Rise in rabies cases in Jammu region: A problem that requires urgent attention.

Context: Rabies is a fatal zoonotic disease that is endemic in India. Both forms of rabies, namely, encephalitic and furious, invariably lead to coma and death. Lack of awareness is the most critical barrier in accessing timely post-exposure prophylaxis that can prevent the progression to clinical disease. Aims: To report the case series of fourteen clinically suspected rabies cases. Settings and Design: We followed a retrospective study design. Data were collected from the Anti Rabies Section of Government Medical College, Jammu, which is a tertiary care hospital of Jammu Division. Methods and Material: We collected data of all patients over a period of three years, from 2017 to 2020, who were diagnosed as cases of clinically suspected rabies on the basis of classic signs and symptoms and who finally succumbed to the disease. Statistical Analysis Used: Descriptive statistics was used to describe the results of the study. Results: In the present description, the mean age of the patients was 31 ± 18.6 years. Out of 14 suspected cases, 9 had not received any post-exposure prophylaxis-neither vaccine nor serum-and instead visited spiritual faith healers. The remaining patients had history of either incomplete, unknown, or incorrect vaccination status. Median duration of presentation of symptoms after dog bite was 42 days, with a range of 15-180 days. Mean survival of patients after presentation of symptoms was around 1.8 days. Conclusions: Low level of awareness resulted in non-seeking of health-care services after animal bites.

Hydrophobia, dis/connection, and difference: Understanding Chinese immigrants' fear of coastal swimming in Aotearoa New Zealand.

New Zealand's coastal blue spaces, from harbours to beaches, provide diverse wellbeing benefits but can also be sites of danger, fear, and cultural contestation. This qualitative research focuses on Chinese migrants in Auckland, a community who are underrepresented in coastal recreation and overrepresented in drowning statistics. Findings show Chinese migrants dis/connection with coastal blue space and fear of coastal swimming, derived from their homeland habitus and lack of coastal 'blue space' cultural capital. Our research contributes to the growing recognition of 'hydrophobia', and how the racialisation of leisure space impacts the potential for blue spaces and practices to be therapeutic.

Perfil dos agravos com animais potencialmente transmissores da raiva, Mato Grosso do Sul, Brasil, 2019 a 2021 / Profile of injury by potential rabies-transmitting animals in Mato Grosso do Sul, Brazil, from 2019 to 2021 / Perfil de enfermedades con animales potencialmente transmisores de rabia en Mato Grosso do Sul, Brasil, de 2019 a 2021

Considerada uma das mais graves doenças tropicais negligenciadas (DTN) do mundo, a raiva promove grande impacto à saúde pública devido a sua evolução letal e ao elevado custo social e econômico. O objetivo desta pesquisa foi descrever o perfil epidemiológico das agressões por animais potencialmente transmissores de raiva, no estado de Mato Grosso do Sul, durante os anos de 2019 a 2021. Foi realizado um estudo epidemiológico retrospectivo, transversal, qualiquantitativo, com dados secundários codificados do Sistema de Informação de Agravos de Notificação: ano e mês, município e zona de ocorrência, idade, sexo, raça, escolaridade, tipo de exposição, região anatômica atingida, características do ferimento, espécie e condição do animal agressor e tratamento preconizado. Foram registradas 24.362 notificações de agressões, com prevalência média de 8,7/1.000 hab. Janeiro apresentou o maior número de notificações. Destacaram-se, entre os agredidos, crianças entre 1 e 9 anos de idade do sexo masculino. A zona de ocorrência de 89,5% dos agravos foi urbana e 81,7% foram provocados por cães. Dentre os indivíduos agredidos, 79,2% receberam tratamento antirrábico pós-exposição com uso de imunobiológico. O estado registrou baixa prevalência de agravos por animais. Notaram-se falhas de preenchimento das fichas de notificação e nos critérios de inclusão de agravos com animais potencialmente transmissores da raiva.

Considered as one of the most serious neglected tropical diseases (NTD) worldwide, rabies greatly impacts public health due to its lethal evolution and high social and economic cost. Given this scenario, this study describes the epidemiological profile of attacks by potential rabies-transmitting animals in the state of Mato Grosso do Sul, Brazil, from 2019 to 2021. A retrospective, cross-sectional, qualitative-quantitative epidemiological study was conducted with secondary data obtained from the Information System for Notifiable Diseases, namely: year and month; municipality and area of occurrence; age; gender; race; education; type of exposure; anatomical region affected; characteristics of the wound; species and condition of the animal; and recommended treatment. A total of 24,362 notifications of animal attacks were reported, with average prevalence of 8.7/1000 inhabitants. January registered the highest number of notifications. Among the victims, male children aged one to nine years stood out. Of the total injuries reported, 89.5% occurred in urban areas and 81.7% were done by dogs. Among the attacked individuals, 79.2% received post-exposure anti-rabies treatment with immunobiological drugs. The state recorded a low prevalence of animal attacks. Results revealed poorly filled out forms and issues with the inclusion criteria used for classifying injuries caused by potential rabies-transmitting animals.

Considerada una de las enfermedades tropicales desatendidas (ETD) más graves del mundo, la rabia tiene un gran impacto en la salud pública debido a su evolución letal y alto costo social y económico. El objetivo de esta investigación es describir el perfil epidemiológico de las agresiones por animales potencialmente transmisores de la rabia, en el estado de Mato Grosso do Sul (Brasil), durante los años de 2019 a 2021. Se realizó un estudio epidemiológico retrospectivo, transversal, cualicualitativo, con datos secundarios codificados del Sistema de Información de Enfermedades de Declaración Obligatoria que contienen: año y mes, municipio y zona de ocurrencia, edad, sexo, raza, nivel de educación, tipo de exposición, región anatómica afectada, características de la herida, especie y condición del animal agresor y tratamiento recomendado. Se registraron 24.362 notificaciones de agresiones, con una prevalencia media de 8,7/1.000 hab. Enero tuvo el mayor número de notificaciones. Entre las víctimas se destacaron niños de entre 1 y 9 años de edad y varones. El área donde ocurrieron el 89,5% de las lesiones fue urbana, y el 81,7% de ellas fueron causadas por perros. Entre los agredidos, el 79,2% recibió tratamiento antirrábico postexposición con uso de inmunobiológicos. El estado registró una baja prevalencia de lesiones causadas por animales. Se observaron fallas en el llenado de los formularios de notificación y en los criterios de inclusión de enfermedades con animales potencialmente transmisores de la rabia.

Diagnosis and management of rabies encephalitis in two patients in northwest Africa: A case series.

In persons bitten by a stray dog, prompt administration of post-exposure rabies vaccination, anti-rabies immunoglobulin, and wound care can save lives. However, rabies is often fatal once the patient develops signs and symptoms. Here, we describe two fatal cases of rabies following a long delay after dog bites.

Light absorption and hydrophobicity of a polystyrene/multiwall carbon nanotube composite with surface nanostructures.

This paper describes an investigation into how combined carbon nanotube doping and surface nanostructuring affects the surface properties of polystyrene. Multiwall carbon nanotubes (MWCNTs) have unique anisotropic electrical properties that can be utilized for light absorption, electromagnetic shielding and nanoscale electostatic forces. Polystyrene was doped with 5 wt% MWCNTs and the resulting composite was wetted onto a porous anodic alumina template to form a nanostructure surface of nanotubes. Scanning electron microscopy revealed a hierarchical surface structure with the composite nanotubes bundled together as the MWCNTs increased the attractive forces between the composite nanotubes. Water droplet testing revealed that this hierarchical surface structure was superhydrophobic. Though the presence of the MWCNTs caused a direct increase in absorption, the hierarchical surface structure increased reflection. The addition of 5 wt% of the anionic surfactant Sodium Dodecyl Benzene Sulfonate to ensure MWCNT dispersal did not significantly change hydrophobicity or light absorption despite the hierarchical surface structure becoming finer. The created composite has potential use as a surface layer on an organic surface cell as it provides reduced cleaning needs and electrical disturbance but further work is required to reduce the reflection.

Hydrophobia of human rabies.

Hydrophobia is a clinical sign characteristic of human rabies. This sign occurs following paroxysmal contractions of pharynx responsible for hydrophobic spasms.

Descriptive analysis of rabies in wild animals in the state of Sergipe, Brazil / Análise descritiva da raiva em animais silvestres no estado de Sergipe, Brasil

The wild cycle of rabies constitutes a serious challenge to epidemiological surveillance for disease control in domestic, companion or production animals, and in humans. The understanding of rabies virus circulation in the natural environment is increasingly important due to the constancy of natural reservoirs of the disease and the presence of potential vectors of the infection to humans and domestic animals. Aiming to evaluate the occurrence of rabies in the State of Sergipe a total of 935 hematophagous bats (Desmodus rotundus), 46 wild dogs (Cerdocyon thous) and 24 primates (Callithrix spp.) were analyzed from 1987 to 2014, of which 1 bat, 17 crab-eating foxes and no primates were positive. Due to the lack of positive results in hematophagous bats, the main vector of herbivorous rabies, more studies are needed to monitor cases, because from an epidemiological point of view, Sergipe is endemic for herbivorous rabies. Epidemiological surveillance of rabies virus in wild animals is primordial for the success of disease control programs in herds of domestic animals and humans.(AU)

O ciclo silvestre da raiva constitui um sério desafio para a vigilância epidemiológica no controle da doença nos animais domésticos, de companhia ou de produção, e nos seres humanos. O entendimento sobre a circulação do vírus rábico no ambiente natural é cada vez mais importante, em razão da constância de reservatórios naturais da doença e da presença de vetores potenciais da infecção aos humanos e aos animais domésticos. Com o objetivo de avaliar a ocorrência da raiva no estado de Sergipe, foram analisados 935 morcegos hematófagos (Desmodus rotundus), 46 cachorros-do-mato (Cerdocyon thous) e 24 primatas (Callithrix spp.) no período de 1987 a 2014, dos quais resultaram positivos um morcego, 17 cachorros-do-mato e nenhum primata. Em que pese a contundente falta de resultados positivos em morcegos hematófagos, principal vetor da raiva dos herbívoros, mais estudos são necessários no monitoramento dos casos, pois o estado, do ponto de vista epidemiológico, é endêmico para a raiva dos herbívoros. A vigilância epidemiológica do vírus da raiva nos animais silvestres é primordial para o sucesso dos programas de controle da doença em rebanhos de animais domésticos e em seres humanos.(AU)

Rabies: a medical perspective.

Rabies is an acute neurological infection of humans and animals, caused by rabies virus and usually transmitted by animal bites. After an incubation period usually lasting weeks or longer, a variety of prodromal symptoms may occur. Encephalitic rabies (80% of cases) is associated with episodes of generalised arousal or hyperexcitability and hydrophobia, in which spasms involve the contraction of inspiratory muscles with swallowing. Paralytic rabies (in 20% of cases) is characterised by progressive lower motor neuron weakness. Laboratory investigations are important for confirming an ante mortem diagnosis of rabies. Cardiopulmonary and many other complications, including multiple organ failure, are common in aggressively managed rabies patients in critical care units. No effective therapy is available for rabies and survivors are uncommon. In contrast, preventative measures for rabies are highly effective after recognised exposures.

La rage est une maladie neurologique aiguë affectant les personnes et les animaux infectés par le virus de la rage, lequel est généralement transmis par la morsure d'un animal. Des signes précurseurs peuvent apparaître après une période d'incubation de quelques semaines voire plus. La rage encéphalique (qui représente 80 % des cas) est associée à des épisodes d'agitation ou d'hyperexcitabilité et d'hydrophobie durant lesquels surviennent des contractions spasmodiques des muscles pharyngés lors de la déglutition. La rage paralytique (20 % des cas) se caractérise par une dégénérescence progressive des neurones moteurs inférieurs. Des analyses de laboratoire sont nécessaires pour obtenir confirmation ante-mortem d'un diagnostic de rage. Des complications notamment cardiopulmonaires ainsi que des défaillances de plusieurs organes sont fréquentes chez les patients atteints soumis à des traitements très lourds dans les services de réanimation. Il n'existe pas de traitement curatif efficace et les survivants sont rares. En revanche, les mesures préventives suite à une exposition avérée sont extrêmement efficaces.

La rabia es una infección neurológica aguda que afecta a personas y animales, causada por el virus de la rabia y transmitida generalmente por la mordedura de un animal. Tras un periodo de incubación que suele durar semanas, o incluso más tiempo, pueden aparecer diversos síntomas prodrómicos. La rabia encefálica (un 80% de los casos) se acompaña de episodios de nerviosismo generalizado hiperexcitabilidad e hidrofobia, con espasmos que entrañan la contracción de los músculos inspiratorios con la deglución. La rabia paralítica (un 20% de los casos) se caracteriza por un debilitamiento progresivo de la neurona motora inferior. Los análisis de laboratorio son importantes para confirmar un diagnóstico ante mortem de rabia. Es frecuente que los pacientes tratados con terapias agresivas en las unidades de cuidados intensivos sufran complicaciones cardiopulmonares, entre otras muchas que pueden ir hasta la insuficiencia multiorgánica. No hay un tratamiento eficaz contra la rabia y son contadas las personas que sobreviven. En cambio, las medidas de profilaxis tras una exposición resultan muy eficaces.

Dog-Mediated Human Rabies Death, Haiti, 2016.

Haiti has experienced numerous barriers to rabies control over the past decades and is one of the remaining Western Hemisphere countries to report dog-mediated human rabies deaths. We describe the circumstances surrounding a reported human rabies death in 2016 as well as barriers to treatment and surveillance reporting.

Human Rabies: a 2016 Update.

Rabies is a zoonotic disease that is usually transmitted to humans by animal bites. Dogs are the most important vector worldwide. There are encephalitic and paralytic forms of the disease. There are differences in the clinical features of the disease acquired from dogs and bats. Neuroimaging is non-specific. Confirmatory diagnostic laboratory tests for rabies include detection of neutralizing anti-rabies virus antibodies in serum or cerebrospinal fluid and rabies virus antigen or RNA in tissues or fluids. Rabies is preventable after recognized exposures with wound cleansing and administration of rabies vaccine and rabies immune globulin. Rabies is virtually always fatal after clinical disease develops, and there have only been rare survivors. The Milwaukee protocol, which includes therapeutic coma, has been shown to be ineffective and should no longer be used. The development of novel therapeutic approaches may depend on a better understanding of basic mechanisms underlying the disease.

Caring for patients with rabies in developing countries - the neglected importance of palliative care.

Although limited publications address clinical management of symptomatic patients with rabies in intensive care units, the overwhelming majority of human rabies cases occur in the rural setting of developing countries where healthcare workers are few, lack training and drugs. Based on our experience, we suggest how clinicians in resource-limited settings can make best use of essential drugs to provide assistance to patients with rabies and their families, at no risk to themselves. Comprehensive and compassionate patient management of furious rabies should aim to alleviate thirst, anxiety and epileptic fits using infusions, diazepam or midazolam and antipyretic drugs via intravenous or intrarectal routes. Although the patient is dying, respiratory failure must be avoided especially if the family, after being informed, wish to take the patient home alive for funereal rites to be observed. Healthcare staff should be trained and clinical guidelines should be updated to include palliative care for rabies in endemic countries.

Prophylaxis of human hydrophobia in South Korea.

Domestic human hydrophobia has not been reported since the one case of 2004 in South Korea, but still a few animal rabies occur persistently since the reemerging stage of rabies from 1993. The government has made efforts to control animal rabies in many aspects, but whether prophylactic strategy for human hydrophobia is performed adequately is in question. The rate of proper post-exposure prophylaxis for animal bite case in 'high-risk region' of rabies is very low with 20% between 2011 and 2013. The National Animal Bite Patient Surveillance targeting 'high-risk region' is missing out animal bite cases who visit directly to hospitals in 'suspect-risk region' of rabies. Little data seems to exist for pre-exposure prophylaxis of domestic hydrophobia. Danger of reoccurrence of human hydrophobia always remain in South Korea. The medical personnel needs to have greater interest on the matter and the government strengthen the management system.

Rabies encephalomyelitis vs. ADEM: Usefulness of MR imaging in differential diagnosis.

We report a case of rabies encephalomyelitis in a 12-year-old boy who had received anti-rabies vaccine 6 weeks after being bitten by a puppy. The MR (magnetic resonance) imaging helped to differentiate rabies from acute disseminated encephalomyelitis (ADEM). ADEM involves the white matter predominantly, whereas rabies has a predilection for grey matter, that too of midline regions. This report emphasizes the usefulness of MRI in differentiating rabies and ADEM when encephalomyelitis occurs in a vaccinated child.