Royal Society of Tropical Medicine and Hygiene meeting at Manson House, London, 20 March 1997. Epidemiology and control of rabies. The growing problem of rabies in Africa.

Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, UK.
Transactions of the Royal Society of Tropical Medicine and Hygiene (Impact Factor: 1.84). 92(2):131-4.
Source: PubMed


Although rabies in Africa is relatively insignificant in terms of human mortality, the disease is still relevant because of the high costs of rabies prevention. Over the past 2 decades, demographic, economic and sociopolitical trends in Africa have increasingly favoured the persistence and spread of rabies, while limiting the effectiveness of control measures. Dog rabies predominates throughout most of Africa; the domestic dog is the principal reservoir host as well as the most important source of infection for people. However, wild-life rabies is increasingly a concern, both as a threat to endangered wildlife populations and because of the possible emergence of new maintenance hosts.

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    • "Since the 1960s, the reported incidence of canine and human rabies has increased in many countries in southern and eastern Africa [1,2] even though detection rates and reporting systems have deteriorated [3] and effective human post-exposure prophylaxis and dog rabies vaccines have become available commercially [4]. Most human rabies deaths worldwide occur in Africa and Asia, with an estimated 24 500 human deaths per year in Africa, more than 100 times the number of cases officially recorded [5]. "
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    ABSTRACT: Background Mass vaccinations of domestic dogs have been shown to effectively control canine rabies and hence human exposure to rabies. Knowledge of dog population demography is essential for planning effective rabies vaccination programmes; however, such information is still rare for African domestic dog populations, particularly so in urban areas. This study describes the demographic structure and population dynamics of a domestic dog population in an urban sub-Saharan African setting. In July to November 2005, we conducted a full household-level census and a cross-sectional dog demography survey in four urban wards of Iringa Municipality, Tanzania. The achievable vaccination coverage was assessed by a two-stage vaccination campaign, and the proportion of feral dogs was estimated by a mark-recapture transect study. Results The estimated size of the domestic dog population in Iringa was six times larger than official town records assumed, however, the proportion of feral dogs was estimated to account for less than 1% of the whole population. An average of 13% of all households owned dogs which equalled a dog:human ratio of 1:14, or 0.31 dogs per household or 334 dogs km-2. Dog female:male ratio was 1:1.4. The average age of the population was 2.2 years, 52% of all individuals were less than one year old. But mortality within the first year was high (72%). Females became fertile at the age of 10 months and reportedly remained fertile up to the age of 11 years. The average number of litters whelped per fertile female per year was 0.6 with an average of 5.5 pups born per litter. The population growth was estimated at 10% y-1. Conclusions Such high birth and death rates result in a rapid replacement of anti-rabies immunised individuals with susceptible ones. This loss in herd immunity needs to be taken into account in the design of rabies control programmes. The very small proportion of truly feral dogs in the population implies that vaccination campaigns aimed at the owned dog population are sufficient to control rabies in urban Iringa, and the same may be valid in other, comparable urban settings.
    BMC Veterinary Research 12/2012; 8(1):236. DOI:10.1186/1746-6148-8-236 · 1.78 Impact Factor
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    • "Such epidemic may have also contributed to the increased frequency of reporting shown in the present study. An increasing rabies incidence in Africa and Asia has been largely attributed to population growth of dogs.[621] "
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    ABSTRACT: The aim of this study was to determine the incidence of humans being bitten by rabies-suspected animals, and the victims' adherence to post-exposure prophylaxis (PEP) regimen. A retrospective analysis of data of victims treated at Bugando Medical Centre during the period 2002-2006 (n=5 years) was done. A total of 767 bite injuries inflicted by rabies-suspected animals were reported, giving a mean annual incidence of ~58 cases per 100,000 (52.5% males, 47.5% females). The proportion of children bitten was relatively higher than that of adults. All victims were treated by using inactivated diploid-cell rabies vaccine and were recommended to appear for the second and third doses. However, only 28% of the victims completed the vaccination regime. Domestic dogs were involved in 95.44% of the human bite cases, whereas cats (3.9%), spotted hyena (Crocuta crocuta) (0.03%), vervet monkey (Cercopithecur aethiops) (0.01%) and black-backed jackal (0.01%) played a minor role. The majority of rabies-suspected case reports were from Nyamagana district and occurred most frequently from June to October each year. In conclusion, this study revealed that incidences of humans being bitten by dogs suspected of rabies are common in Tanzania, involve mostly children, and victims do not comply with the prophylactic regimen. Rigorous surveillance to determine the status of rabies and the risk factors for human rabies, as well as formulation and institution of appropriate rabies-control policies, is required.
    Journal of global infectious diseases 09/2010; 2(3):216-20. DOI:10.4103/0974-777X.68530
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    • "The study implicated that: (1) the incidence of human rabies, which China was largely free from in the final years of the last millennium, is now increasing which should be a warning sign for control and prevention; (2) there is a need to improve the current rabies control programme in order to reduce non-compliance rates and to decrease the occurrence of flaws in the surveillance programme and in the provision of health care. Given the findings of the study, we view the implementation of the following measures as appropriate [9-12,41,42]: (a) continuing supervision of the current human rabies control programme, in order to reduce both non-compliance rates and the occurrence of flaws in health-care provision; (b) improving the interactions between professionals from the divisions of the municipal health-care network and teams of national programmes; (c) increase rabies awareness among Chinese health authorities and policymakers, improve the training of general practitioners and health care workers, and educate school children and the general public, which is crucial for effective rabies control; and (d) urban planning and development should take ecosystem preservation into account, in an attempt to balance the interaction between humans and animals. "
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    ABSTRACT: Rabies is a major public-health problem in developing countries such as China. Although the recent re-emergence of human rabies in China was noted in several epidemiological studies, little attention was paid to the reasons behind this phenomenon paralleling the findings of the previous reports. The purpose of this study is thus first to characterize the current trends of human rabies in China from 1990 to 2007, and then to define better recommendations for improving the post-exposure prophylaxis (PEP) schedules delivered to rabies patients. The most updated epidemiological data for 22527 human rabies cases from January 1990 to July 2007, retrieved from the surveillance database of reportable diseases managed by the Ministry of Health of China, were analysed. To investigate the efficiency for the post-exposure treatment of rabies, the details of 244 rabies patients, including their anti-rabies treatment of injuries or related incidents, were ascertained in Guangdong provincial jurisdiction. The risk factors to which the patients were predisposed or the regimens given to 80 patients who received any type of PEP were analysed to identify the reasons for the PEP failures. The results from analysis of the large number of human rabies cases showed that rabies in China was largely under control during the period 1990-1996. However, there has been a large jump in the number of reported rabies cases since 2001 up to a new peak (with an incidence rate of 0.20 per 100000 people) that was reached in 2004, and where the level has remained until present. Then, we analysed the PEP in 244 rabies cases collected in the Guangdong province in 2003 and 2004, and found that 67.2% of the patients did not seek medical services or did not receive any PEP. Further analysis of PEP for the 80 rabies patients who received any type of PEP indicated that almost all of the patients did not receive proper or timely treatment on the wounds or post-exposure vaccination or rabies immunoglobulins. While the issue of under-reporting of rabies in previous years may well be a factor in the apparent upwards trend of human rabies in recent years, the analysis of PEP in the Guangdong province provides evidence that suggests that the failure to receive PEP was a major factor in the number of human cases in China. Thus, the data underline the need for greatly improved availability and timely application of high-quality anti-rabies biologicals, both vaccines and immunoglobulins, in the treatment of human bite victims. Controlling dog rabies through pet vaccination schemes may also play a huge role in reducing the rate of human exposure. Education of the public, health care staff and veterinarians will also help to change the current situation.
    BMC Infectious Diseases 02/2008; 8(1):113. DOI:10.1186/1471-2334-8-113 · 2.61 Impact Factor
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