Rabies elimination in rural Kenya:Need for improved availability of human vaccines, awareness and knowledge on rabies and its management among healthcare workers

BACKGROUND: In Africa, rabies causes an estimated 24,000 human deaths annually. Mass dog vaccinations coupled with timely post-exposure prophylaxis (PEP) for dog-bite patients are the main interventions to eliminate human rabies deaths. A well-informed healthcare workforce and the availability and accessibility of rabies biologicals at health facilities are critical in reducing rabies deaths. We assessed awareness and knowledge regarding rabies and the management of rabies among healthcare workers, and PEP availability in rural eastern Kenya. METHODOLOGY: We interviewed 73 healthcare workers from 42 healthcare units in 13 wards in Makueni and Kibwezi West sub-counties, Makueni County, Kenya in November 2018. Data on demographics, years of work experience, knowledge of rabies, management of bite and rabies patients, and availability of rabies biologicals were collected and analyzed. RESULTS: Rabies PEP vaccines were available in only 5 (12%) of 42 health facilities. None of the health facilities had rabies immunoglobulins in stock at the time of the study. PEP was primarily administered intramuscularly, with only 11% (n = 8) of the healthcare workers and 17% (7/42) healthcare facilities aware of the dose-sparing intradermal route. Less than a quarter of the healthcare workers were aware of the World Health Organization categorization of bite wounds that guides the use of PEP. Eighteen percent (n = 13) of healthcare workers reported they would administer PEP for category I exposures even though PEP is not recommended for this category of exposure. Only one of six respondents with acute encephalitis consultation considered rabies as a differential diagnosis highlighting the low index of suspicion for rabies. CONCLUSION: The availability and use of PEP for rabies was sub-optimal. We identified two urgent needs to support rabies elimination programmes: improving availability and access to PEP; and targeted training of the healthcare workers to improve awareness on bite wound management, judicious use of PEP including appropriate risk assessment following bites and the use of the dose-sparing intradermal route in facilities seeing multiple bite patients. Global and domestic funding plan that address these gaps in the human health sector is needed for efficient rabies elimination in Africa

Le virus de la dengue et sécurité transfusionnelle

La prévalence de la dengue s'est dramatiquement accrue au cours des dernières décennies et près de 40% de la population mondiale y est aujourd'hui exposée. Classé comme virus ré-émergent, la dengue remet actuellement en question la sécurité transfusionnelle. Après un rappel des généralités de l'infection, les cas de transmission par transfusion du virus décrits dans la littérature. Ainsi que plusieurs études déterminant la prévalence du virus dans le sang des donneurs asymptomatiques seront présentes. Un modèle mathématique du risque de transmission lors d'une transfusion sanguinesera discute. L'évaluation de ce risque devrait aider les autorités à déterminer les mesures les plus appropriées pour le réduire, en fonction de leur bénéfice et de leur coût. Ces mesures comprennent la sélection ou l'exclusion des donneurs, la mise en quarantaine du plasma, l'utilisation de méthodes pour amplifier le matériel génétique du virus, et surtout les méthodes d'inactivation du pathogène.The prevalence of dengue infection has dramatically increased over the past decades and nearly 40% of the world's population is now exposed to this disease. There is currently no specific treatment nor is the prevention completely effective. Classified as a re-emerging virus, the dengue virus is challenging transfusion safety, especially in endemic countries. The different transfusion transmission cases are detailed here, follwed by several studies determining the prevalence of dengue virus amongst asymptomatic blood donors, and a model of the risk of dengue transmission during a transfusion is discussed. The assessment of this risk will help authorities to determine the most appropriate risk reduction measures. These measures, which have differing costs and benefits, include the selection or exclusion of donors, the quarantining of plasma, the use of methods to amplify genetic material in order to detect a pathogen, and pathogen inactivation techniques that appear the most promising.RENNES1-BU Santé (352382103) / SudocLYON1-BU Santé (693882101) / SudocSudocFranceF

Changing sero-epidemiology of hepatitis A in Asia Pacific countries: A systematic review

Objectives: Hepatitis A is a viral liver disease whose prevalence is associated with low socio-economic and hygiene levels due to its faecal–oral transmission. Severity increases with age, and immunity is life-long. Decreased endemicity could result in increased age and severity of cases. A literature review was conducted to describe changes in age-stratified hepatitis A seroprevalence in Asia Pacific countries from 1980 to 2016, and to identify gaps in the literature. The PRISMA guidelines were followed. Methods: The PubMed database was searched for studies on age-specific hepatitis A seroprevalence in 17 Asia Pacific countries. All studies published in the English language, reporting human hepatitis A seroprevalence levels in any age group, were included. Results: Seventy-three publications from 11 countries were identified. A trend of increasing age at first exposure over time was observed, particularly in developed countries such as Japan, Taiwan, Thailand, and Korea, suggesting a transition in terms of endemicity. Conclusions: Extensive gaps in the literature were identified between countries and year of publication, indicating the need for further research. Decreasing hepatitis A exposure and thus immunity conferred during childhood, may render older populations susceptible to infection. The public health and economic value of vaccination against hepatitis A should be assessed within this changing epidemiological context. Keywords: Hepatitis A, Seroprevalence, Asia Pacific, Epidemiolog

Human rabies in Côte d'Ivoire 2014-2016: Results following reinforcements to rabies surveillance.

In Côte d'Ivoire, rabies is endemic and remains largely uncontrolled. The numbers of human exposures and rabies cases are unknown and are probably much higher than reported. Data on human rabies cases are collected by the National Institute of Public Health (NIPH) Anti-rabies Center in Abidjan through a network of 28 NIPH local units, which cover the population of the entire country. During 2014, the NIPH initiated a program to reinforce the human rabies surveillance system in those 28 NIPH local units, with specific goals of improving the infrastructure, training, communication, and government involvement. Here, we report the progress and findings during 2014-2016. The reinforced system recorded 50 cases of human rabies (15-18 cases/year; annual incidence = 0.06-0.08 per 100,000) and more than 30,000 animal exposures (annual incidence = 41.8-48.0 per 100,000). Almost one-half of the human rabies cases were in children ≤15 years old. All were fatal and dog bites were the most common route by which rabies virus was transmitted. In the 32 cases where samples of sufficient quality for analysis were available, rabies was confirmed by reverse transcription-polymerase chain reaction RT-PCR. Post-exposure prophylaxis with rabies vaccine was administered to all animal exposure victims presenting at the NIPH local units, although only about 57% completed the full immunization schedule. All available reports were provided by the NIPH local units, indicating effective communication between them and the NIPH Anti-rabies Center. These findings indicate that the reinforcements resulted in highly specific detection of human rabies, provided detailed epidemiological data about these cases, and improved estimates of animal exposure numbers. These represent substantial advances, but further improvements to the surveillance system are needed to increase disease awareness and capture cases that are currently missed by the system. In the future, better communication between local health centers and the NIPH units, surveillance at the local health center level, and increased veterinarian engagement will help provide a more complete picture of the rabies burden in Côte d'Ivoire