On the path to rabies elimination: The need for risk assessments to improve administration of post-exposure prophylaxis.

Rysava, K., Miranda, M.E., Zapatos, R., Lapiz, S., Rances, P., Miranda, L.M., Roces, M.C., Friar, J., Townsend, S.E. and Hampson, K. (2019) On the path to rabies elimination: The need for risk assessments to improve administration of post-exposure prophylaxis. Vaccine, 37, A64-A72. (doi: 10.1016/j.vaccine.2018.11.066) (PMID:30573356) (PMCID:PMC6863041)

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Abstract

Costs of rabies post-exposure prophylaxis (PEP) often remain high in regions where rabies has been controlled in dogs, presenting a challenge for sustaining rabies elimination programmes. We investigated the potential for bite patient risk assessments to improve PEP provision and surveillance in settings approaching elimination of dog-mediated rabies. We conducted a longitudinal study of patients presenting to animal bite treatment centres (ABTCs) on the island province of Bohol in the Philippines to investigate the health status of biting dogs and to quantify current expenditure on PEP. Incidence of bite patients presenting to ABTCs was high (>300/100,000 persons/year) and increasing, resulting in substantial health provider costs. Over $142,000 was spent on PEP in 2013 for a population of 1.3 million. From follow up of 3820 bite patients we found that  >92% were bitten by healthy dogs (alive 14 days after the bite) and just 1.4% were bitten by probable or confirmed rabid dogs. The status of dogs that bit 6% of patients could not be determined. During the course of investigations of bites by suspect dogs, we were able to obtain samples for case confirmation, identify exposed persons who had not sought PEP as well as in-contact dogs at risk of developing rabies. We calculate that expenditure on PEP could at least be halved through more judicious approaches to provision of PEP, based on the histories of biting animals determined through risk assessments with bite patients. We conclude that a One Health approach to surveillance based on Integrated Bite Case Management could improve the sustainability and effectiveness of rabies elimination programmes while also improving patient care by identifying those genuinely in need of lifesaving PEP.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Hampson, Professor Katie
Authors: Rysava, K., Miranda, M.E., Zapatos, R., Lapiz, S., Rances, P., Miranda, L.M., Roces, M.C., Friar, J., Townsend, S.E., and Hampson, K.
College/School:College of Medical Veterinary and Life Sciences > Institute of Biodiversity Animal Health and Comparative Medicine
Journal Name:Vaccine
Publisher:Elsevier
ISSN:1873-2518
ISSN (Online):1873-2518
Published Online:17 December 2018
Copyright Holders:Copyright © 2019 The Authors
First Published:First published in Vaccine 37:A64-A72
Publisher Policy:Reproduced under a Creative Commons License

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
539491Understanding the role of contact networks in the epidemiological and evolutionary dynamics of zootonic diseaseSarah CleavelandWellcome Trust (WELLCOTR)082715/B/07/ZRI BIODIVERSITY ANIMAL HEALTH & COMPMED
569041Hierarchical epidemiology: the spread and persistence of infectious diseases in complex landscapesKatie HampsonWellcome Trust (WELLCOTR)095787/Z/11/ZRI BIODIVERSITY ANIMAL HEALTH & COMPMED