Avoiding bites and scratches? Understanding the public health implication of human–bat interactions in Ghana

Zoonotic pathogens cause an estimated 70% of emerging and re‐emerging infectious diseases in humans, affecting various aspects of human development on a global scale. The significance of bats as a source of emerging infectious diseases is being progressively appreciated. This study was undertaken post‐Ebola virus disease in West Africa and assessed the public health implications of human–bat interactions by exploring the reasons for contact between humans and bats, as well as reported actions taken upon experiencing bat bites or scratches. The paper highlights the nuances of human–bat interactions, stressing zoonotic disease risk awareness as well as the sources of information. The study used questionnaires to solicit information from 788 respondents in five communities with significant bat populations. We show that bat consumption was one of the main reasons for human–bat interactions. More men across the various communities ate bat meat. Only a small number of respondents (4.4%) reported being bitten by a bat, and 6.1% had been scratched by a bat. More than 21% had come into direct contact with bat blood. An even lower number went to the hospital after been bitten or scratched by bats. There was little knowledge on post‐exposure management. The most common places human–bat interactions occurred were at home and on farms. Seventy‐three per cent of the respondents believed that bats carried diseases, with Ebola virus disease being the most mentioned. Respondents indicated that the way they interacted with bats had not changed, even though they believed bats carried diseases and 46% stated that they had not changed the way they interacted with bats over the last two years. Apart from providing information on avoiding bites and scratches, a more holistic framework is needed to reduce human–bat interactions. The paper recommends a comprehensive and coordinated approach to optimizing an effective response to a potential bat‐borne zoonotic disease spillover.     

Correlations between acute radiation scores and pain scores in canine radiation patients with cancer of the forelimb

Objective To determine whether there is a correlation between skin acute radiation score (ARS) and pain scores and to determine if skin ARSs can be used to predict future pain scores and increased need for analgesia in dogs undergoing radiation therapy for cancer of the forelimb. Study design Prospective observational study. Animals Seven middle‐aged dogs of various breeds with cancer of the forelimb. Methods Each neoplasm was surgically removed and a histologic diagnosis was obtained. Curative intent radiation therapy was initiated 2½–4½ weeks after surgery. Curative intent radiation therapy was delivered as prescribed. Two trained observers scored the dogs using a visual analog pain scale (VAS), Glasgow composite measure of pain scale, short form (GCMPS) and skin ARS prior to each day’s therapy. Daily scores were averaged and scatter plots were developed. Generalized estimating equation regressions were used to calculate standard error, 95% confidence interval, and p‐values for each relationship. Confidence and prediction bands were plotted. Results A statistically significant correlation between skin ARS and VAS and GCMPS pain scores was identified indicating that as the skin ARS increased so did the pain scores. A general correlation between VAS and GCMPS scores was observed. Early (fraction days 1–6) GCMPS scores were significantly influenced by anxiety behavior unrelated to pain. Skin ARS was found to predict precisely current and future presence of pain, but could only predict a range of potential future pain scores based on the pain management approach in use during this study. Conclusions Skin ARS can provide valuable information for initiating preemptive analgesia and intensifying pain management during curative intent radiation therapy. Daily pain scoring with an acceptable pain scale should be used in conjunction with the skin ARS to improve patient pain management. Clinical relevance Pain is an anticipated consequence of curative intent radiation therapy. Understanding the correlation between pain and skin ARS may facilitate more effective pain management.     

The risk of death: the confidential enquiry into perioperative small animal fatalities

Objective To estimate the risks of anaesthetic and sedation‐related mortality in companion animals in the UK. (The Confidential Enquiry into Perioperative Small Animal Fatalities, CEPSAF). Study design A prospective cohort study with nested case–control study. Animal population All small animals anaesthetized and sedated at participating centres between June 2002 and June 2004. Methods Patient outcomes at 48 hours (alive, dead and killed) were recorded. Anaesthetic and sedation‐related death was defined as death where surgical or pre‐existing medical causes did not solely cause death. Species‐specific risks of anaesthetic‐related death and 95% confidence intervals (95% CI) were calculated. Risks were also estimated in the sub‐sets of dogs, cats and rabbits that were either healthy or sick (ASA 1–2 and 3–5, respectively). Results One hundred and seventeen veterinary practices participated in the study and 98 036 dogs, 79 178 cats and 8209 rabbits were anaesthetized and sedated. Overall risks of anaesthetic and sedation‐related death in dogs were 0.17% (1 in 601, 95% CI 0.14–0.19%), in cats 0.24% (1 in 419, 95% CI 0.20–0.27%) and in rabbits 1.39% (1 in 72, 95% CI 1.14–1.64%) within 48 hours of the procedure. In healthy dogs, cats and rabbits, the risks were estimated to be 0.05% (1 in 1849, 95% CI 0.04–0.07%), 0.11%, (1 in 895, 95% CI 0.09–0.14%) and 0.73% (1 in 137, 95% CI 0.54–0.93%), respectively. In sick dogs, cats and rabbits, the risks were 1.33%, (1 in 75, 95% CI 1.07–1.60%), 1.40% (1 in 71, 95% CI 1.12–1.68%) and 7.37% (1 in 14, 95% CI 5.20–9.54%), respectively. Postoperative deaths accounted for 47% of deaths in dogs, 61% in cats and 64% in rabbits. Most other small animal species had higher mortality risks. Conclusions and clinical relevance Small animal anaesthesia appears to be increasingly safe. Greater patient care in the postoperative period could reduce fatalities.     

Inter-observer agreement between two observers for bovine digital dermatitis identification in New Zealand using digital photographs

Aims: To assess the inter-observer agreement for detecting bovine digital dermatitis (BDD) lesions in digital colour photographs of the hind feet of cows, which had been taken while the animals were standing to be milked, between two trained observers.

Methods: Thirty-six photographs were selected from a total of 184 photographs held by the first author (R1), who had classified them as negative (n=11) or positive (n=25) for BDD. They were delivered to a technician (R2) who had previously visually inspected cattle for BDD lesions, and who then recorded the photographs as being either BDD-positive or BDD-negative. The percentage agreement between R1 and R2, and two other inter-observer agreement statistics, Cohen’s κ and Gwet’s first-order chance correction agreement coefficient (AC1), were calculated. The cumulative membership probabilities of Cohen’s κ and Gwet’s AC1 were then calculated for different benchmark ranges of κ.

Results: The percentage agreement between R1 and R2 was 33/36 (92%), Cohen’s κ was 0.80 (95% CI=0.57–1.0) and Gwet’s AC1 was 0.86 (95% CI=0.69–1.0). Based on the cumulative membership probabilities for Gwet’s AC1, there was 75% probability that the two observers had almost perfect agreement (κ≥0.81). For both Cohen’s κ and Gwet’s AC1, there was >95% probability that the two observers had at least substantial agreement (κ≥0.61).

Conclusions: The two trained observers had at least substantial agreement in identifying from a digital photograph as to whether BDD lesions were present or absent. Therefore results from the two could be used interchangeably.

Clinical Relevance: Visual assessment for BDD lesions in the milking parlour can be subjective. However a high agreement between these two trained BDD inspectors means BDD prevalence reported from different regions in New Zealand by these two can be directly compared.     

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.     

Multivariate relationships between epidemiologic risk factors and zoonotic infections among military personnel in the country of Georgia: A non‐linear canonical correlation analysis

Zoonotic diseases are endemic in the country of Georgia. Using the non‐linear canonical correlation (NCC) method, the aim of this study was to examine the relationship between thirteen epidemiological risk factors and seropositivity to five zoonotic infections (anthrax, Q fever, tularemia, leptospirosis, and Crimean‐Congo hemorrhagic fever [CCHF]) among Georgian military recruits during 2014–2016. According to this multivariate statistical technique, which is suitable for the analysis of two or more sets of qualitative variables simultaneously, two canonical variables were identified. These variables accounted for 68% of the variation between the two sets of categorical variables (“risk factors” and “zoonotic infections”). For the first canonical variable, there was a relationship among CCHF (canonical loading, which is interpreted in the same way as the Pearson's correlation coefficient, [cl] = 0.715), tick bites (cl = 0.418) and slaughter of animals (cl = 0.351). As for the second canonical variable, Q fever (cl = ?0.604) and leptospirosis (cl = ?0.486) were related to rodents inside and outside home (cl = ?0.346) and sweeping in or around home (cl = ?0.317). The NCC method allows researchers to obtain additional insights into the complex relationship between epidemiological risk factors and multiple zoonotic infections.