The current status of neglected tropical diseases in Japan: A scoping review.

Little attention has been paid to neglected tropical diseases (NTDs) in high-income countries and no literature provides an overview of NTDs in Japan. This scoping review aims to synthesize the latest evidence and information to understand epidemiology of and public health response to NTDs in Japan. Using three academic databases, we retrieved articles that mentioned NTDs in Japan, written in English or Japanese, and published between 2010 and 2020. Websites of key public health institutions and medical societies were also explored. From these sources of information, we extracted data that were relevant to answering our research questions. Our findings revealed the transmission of alveolar echinococcosis, Buruli ulcer, Chagas disease, dengue, foodborne trematodiases, mycetoma, scabies, and soil-transmitted helminthiasis as well as occurrence of snakebites within Japan. Other NTDs, such as chikungunya, cystic echinococcosis, cysticercosis, leishmaniasis, leprosy, lymphatic filariasis, rabies, and schistosomiasis, have been imported into the country. Government agencies tend to organize surveillance and control programs only for the NTDs targeted by the Infectious Disease Control Law, namely, echinococcosis, rabies, dengue, and chikungunya. At least one laboratory offers diagnostic testing for each NTD except for dracunculiasis, human African trypanosomiasis, onchocerciasis, and yaws. No medicine is approved for treatment of Chagas disease and fascioliasis and only off-label use drugs are available for cysticercosis, opisthorchiasis, human African trypanosomiasis, onchocerciasis, schistosomiasis, and yaws. Based on these findings, we developed disease-specific recommendations. In addition, three policy issues are discussed, such as lack of legal frameworks to organize responses to some NTDs, overreliance on researchers to procure some NTD products, and unaffordability of unapproved NTD medicines. Japan should recognize the presence of NTDs within the country and need to address them as a national effort. The implications of our findings extend beyond Japan, emphasizing the need to study, recognize, and address NTDs even in high-income countries.

Historia de la rabia en Chile: tres tesis médicas / History of rabies in Chile: three medical theses

En la antigüedad ya se describía la rabia como una enfermedad zoonótica fatal cuyo pronóstico inexorable superaba todas las alter-nativas terapéuticas de los más célebres médicos. La realidad chilena sobre esta enfermedad a fines del siglo XIX fue descrita certeramente por el médico mártir Pedro Videla Órdenes en su tesis "La rabia" de 1879, destacando la descripción clínica de la rabia, su pronóstico fatal y la ausencia de tratamientos eficaces. Tan sólo seis años después, en 1885, el aclamado químico y microbiólogo Louis Pasteur desarrolló la vacuna antirrábica, logrando por primera vez en la historia de la humanidad prevenir esta terrible enfermedad. En Chile, se inició rápidamente la implementación de la vacuna Pasteur, vacunando al primer chileno el 7 de julio de 1896. Los doctores Milcíades Espinosa y Arturo Atria, en sus tesis "Generalidades sobre la rabia" (1898) y "Sobre la rabia y su profilaxia en Chile" (1905), respectivamente, abordaron esta primera etapa del desarrollo de la vacuna antirrábica en el país.

In antiquity, rabies was already described as a fatal zoonotic disease whose inexorable prognosis exceeded all the therapeutic alternatives of the most famous doctors. The Chilean reality about this disease at the end of the 19th century was accurately described by the martyred doctor Pedro Videla Ordenes in his thesis "La rabia" of 1879, highlighting in it his description about the unknown etiological agent, the fatal prognosis of the disease and the absence of effective treatments. Just six years later, in 1885, the acclaimed chemist and microbiologist Louis Pasteur developed the rabies vaccine, managing to prevent this terrible disease for the first time in human history. In Chile, the implementation of the Pasteur vaccine began rapidly, vaccinating the first Chilean on July 7, 1896. Doctors Milcíades Espinosa and Arturo Atria, in their theses "Generalidades sobre la rabia" (1898) and "Sobre la rabia y su profilaxia en Chile" (1905), respectively, addressed this first stage of the development of the rabies vaccine in the country.

Boletim epidemiológico: perfil epidemiológico de atendimento antirrábico humano em Goiás de 2017 a 2021 / Epidemiological bulletin: epidemiological profile of human anti-rabies care in Goiás from 2017 to 2021

A raiva é uma doença caracterizada por uma encefalite progressiva e aguda, com quase 100% de letalidae, causada por um vírus, que compromete o Sitema Nervoso Central (SNC)É uma antropozoonose transmitida ao ser humano pela inoculação do vírus presente na saliva de animais infectados, através de mordedura, arranhadura e lambedura. esse boletim tem por obketivo demosntrar qual é o perfil dos atendimentos antirrábicos hymanos no estado de Goiás, foi desenvolvido com bases nas fichas de notificação dos atendimentos antirrábicos humanos em Goiás, registrados no Sistema de Informação de Agravos de Notificação (SINAN)

Rabies is a disease characterized by a progressive and acute encephalitis, with almost 100% lethality, caused by a virus, which compromises the Central Nervous System (CNS) It is an anthropozoonosis transmitted to humans by inoculation of the virus present in animal saliva infected, through biting, scratching and licking. This bulletin aims to demonstrate the profile of human anti-rabies care in the state of Goiás, it was developed based on the notification forms of human anti-rabies care in Goiás, registered in the Notifiable Diseases Information System (SINAN)

Virología molecular de la rabia: un enfoque clínico / Rabies molecular virology: a clinical approach

Introducción: La rabia es una enfermedad zoonótica asociada al virus RABV, el cual tiene características neurotrópicas. El virus se transmite por el contacto con saliva de animales infectados; la mordedura de un perro es la causa más común. Es un virus que causa la muerte de miles de personas cada año. Objetivo: Describir a profundidad los principios moleculares de la infección por rabia, así como su patogenia, diagnóstico y tratamiento. Métodos: Se realizó una búsqueda de bibliografía en PubMed, SciELO, Scopus, Researchgate; se consultaron 163 referencias y se seleccionaron 51 fuentes que contenían la información más relevante para cumplir con el objetivo del trabajo. Conclusión: Actualmente es posible entender de mejor manera los mecanismos de transmisión y propagación del virus en el organismo; existe nuevo conocimiento sobre los receptores involucrados, así como la función de estos en la replicación viral. Sin embargo, el objetivo de la erradicación de la rabia a corto plazo es complejo. La invasión de territorios selváticos vuelve a la rabia un posible patógeno reemergente; la vacunación de especies transmisoras es el medio ideal para conseguir el control de la enfermedad.

Introduction: Rabies is a zoonotic disease associated with the RABV virus, which has neurotropic characteristics. The virus is transmitted by contact with saliva from infected animals; a dog's bite is the most common cause. This virus causes the death of thousands of people every year. Objective: To describe in depth the molecular principles of rabies infection, as well as its pathogenesis, diagnosis and treatment. Methods: A literature search was conducted in PubMed, SciELO, Scopus, and Researchgate. A total of 163 references were consulted, and 51 sources containing the most relevant information were selected to fulfill the objective of the work. Conclusions: It is currently possible to better understand the mechanisms of transmission and spread of the virus in the organism; there is new knowledge about the receptors involved, as well as their function in viral replication. However, the goal of eradicating rabies in the short term is complex. The invasion of wild territories makes rabies a possible re-emerging pathogen; vaccination of transmitting species is the ideal means to achieve disease control.

Rabies: Perils and Prevention, an Insight into Practices and Perception in Residents of Pakistan

Background: There is a sheer lack of knowledge in treating rabies in Pakistan. To decrease the number of victims every year, immunization and awareness programs are the basic necessities of Pakistani population. The aim of this study was to highlight the lack of learning strategies and how to overcome this problem, so as to eliminate rabies. Methods: This cross-sectional study was conducted on 692 respondents, aged 8-50 years, in Karachi city of Pakistan from January 2022 to June 2022. The study was based on demographic characteristics and basic knowledge of rabies, mode of transmission, clinical signs, and range of animal host species. Binary logistic regression analysis was performed to know the risk factor of rabies among different age groups, marital status, occupation, etc. Results: Results revealed that all the age groups were at risk of the wrong knowledge about rabies, odds = 1.182 and odds = 1.775 for 20-30 and 31-40 years of age, respectively; however, 31-40 years were at the high risk of showing odds=3.597 (95% C.I 1.621-7.983). The correlation of occupation was also checked with rabies knowledge. Only doctors (odds = 1.396) and students (odds = 1.955) showed their unawareness about rabies. Conclusion: This study highlights the grave situation that holds the country in the form of rabies. Through this study we aspire to raise awareness regarding the transmission, spread, and control of rabies

Vigilancia, prevención y control de enfermedades zoonóticas de notificación obligatoria en animales: Ciudad de Buenos Aires, junio 2022 / Surveillance, prevention and control of notifiable zoonotic diseases in animals: Buenos Aires City, june 2022

Informe con datos de vigilancia de rabia animal, y de otras enfermedades zoonóticas de notificación obligatoria, en la Ciudad de Buenos Aires: observación de animales mordedores, detección de virus rábico en muestras de laboratorio, vigilancia de reservorios de enfermedades zoonóticas, y vacunación antirrábica de animales, durante junio de 2022.

Vigilancia, prevención y control de enfermedades zoonóticas de notificación obligatoria en animales: Ciudad de Buenos Aires, mayo 2022 / Surveillance, prevention and control of notifiable zoonotic diseases in animals: Buenos Aires City, may 2022

Informe con datos de vigilancia de rabia animal, y de otras enfermedades zoonóticas de notificación obligatoria, en la Ciudad de Buenos Aires: observación de animales mordedores, detección de virus rábico en muestras de laboratorio, vigilancia de reservorios de enfermedades zoonóticas, y vacunación antirrábica de animales, durante mayo de 2022.

[Anti-rabies vaccines applied in the Russian Federation and perspectives for their improvement].

Rabies is almost ubiquitous (except in certain areas) and poses a significant danger to both animals and humans. Every year around 55,000 people die from this disease worldwide. In the Russian Federation alone 400,000- 450,000 patients annually apply for anti-rabies treatment. In the absolute majority of cases human infection is caused by contact with infected animals. In RF, a number of cultured inactivated anti-rabies vaccines for medical and veterinary purposes have been developed, registered and used for specific prevention of rabies. These vaccine preparations have shown high effectiveness in preventing infection in domestic and farm animals. At the same time, the main reservoir of the rabies virus (Mononegavirales: Rhabdoviridae: Lyssavirus) (RV) are wild carnivores (Mammalia: Carnivora). For the purpose of their oral immunization, live virus vaccines from attenuated (fixed) strains of RV that are little resistant in the external environment are used. In Western Europe and North America there is successful experience with recombinant anti-rabies vaccine preparations containing a viral glycoprotein gene (G-protein). Such vaccines are safe for humans and animals. In Russia also had been developed a vector anti-rabies vaccine based on adenovirus (Adenoviridae), which can be used to combat this infection. Currently, in addition to classical rabies, diseases caused by new, previously unknown lyssaviruses (Lyssavirus) are becoming increasingly important. Bats (Mammalia: Microchiroptera) are their vectors. Cases of illness and death after contact with these animals have been described. In the near future, we should expect the development of new vaccines that will provide protection not only against RV, but also against other lyssaviruses.

Vigilancia, prevención y control de enfermedades zoonóticas de notificación obligatoria en animales: Ciudad de Buenos Aires, marzo 2022 / Surveillance, prevention and control of notifiable zoonotic diseases in animals: Buenos Aires City: march 2022

Informe con datos de vigilancia de rabia animal, y de otras enfermedades zoonóticas de notificación obligatoria, en la Ciudad de Buenos Aires: observación de animales mordedores, detección de virus rábico en muestras de laboratorio, vigilancia de reservorios de enfermedades zoonóticas, y vacunación antirrábica de animales.

Vacunacion antirrábica en caninos y felinos de la Ciudad de Buenos Aires: Año 2021 / Rabies vaccination in Buenos Aires City: Year 2021

El objetivo del presente informe es exponer la situación actual de la vacunación antirrábica de la Ciudad de Buenos Aires, con el fin de realizar una planificación estratégica de prevención y control de la enfermedad. Se utilizaron datos sobre vacunación realizada por veterinarias privadas estimados a partir de la venta de talonarios por parte del Consejo Profesional de Médicos Veterinarios (CPMV); así como la vacunación realizada por los efectores públicos de salud: Instituto de Zoonosis Luis Pasteur (IZLP) y Mascotas de la Ciudad (MC).

Análise da correlação dos índices de estrutura e recursos humanos do serviço veterinário oficial em 2019 e as incidências acumuladas (2017 ­ 2019) de doenças de notificação obrigatória em bovinos e equinos no Brasil / Analysis of the correlation between the structure and human resources indexes of the official veterinary service in 2019 and the accumulated incidences (2017 ­ 2019) of notifiable diseases in cattle and horses in Brazil

As doenças de notificação obrigatória em bovinos podem gerar impactos sociais e econômicos significativos na cadeia pecuária brasileira, além de consequências negativas no mercado internacional devido a embargos sanitários. Para auxiliar no entendimento de como um sistema de vigilância epidemiológica com mais recursos pode gerar mais credibilidade para o país, foram realizadas análises de correlação entre a notificação de doenças e a estrutura veterinária disponível nos Órgãos Executores de Sanidade Agropecuária (OESAs), a partir dos dados contidos no Sistema Nacional de Informação Zoossanitária (SIZ), entre os anos de 2017 e 2019. Com base nos dados do serviço veterinário, foram produzidos o Índice de Estrutura Física Oficial (IEFO) e o Índice de Recursos Humanos do Serviço Oficial (IRHSO). Foi realizada análise de correlação entre a notificação de doenças de bovinos com a capacidade de estrutura física e recursos humanos de vigilância epidemiológica disponíveis no Serviço Veterinário brasileiro. Os estados AP, RR e SC foram os que mais notificaram brucelose e tuberculose no período e estão entre os melhores índices de estrutura e recursos humanos do país. A análise dos índices mostrou que a raiva não possui correlação significativa com estrutura e recursos humanos do serviço, entretanto, brucelose e tuberculose possuem correlação positiva com estrutura veterinária oficial disponível para a vigilância em bovinos. Portanto, melhorias na estrutura podem refletir no incremento dos índices de notificação das doenças de bovinos, assim como na qualidade de suas informações.

Notifiable diseases in cattle can generate significant social and economic impacts on the Brazilian livestock chain, in addition to impacts on the international market due to sanitary embargoes. To help understand how an epidemiological surveillance system with more resources can generate more credibility for the country, correlation analyzes were carried out between the notification of diseases and the veterinary structure available in the Executing Bodies of Agricultural Health (OESAs), based on the data contained in the National System of Zoosanitary Information (SIZ), between the years 2017 to 2019. Based on public data from the veterinary service, the Official Physical Structure Index (IEFO) and the Official Service Human Resources Index (IRHSO) were produced. Correlation analysis was performed between the notification of bovine diseases with the capacity of physical structure and human resources for epidemiological surveillance available in the Brazilian Veterinary Service. AP, RR and SC were the states that most notified brucellosis and tuberculosis in the period and are among the best indices of structure and human resources in the country. The analysis of correlation indices showed that the rabies disease does not have a significant correlation with the structure and the human resources of the service, however, brucellosis and tuberculosis does have a positive correlation with the official veterinary structure available for surveillance in cattle. Therefore, Improvements in the structure can reflect in the increase of the notification rates, as well as in the quality of its information.

Vigilancia, prevención y control de enfermedades zoonóticas de notificación obligatoria en animales: Ciudad de Buenos Aires, febrero 2022 / Surveillance, prevention and control of notifiable zoonotic diseases in animals: Buenos Aires City, february 2022

La vigilancia epidemiológica permite alertar en forma temprana acerca de la ocurrencia de casos y del riesgo de transmisión en un lugar y tiempo determinados, registrar la tendencia a través del tiempo en diferentes áreas geográficas y monitorear las variantes de los virus circulantes. Su propósito es servir a las acciones de prevención y control, y a la orientación de las políticas públicas. La confirmación del diagnóstico por el laboratorio especializado y la efectiva notificación de los casos humanos y animales resultan elementos fundamentales para la vigilancia. En este informe se ofrecen datos de vigilancia de rabia animal, y de otras enfermedades zoonóticas de notificación obligatoria.

Descrição das notificações de atendimento antirrábico humano para profilaxia pós-exposição no Brasil, 2014-2019 / Descripción de notificaciones de atención antirrábica humana para la profilaxis post-exposición en Brasil, 2014-2019 / Description of human anti-rabies post-exposure prophylaxis care notifications in Brazil, 2014-2019

Objetivo: Analisar os atendimentos antirrábicos humanos de profilaxia pós-exposição no Brasil. Métodos: Estudo descritivo utilizando dados do Sistema de Informação de Agravos de Notificação no Brasil, de 2014 a 2019. Resultados: Foram notificados 4.033.098 atendimentos antirrábicos, com média de 672.183 ao ano. Houve maior percentual de atendimentos em pessoas do sexo masculino (n = 2.111.369; 52,4%), menores de 19 anos de idade (n = 1.423.433; 35,3%), residentes em área urbana (n = 3.386.589; 88,1%), agredidas por cães (n = 3.281.190; 81,5%) e com mordeduras (n = 3.575.717; 81,9%), principalmente em mãos e pés (n = 1.541.201; 35,3%). A conduta profilática mais frequente foi observação e vacina (n = 1.736.036; 44,2%). A conduta profilática foi adequada em 57,8% (n = 2.169.689) e inadequada em 42,2% (n = 1.582.411) dos casos. Conclusão: Apesar das condutas profiláticas adequadas, foram observadas indicações inadequadas que, quando insuficientes, podem acarretar casos de raiva humana e, quando desnecessárias, desperdícios, inclusive desabastecimento de imunobiológicos.

Objetivo: Analizar la atención antirrábica humana de profilaxis post exposición en Brasil, de 2014 a 2019. Métodos: Estudio descriptivo utilizando datos del Sistema de Información de Agravamientos de Notificación en Brasil, de 2014 a 2019. Resultados: Se notificaron 4.033.098 atendimientos antirrábicos, con un promedio de 672.183 al año. Hubo mayor porcentual de atención a personas del sexo masculino (n = 2.111.369; 52,4%), menores de 19 años (n = 1.423.433; 35,3%), residentes en área urbana (n = 3.386.589; 88,1%), agredidas por perros (n = 3.281.190; 81,5%) y con mordidas (n = 3.575.717; 81,9%), principalmente en las manos y pies (n = 1.541.201; 35,3%). La conducta profiláctica más frecuente fue la observación y vacuna (n = 1.736.036; 44,2%). La conducta profiláctica fue adecuada en 57,8% (n = 2.169.689) e inadecuada en 42,2% (n = 1.582.411) de los casos. Conclusión: A pesar de las conductas profilácticas adecuadas, se observaron indicaciones inadecuadas que, cuando insuficientes, pueden resultar en casos de rabia humana y, cuando desnecesarias, desperdicios, incluso desabastecimiento de inmunobiológicos.

Objective: To analyze human anti-rabies post-exposure prophylaxis notifications in Brazil. Methods: This was a descriptive study using data from the Notifiable Diseases Information System in Brazil, from 2014 to 2019. Results: A total of 4,033,098 anti-rabies medical consultations were notified, averaging 672,183 a year. Percentage care was higher among males (n = 2,111,369; 52.4%), those under 19 years old (n = 1,423,433; 35.3%), living in urban areas (n = 3,386,589; 88.1%), attacked by dogs (n = 3,281,190; 81.5%) and bitten (n = 3,575,717; 81.9%), mainly on the hands and feet (n = 1,541,201; 35.3%). The most frequent prophylactic procedure was observation plus vaccination (n = 1,736,036; 44.2%). Prophylactic procedure was appropriate in 57.8% (n = 2,169,689) of cases and inappropriate in 42.2% (n = 1,582,411) of cases. Conclusion: Although there were appropriate prophylactic procedures, we also found procedures that were inappropriate and which, when insufficient, can result in cases of human rabies and, when unnecessary, can result in waste, including shortage of immunobiological products.

Clinical aspects of human rabies in the state of Ceará, Brazil: an overview of 63 cases

Abstract INTRODUCTION Rabies is considered one of the most relevant public health problems owing to its high fatality rate and the high number of deaths worldwide. METHODS We included patients with human rabies who attended a reference hospital in the state of Ceará during 1976-2019. RESULTS Data were available for 63 out of 171 (36.8%) patients. Of these patients, 48 (76.2%) were attacked by dogs. In recent years, wild animals have been the most common aggressor species (marmosets and bats). Only 39 (70%) patients were initially correctly suspected with rabies. Bites were the most frequent exposure (56; 96%), most commonly on the hands (21; 42%) and the head (9; 18.4%). Only 14 (22%) patients had sought medical assistance before the onset of symptoms, and only one completed post-exposure prophylaxis. The most prevalent signs and symptoms included aggressiveness/irritability (50; 79.4%), fever (42; 66.7%), sore throat/dysphagia (40; 63.5%), and myalgia (28; 44.4%). Hydrophobia was present in 17 patients (22.0%). CONCLUSIONS Most cases of human rabies in Ceará occurred due to the failure to seek medical assistance and/or the failure of the health system in initiating early post-exposure prophylaxis. There is a need for specific information and education campaigns focusing on the cycle of sylvatic rabies as well as prevention measures. Health professionals should undergo refresher training courses on the signs and symptoms of rabies and on the specific epidemiological features of the disease in Brazil.

Epidemiologia da raiva humana no estado do Ceará, 1970 a 2019 / Epidemiología de la rabia humana en el estado de Ceará, Brasil, 1970 a 2019 / Epidemiology of human rabies in the state of Ceará, Brazil, 1970 to 2019

Objetivo: Descrever os casos de raiva humana no estado do Ceará, Brasil, no período 1970-2019. Métodos: Estudo descritivo, sobre dados secundários da Secretaria da Saúde e do hospital de referência do Ceará. Resultados: Dos 171 casos, 75,7% ocorreram em homens, 60,0% nas idades até 19 anos e 56,0% em áreas urbanas. O cão foi agente transmissor em 74,0% dos casos; sagui em, 16,7%; e morcego, em 7,3%. Entre 1970 e 1978, houve crescimento do número de casos (pelo Joinpoint Regression Program, percentual da mudança anual [APC] = 13,7 - IC95% 4,6;41,5); e entre 1978 e 2019, redução (APC = -6,7 - IC95% -8,8;-5,9). Houve redução da transmissão por cães (71 casos; último caso em 2010) e aumento relativo por mamíferos silvestres (5 casos a partir de 2005). Conclusão: O estudo evidencia mudança na dinâmica da transmissão da raiva no período observado, com redução da transmissão por cão e incremento de casos por animais silvestres.

Objetivo: Describir los casos de la rabia humana en Ceará, Brasil, 1970-2019. Métodos: Estudio descriptivo con datos secundarios de la Secretaría de Salud y del hospital de referencia de Ceará. Resultados: De los 171 casos, 75,7% ocurrió en hombres, el 60,0% en los 19 años y el 56,0% en áreas urbanas. El perro fue transmisor en 74,0%, el mono tití en 16,7% y el murciélago el 7,3%. Entre 1970 y 1978, hubo un aumento de casos (por el Joinpoint Regression Program, cambio porcentual anual [APC] = 13,7 - IC95% 4,6; 41,5), entre 1978 y 2019 una disminución (APC= -6,7 - IC95% -8,8; -5,9). Hubo una reducción de la transmisión por perros (71 casos, el último en 2010) y un aumento por mamíferos salvajes (5 casos, desde 2005). Conclusión: El estudio muestra un cambio en la dinámica de la transmisión de la rabia en los últimos años, con reducción de la transmisión por perros y aumento de casos por animales salvajes.

Objective: To describe cases of human rabies in Ceará State, Brazil between 1970 and 2019. Methods: This was a descriptive study using secondary data from the Ceará State Department of Health and the state reference hospital. Results: Of 171 cases, 75.7% occurred in males, 60.0% in <19-year-olds, and 56.0% in urban areas. Rabies was transmitted by dogs in 74.0% of cases, marmosets in 16.7% and bats in 7.3%. Between 1970 and 1978, there was an increase of cases (using the Joinpoint Regression Program, annual percentage change [APC] = 13.7 - 95%CI 4.6;41.5), while between 1978 and 2019 there was a decrease (APC = -6.7 - 95%CI -8.8;-5.9). There was a reduction in transmission by dogs (71 cases, last case in 2010) and an increase by sylvatic animals (5 cases since 2005). Conclusion: This study demonstrates changes in rabies transmission dynamics during the period studied, with a reduction in transmission by dogs and an increase of transmission by sylvatic animals.

Circumstances of human conflicts with bears and patterns of bear maul injuries in Bhutan: Review of records 2015-2019.

Bhutan is one of the biological hotspots in the world where humans and natural flora and fauna co-exist in close proximity. Bhutan is home to two species of bears: Sloth Bear and Himalayan Black Bear. Human conflicts with bears are reported from all over the country. This study describes the profile of the victims and the pattern of injury resulting from bear attacks and circumstances around human conflicts with bears in Bhutan between 2015 and 2019. This was a cross-sectional study with a review of hospital records of patients treated at the National Referral Hospital from 01 January 2015 till 31 December 2019. Data were extracted into a structured pro forma and entered into EpiData Entry 3.1 and analysed in STATA 13.1. There were thirty-four patients who were provided care for bear maul injuries, with an average annual caseload of 6.8 cases per year. The injury prevalence was 100% and the kill prevalence was 0%. Bear attacks were reported from fourteen of twenty districts of the country. The mean age of the victims was 49 (±13) years. Males (26, 76%) and farmers (26, 76%) were the common victims; the risk of bear attacks was 0.16 per 100,000 farmers per year. The commonest region of the body attacked was the face (29, 85%) and victims were provided emergency and rehabilitative care within and outside the country. Thirty-three victims (97%) were provided post-exposure prophylaxis for rabies. All victims received antibiotics despite the lack of national guidelines on the choice of antibiotics post-bear maul. Human-bear conflict is multi-faceted, puts a considerable strain on bear-conservation efforts and requires multi-disciplinary efforts in the prevention of human injury and socioeconomic losses.

Análise epidemiológica dos atendimentos da profilaxia antirrábica humana associados a acidentes com gatos / Epidemiological analysis of human anti-rabies prophylaxis associated with accidents with cats

Objetivou-se conhecer o perfil epidemiológico do paciente que buscou atendimento antirrábico pós-exposição associado a acidentes com gatos domésticos, em Belo Horizonte/MG, no período de 2007 a 2016. Realizou-se uma análise exploratória das fichas de notificação do atendimento antirrábico humano do Sistema de Informação de Agravos de Notificações (Sinan). Nos resultados, observou-se que 37,4% das pessoas eram adultas do gênero feminino, com idade entre 20 e 59 anos, 88,7% residentes em área urbana, 26,1% de etnia branca e apenas 31,7% dos pacientes buscaram atendimento antirrábico com até 24 horas da exposição ao vírus rábico. Lesões por mordedura ocorreram em 75,6% dos casos notificados. Quanto às características dos ferimentos, 59,6% foram superficiais, 62,2% ocorreram em mãos/pés e 50,1% foram lesões únicas. Na faixa etária de zero a 10 anos, as regiões anatômicas mãos/pés e cabeça/pescoço/face totalizaram 58,35%. Ressalta-se a necessidade de adoção de ações socioeducativas junto à população, devido ao risco de transmissão de raiva pelo gato, principalmente em áreas em que o vírus rábico circula em populações de morcegos. Sugerem-se melhorias no preenchimento das fichas de notificação do Sinan para melhor compreender o perfil epidemiológico dos pacientes que buscam o atendimento antirrábico e, assim, tornar mais eficaz a gestão desse serviço público.(AU)

The objective of this study was to know the epidemiological profile of the patient who sought post-exposure anti-rabies treatment associated with accidents with domestic cats in Belo Horizonte, Minas Gerais Brazil, from 2007 to 2016. An exploratory analysis of the reports on human rabies of the Notification of Injury Information System was performed. In the results, it was observed that 37.4% of the individuals were female adults aged 20-59 years, 88.7% were urban residents, 26.1% were white, and only 31.7% sought anti-rabies care within 24 hours of exposure to the rabies virus. Bite lesions occurred in 75.6%. Regarding the type of wound, 59.6% were superficial; as for the anatomical location, 62.2% occurred in hands / feet and 50.1% were single lesions. It is necessary to adopt socio-educational actions among the population, due to the risk of transmission of the rabies by the cat, especially in areas where the rabies virus circulates in bat populations. Improvements in the completion of the SINAN notification sheets are suggested to better understand the epidemiological profile of patients seeking anti-rabies treatment and thus improve the management of this public service.(AU)

Modern biologics for rabies prophylaxis and the elimination of human cases mediated by dogs.

Introduction: Rabies is a major viral zoonosis and neglected tropical disease, with a global distribution. Humans, domestic animals, and wild mammals are susceptible to infection. Etiological agents reside in the Order Mononegavirales, Family Rhabdoviridae, Genus Lyssavirus. This acute, progressive encephalitis causes the highest case fatality of any conventional infectious disease. Tens of millions of humans become exposed annually to the bites of infected mammals, predominantly in Asia and Africa. Despite the existence of effective vaccines and immune globulins, tens of thousands of people, typically children in the developing world, succumb. Areas covered: Concentrating upon both historical and major published references from the peer-reviewed literature over the past 5 years, we describe current biologics for rabies prevention, newly recommended principles for prophylaxis, and relevant future products in the developmental pipeline. Expert opinion: Modern human rabies biologics are pure, potent, safe, and efficacious, when used in a timely and appropriate manner. Few individuals survive after clinical signs. Anti-viral compounds are not licensed. Experimental therapy, while obviously desirable, is highly controversial. Education on bite prevention and integrated risk management are critical. Access to affordable care, dose-sparing, and shortened regimens of human rabies biologics remain key.

Livestock rabies in Pará state, Brazil: a descriptive study (2004 to 2013) / Raiva em herbívoros no estado do Pará, Brasil: estudo descritivo (2004 a 2013)

Rabies is an important zoonosis to public health associated with lethal encephalitis and economic losses. Analysis of its spatial distribution is a meaningful tool in understanding its dispersion, which may contribute to the control and prophylaxis of the disease. This study analyzed the spatial-temporal distribution of rabies outbreaks in livestock in Pará state, Brazil, from 2004 to 2013. We used records of neurological syndromes obtained from the state's livestock authority (Adepará). The analysis recorded 711 neurological syndromes reports in livestock, of which 32.8% were positive for rabies. In 8% of the neurological syndromes (n=57) was not possible to perform the analysis because of bad-packaging conditions of the samples sent. Outbreaks involved at least 1,179 animals and cattle were the most affected animal species (76.8%). The numbers of reported neurological syndromes and of rabies outbreak shad strong positive correlation and exhibited decreasing linear trend. Spatially, most outbreaks occurred in two mesoregions in Pará (Northeast and Southeast). One of the justifications for this spatial distribution may be related with the distribution of the animals in the state, since these mesoregions are the largest cattle producers in Pará and have most of their territory deforested for pasture implementation.(AU)

A raiva é uma zoonose importante para a saúde pública associada à encefalite letal e às perdas econômicas. A análise de sua distribuição espacial é uma ferramenta importante no entendimento de sua dispersão, o que pode contribuir para o controle e a profilaxia da doença. Este estudo analisou a distribuição espaço-temporal do surto de raiva em rebanhos no estado do Pará, Brasil, entre 2004 e 2013. Foram utilizados registros de síndromes neurológicas obtidas junto à agência de defesa agropecuária do estado (Adepará). A análise revelou 711 notificações de síndromes neurológicas em herbívoros, das quais 32,8% foram positivas para raiva. Em 8% das síndromes neurológicas (n=57) não foi possível realizar as análises devido às más condições das amostras enviadas. Surtos envolveram pelo menos 1.179 animais e os bovinos foram a espécie animal mais afetada (76,8%). Os números de síndromes neurológicas relatadas e de surtos de raiva apresentam forte correlação positiva e exibem tendência linear decrescente. Espacialmente, a maioria dos surtos ocorreu em duas mesorregiões no Pará (Nordeste e Sudeste). Uma das justificativas para essa distribuição espacial pode estar relacionada à distribuição dos animais no estado, uma vez que essas mesorregiões são os maiores produtores de gado do Pará e possuem grande parte do seu território desflorestado para implantação de pastagens.(AU)