Epidemiological Characteristics of Human and Animal Rabies in Azerbaijan

The Caucasus is a region of geopolitical importance, in the gateway between Europe and Asia. This geographical location makes the region equally important in the epidemiology and control of transboundary infectious diseases such as rabies. Azerbaijan is the largest country in the Caucasus, and although rabies is notifiable and considered endemic, there is little information on the burden of human and animal rabies. Here, we describe a cross‐disciplinary international collaboration aimed at improving rabies control in Azerbaijan. Partial nucleoprotein gene sequences were obtained from animal rabies cases for comparison with those from surrounding areas. Reported human and animal rabies cases between 2000 and 2010 were also reviewed and analysed by region and year. Comparison of rabies virus strains circulating in Azerbaijan demonstrates more than one lineage of rabies virus circulating concurrently in Azerbaijan and illustrates the need for further sample collection and characterization. Officially reported rabies data showed an increase in human and animal rabies cases, and an increase in animal bites requiring provision of post‐exposure prophylaxis, since 2006. This is despite apparently consistent levels of dog vaccination and culling of stray dogs.     

Review of Rabies Epidemiology and Control in South,South East and East Asia: Past,Present and Prospects for Elimination

Rabies is a serious public health problem in Asia. It causes substantial animal welfare, economic and human health impacts, with approximately 39 000 human deaths each year. Domestic dogs are the main reservoir and source of rabies in Asia. Common constraints for the control of rabies in the countries of Asia include inadequate resources; lack of political commitment to control programs; lack of consensus on strategy; weak intersectoral coordination and inadequate management structure; insensitive surveillance systems; limited accessibility to modern rabies vaccine and supply problems; lack of public awareness and public cooperation; and the existence of myths and religious issues. In this review, we summarize the epidemiology of rabies in both human and animals in each South and South East Asian country, the past and current approaches to control and the prospect for rabies elimination. We conclude that defining the cost of rabies to society and communicating this to decision‐makers might be the key to achieving such an advance.     

Rabies

The practicing veterinarian has a key role to play in rabies control in the maintenance of protection in the companion animal populations, in the education of the pet-owning community on rabies, and in the decision-making process that accompanies human exposure to potentially rabid animals. This role encompasses far more than the routine maintenance of health and well-being in pet animal populations. Although it is important to remain diligent in the immunization of domestic pets against rabies to provide a barrier between wildlife, the main reservoir of infection, and man, it is also important to be aware of the current trends in wildlife rabies within a region. Research is currently underway to investigate methods of immunizing wildlife populations, but the effective and widespread control of rabies in these species is still a long way off; in the meantime, there will be an increasing demand for practicing veterinarians to take the lead in the control of this most fearful zoonotic disease.     

Prevention and Control of Rabies in an Age of Global Travel: A Review of Travel‐ and Trade‐Associated Rabies Events – United States, 1986–2012

Rabies prevention and control efforts have been successful in reducing or eliminating virus circulation regionally through vaccination of specific reservoir populations. A notable example of this success is the elimination of canine rabies virus variant from the United States and many other countries. However, increased international travel and trade can pose risks for rapid, long‐distance movements of ill or infected persons or animals. Such travel and trade can result in human exposures to rabies virus during travel or transit and could contribute to the re‐introduction of canine rabies variant or transmission of other viral variants among animal host populations. We present a review of travel‐ and trade‐associated rabies events that highlight international public health obligations and collaborative opportunities for rabies prevention and control in an age of global travel. Rabies is a fatal disease that warrants proactive coordination among international public health and travel industry partners (such as travel agents, tour companies and airlines) to protect human lives and to prevent the movement of viral variants among host populations.     

狂犬病及其防制措施

针对目前狂犬病在全世界流行日益严峻的形势，通过大量的数字详细列举了国内外人和动物狂犬病的流行现状、欧美等发达国家防制狂犬病的有效措施及我国防制措施，结合我国狂犬病流行现状，分析了狂犬病流行的原因，提出了我国防制狂犬病的几点建议。     

Control of rabies: epidemiology of rabies in Asia and development of new-generation vaccines for rabies

Rabies is an enzootic viral disease widespread throughout the world. Although it is a vaccine-preventable disease, the annual number of human deaths caused by rabies is estimated to be 32,000 in Asia. Phylogenetic analysis based on sequence data of the partial N gene of rabies viruses in Asia has shown that the viruses are divided into five genogroups, distributed in Middle East, South Asia, South East Asia, Malay, and Arctic regions. The genetic relationships among these rabies viruses agree basically with the results of previous studies. Meanwhile, new types of vaccines are being developed by applying gene manipulation techniques to rabies virus in order to overcome the disadvantages of current vaccines. This article reviews the molecular epidemiology of rabies in Asia and progress made in the development of new-generation rabies vaccines with the goal of elimination or control of rabies in Asia.     

Surveillance of Human Rabies by National Authorities – A Global Survey

Effective prevention of deaths due to human rabies is currently hampered by a lack of understanding of the scale of the problem, and the distribution of both animal and human cases across countries, regions and continents. Unfortunately, despite the severity of the disease, accurate data on which to assess these questions and to prioritize and direct public health interventions are not available for many parts of the world. This survey sought to understand the current global situation regarding the surveillance of human rabies. Data were collected from 91 countries across all continents and all categories of human rabies risk, generating the most complete and representative global data set currently available. Respondents were asked key questions about whether human rabies was a notifiable disease, how the surveillance system for human rabies operated and whether the respondent considered that the surveillance system was working effectively. Across the 91 countries from which data were collated, human rabies was a notifiable disease in all but eight. Despite international guidance, surveillance systems were very varied. Even where rabies is a notifiable disease, many countries had surveillance system judged to be ineffective, almost all of these being high and moderate rabies risk countries in Africa and Asia. Overall, 41% of the population covered by this survey (around 2.5 billion people) live in countries where there is no or ineffective rabies surveillance. The lack of robust surveillance is hindering rabies control efforts. However, whilst worldwide rabies surveillance would be improved if rabies were notifiable in all countries, many other challenges to the implementation of effective global human rabies surveillance systems remain.     

Surveillance and control of rabies in La Reunion,Mayotte, and Madagascar

Mayotte and La Reunion islands are currently free of animal rabies and surveillance is performed by the French Human and Veterinary Public Health Services. However, dog rabies is still enzootic in Madagascar with 4 to 10 confirmed human cases each year. The number of antirabies medical centres in Madagascar is still scarce to provide easy access to the local population for post-exposure rabies prophylaxis. Furthermore, stray dog populations are considerable and attempts to control rabies by mass campaigns of dog vaccination have not received sufficient attention from the national health authorities. To address these challenges, an expanded program to control rabies needs to be initiated by the Malagasy authorities.     

Knowledge of Rabies Prevention in Vietnamese Public Health and Animal Health Workers

Rabies is an invariably fatal, but preventable zoonotic disease. Despite a national programme for its prevention and control, the number of rabies associated deaths in Vietnam has increased in recent years. A cross‐sectional survey was undertaken in 2012 to assess and compare the knowledge, awareness and practices of 189 public health workers (PHW) and animal health workers (AHW) attending a joint training course for professionals from provinces in northern Vietnam with the highest number of deaths from rabies. Questionnaires facilitating self‐evaluation were provided, and total knowledge scores were calculated (maximum 38 points) and categorized into: ‘high’ (>30 points), ‘moderate’ (21–30) and ‘low’ (<21). The response rate was 100%, and among the 189 participants, 56% were PHW compared to 44% who were AHW. Although most respondents knew rabies could be transmitted through the bite of an animal, most commonly a dog, and that rabies is a preventable disease, significant differences between groups were identified. Major areas included poor knowledge of common rabies reservoirs, wound management and guidance on post‐exposure prophylaxis. Overall, the total mean knowledge scores for PHW was significantly higher (P = 0.011) compared to those for AHW, but both scores fell within the ‘moderate’ knowledge range. However, proportionately more PHW than AHW achieved ‘high’ knowledge scores (P = 0.0098). To our knowledge this is the first published study to simultaneously assess the knowledge and awareness of animal health and public health professionals attending joint training activities aimed at strengthening rabies prevention and control. To ensure effective prevention and control of rabies requires that AHW and PHW not only coordinate and collaborate, but have a common knowledge and understanding of rabies prevention and control measures. This study provides important baseline data in a relatively unexplored area of research that can focus future interventions and research.     

Rabies Prevention and Management of Cats in the Context of Trap–Neuter–Vaccinate–Release Programmes

Domestic cats are an important part of many Americans' lives, but effective control of the 60–100 million feral cats living throughout the country remains problematic. Although trap–neuter–vaccinate–return (TNVR) programmes are growing in popularity as alternatives to euthanizing feral cats, their ability to adequately address disease threats and population growth within managed cat colonies is dubious. Rabies transmission via feral cats is a particular concern as demonstrated by the significant proportion of rabies post‐exposure prophylaxis associated with exposures involving cats. Moreover, TNVR has not been shown to reliably reduce feral cat colony populations because of low implementation rates, inconsistent maintenance and immigration of unsterilized cats into colonies. For these reasons, TNVR programmes are not effective methods for reducing public health concerns or for controlling feral cat populations. Instead, responsible pet ownership, universal rabies vaccination of pets and removal of strays remain integral components to control rabies and other diseases.     

Canine Rabies in Australia: A Review of Preparedness and Research Needs

Australia is unique as a populated continent in that canine rabies is exotic, with only one likely incursion in 1867. This is despite the presence of a widespread free‐ranging dog population, which includes the naturalized dingo, feral domestic dogs and dingo‐dog cross‐breeds. To Australia's immediate north, rabies has recently spread within the Indonesian archipelago, with outbreaks occurring in historically free islands to the east including Bali, Flores, Ambon and the Tanimbar Islands. Australia depends on strict quarantine protocols to prevent importation of a rabid animal, but the risk of illegal animal movements by fishing and recreational vessels circumventing quarantine remains. Predicting where rabies will enter Australia is important, but understanding dog population dynamics and interactions, including contact rates in and around human populations, is essential for rabies preparedness. The interactions among and between Australia's large populations of wild, free‐roaming and restrained domestic dogs require quantification for rabies incursions to be detected and controlled. The imminent risk of rabies breaching Australian borders makes the development of disease spread models that will assist in the deployment of cost‐effective surveillance, improve preventive strategies and guide disease management protocols vitally important. Here, we critically review Australia's preparedness for rabies, discuss prevailing assumptions and models, identify knowledge deficits in free‐roaming dog ecology relating to rabies maintenance and speculate on the likely consequences of endemic rabies for Australia.     

Impact of Rabies Vaccination History on Attainment of an Adequate Antibody Titre Among Dogs Tested for International Travel Certification,Israel – 2010–2014

Rabies is endemic in wildlife or domestic carnivore populations globally. Infection of domestic dogs is of particular concern in many areas. In regions where domestic animals are at risk of exposure to rabies virus, dogs should be routinely vaccinated against rabies to protect both pet and human populations. Many countries require demonstration of an adequate level of serum rabies neutralizing antibodies to permit entry of dogs during international travel. We analysed rabies titres of dogs seeking travel certification in Israel to assess demographic and vaccine history factors associated with antibody titres below the acceptable threshold for travel certification. Having received only one previous rabies vaccination and a longer duration since the most recent vaccination was received were primary risk factors for not achieving an adequate rabies virus neutralizing antibody titre for travel certification. These risk factors had stronger effects in younger animals, but were consistent for dogs of all ages. In particular, these findings reiterate the importance of administering at least two rabies vaccinations (the primo vaccination and subsequent booster) to ensure population‐level protection against rabies in dogs globally.     

Rabies postexposure prophylaxis. Human and domestic animal considerations.

The emphasis on rabies control and prevention in the United States seems to be a function of our perception of proximity of the threat. Wildlife rabies epizootics within a state may be of little concern to the uninformed urban dweller. Additionally, many parts of the western United States are free of terrestrial rabies; were it not for the presence of bat rabies, people in those areas would likely interpret rabies control as a minor public health concern. It is essential that federal, state, and local public health programs emphasize the importance of rabies control through activities that include rabies education, sponsorship of legislated requirements for domestic animal vaccination, support for local animal control programs, and the promotion of recommendations that encourage the appropriate use of PEP. We are almost guaranteed that rabies is going to remain a major public health issue well into the next century because of expanding wildlife rabies epizootics, identification of new rabies viral variants with increased public health concern, emotional and legal concerns associated with rabies exposure, and increasing national cost associated with rabies control and prevention. Nevertheless, the development of new laboratory technology that allows an understanding of the epidemiologic nature of the rabies virus based on an evolving genetic history and the interrelationship with wildlife reservoirs should allow access to valuable tools for rabies control. When combined with programs using new developments in oral rabies vaccine that can immunize whole populations of wildlife reservoirs, that technology offers encouragement in our effort to control one of the diseases of antiquity.     

Expert Opinion to Identify High‐Risk Entry Routes of Canine Rabies into Papua New Guinea

The proximity of Papua New Guinea (PNG) to canine rabies‐endemic countries in South‐East Asia presents a risk of incursion of this disease into PNG and the rest of the Oceanic region. The objective of this study was to identify the highest risk routes for entry of dogs – associated with movement of people – into PNG from canine rabies‐endemic countries. A structured, in‐country expert‐elicitation workshop was used, and 20 entry routes were identified. The highest risk routes were three land routes from Papua, Indonesia (hunters, traditional border crossers and unregulated, unchecked ‘shopper‐crossers’) and two sea routes (fishing and logging). These results will be used to direct more detailed risk assessments to develop surveillance strategies and incursion response plans.     

Factors Associated with Dog Rabies Vaccination in Bhol,Philippines: Results of a Cross‐Sectional Cluster Survey Conducted Following the Island‐Wide Rabies Elimination Campaign

The Philippines has a long history of rabies control efforts in their dog populations; however, long‐term success of such programmes and the goal of rabies elimination have not yet been realized. The Bohol Rabies Prevention and Elimination Program was developed as an innovative approach to canine rabies control in 2007. The objective of this study was to assess canine rabies vaccination coverage in the owned‐dog population in Bohol and to describe factors associated with rabies vaccination 2 years after implementation of the programme. We utilized a cross‐sectional cluster survey based on the World Health Organization’s Expanded Programme on Immunization coverage survey technique. We sampled 460 households and collected data on 539 dogs residing within these households. Seventy‐seven per cent of surveyed households reported owning at least one dog. The human‐to‐dog ratio was approximately 4 : 1, and the mean number of dogs owned per household was 1.6. Based on this ratio, we calculated an owned‐dog population of almost 300 000. Overall, 71% of dogs were reported as having been vaccinated for rabies at some time in their lives; however, only 64% of dogs were reported as having been recently vaccinated. Dogs in our study were young (median age = 24 months). The odds of vaccination increased with increasing age. Dogs aged 12–23 months had 4.6 times the odds of vaccination compared to dogs aged 3–11 months (95% CI 1.8–12.0; P = 0.002). Confinement of the dog both day and night was also associated with increased odds of vaccination (OR = 2.1; 95% CI 0.9–4.9; P = 0.07), and this result approached statistical significance. While the programme is on track to meet its goal of 80% vaccination coverage, educational efforts should focus on the need to confine dogs and vaccinate young dogs.     

A Large‐scale,Rapid Public Health Response to Rabies in an Organ Recipient and the Previously Undiagnosed Organ Donor

This article describes and contrasts the public health response to two human rabies cases: one organ recipient diagnosed within days of symptom onset and the transplant donor who was diagnosed 18 months post‐symptom onset. In response to an organ‐transplant‐related rabies case diagnosed in 2013, organ donor and recipient investigations were conducted by multiple public health agencies. Persons with potential exposure to infectious patient materials were assessed for rabies virus exposure. An exposure investigation was conducted to determine the source of the organ donor's infection. Over 100 persons from more than 20 agencies spent over 2700 h conducting contact investigations in healthcare, military and community settings. The 564 persons assessed include 417 healthcare workers [5.8% recommended for post‐exposure prophylaxis (PEP)], 96 community contacts (15.6% recommended for PEP), 30 autopsy personnel (50% recommended for PEP), and 21 other persons (4.8% recommended for PEP). Donor contacts represented 188 assessed with 20.2% recommended for PEP, compared with 5.6% of 306 recipient contacts recommended for PEP. Human rabies cases result in substantial use of public health and medical resources, especially when diagnosis is delayed. Although rare, clinicians should consider rabies in cases of encephalitis of unexplained aetiology, particularly for cases that may result in organ donation.     

Canine vaccination--providing broader benefits for disease control

This paper reviews the broader benefits of canine vaccination to human and animal health and welfare with an emphasis on the impacts of mass dog vaccination against rabies in countries of the less-developed world. Domestic dogs are the source of infection for the vast majority (>95%) of cases of human rabies worldwide, and dogs remain the principal reservoir throughout Africa and Asia. Canine vaccination against rabies has been shown to dramatically reduce the number of cases in dogs, the incidence of human animal-bite injuries (and hence the demand for costly post-exposure prophylaxis) and the likely number of human cases, primarily in children. Further benefits include the mitigation of the psychological consequences of rabies in a community, improved attitudes towards animals and animal welfare and reduced livestock losses from canine rabies. Mass vaccination has recently been used in the conservation management of wild carnivore populations threatened by transmission of rabies and canine distemper virus from domestic dog populations. Vaccination of wildlife hosts directly may also provide an option for mitigating infectious disease threats. The development of integrated control measures involving public health, veterinary, wildlife conservation and animal welfare agencies is needed to ensure that control of canine diseases becomes a reality in Africa and Asia. The tools and delivery systems are all available--all that is needed is the political will to free the world from the ongoing tragedy of these diseases.     

Recurrent Temporary Paralysis Reported After Human Rabies Post‐Exposure Prophylaxis

Adverse events can occur after rabies post‐exposure prophylaxis (PEP), and linkage to causality is often difficult to determine. We report a case of recurrent temporary paralysis that began immediately after the initiation of rabies PEP in a man exposed to a bat. The recurrent temporary paralysis first occurred in the patient after his initial dose and then again after day 3 of his rabies PEP. The PEP was terminated prior to a serologic response. The patient continued to experience numerous discrete episodes of temporary paralysis for over two years.