RESUMO
Dog-mediated rabies kills tens of thousands of people each year in India, representing one third of the estimated global rabies burden. Whilst the World Health Organization (WHO), World Organization for Animal Health (OIE) and the Food and Agriculture Organization of the United Nations (FAO) have set a target for global dog-mediated human rabies elimination by 2030, examples of large-scale dog vaccination programs demonstrating elimination remain limited in Africa and Asia. We describe the development of a data-driven rabies elimination program from 2013 to 2019 in Goa State, India, culminating in human rabies elimination and a 92% reduction in monthly canine rabies cases. Smartphone technology enabled systematic spatial direction of remote teams to vaccinate over 95,000 dogs at 70% vaccination coverage, and rabies education teams to reach 150,000 children annually. An estimated 2249 disability-adjusted life years (DALYs) were averted over the program period at 526 USD per DALY, making the intervention 'very cost-effective' by WHO definitions. This One Health program demonstrates that human rabies elimination is achievable at the state level in India.
Assuntos
Doenças do Cão , Saúde Única , Raiva , Animais , Análise Custo-Benefício , Doenças do Cão/epidemiologia , Doenças do Cão/prevenção & controle , Cães , Humanos , Índia/epidemiologia , Raiva/epidemiologia , Raiva/prevenção & controle , Raiva/veterináriaRESUMO
The highest rate of human rabies deaths reported in the Americas is in Haiti, and most of these deaths result from rabies virus infections that occur after individuals are bitten by infected dogs and do not receive rabies post-exposure prophylaxis. One barrier to rabies prevention in Haiti is a lack of knowledge about this disease among healthcare professionals and community members. During the past 4 years, The US Centers for Disease Control and Prevention has collaborated with public health officials and partners to develop, test and refine educational materials aimed at filling this need for rabies education. This report summarizes the use of feedback from knowledge, attitudes and practises surveys; key informant interviews; and focus groups to develop culturally appropriate rabies prevention materials for community members, health officials, clinicians, laboratory professionals, veterinary professionals, government officials and national and local district leaders about ways to prevent rabies. These formative research methods were critically important in ensuring that the materials would be culturally appropriate and would stand the greatest likelihood of motivating Haitians to protect themselves from rabies. Centers for Disease Control and Prevention is using lessons learned in Haiti to develop and test materials in other countries with high rates of canine rabies.
Assuntos
Doenças do Cão/virologia , Educação em Saúde/normas , Vacina Antirrábica/imunologia , Raiva/veterinária , Zoonoses , Animais , Mordeduras e Picadas , Doenças do Cão/epidemiologia , Doenças do Cão/prevenção & controle , Cães , Haiti/epidemiologia , Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde , Humanos , Saúde Pública , Raiva/mortalidade , Raiva/prevenção & controleRESUMO
Rabies is one of the oldest recorded pathogens, with the broadest distribution of any known viral zoonosis. Antarctica is believed to be free of all lyssaviruses, but no laboratory-based surveillance has taken place to support this supposition. Re-introduction of the disease is possible in Pacific Oceania, as evidenced by a historical outbreak in Guam and the translocation of rabid bats to Hawaii. Australia is the only inhabited continent with enzootic rabies, without the presence of rabies virus. Europe and North America have broken the cycle of dog-mediated rabies, with a few remaining focal points in Latin America and the Caribbean, but wildlife rabies predominates. The greatest burden resides in the 'Old World'. The elimination of human rabies mediated via dogs by 2030 in Africa, Asia and the Middle East will not be simple, rapid or inexpensive, but it may be achievable through the use of widely available tools and the application of lessons learned during the course of the 20th century.
La rage est l'une des plus anciennes maladies infectieuses enregistrées et la zoonose virale la plus largement représentée dans le monde. On présume que l'Antarctique est indemne de tout lyssavirus mais cette hypothèse n'est étayée par aucune surveillance basée sur des analyses de laboratoire. Il existe une menace de réintroduction de la maladie en Océanie, comme l'ont révélé le foyer historique survenu à Guam ainsi que l'arrivée de chauves-souris enragées à Hawaï. L'Australie est le seul continent habité où la rage ne sévit pas à l'état enzootique, le virus de la rage y étant absent. L'Europe et l'Amérique du Nord ont mis fin au cycle de la rage transmise par les chiens, dont il ne subsiste que quelques rares foyers de propagation en Amérique latine ; en revanche, la rage sylvatique reste prépondérante dans ces régions. Le fardeau le plus lourd est supporté par l'Ancien Monde. L'élimination de la rage humaine transmise par les chiens à l'horizon 2030 en Afrique, en Asie et au Moyen-Orient ne sera pas une tâche facile, rapide ni exempte de coûts mais elle peut réussir grâce aux outils disponibles partout dans le monde et aux enseignements tirés de l'expérience acquise tout au long du xxe siècle.
La rabia, causada por uno de los patógenos más antiguos de los que hay constancia, presenta la distribución más amplia de cuantas zoonosis víricas se conocen. Se piensa que la Antártida está libre de todo tipo de lisavirus, pero no ha habido labores de vigilancia en laboratorio que prueben tal suposición. Oceanía está bajo la amenaza de reintroducción de la enfermedad, como demuestran el histórico brote registrado en Guam o el desplazamiento de murciélagos rabiosos a Hawái. Australia es el único continente habitado en el que no hay rabia enzoótica, esto es, en que el virus rábico no está presente. Europa y América del Norte han interrumpido el ciclo de la rabia transmitida por perros, de la que aún quedan contados focos en América Latina y el Caribe, aunque sigue prevaleciendo la rabia de la fauna silvestre. La carga más importante recae en el «Viejo Mundo¼. La eliminación de la rabia humana transmitida por perros para 2030 en África, Asia y el Oriente Medio no será sencilla, rápida ni barata, pero es factible si se emplean herramientas que ya están extendidas y se aplican las lecciones que hemos aprendido a lo largo del siglo XX.
Assuntos
Saúde Global , Raiva/veterinária , Animais , Animais Domésticos , Animais Selvagens , Humanos , Raiva/epidemiologia , Raiva/prevenção & controle , ZoonosesRESUMO
Rabies is a major neglected zoonotic disease, despite the availability of highly sensitive diagnostic tests and efficacious human and animal vaccines. Perpetuation of rabies among multiple species of bats and wild carnivores, together with the presence of diverse lyssaviruses, remains a challenge for the prevention and control of this disease. However, most of the global burden may be reduced by mass vaccination of dogs, the major reservoir. Elimination of human rabies mediated by dogs may be feasible, based upon the elicitation of herd immunity, the application of sound health economic principles for appropriate disease management and technology transfer to those developing countries where rabies is hyper-endemic. Global canine rabies elimination has clear benefits for public health, veterinary medicine and conservation biology, so these sectors must collaborate using a transdisciplinary 'One Health' approach that allows the creation of long-term regional strategies for enhanced surveillance and practical intervention.
La rage est une maladie zoonotique majeure, qui demeure négligée malgré l'existence de tests de diagnostic hautement sensibles et de vaccins efficaces chez l'homme comme chez l'animal. La persistance de la rage chez de nombreuses espèces de carnivores sauvages et de chauves-souris et la diversité des espèces de Lyssavirus continuent de poser des difficultés en termes de prévention et de lutte contre la maladie. Néanmoins, le fardeau mondial de la rage peut être considérablement réduit en pratiquant la vaccination massive des chiens, ces derniers constituant le principal réservoir. L'élimination de la rage transmise par les chiens est un objectif atteignable si l'on s'appuie sur des concepts solides en matière d'immunité à l'échelle des troupeaux, d'économie de la santé et de transfert technologique, tout en apportant des bénéfices mutuels accrus pour la santé publique, la médecine vétérinaire et la biologie de la conservation grâce à la mise en oeuvre d'une approche régionale pour la surveillance, les interventions, la certification et la collaboration pluridisciplinaire dans un contexte Une seule santé.
La rabia es una importante enfermedad zoonótica desatendida, y ello pese a que existen pruebas de diagnóstico de gran sensibilidad y vacunas de contrastada eficacia en personas y animales. La perpetuación de la rabia en múltiples especies de carnívoros silvestres y murciélagos y la presencia de diversos lisavirus siguen dificultando el trabajo de prevención y control de la enfermedad. Con todo, cabe reducir buena parte de la carga mundial que impone la rabia mediante la vacunación masiva de perros, que son su principal reservorio. Si se aplican conceptos sólidos en materia de inmunidad de rebaño, economía de la salud y transferencia de tecnología, abordando las labores de vigilancia, intervención, certificación y colaboración multidisciplinar desde una lógica regional y desde los postulados de «Una sola salud¼, la eliminación de la rabia humana transmitida por perros puede ser un objetivo factible y muy beneficioso para la salud pública, la medicina veterinaria y la biología de la conservación.
Assuntos
Controle de Doenças Transmissíveis/métodos , Saúde Global , Raiva/prevenção & controle , Animais , Controle de Doenças Transmissíveis/organização & administração , Controle de Doenças Transmissíveis/normas , HumanosRESUMO
Rabies is an essentially 100% fatal, zoonotic disease, caused by Lyssaviruses. Currently, the disease is vaccine-preventable with pre- and post-exposure prophylaxis (PrEP and PEP). Still, rabies virus is estimated to cause up to 60,000 human deaths annually, of which the vast majority occurs in rural Asia and Africa, due to the inaccessibility of prophylaxis and non-existence of treatment. Despite these unmet clinical needs, rabies control mainly focuses on the sylvatic reservoir and drug innovation receives relatively little attention compared to other neglected tropical diseases (NTDs). As such, the lag of innovation in human rabies prophylaxis and treatment cannot be explained by limited return on investment alone. Strategies countering rabies-specific innovation barriers are important for the acceleration of innovation in human rabies prophylaxis and treatment. Barriers throughout society, science, business development and market domains were identified through literature review and 23 semi-structured interviews with key opinion leaders worldwide. A subsequent root cause analysis revealed causal relations between innovation barriers and a limited set of root causes. Finally, prioritization by experts indicated their relative importance. Root causes, which are fundamental to barriers, were aggregated into four types: market and commercial, stakeholder collaboration, public health and awareness, and disease trajectory. These were found in all domains of the innovation process and thus are relevant for all stakeholders. This study identifies barriers that were not previously described in this specific context, for example the competition for funding between medical and veterinary approaches. The results stress the existence of barriers beyond the limited return on investment and thereby explain why innovation in human rabies medication is lagging behind NTDs with a lower burden of disease. A re-orientation on the full spectrum of barriers that hinder innovation in rabies prophylaxis and treatment is necessary to meet unmet societal and medical needs.
Assuntos
Pesquisa Biomédica , Vacina Antirrábica/imunologia , Raiva/mortalidade , Raiva/prevenção & controle , Saúde Global , Humanos , Profilaxia Pós-Exposição , Saúde Pública , VacinaçãoRESUMO
Rabies is endemic in the Philippines. In 2010, with support from the Bill and Melinda Gates Foundation, a canine rabies elimination project was initiated in the Philippine Archipelago of Visayan. We conducted an analysis of dog vaccination and human PEP costs for dog bite patients in a highly urbanized area and a low-income rural municipality in Cebu Province, Philippines, from 2010 to 2012. Our findings indicated that eliminating rabies in dogs through mass vaccination is more cost-effective than treating rabies exposures in humans. The average costs (in USD) per human life saved through PEP were $1620.28 in Cebu City and $1498 in Carmen. Costs per dog vaccinated ranged from $1.18 to $5.79 in Cebu City and $2.15 to $3.38 in Carmen. Mass dog vaccination campaigns conducted in each village were more cost-effective than fixed-site campaigns. The costs of dog vaccination can be reduced further through bulk vaccine purchase by the national government or large donor agency, for example the BMGF. As communities achieve canine rabies elimination, more judicious use of PEP will result in significant public savings. The study affirms the willingness of local governments to invest and reassure donors of their cooperation and resource contribution to sustain disease elimination efforts.
Assuntos
Análise Custo-Benefício , Erradicação de Doenças/economia , Doenças do Cão/prevenção & controle , Vacinação em Massa/veterinária , Vacina Antirrábica/economia , Raiva/veterinária , Animais , Cães , Humanos , Vacinação em Massa/economia , Filipinas , Raiva/prevenção & controle , Raiva/virologiaRESUMO
An estimated 59 000 people die annually from rabies, keeping this zoonosis on the forefront of neglected diseases, especially in the developing world. Most deaths occur after being bitten by a rabid dog. Those exposed to a suspect rabid animal should receive appropriate post-exposure prophylaxis (PEP) or risk death. However, vaccination of dogs to control and eliminate canine rabies at the source has been implemented in many places around the world. Here, we analysed the vaccination and cost data for one such campaign in the area surrounding and including Dar es Salaam, Tanzania and estimated the cost per dog vaccinated. We also estimated the cost of human PEP. We found that the cost per dog vaccinated ranged from $2.50 to $22.49 across districts and phases, with the phase average ranging from $7.30 to $11.27. These figures were influenced by over purchase of vaccine in the early phases of the programme and the significant costs associated with purchasing equipment for a programme starting from scratch. The cost per human PEP course administered was approximately $24.41, with the average patient receiving 2.5 of the recommended four vaccine doses per suspect bite. This study provides valuable financial insights into programme managers and policymakers working towards rabies elimination.
Assuntos
Doenças do Cão/prevenção & controle , Custos de Cuidados de Saúde , Vacina Antirrábica , Raiva/veterinária , Animais , Mordeduras e Picadas/prevenção & controle , Doenças do Cão/epidemiologia , Cães , Humanos , Doenças Negligenciadas/epidemiologia , Doenças Negligenciadas/prevenção & controle , Raiva/epidemiologia , Raiva/prevenção & controle , Vacina Antirrábica/economia , Tanzânia/epidemiologia , Vacinação/economia , ZoonosesRESUMO
Rabies remains a significant problem throughout much of the developing world. An estimated 69 000 people die annually from exposure to rabies. Most of these deaths are the result of being bitten by a rabid dog. Mass vaccination campaigns targeting dogs have been implemented around the world in an attempt to control or eliminate canine rabies. We analysed the vaccination and cost data for a campaign in the KwaZulu-Natal province of South Africa; we found that the cost per dog vaccinated to be $6.61 for mass campaigns and $5.41 for local campaigns. We also estimated the cost of human post-exposure prophylaxis (PEP). The cost of PEP is approximately $64.50 on average per patient, and $333 on average for the 9% of patients who receive RIG. We also found that the districts that vaccinated the most dogs per capita experienced the highest rates of human treatment and thus had the highest PEP costs.
Assuntos
Mordeduras e Picadas , Doenças do Cão/prevenção & controle , Promoção da Saúde , Vacina Antirrábica/economia , Raiva/prevenção & controle , Animais , Cães , Humanos , África do Sul , Vacinação/economiaRESUMO
As most newly characterized emerging infectious diseases are considered to be zoonotic, a modern pre-eminence ascribed within this classification lies clearly within the viral taxonomic realm. In particular, RNA viruses deserve special concern given their documented impact on conservation biology, veterinary medicine and public health, with an unprecedented ability to promote an evolutionary host-pathogen arms race from the ultimate infection and immunity perspective. However, besides the requisite molecular/gross anatomical and physiological bases for infectious diseases to transmit from one host to another, both viral pathogens and their reservoirs/vectors exploit a complex anthropological, cultural, historical, psychological and social suite that specifically defines the phylodynamics within Homo sapiens, unlike any other species. Some of these variables include the ecological benefits of living in groups, decisions on hunting and foraging behaviours and dietary preferences, myths and religious doctrines, health economics, travel destinations, population planning, political decisions on agricultural product bans and many others, in a homo-sociome memetic complex. Taken to an extreme, such complexities elucidate the underpinnings of explanations as to why certain viral zoonoses reside in neglected people, places and things, whereas others are chosen selectively and prioritized for active mitigation. Canine-transmitted rabies serves as one prime example of how a neglected viral zoonosis may transition to greater attention on the basis of renewed advocacy, social media, local champions and vested international community engagement. In contrast, certain bat-associated and arboviral diseases suffer from basic ignorance and perpetuated misunderstanding of fundamental reservoir and vector ecology tenets, translated into failed control policies that only exacerbate the underlying environmental conditions of concern. Beyond applied biomedical knowledge, epidemiological skills and biotechnical abilities alone, if a homo-sociome memetic complex approach is also entertained in a modern transdisciplinary context, neglected viral zoonosis may be better understood, controlled, prevented and possibly eliminated, in a more holistic One Health context.
Assuntos
Controle de Doenças Transmissíveis/organização & administração , Reservatórios de Doenças , Transmissão de Doença Infecciosa , Vetores de Doenças , Doenças Negligenciadas/epidemiologia , Viroses/epidemiologia , Zoonoses/epidemiologia , Animais , Controle de Doenças Transmissíveis/métodos , Humanos , Viroses/transmissão , Zoonoses/transmissãoRESUMO
Adverse events can occur after rabies post-exposure prophylaxis (PEP), and linkage to causality is often difficult to determine. We report a case of recurrent temporary paralysis that began immediately after the initiation of rabies PEP in a man exposed to a bat. The recurrent temporary paralysis first occurred in the patient after his initial dose and then again after day 3 of his rabies PEP. The PEP was terminated prior to a serologic response. The patient continued to experience numerous discrete episodes of temporary paralysis for over two years.
Assuntos
Paralisia/induzido quimicamente , Vacina Antirrábica/efeitos adversos , Vírus da Raiva/imunologia , Raiva/prevenção & controle , Animais , Humanos , Masculino , Pessoa de Meia-Idade , Profilaxia Pós-Exposição , Raiva/imunologiaRESUMO
Subsequent to a human rabies death in Sumter County, South Carolina, we assessed the frequency of exposures to bats in homes and citizens' rabies knowledge. A self-administered survey was mailed to 6033 randomly selected Sumter County addresses. The survey inquired about household exposures to bats and respondents' rabies knowledge. Surveys were returned by mail for descriptive analysis. Of 597 respondents, 3.5% (21/597) reported having bats living in (2.8% or 17/597) or entering their homes (2.5% or 15/597) during 2010-2012. Respondents generally understood that mammals transmit rabies virus through bites, but were less aware of the severity of rabies illness and modern post-exposure vaccine administration. Respondents were unsure about how to exclude bats from homes and ranked highly both healthcare and non-healthcare entities as preferred resources for obtaining assistance with bat-related concerns. We found potential for human exposures to bats in Sumter County households and gaps in citizen knowledge of rabies and bat exclusion. Public health officials should engage non-healthcare partners in assistance disseminating rabies educational materials and for providing appropriate referral for persons potentially exposed to bats.
Assuntos
Atitude Frente a Saúde , Quirópteros/virologia , Promoção da Saúde , Vírus da Raiva/fisiologia , Raiva/prevenção & controle , Adolescente , Adulto , Idoso , Animais , Mordeduras e Picadas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Saúde Pública , Raiva/virologia , South Carolina/epidemiologia , Inquéritos e Questionários , Adulto Jovem , ZoonosesRESUMO
Rabies remains a major neglected global zoonosis. New vaccine strategies are needed for human rabies prophylaxis. A single intramuscular immunization with a moderate dose of an experimental chimpanzee adenovirus (Ad) vector serotype SAd-V24, also termed AdC68, expressing the rabies virus glycoprotein, resulted in sustained titers of rabies virus neutralizing antibodies and protection against a lethal rabies virus challenge infection in a non-human primate model. Taken together, these data demonstrate the safety, immunogenicity, and efficacy of the recombinant Ad-rabies vector for further consideration in human clinical trials.
Assuntos
Vacina Antirrábica/administração & dosagem , Vírus da Raiva/imunologia , Raiva/prevenção & controle , Adenoviridae/genética , Adenoviridae/metabolismo , Animais , Anticorpos Antivirais/imunologia , Feminino , Expressão Gênica , Vetores Genéticos/genética , Vetores Genéticos/metabolismo , Humanos , Macaca fascicularis , Macaca mulatta , Masculino , Raiva/imunologia , Raiva/virologia , Vacina Antirrábica/genética , Vacina Antirrábica/imunologia , Vírus da Raiva/genética , Vacinação , Vacinas Sintéticas/administração & dosagem , Vacinas Sintéticas/genética , Vacinas Sintéticas/imunologia , Proteínas Virais/administração & dosagem , Proteínas Virais/genética , Proteínas Virais/imunologiaRESUMO
Rabies prevention and control efforts have been successful in reducing or eliminating virus circulation regionally through vaccination of specific reservoir populations. A notable example of this success is the elimination of canine rabies virus variant from the United States and many other countries. However, increased international travel and trade can pose risks for rapid, long-distance movements of ill or infected persons or animals. Such travel and trade can result in human exposures to rabies virus during travel or transit and could contribute to the re-introduction of canine rabies variant or transmission of other viral variants among animal host populations. We present a review of travel- and trade-associated rabies events that highlight international public health obligations and collaborative opportunities for rabies prevention and control in an age of global travel. Rabies is a fatal disease that warrants proactive coordination among international public health and travel industry partners (such as travel agents, tour companies and airlines) to protect human lives and to prevent the movement of viral variants among host populations.
Assuntos
Comércio , Saúde Global , Raiva/epidemiologia , Raiva/prevenção & controle , Viagem , Animais , HumanosRESUMO
Domestic cats are an important part of many Americans' lives, but effective control of the 60-100 million feral cats living throughout the country remains problematic. Although trap-neuter-vaccinate-return (TNVR) programmes are growing in popularity as alternatives to euthanizing feral cats, their ability to adequately address disease threats and population growth within managed cat colonies is dubious. Rabies transmission via feral cats is a particular concern as demonstrated by the significant proportion of rabies post-exposure prophylaxis associated with exposures involving cats. Moreover, TNVR has not been shown to reliably reduce feral cat colony populations because of low implementation rates, inconsistent maintenance and immigration of unsterilized cats into colonies. For these reasons, TNVR programmes are not effective methods for reducing public health concerns or for controlling feral cat populations. Instead, responsible pet ownership, universal rabies vaccination of pets and removal of strays remain integral components to control rabies and other diseases.
Assuntos
Doenças do Gato/prevenção & controle , Vacina Antirrábica/imunologia , Raiva/veterinária , Esterilização Reprodutiva/veterinária , Animais , Gatos , Controle da População/métodos , Raiva/prevenção & controle , ZoonosesRESUMO
The direct and interactive effects of climate change on host species and infectious disease dynamics are likely to initially manifest\ at latitudinal extremes. As such, Alaska represents a region in the United States for introspection on climate change and disease. Rabies is enzootic among arctic foxes (Vulpes lagopus) throughout the northern polar region. In Alaska, arctic and red foxes (Vulpes vulpes) are reservoirs for rabies, with most domestic animal and wildlife cases reported from northern and western coastal Alaska. Based on passive surveillance, a pronounced seasonal trend in rabid foxes occurs in Alaska, with a peak in winter and spring. This study describes climatic factors that may be associated with reported cyclic rabies occurrence. Based upon probabilistic modelling, a stronger seasonal effect in reported fox rabies cases appears at higher latitudes in Alaska, and rabies in arctic foxes appear disproportionately affected by climatic factors in comparison with red foxes. As temperatures continue a warming trend, a decrease in reported rabid arctic foxes may be expected. The overall epidemiology of rabies in Alaska is likely to shift to increased viral transmission among red foxes as the primary reservoir in the region. Information on fox and lemming demographics, in addition to enhanced rabies surveillance among foxes at finer geographic scales, will be critical to develop more comprehensive models for rabies virus transmission in the region.
Assuntos
Raposas/virologia , Vírus da Raiva/isolamento & purificação , Raiva/veterinária , Alaska/epidemiologia , Animais , Clima , Mudança Climática , Monitoramento Ambiental , Geografia , Modelos Teóricos , Raiva/epidemiologia , Raiva/virologia , Análise de Regressão , Estações do Ano , Especificidade da EspécieRESUMO
The ecology of infectious disease in wildlife has become a pivotal theme in animal and public health. Studies of infectious disease ecology rely on robust surveillance of pathogens in reservoir hosts, often based on serology, which is the detection of specific antibodies in the blood and is used to infer infection history. However, serological data can be inaccurate for inference to infection history for a variety of reasons. Two major aspects in any serological test can substantially impact results and interpretation of antibody prevalence data: cross-reactivity and cut-off thresholds used to discriminate positive and negative reactions. Given the ubiquitous use of serology as a tool for surveillance and epidemiological modeling of wildlife diseases, it is imperative to consider the strengths and limitations of serological test methodologies and interpretation of results, particularly when using data that may affect management and policy for the prevention and control of infectious diseases in wildlife. Greater consideration of population age structure and cohort representation, serological test suitability and standardized sample collection protocols can ensure that reliable data are obtained for downstream modeling applications to characterize, and evaluate interventions for, wildlife disease systems.
Assuntos
Anticorpos/análise , Doenças Transmissíveis/imunologia , Doenças Transmissíveis/microbiologia , Ecologia , Testes Sorológicos/métodos , Animais , Reações Cruzadas , Limiar Diferencial , Reservatórios de Doenças , Monitoramento Epidemiológico , Incidência , Prevalência , Reprodutibilidade dos TestesRESUMO
BACKGROUND: Encephalitis continues to result in substantial morbidity and mortality worldwide. Advances in diagnosis and management have been limited, in part, by a lack of consensus on case definitions, standardized diagnostic approaches, and priorities for research. METHODS: In March 2012, the International Encephalitis Consortium, a committee begun in 2010 with members worldwide, held a meeting in Atlanta to discuss recent advances in encephalitis and to set priorities for future study. RESULTS: We present a consensus document that proposes a standardized case definition and diagnostic guidelines for evaluation of adults and children with suspected encephalitis. In addition, areas of research priority, including host genetics and selected emerging infections, are discussed. CONCLUSIONS: We anticipate that this document, representing a synthesis of our discussions and supported by literature, will serve as a practical aid to clinicians evaluating patients with suspected encephalitis and will identify key areas and approaches to advance our knowledge of encephalitis.
Assuntos
Algoritmos , Técnicas e Procedimentos Diagnósticos/normas , Encefalite/diagnóstico , Adulto , Criança , Consenso , HumanosRESUMO
Rabies in dogs can be controlled through mass vaccination. Oral vaccination of domestic dogs would be useful in the developing world, where greater vaccination coverage is needed especially in inaccessible areas or places with large numbers of free-roaming dogs. From this perspective, recent research has focused on development of new recombinant vaccines that can be administered orally in a bait to be used as adjunct for parenteral vaccination. One such candidate, a recombinant canine adenovirus type 2 vaccine expressing the rabies virus glycoprotein (CAV2-RG), is considered a promising option for dogs, given host specificity and safety. To assess the potential use of this vaccine in domestic dog populations, we investigated the prevalence of antibodies against canine adenovirus type 2 in South African dogs. Blood was collected from 241 dogs from the Gauteng and KwaZulu-Natal provinces. Sampled dogs had not previously been vaccinated against canine adenovirus type 1 (CAV1) or canine adenovirus type 2 (CAV2). Animals from both provinces had a high percentage of seropositivity (45% and 62%), suggesting that CAV2 circulates extensively among domestic dog populations in South Africa. Given this finding, we evaluated the effect of pre-existing CAV-specific antibodies on the efficacy of the CAV2-RG vaccine delivered via the oral route in dogs. Purpose-bred Beagle dogs, which received prior vaccination against canine parvovirus, canine distemper virus and CAV, were immunized by oral administration of CAV2-RG. After rabies virus (RABV) infection all animals, except one vaccinated dog, developed rabies. This study demonstrated that pre-existing antibodies against CAV, such as naturally occurs in South African dogs, inhibits the development of neutralizing antibodies against RABV when immunized with a CAV-based rabies recombinant vaccine.
Assuntos
Adenovirus Caninos/imunologia , Anticorpos Antivirais/sangue , Doenças do Cão/prevenção & controle , Vacina Antirrábica/imunologia , Raiva/imunologia , Vacinas Sintéticas/imunologia , Adenovirus Caninos/genética , Administração Oral , Animais , Anticorpos Neutralizantes , Anticorpos Antivirais/imunologia , Doenças do Cão/imunologia , Cães , Raiva/prevenção & controle , Raiva/veterinária , Vacina Antirrábica/administração & dosagem , Vacina Antirrábica/genética , Estudos Soroepidemiológicos , África do Sul , Resultado do Tratamento , Vacinas Sintéticas/administração & dosagemRESUMO
Zoonotic disease surveillance is typically initiated after an animal pathogen has caused disease in humans. Early detection of potentially high-risk pathogens within animal hosts may facilitate medical interventions to cope with an emerging disease. To effectively spillover to a novel host, a pathogen may undergo genetic changes resulting in varying transmission potential in the new host and potentially to humans. Rabies virus (RABV) is one model pathogen to consider for studying the dynamics of emerging infectious diseases under both laboratory and field conditions. The evolutionary history of RABV is characterized by regularly documented spillover infections and a series of notable host shifts. Within this context, enhanced field surveillance to improve detection of spillover infections will require validated techniques to non-invasively differentiate infected from non-infected individuals. In this study, we evaluate the use of infrared thermography to detect thermal changes associated with experimental RABV infection in big brown bats (Eptesicus fuscus) in a captive colony. Our results indicated that 62% of rabid bats had detectable facial temperature decreases (-4.6°C, SD ± 2.5) compared with pre-inoculation baseline values. These data suggest potential utility for discriminating rabid bats in natural field settings. In addition, focusing upon RABV circulating in the United States between 2008 and 2011, we confirmed spillover events of bat RABV among carnivores and identified cross-species transmission events caused by four lineages of RABV associated with insectivorous bats. Additionally, our analysis of RABV glycoprotein sequences identified substitutions in antigenic sites that may affect neutralizing activity associated with monoclonal antibodies proposed for use in human post-exposure prophylaxis. This study provides a glimpse into RABV pathobiology and spillover dynamics among and between bats and a variety of mesocarnivores.
Assuntos
Quirópteros/virologia , Doenças Transmissíveis Emergentes/veterinária , Vírus da Raiva/imunologia , Raiva/veterinária , Substituição de Aminoácidos , Animais , Antígenos Virais/imunologia , Sequência de Bases , Carnívoros/virologia , Doenças Transmissíveis Emergentes/epidemiologia , Doenças Transmissíveis Emergentes/transmissão , Doenças Transmissíveis Emergentes/virologia , Reservatórios de Doenças , Face , Glicoproteínas/genética , Humanos , Filogenia , Profilaxia Pós-Exposição , RNA Viral/química , RNA Viral/genética , Raiva/epidemiologia , Raiva/transmissão , Raiva/virologia , Vírus da Raiva/genética , Vírus da Raiva/patogenicidade , Análise de Sequência de RNA , Temperatura , Termografia/métodos , Termografia/veterinária , Estados Unidos/epidemiologia , Proteínas Virais/genéticaRESUMO
A 48-year-old male kidney-transplant recipient was bitten by a rabid dog. His immunosuppressive treatment consisted of cyclosporine 60 mg b.i.d., mycophenolate mofetil (MMF) 250 mg t.i.d., and prednisone 5 mg. After wound care, he received 5 doses of purified vero cell rabies vaccine on days 0, 3, 7, 14, and 28, and human rabies immunoglobulin, according to international guidelines. Adequate levels of rabies virus neutralizing antibodies were observed after the administration of the third vaccine dose. However, a decrease of antibody titer was detected by day 28. Immunosuppressive medication was minimized, withdrawing MMF and reducing the dose of cyclosporine. Booster doses of the same vaccine were administered on days 38, 41, 45, 52, and 66. Adequate neutralizing antibody response was recovered during the ensuing 12 months, under reduced immunosuppression. Nineteen months after the incident, the patient remains with good graft function and is asymptomatic for rabies. It remains to be determined whether the attained immune response was either the result of the booster vaccinations or the reduction of immunosuppression alone. Nevertheless, such an outcome would have been possible only with the combined management strategy implemented.