been found to have this disease. The deteriorated condition of the bat did not allow for CDC to definitively rule out whether this bat had rabies.

Transmission of rabies by eating a rabid animal is extremely uncommon, and the virus does not survive very long outside of the infected animal. CDC is supporting Florida local and state health officials in evaluating the people who found the bat in the salad. In this circumstance, the risk of rabies transmission is considered to be very low, but because it isn’t zero, the two people who ate salad from the package that contained the bat were recommended to begin post-exposure rabies treatment. Both people report being in good health and neither has any signs of rabies. CDC is not aware of any other reports of bat material found in packaged salads.

On April 8, 2017, Fresh Express issued a recall of a limited number of cases of Organic Marketside Spring Mix. The salads were sold in a clear container with production code G089B19 and best-if-used-by date of APR 14, 2017 located on the front label. The recalled salads were distributed only to Walmart stores located in the Southeastern region of the United States. All remaining packages of salad from the same lot have been removed from all store locations where the salad was sold.

Consumers who may have already purchased the recalled product should discard and not consume it.  A full refund is available where purchased or by calling the Fresh Express Consumer Response Center toll-free at (800) 242-5472 during the hours of 8 a.m. to 7 p.m. Eastern Time.

People who have eaten the recalled salad product and did not find animal material are not at risk and do not need to contact their health department. CDC recommends that anyone who ate the recalled salad product and found animal material in it contact their health department for evaluation.

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A Presumptive Case of Human Rabies in Rural Ghana

Frontiers in Public Health

Case Report

Front. Public Health, 11 November 2016 | http://dx.doi.org/10.3389/fpubh.2016.00256
A Presumptive Case of Human Rabies: A Rare Survived Case in Rural Ghana
Map of the world

September 28 is World Rabies Day.

CDC

Take a Bite Out of Rabies!

September 28 is World Rabies Day. Established in 2007, it aims to raise awareness about rabies and help the world come together to fight this dreadful but neglected disease. This year on the 10th anniversary of the effort, we are reminded that the fight is not yet over.

In the United States and most of the American continent, dying of rabies is rare thanks to successful animal control and vaccination programs. But around the world, rabies kills more than 59,000 people every year—that is nearly one death every nine minutes. Most affected are countries in Africa and Asia, and almost half of the victims are children under the age of 15.

The good news is that rabies can be prevented through vaccination, both in our animals and in people. On World Rabies Day, as we celebrate our progress, we must also renew our commitment to eliminate human rabies deaths.

Get the facts on rabies prevention and control, and become an advocate for rabies elimination. Find events in your area to participate in World Rabies Day activities.

	Boy and dog riding in car together

The U.S. has been successful in eliminating canine rabies. Take steps to prevent rabies in your pets!

	Haitian children with puppies

Children in Haiti bring their puppies to the rabies vaccination clinic. Learn more about what CDC is doing to control rabies in Haiti(http://www.cdc.gov/worldrabiesday/), which has the highest rates of rabies infection in the Americas.

	Vet examining Jack Russell Terrier

Be sure to take your cats and dogs to the veterinarian each year.

	Racoon

Raccoons, bats, skunks and foxes often get rabies and should be avoided.

	Bat

In U.S., bats often spread rabies to other animals, but also to people.

The Challenge of Rabies

The group of viruses that cause rabies are present on every continent except Antarctica. Rabies viruses are deadly and can kill anyone who gets them. Every year, an estimated 40,000 people in the U.S. receive a series of shots known as post-exposure prophylaxis (PEP) after contact with a possibly rabid animal. The U.S. public health cost associated with rabies is estimated to be as high as $500 million annually.

People usually get rabies when they are bitten by an animal that has the virus. In the U.S., the animals that most often get rabies are wild animals such as raccoons, skunks, bats, and foxes. A particular kind of rabies virus, called canine rabies that spreads from dog to dog, is the cause of 98% of human deaths worldwide. While the U.S. successfully eliminated the canine rabies virus, we still need to keep our dogs and cats vaccinated to prevent this kind of virus from coming back, and to protect our pets from rabies viruses they could get from wildlife.

However, canine rabies is not controlled in many regions of the world and continues to threaten the health of people and animals in these areas. Scientists estimate there are about 500 million dogs in the world. In many countries, most dogs are unvaccinated and allowed to roam freely. When these dogs get rabies, they often pass the virus to their owners, family members, and neighbors. Vaccination of dogs is the best way to prevent human deaths.

CDC disease detectives and scientists work around the world to help start programs for better control of rabies. The most effective way to prevent the disease in people is to vaccinate the dogs. Scientists have shown that once 70% of dogs are vaccinated, rabies can be successfully controlled in that area and human deaths can be prevented. People everywhere will directly benefit from these efforts.

What You Can Do to Protect Yourself and Others from Rabies

Whether you are a pet owner, a parent, an outdoor adventurer or a backyard explorer, there are steps you can take to keep yourself and your family free from rabies throughout the year.

1. Take Pets to a Veterinarian for Their Rabies Shot

Pets, like dogs, cats, and ferrets, need to see a veterinarian regularly. A veterinarian can make sure your pets are up to date on their rabies shot, which can protect them from getting rabies. All dogs and cats should be vaccinated around four months of age, and then again one year later. After these two shots, your veterinarian will develop a vaccination plan that is best for your pet and complies with local laws. This is important, since animals that have not received a rabies shot and are in contact with potentially rabid wild animals may need to be quarantined for six months or euthanized.

Talk to your veterinarian about spaying or neutering your pet. This helps cut down on the number of unwanted and stray animals, which often do not have their rabies shot and are in close contact with wild animals.

2. Keep Away From Wildlife and Unfamiliar Animals

In the United States, more than 90% of all animal rabies cases reported to CDC each year occur in wild animals. The main animals that get rabies are raccoons, bats, skunks and foxes.

One of the best ways to protect yourself and your family is to avoid contact with wild animals. Do not feed or handle them, even if they seem friendly.

You should also avoid dogs and cats that are unfamiliar to you and your family. These animals may be in contact with wildlife and can also spread rabies to humans.

If you see an animal acting strangely, report it to animal control or your local health department. Some things to look for are:

  • General sickness
  • Problems swallowing
  • Lots of drool or saliva
  • An animal that appears more tame than you would expect
  • An animal that bites at everything
  • An animal that’s having trouble moving or may even be paralyzed

Sometimes, people may come across a dead animal. Never pick up or touch dead animals. The rabies virus may still be present in the saliva or nervous tissue, especially if they have only been dead for a short time. If you see a dead animal, call animal control to take care of the animal’s body.

3. Keep Your Pets Indoors or Supervised

No matter where you live, rabies can threaten your family’s health. Fortunately, there are things you can do around the home to help reduce the risk of getting rabies.

  • Keep your pets indoors. When you let your dog or cat go outside, it’s best to have a fenced-in yard and make sure someone is there to watch it and keep it safe. Use a leash when walking your dog.
  • Do not feed or put water for your pets outside and keep garbage securely covered. These items may attract wild animals or stray animals to your yard.
  • Teach children never to handle wild animals or unfamiliar domestic animals.

While most wild animals are found primarily outdoors, bats can sometimes fly into buildings. This includes your home and even the room where you sleep. Every year indoor-only cats develop rabies because of bats in the home. It is important to keep all cats up to date on rabies vaccination, even if they never leave your home. Learn what to do when you find a bat in your home(http://www.cdc.gov/rabies/bats/contact/capture.html). There are also steps you can take to “bat-proof” your home(http://www.cdc.gov/rabies/bats/index.html)

 


Control of Canine Rabies in Ethiopia, 2015: Challenges Galore!

CDC

 

 

Notes from the Field: Assessment of Health Facilities for Control of Canine Rabies — Gondar City, Amhara Region, Ethiopia, 2015

Emily G. Pieracci, DVM1,2; Betsy Schroeder, MPH3; Araya Mengistu, DVM, PhD4; Achenef Melaku, DVM4; Miriam Shiferaw, MD5; Jesse D. Blanton, MPH5; Ryan Wallace, DVM5

Rabies is an encephalitic disease that is nearly always fatal after onset of illness. Worldwide, rabies kills an estimated 59,000 humans each year (95% confidence interval [CI] = 25,000–159,000); the majority of the deaths are caused by the rabies virus variant that circulates in dogs (1,2). Canine rabies is endemic in Ethiopia, with an estimated 2,771 human deaths annually (CI = 1,116–12,660) (13). Annual rabies-associated livestock losses are estimated at >$50 million (USD), making rabies important to both human and animal health (1).

Human health care delivery in Ethiopia occurs through hospitals, health centers, and health posts. The Ethiopian government runs veterinary clinics, and some private veterinarians operate in large cities; however, human and animal health providers do not routinely collaborate to control zoonotic diseases. The World Organisation for Animal Health’s Tool for the Evaluation of Performance of Veterinary Services identified a need to improve animal disease surveillance as well as collaboration on zoonotic diseases between the Ministry of Health and veterinary services in Ethiopia (4).

Dog bites are nationally notifiable in Ethiopia and bite victims are referred to health centers for rabies postexposure prophylaxis (PEP). No additional public health interventions occur at the community level. In an integrated bite-case management (IBCM) program, animal health workers would investigate biting dogs to provide the health sector with information for rabies risk assessments. Studies have shown that IBCM can increase bite detection rates by up to 30% and decrease unnecessary PEP by 60% (5). Because IBCM represents integration of both human and animal health, it offers an opportunity to prevent human rabies deaths as well as decrease the high costs of unnecessary PEP.

In January 2015, CDC, in collaboration with Ohio State University, the University of Gondar (Amhara Region, Ethiopia), and the Ethiopian Public Health Institute developed an IBCM pilot program in the city of Gondar. Bite events are reported from human health sectors to animal health workers, who conduct animal rabies assessments to guide management decisions for exposed persons. Program goals include recording dog bites, testing suspected rabid dogs, and reducing community rabies exposures.

In September 2015, a CDC team evaluated the IBCM pilot program and assessed the feasibility of program expansion. The evaluation included informal interviews with animal health workers, laboratorians, and program supervisors, and field observation of animal health workers. The feasibility assessment included semi-structured interviews with key stakeholders at human and animal health facilities and evaluation of infrastructural requirements necessary for IBCM program expansion (i.e., cold-chain capacity, sample transportation, and access to rabies vaccines).

Delays in the distribution of funds and shortages of PEP slowed program implementation during the first 9 months. In addition, the preference of community members to seek bite-wound treatment from traditional healers rather than health professionals resulted in a low dog-bite reporting rate. Rabies diagnostic testing capacity was lacking, related to delays in construction of a regional animal disease diagnostic center. Quarantine facilities for suspected rabid dogs did not adhere to international animal welfare regulations; therefore, most suspected rabid animals were quarantined within owners’ homes. Inconsistencies in animal health workers’ handling of animals, including euthanasia practices and sample collection, also hampered implementation. Resource gaps included inadequate access to PEP and canine vaccines and a lack of cold-chain capacity.

Despite the implementation challenges, efforts were undertaken to enhance IBCM capacity in Gondar through training of additional animal health workers, laboratorians, and program supervisors. Ethiopia has regional and national plans to increase access to PEP and canine rabies vaccine during the next year. A national animal rabies surveillance system, based on IBCM, is being jointly developed by human and animal health agencies with CDC support, and will be implemented in the Amhara Region during 2016. Construction of the rabies laboratory is under way, and temporary diagnostic laboratory space has been identified. Construction of regional quarantine facilities is expected to begin in 2016. During the feasibility assessments, the IBCM program was introduced to clinicians unaware of this activity.

Further work is needed to increase community reporting of suspected rabid dogs through improved awareness of the IBCM program. Expanded access to WHO-approved PEP is needed, but distribution of vaccine should be limited to facilities with stable cold-chain capacity. Traditional healers should be encouraged to refer dog-bite victims for PEP, and health clinics and veterinary facilities should coordinate IBCM investigations. Enhancement of the IBCM program is anticipated to continue as the program is introduced in new areas.

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Corresponding author: Emily G. Pieracci, epieracci@cdc.gov, 404-639-2603.

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1Epidemic Intelligence Service, CDC; 2Division of Vector-Borne Diseases, National Center for Emerging Zoonotic Infectious Diseases, CDC; 3Virginia-Maryland College of Veterinary Medicine; 4University of Gondar, Amhara Region, Ethiopia; 5Division of High-Consequence Pathogens and Pathology, National Center for Emerging Zoonotic Infectious Diseases, CDC.

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References

  1. Hampson K, Coudeville L, Lembo T, et al. . Estimating the global burden of endemic canine rabies. PLoS Negl Trop Dis 2015;9:e0003709. CrossRef PubMed
  2. Jemberu WT, Molla W, Almaw G, Alemu S. Incidence of rabies in humans and domestic animals and people’s awareness in North Gondar Zone, Ethiopia. PLoS Negl Trop Dis 2013;7:e2216.CrossRef PubMed
  3. Paulos A, Eshetu Y, Bethelhem N, et al. A study on the prevalence of animal rabies in Addis Ababa during 1999–2002. Ethiopian Veterinary Journal 2002;7:69–77.
  4. World Organisation for Animal Health (OIE). OIE tool for the evaluation of performance of veterinary services. 6th ed. Paris, France: World Organisation for Animal Health; 2013.http://www.oie.int/fileadmin/Home/eng/Support_to_OIE_Members/pdf/PVS_A_Tool_Final_Edition_2013.pdf
  5. Wallace RM, Reses H, Franka R, et al. Establishment of a high canine rabies burden in Haiti through the implementation of a novel surveillance program. PLoS Negl Trop Dis 2015;9:e0004245.CrossRef PubMed

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Suggested citation for this article: Pieracci EG, Schroeder B, Mengistu A, et al. Notes from the Field. Assessment of Health Facilities for Control of Canine Rabies — Gondar City, Amhara Region, Ethiopia, 2015. MMWR Morb Mortal Wkly Rep 2016;65:456–457. DOI: http://dx.doi.org/10.15585/mmwr.mm6517a4.


Milestone international conference to target global elimination of dog-mediated human rabies

WHO

WHO hosts milestone international conference to target global elimination of dog-mediated human rabies

Global Elimination of Dog-mediated Human Rabies – The Time is Now

30 November 2015 | Geneva –– Rabies kills tens of thousands of people every year. Yet we have the means and the strategic knowledge to prevent dog-mediated human rabies. This will be the key message of an international conference to be hosted by WHO, the World Organisation for Animal Health (OIE) and the Food and Agriculture Organization of the United Nations (FAO), with the support of the Global Alliance for Rabies Control (GARC), at WHO headquarters in Geneva, Switzerland, on 10–11 December 2015.

The first event of its kind, the conference will be instrumental in securing the required support to advance the goal of global elimination of rabies by 2030.

This meeting will be crucial to setting the stage for intersectoral collaboration and to achieving the global elimination of this preventable disease,” says Dr Bernadette Abela-Ridder, Team Leader, Neglected Zoonotic Diseases, WHO.

Rabies disproportionately affects rural and socio-economically disadvantaged communities of Africa and Asia, where awareness of the disease, access to dog vaccination programmes and appropriate post-bite treatment are limited or non-existent. Lack of rabies awareness and resources make the difference between life and death: rabies is fatal if not treated before symptoms appear.

Proof-of-concept projects demonstrate that rabies control strategies are effective and feasible. More than 95% of human rabies cases result from the bite of a rabid dog. Human rabies cases can be eliminated at source by vaccinating dogs and raising public awareness about dog bite prevention. These measures should be complemented by providing access to correct bite wound management and post-exposure prophylaxis when required.

We’ve shown that mass vaccination of dogs can eliminate canine rabies,” says Dr Kevin Le Roux, Rabies Programme Manager, KwaZulu-Natal, South Africa. “We have demonstrated success, which has spurred interest in neighbouring countries. Stimulus packages consisting of vaccines and vaccination campaign equipment, coupled with training, allow countries to kick-start a programme. The result is a significant drop in human deaths. Investments for these stimulus packages are needed to roll out elimination programmes in affected communities and countries.”

Drawing on the results of successful WHO proof-of-concept rabies control programmes implemented using a One Health approach, the conference will rally countries and the wider support networks to assume the challenge of investing in global rabies elimination.

The international conference will make the case that elimination of rabies is feasible. It will include next steps on making dog and human vaccines and rabies immunoglobulins more accessible to catalyse progress. An estimated 300 participants will attend, including members of national health ministries and veterinary services, experts from the veterinary and human health sectors, international organizations, policy-makers, nongovernmental organizations, donors, national rabies coordinators and the private sector. All have a role to play in achieving the shared goal of global rabies elimination. The Time is Now!


New global framework to eliminate rabies

OIE

Geneva, 10 December 2015 – A new framework to eliminate human rabies and save tens of thousands of lives each year has been launched today by the World Health Organization (WHO), the World Organisation for Animal Health (OIE), the Food and Agriculture Organization of the United Nations (FAO) and the Global Alliance for the Control of Rabies (GARC).

The framework calls for three key actions – making human vaccines and antibodies affordable, ensuring people who get bitten receive prompt treatment, and mass dog vaccinations to tackle the disease at its source.

“Rabies is 100% preventable through vaccination and timely immunization after exposure, but access to post bite treatment is expensive and is not affordable in many Asian and African countries. If we follow this more comprehensive approach, we can consign rabies to the history books,” says WHO Director-General Dr Margaret Chan.

Tens of thousands of people die from rabies each year and, worldwide, 4 out of every 10 people bitten by suspected rabid dogs are children aged under 15 years. One person dies every 10 minutes, with the greatest burden in Asia and Africa.

The cost of human vaccines to protect from rabies is, however, beyond the reach of many of those who may need it. And treatment for people who are bitten can cost US$ 40–50, representing an average of 40 days of wages in some of the affected countries. Recognizing that human vaccination is currently not always affordable, the new framework emphasizes prevention through vaccinating dogs – whose bites cause 99% of all human rabies cases. A dog vaccine costs less than US$1.

“Vaccinating 70% of dogs regularly in zones where rabies is present can reduce human cases to zero. Eliminating canine rabies through dog vaccination is the most cost-effective and only long-term solution,” states OIE Director General Dr Bernard Vallat. “Human deaths can be prevented when mass dog vaccination is combined with responsible pet ownership and stray dog population management, both complying with OIE intergovernmental standards, as well as with bite treatment, as recommended by WHO.”

Whilst vaccinating dogs will be key in the new approach, the elimination of rabies – and saving the lives of those who are bitten – will not be possible without more widely-available human vaccines.

Currently, about 80% of people exposed to rabies live in poor, rural areas of Africa and Asia with no access to prompt treatment should they be bitten. Bringing treatment closer to victims and providing wider access to affordable vaccines and potent rabies immunoglobulins, which neutralize the rabies virus before it can get a hold in the body, are vital to achieving zero rabies deaths.

Bringing down the cost of human rabies vaccines and treatments will require strong international collaboration to make quality-assured vaccines and rabies immunoglobulin available to health centres in regions where rabies is endemic.
As of 2015, WHO and the OIE Vaccine Bank have delivered more than 15 million doses of canine rabies vaccines in many countries.

Global elimination of human rabies – The time is now!
On 10 and 11 December 2015, experts, donors, and veterinary and public health officials will adopt a plan of action that is expected to deliver prompt post-exposure prophylaxis for all in rabies endemic areas as well as a framework for scaling up sustained, large-scale dog vaccination. This milestone international conference will also discuss a push for coordinated activities targeting dog and human populations by adapting proven control strategies.

Another important component is harnessing support for community awareness and engagement to facilitate and strengthen data collection, bite incidence reporting and demand for post-exposure prophylaxis.  Educating children on how to avoid being bitten is also vital.

The conference “Global elimination of dog-mediated human rabies – The time is now” is jointly organized by WHO and the OIE, in collaboration with FAO with the support of GARC.

Follow the conference online!

For media inquiries, please contact:

Christian Lindmeier
WHO Department of Communications
Telephone: +41 79 500 65 52+41 79 500 65 52
Mobile: +41 7 94 45 31 64+41 7 94 45 31 64
Email: lindmeierch@who.int

Dr Catherine Bertrand-Ferrandis
Head of Communication
World Organisation for Animal Health
Mobile: +33 6 16 46 28 90+33 6 16 46 28 90
Email : c.bertrand-ferrandis@oie.int

 


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