Post‐exposure rabies prophylaxis for mass bat exposures: Case series and systematic review

To assess and describe the use of rabies post‐exposure prophylaxis (PEP) related to mass bat exposures (MBEs) in the literature and in the state of Rhode Island. Data on MBE events occurring between 2010 and 2016 from the Rhode Island Department of Health (RIDOH) were reviewed to determine PEP usage. For comparison, a systematic review was also performed by searching PubMed, EMBASE, Cochrane Library and Web of Science using the keywords ‘rabies,’ ‘bat’ and ‘exposure.’ There were three MBE events in Rhode Island between 2010 and 2016 in which groups of individuals were asleep during the potential exposure. As a result, RIDOH provided PEP to those involved in the event. In a systematic review of 12 published reports, a variety of settings were involved in MBEs: camping sites, a domestic flight, a neonatal intensive care unit and dormitories. The number of potential rabies exposures ranged from five to 1,429 people. PEP recommendations for assessed persons ranged from 0% to 100% across events (median 21%). The variation in PEP recommendations following a MBE may be dependent on medical need, past precedent or preference. Federal guidance for MBE is needed to add clarity and to minimize the variability in PEP recommendations for such events in the future.     

Evaluating the public health response to a mass bat exposure—Wyoming, 2017

Mass bat exposures (MBEs) occur when multiple people are exposed to a bat or a bat colony, often over an extended period. In August 2017, a public health investigation was started in response to an MBE that occurred during May–August 2017 at a national park research station in Wyoming. We identified 176 people who had slept primarily in two lodges (Lodges A and B) at the research station, and successfully contacted 165 (93.8%) of these individuals. Risk assessments (RAs) were administered to all 165 individuals to determine degree and type of exposures to bats (e.g., biting or scratching). Exposure status for research station guests was classified as “non‐exposed,” “low risk” or “high risk,” and counselling was provided to guide post‐exposure prophylaxis (PEP) recommendations. Prior to public health notification and intervention, 19 persons made the decision to pursue PEP. The healthcare‐seeking behaviours of this group were taken to represent outcomes in the absence of public health intervention. (These persons received a RA, and their risk classification was retrospectively assigned.) Approximately 1–2 weeks after conducting the RAs, we conducted a follow‐up survey to determine whether recommendations regarding PEP were ultimately followed. The proportion of individuals that unnecessarily pursued PEP was higher among the 19 individuals that sought health care prior to receiving the RA (p < 0.00001). Among those receiving the RA first, all persons classified as high risk followed public health guidance to seek PEP treatment. Despite this, upon re‐interview, only 21/79 (26.6%) of guests could accurately recall their risk classification, with most people (55.7%) overestimating their risk. Study findings demonstrate that early public health interventions such as RAs can reduce unnecessary use of PEP and that messaging used during rabies counselling should be clear.     

Determinants of health seeking behaviour following rabies exposure in Ethiopia

The objective of this study was to identify factors that determine medical treatment seeking behaviour following potential rabies exposure after being bitten by a suspected dog and the likelihood of compliance to receive sufficient doses of post‐exposure prophylaxis after the visit to a health centre visit. A detailed survey based on case investigation was conducted on suspected rabid dog bite cases in three areas of Ethiopia. Two multivariable logistic regression models were created with a set of putative variables to explain treatment seeking and compliance outcomes. Based on the registered bite cases at each health centre and the set of unregistered bite cases derived by contact tracing, 655 bite victim cases were identified to have occurred between September 2013 and August 2014. Of these evaluated bite incidences, 465 cases were considered to have been caused by a potentially rabid dog. About 77% of these suspected rabid dog bite victims visited a health centre, while 57% received sufficient doses of PEP. The overall likelihood of seeking medical services following rabies exposure was higher for people bitten by dogs of unknown ownership, where the bite was severe, being bitten on the leg, spend of more than 100 USD per month and where the victim lived close to the nearest health centre, while the likelihood of receiving sufficient doses of PEP was sensitive to monthly spending and distance to health centre. However, the evaluated factors did only explain a part of the variation among the three districts. The district in which victims lived appeared to have a relevant influence on the likelihood of seeking medical treatment but did not improve the prediction on the likelihood of treatment compliance. Given the insights obtained from this study, improvements in the rural districts with regard to accessibility of post‐exposure prophylaxis delivering health centres in shorter distance could improve health seeking behaviour. In addition, in rural districts, majority of exposed persons who seek medical treatment tend to comply with treatment regimen, indicating that the promotion of medical treatment through awareness creation campaigns could be beneficial.     

Increased detection of rabies virus in bats in Ceará State (Northeast Brazil) after implementation of a passive surveillance programme

The intensification of dog, cat and livestock vaccination campaigns significantly reduced rabies cases in humans and domestic animals in Ceará State, Brazil. However, sylvatic animals—bats (order Chiroptera), wild canids, raccoons and non‐human primates— remain as reservoirs for the virus. Our hypothesis is that surveillance and monitoring of rabies virus in bats, especially passive surveillance, is of fundamental importance, besides the implementation of health education and strengthening of surveillance actions in humans exposed to aggressions. Thus, we assessed the occurrence of rabies virus in animals focusing on bats, before and after launching of the Sylvatic Rabies Surveillance Program in 2010. Surveillance data from the 184 municipalities of Ceará State were analysed, collected during the periods 2003–2010 (active surveillance) and 2011–2016 (passive surveillance), respectively. A total of 13,543 mammalian samples were received for rabies diagnosis from 2003 to 2016. Of these, 10,960 were from dogs or cats (80.9%), 1,180 from bats (8.7%), 806 from other sylvatic animals (foxes, marmosets, raccoons; 6.0%) and 597 from herbivores (cattle, goats, sheep, equines, pigs; 4.4%). A total of 588 (4.3%) samples were positive for rabies. About 8.4% (99/1,180) of the bat samples were infected with rabies virus, 92 (92.9%) of these were from non‐haematophagous bat species and 7 (7.1%) from haematophagous species. The number of bat samples received and infection rates increased considerably, after a shift from active surveillance (9/355 [2.5%] samples positive), to passive surveillance (90/825 [10.9%] samples positive). Surveillance of rabies virus in bats is fundamental for human and domestic animal health in Ceará State. Bats have to be considered as targets in surveillance and control programmes. Virus lineages should be characterized to increase knowledge on transmission dynamics of sylvatic rabies virus to domestic animals and the human population, and to provide additional evidence for planning and implementation of improved control measures.     

Human Exposure to Rabid Free‐Ranging Cats: A Continuing Public Health Concern in Pennsylvania

Rabid free‐ranging cats have been a public health concern in Pennsylvania since raccoon variant rabies first was recognized in the state in the early 1980s. Over the last decade, between 1.5 and 2.5% of cats submitted to Pennsylvania's state laboratories for rabies testing have been positive. In this report, we describe the extent of rabies in free‐ranging cats in Pennsylvania. We also present two examples of human exposure to rabid free‐ranging cats that occurred in Pennsylvania during 2010–2011 and the public health actions taken to address rabies exposure in the humans and animals. We then describe the concerns surrounding the unvaccinated and free‐ranging cat population in Pennsylvania and possible options in managing this public and animal health problem.     

Ouch! A cross‐sectional study investigating self‐reported human exposure to dog bites in rural and urban households in southern Ontario,Canada

This study investigated self‐reported dog bites in humans in rural and urban households in southern Ontario, Canada. Our objectives were to determine, and compare, the incidence of dog bites in rural and urban households, and to describe the profile of bite victims, biting dogs, and the proportion of biting dogs that respondents self‐reported as being not up to date on rabies vaccination. We conducted a cross‐sectional observational study using an online questionnaire. The 2,006 respondents, each representing one household, included 1,002 rural and 1,004 urban residences. The incidence risk of at least one person in the household being bitten over the previous year in rural households (6.09% per year) was less than in urban households (10.76% per year). In 53.20% of households from which at least one person had been bitten within the past year, only a single person had been bitten. Mostly, victims were 25 to 34 years old (21.67%), male (54.19%), and playing with or interacting with the biting dog at the time of the incident (59.11%). Most biting dogs were 3 to 5 years old (32.02%), males (53.69%), and unleashed (76.85%). Based on self‐reporting by respondents, 83.33% of respondent‐owned biting dogs were vaccinated against rabies at the time of the biting incident. Irrespective of dog ownership, the odds of an individual in a rural household being bitten by a dog were 0.53 (95% CI: 0.38–0.73) the odds for an individual in an urban household. Dog bites constitute a serious, yet preventable, public health concern that requires targeted, community‐specific efforts. Public health organizations could consider findings in developing messaging, particularly as we highlight biting dogs reported by their owners as not up to date on rabies vaccination.     

Lifestyle,habitat and farmers' risk of exposure to tick bites in an endemic area of tick‐borne diseases in Hungary

Controlling tick bites on farmers is important to the management of tick‐borne diseases and occupational health risks in agriculture. Based on an extensive household survey conducted between June and August 2015 with 219 farmers from western Hungary where tick‐borne diseases are endemic, we analysed the pattern of farmers' self‐reported contacts with ticks and investigated the potential interactions between farmers, landscape and the risk of exposure to tick bites. We developed a lifestyle typology based on farmers' socioeconomic profiles, farming objectives and time use patterns, and a habitat typology describing different configurations of tick habitats and agricultural areas in place of farming. We found no relationship between tick exposure risk and self‐prevention. The lifestyle typology could be used to classify the risk of tick bites and the adoption of prevention measures into different levels, the difference between which could further be modified by the habitat typology. Our results suggest that (i) farmers who are frequently engaged in outdoor recreations and (ii) part‐time and inexperienced farmers who have lower rate of preventive actions are likely to experience greater exposure to tick bites either in less cultivated, semi‐natural habitats or in agricultural landscape with highly diverse land uses. Future disease prevention practices should take into consideration the interaction of lifestyle and habitat and the need to associate different farmer groups with different landscape configurations.     

Alfaxalone or ketamine‐medetomidine in cats undergoing ovariohysterectomy: a comparison of intra‐operative parameters and post‐operative pain

ObjectiveTo compare post-operative pain in cats after alfaxalone or ketamine- medetomidine anaesthesia for ovariohysterectomy (OHE) and physiologic parameters during and after surgery.Study designProspective ‘blinded’ randomized clinical study.AnimalsTwenty-one healthy cats.MethodsCats were assigned randomly into two groups: Group A, anaesthesia was induced and maintained with alfaxalone [5 mg kg^?1 intravenously (IV) followed by boli (2 mg kg^?1 IV); Group MK, induction with ketamine (5 mg kg^?1 IV) after medetomidine (30 μg kg^?1 intramuscularly (IM)], and maintenance with ketamine (2 mg kg^?1 IV). Meloxicam (0.2 mg kg^?1 IV) was administered after surgery. Basic physiological data were collected. At time T = -2, 0, 0.5, 1, 2, 4, 6, 8, 12, 16, 20, and 24 hours post-operatively pain was assessed by three methods, a composite pain scale (CPS; 0–24 points), a visual analogue scale (VAS 0–100 mm), and a mechanical wound threshold (MWT) device. Butorphanol (0.2 mg kg^?1 IM) was administered if CPS was scored =13. Data were analyzed using a general linear model, Kruskal–Wallis analyses, Bonferroni-Dunn test, unpaired t-test and Fisher's exact test as relevant. Significance was set at p < 0.05.ResultsVASs were significantly higher at 0.5, 1, 2, 4, and 20 hours in group A; MWT values were significantly higher at 8 and 12 hours in group MK. Post-operative MWT decreased significantly compared to baseline in both groups. There was no difference in CPS at any time point. Five cats required rescue analgesia (four in A; one in MK).Conclusion and clinical relevanceAnaesthesia with ketamine-medetomidine was found to provide better post-surgical analgesia than alfaxalone in cats undergoing OHE; however, primary hyperalgesia developed in both groups. Alfaxalone is suitable for induction and maintenance of anaesthesia in cats undergoing OHE, but administration of additional sedative and analgesic drugs is highly recommended.     

Tick bite and Lyme disease‐related emergency department encounters in New Hampshire, 2010–2014

Lyme disease (LD) is a common tick‐borne disease in New Hampshire (NH). While LD is a reportable condition and cases are counted for public health surveillance, many more people receive care for tick bites or diagnoses of LD than are reflected in surveillance data. NH's emergency department (ED) data system was queried for tick bite and LD‐related encounters. Chief complaint text was queried for words related to LD or tick bites. International Classification of Diseases 9th Revision (ICD‐9) codes were queried for the LD diagnosis code (088.81). Emergency department patient data were matched to reportable disease data to determine the proportion of ED patients reported to the health department as a suspected LD case. Data were analysed to calculate frequencies for key demographic and reporting characteristics. From 2010 to 2014, 13,615 tick bite or LD‐related ED encounters were identified in NH, with most due to tick bites (76%). Of 3,256 patients with a LD‐related ED encounter, 738 (23%) were reported to the health department as a suspected LD case. The geographic distribution of ED patients was similar to reported LD cases; however, the regions of the state that experienced higher rates of ED encounters were different than the regions that observed higher rates of reported LD cases. Seasonal distribution of ED encounters peaked earlier than reported LD cases with a second peak in the fall. While age and sex distribution was similar among ED patients and reported LD cases, the rates for children 5 years and younger and adults 65 years and older were greater for ED encounters. Patients frequently visit the ED to seek care for tick bites and suspected LD. Results of ED data analyses can be used to target education, in particular for ED providers and the public through timely distribution of evidence‐based educational materials and training programmes.     

Effect of dosage and application mode of l‐carnitine on plasma lipid and egg‐yolk cholesterol of turkeys,hatchability of eggs and post‐hatch growth of their offsprings

The effect of dosage and application mode of l ‐carnitine on plasma lipid and egg‐yolk cholesterol of breeder turkeys, hatchability of eggs and post‐hatch growth response was investigated using 180 breeder hens. The hens were assigned to six dietary treatments in a 2 × 3 factorial arrangements of two application modes of l ‐carnitine (diet and drinking water) supplemented at 0, 50 and 100 ppm (mg/kg or mg/l) levels, respectively. Each treatment was replicated five times with six hens per replicate. Dietary inclusion of 50 ppm l ‐carnitine showed the lowest (p < 0.01) plasma total cholesterol (TC) and low‐density lipoprotein concentration (LDL). Breeder hens offered 50 ppm l ‐carnitine with no regard to application mode recorded the highest (p < 0.01) plasma high‐density lipoprotein (HDL). Hens offered 50 and 100 ppm l ‐carnitine irrespective of application mode also showed reduced (p < 0.01) egg‐yolk TC concentration at 32 weeks of age. Dietary supplementation of 50 ppm l ‐carnitine for breeder turkeys recorded the lowest (p < 0.01) egg‐yolk triglyceride (TG) at 40 weeks of age. Hens offered 50 ppm l ‐carnitine irrespective of application mode recorded the highest (p < 0.05) hen‐day egg production. Incidence of dead‐in‐shell also reduced (p < 0.05) with increasing dosage of l ‐carnitine. Dietary supplementation of 50 ppm and oral application in drinking water of 100 ppm l ‐carnitine for breeder turkeys resulted in highest (p < 0.05) egg fertility. Offsprings from breeder hens fed diets supplemented with l ‐carnitine recorded no post‐hatch mortality. Highest (p < 0.05) post‐hatch final live weight and weight gain was obtained with poults obtained from hens fed diet supplemented with 50 ppm l ‐carnitine. In conclusion, dietary supplementation of 50 ppm l ‐carnitine for turkey hens showed improved serum lipid profile, egg fertility, reduced dead‐in‐shell, egg‐yolk cholesterol and resulted in improved post‐hatch growth performance.     

Short‐term methionine supplementation during the early post‐partum period in primiparous rabbits improves prolificacy associated with an increase in serum concentrations of IGF‐I

The aim of this study was to evaluate the effects of methionine supplementation on energy metabolism and reproductive performance during the early post‐partum period in primiparous does. Forty nulliparous New Zealand White does were used. Females were randomized in two groups at calving: the control group (n = 20) was fed with the basal diet, and the methionine group (n = 20) was fed the basal diet plus 1 g/animal/day of methionine from the day of calving to 4 days post‐partum. Results showed that methionine supplementation increased (p = 0.032) the concentration of insulin‐like growth factor‐1 with respect to control group 4 days post‐partum. It similarly increased the prolificacy (p = 0.03), the number of kits born alive per litter (p = 0.06) and the body gain weight of the litter during supplementation (p = 0.035). These results were observed despite the does in the methionine group having a deeper negative energy balance than the does in the control group. Finally, methionine supplementation did not affect receptivity (p = 0.23), fertility (p = 0.49), the number of kits born dead per litter (p = 0.86) insulin and metabolites as glucose, non‐esterified fatty acids and triglycerides. In conclusion, our results show that methionine supplementation during the first 4 days of the post‐partum period in rabbits increases total litter size and the corporal weight of kits and is associated with an increase in blood concentration of IGF‐1.     

Effect of vaccination and the immunomodulators “bacillus of Calmette–Guérin, Avridine and Propionibacterium acnes” on rabies in mice

Responses of vaccination and treatment to immunomodulators against rabies in mice were evaluated through macrophage inhibition factor (MIF), intra-pad inoculation (IPI) and serum neutralization (SN) tests and by the detection of γ-interferon (IFN-γ). Onco-BCG, Avridine and Propionibacterium acnes were administered to groups of mice. Higher survival rates were found in animals treated with P. acnes. Lower levels of IFN-γ were observed in the groups of infected and vaccinated mice. The IPI was not effective on detecting the response of delayed-type hypersensitivity. Vaccine induced in the infected animals a more intense response to MIF reaction.

Résumé

Les réponses aux immunomodulateurs vis à vis de la vaccination et du traitement antirabique chez la souris ont été évaluées à travers le facteur inhibant les macrophages, inoculation du test du coussinet plantaire et des anticorps neutralisants ainsi que la détection d'interféron γ. Onco-BCG, Avridine et Propionibacterium acnes ont été administrés à des groupes de souris. Le taux de survie le plus élevé a été observé chez les animaux traités par P. acnes. Les taux les plus bas d'interféron ont été observés dans les groupes de souris infectées et vaccinées. Le test du coussinet plantaire n'a pas permis de détecter la réponse d'hypersensibilité retardée. Le vaccin induit chez les animaux infectés une réponse plus intense au facteur inhibant les macrophages.     

Government Response to the Discovery of a Rabies Virus Reservoir Species on a Previously Designated Rabies‐Free Island,Taiwan, 1999–2014

Taiwan had been considered rabies free since 1961. In 2013, Taiwan confirmed the detection of rabies virus in wild Taiwan ferret‐badgers. Up to December 2014, there have been 423 rabies‐confirmed ferret‐badgers and three cases of spillover infection into non‐reservoir hosts. Genetic analysis indicates that TFBV is distinct from all other known rabies virus variants. To date, ferret‐badger rabies is known to occur only in China and Taiwan. The temporal dynamics of rabid ferret‐badgers in Taiwan suggests that the epizootic appears to have subsided to enzootic levels as of December 2014. According to the current epidemiologic data, there is only one TFBV strain in Taiwan. TFBV is still sequestered to the mountainous regions. Humans are at risk mainly through exposure to the virus from infected domestic meso‐carnivores, mainly dogs and cats. Dogs and cats should be vaccinated to establish an immunological barrier to stop the spread of the disease from mountainous regions to domestic meso‐carnivores.     

Effect of system of lamb rearing and season on early post‐partum fertility of ewes and growth performance of lambs in Katahdin sheep

The effect of season (S), lamb rearing system (RT) and grain supplementation (GS) on post‐partum fertility in Katahdin ewes and growth in Katahdin lambs was evaluated. Katahdin ewes were bred to lamb in fall (n = 36) or spring (n = 56) and at approximately 2.5 months post‐partum were randomly assigned to be permanently separated or to continue to suckle their lambs for an additional 3 months. All ewes were joined with rams following treatment to synchronize oestrus. Weaned (W, n = 84) and continuously suckled lambs (CSK, n = 88) were fed forage only (n = 84; hay and pasture for fall‐ and spring‐born lambs respectively) or were supplemented (n = 88; 18% crude protein ration ad libitum) and all weighed biweekly. Ewes rebred in the fall had a shorter ram introduction to lambing interval (p < 0.05), higher prolificacy (p = 0.001) and higher lambing rates (p = 0.02); however, the proportion of ewes lambing was not affected by season. The first service lambing rate was lower in ewes continuously suckling lambs in the spring, but not in the fall breeding season (S × RT, p = 0.03). Lambs that continuously suckled their dams and were supplemented grew quicker and gained more (p < 0.001) than their weaned and unsupplemented counterparts. The effect of CSK on growth rate of lambs was greater in the spring (RT × S; p = 0.05), and the effect of supplementation on growth rate of lambs was greater in the fall (GS × S; p < 0.0001). In conclusion, Katahdin lambs achieved higher weight gains from continuous suckling and grain supplementation. Moreover, Katahdin ewes are capable of early rebreeding post‐partum while suckling their lambs, which makes them suited for use in accelerated lambing programmes.     

A between‐experiment analysis of relationships linking dietary protein intake and post‐weaning diarrhea in weanling pigs under conditions of experimental infection with an enterotoxigenic strain of Escherichia coli

Numerous experiments have demonstrated that feeding a lower protein diet decreases protein fermentation in the gastrointestinal tract (GIT) and reduces the incidence of post‐weaning diarrhea (PWD). However, there is a lack of holistic evidence underpinning the relationship between feeding a lower protein diet and PWD in relation to physiological responses and protein fermentation in the GIT. The scope of this article, therefore, will: (i) focus on the impact of dietary protein levels on selected indices of GIT health in weaned pigs without and with experimental infection with an enterotoxigenic strain of Escherichia coli; and (ii) attempt to conduct regression analysis to examine the relationships between dietary‐origin protein intake, nitrogen fermentation indices, fecal consistency and the incidence of PWD. We used datasets generated from a series of four intensive experiments in weaned pigs. The collective results derived from these datasets indicate that restriction of daily protein intake to less than 60 g through feeding a lower protein diet for as little as 7 days after weaning reduced the incidence of PWD commensurate with a reduction in protein fermentation indices.     

Gastrointestinal health and function in weaned pigs: a review of feeding strategies to control post‐weaning diarrhoea without using in‐feed antimicrobial compounds

For the last several decades, antimicrobial compounds have been used to promote piglet growth at weaning through the prevention of subclinical and clinical disease. There are, however, increasing concerns in relation to the development of antibiotic‐resistant bacterial strains and the potential of these and associated resistance genes to impact on human health. As a consequence, European Union (EU) banned the use of antibiotics as growth promoters in swine and livestock production on 1 January 2006. Furthermore, minerals such as zinc (Zn) and copper (Cu) are not feasible alternatives/replacements to antibiotics because their excretion is a possible threat to the environment. Consequently, there is a need to develop feeding programs to serve as a means for controlling problems associated with the weaning transition without using antimicrobial compounds. This review, therefore, is focused on some of nutritional strategies that are known to improve structure and function of gastrointestinal tract and (or) promote post‐weaning growth with special emphasis on probiotics, prebiotics, organic acids, trace minerals and dietary protein source and level.