Patterns of Rabies Occurrence in Bhutan between 1996 and 2009

This study was conducted to evaluate incidence and seasonal trends of rabies in dogs and other domestic animals in Bhutan from 1996 to 2009. Time series analysis approach was used to determine the seasonal trend and temporal association between species-specific rabies cases in animals. A total of 814 rabies cases were reported during the 14-year period, of which cattle and domestic dogs accounted for 55% (447/814) and 39% (317/814) of the cases, respectively. The remaining 6% of the cases (50/814) were reported in horses (2%), cats (2%), pigs (1%) and goats (1%). Rabies cases were reported throughout the year with more reports during spring and summer months. The annual patterns of cases were stable from 1996 to 2005, but the incidence increased during 2006 and 2008. Fifty-nine of the 205 sub-districts reported rabies in animals from 1996 to 2009 with increased incidences in the four districts in southern Bhutan, an area located close to the border towns of India. A significant (P < 0.05) positive cross-correlation was observed between the number of cases in dogs and other domestic animals at time lags (months) 1–3 with the highest correlation (r = 0.94, P < 0.05) observed at time lag 0 (same month) indicating that the peak in rabies incidences occur in the same month when both dogs and other domestic animal cases are reported. Regression analysis predicted rabies in other domestic animal when there are reports of rabies in dogs during the previous months. This study provides useful information about the epidemiology of rabies that can be used to plan a rabies control programme in Bhutan. Keywords: Rabies; domestic animals; surveillance; time series analysis; Bhutan Impacts This study evaluated rabies incidence and seasonal trends in domestic animals in Bhutan from 1996 to 2009. Rabies cases in animals were reported throughout the year with a higher incidence during spring and summer months. The number of reported cases was stable from 1996 to 2005 but increased in 2006 and 2008. Fifty-nine of the 205 sub-districts reported rabies between 1996 and 2009, with a higher incidence in southern Bhutan. There was a positive temporal correlation between the number of cases reported in dogs and other domestic animals

Anthropogenic and environmental risk factors for rabies occurrence in Bhutan.

Anthropogenic and environmental factors were assessed as predictors of sub-districts in Bhutan that reported rabies in domestic animals during the period 1996−2009. Rabies surveillance data were retrieved from the Veterinary Information System database. Anthropogenic and environmental information were obtained from public data sources. Using the total number of rabies cases reported in domestic animals, the 205 sub-districts of Bhutan were categorized as those sub-districts that reported rabies and those that did not report rabies (n=146). Logistic regression models were fit to the data and odds ratios and 95% confidence intervals were estimated. Sub-districts that share a border with India (OR 10.43; 95% CI: 4.42–24.64; P<0.001); sub-districts connected by major roads (OR 3.09; 95% CI: 1.24–7.68; P=0.015); and greater human population density (OR 3.26; 95% CI: 1.48–7.21, P=0.003) were significantly associated with a sub-district reporting animal rabies in Bhutan during 1996−2009. Results suggest that human population characteristics play an important role in rabies occurrence. Keywords: Rabies, domestic animals, anthropogenic and environmental risk factors, Bhuta

Human rabies post exposure prophylaxis in Bhutan, 2005-2008: Trends and risk factors.

The aim of this study was to understand the use and distribution of human rabies post exposure prophylaxis (PEP) vaccine in Bhutan and to identify risk factors for receiving an incomplete course of the vaccine. We analysed post exposure treatment records from 28 medical hospitals from 2005 to 2008. Males (59%) accounted for significantly more PEP events than females (41%) across all age groups (P 2800 events, respectively. Significantly (P < 0.001) more PEP events were reported from the southern parts of Bhutan that are endemic for rabies or those areas in eastern Bhutan that have reported rabies outbreaks than other parts of Bhutan. Forty percent (n = 3360) of the patients received an incomplete course of vaccine (<5-doses of vaccine intramuscular). Results suggest that patients with animal bite injury were less likely to receive an incomplete vaccine course than non-bite recipients, and patients presented to hospitals in rabies endemic or outbreak areas were less likely to receive an incomplete course than in non-rabies areas or rabies free areas. Similarly, patients presenting to hospitals for PEP during spring and summers months were less likely to receive an incomplete vaccine course than those during other seasons. Public education campaigns need to be conducted in Bhutan to reduce dog bite incidents and also to prevent mass exposures to rabies. A thorough assessment of each individual case based on the WHO guidelines would reduce unnecessary PEP (and therefore costs) in Bhutan

Re-emergence of rabies in dogs and other domestic animals in eastern Bhutan, 2005-2007

We report a major outbreak of rabies in dogs and other domestic animals that occurred in eastern Bhutan between May 2005 and November 2007. The outbreak peaked in February 2006 and subsided by the end of April 2006 with sporadic cases reported until November 2007. Rabies affected 18 of the 40 sub-districts in the three eastern districts of Bhutan. There were reportedly one human and 256 domestic animal fatalities. The outbreak affected cattle (n=141, 55%), dogs (n=106, 41%), horses (n=7, 3%) and cats (n=2, 1%). Rabies was primarily diagnosed by clinical signs but 36 cases were confirmed by fluorescent antibody test of brain samples. High densities and movements of free-roaming dogs might have been responsible for the rapid spread and persistence of the infection for a longer period than expected in dogs in eastern Bhutan. Key words: Eastern Bhutan, epidemic, rabies outbreak

Re-emergence of rabies in dogs and other domestic animals in eastern Bhutan, 2005-2007

postprintWe report a major outbreak of rabies in dogs and other domestic animals that occurred in eastern Bhutan between May 2005 and November 2007. The outbreak peaked in February 2006 and subsided by the end of April 2006 with sporadic cases reported until November 2007. Rabies affected 18 of the 40 sub-districts in the three eastern districts of Bhutan. There were reportedly one human and 256 domestic animal fatalities. The outbreak affected cattle (n=141, 55%), dogs (n=106, 41%), horses (n=7, 3%) and cats (n=2, 1%). Rabies was primarily diagnosed by clinical signs but 36 cases were confirmed by fluorescent antibody test of brain samples. High densities and movements of free-roaming dogs might have been responsible for the rapid spread and persistence of the infection for a longer period than expected in dogs in eastern Bhutan. Key words: Eastern Bhutan, epidemic, rabies outbreak

Community-based study on knowledge, attitudes and perception of rabies in Gelephu, south-central Bhutan.

postprintCommunity knowledge, attitudes and practices are important both for prevention of human deaths due to rabies and for control of the disease in animals. This study was a cross-sectional survey investigating the level of community knowledge as well as attitudes and perceptions about rabies in Gelephu, south central Bhutan, a region endemic for rabies. A total of 615 household respondents were interviewed, of which 224 (36%) were males and 391 (64%) were females. The majority of the respondents had high level of knowledge, and attitude and perception of rabies, and has a positive attitude towards the prevention and control of rabies. Multivariable logistic regression model showed that better knowledge about rabies was predicted by gender, educational level and dog ownership status of the respondents, whilst health-seeking behaviours of animal bite injuries were predicted by dog ownership status, presence of children in the household and occupation of the respondents. The majority of the respondents believed that stray dogs are a problem in the community and felt that it was important to control the dog population in Gelephu. These findings also indicate that there exists a knowledge gap about rabies in the community that could be improved by creating an awareness education programme. Keywords: Knowledge, Attitude, Perception, Rabies, Cross-sectional survey, Bhuta

Community-based study on knowledge, attitudes and perception of rabies in Gelephu, south-central Bhutan.

Community knowledge, attitudes and practices are important both for prevention of human deaths due to rabies and for control of the disease in animals. This study was a cross-sectional survey investigating the level of community knowledge as well as attitudes and perceptions about rabies in Gelephu, south central Bhutan, a region endemic for rabies. A total of 615 household respondents were interviewed, of which 224 (36%) were males and 391 (64%) were females. The majority of the respondents had high level of knowledge, and attitude and perception of rabies, and has a positive attitude towards the prevention and control of rabies. Multivariable logistic regression model showed that better knowledge about rabies was predicted by gender, educational level and dog ownership status of the respondents, whilst health-seeking behaviours of animal bite injuries were predicted by dog ownership status, presence of children in the household and occupation of the respondents. The majority of the respondents believed that stray dogs are a problem in the community and felt that it was important to control the dog population in Gelephu. These findings also indicate that there exists a knowledge gap about rabies in the community that could be improved by creating an awareness education programme. Keywords: Knowledge, Attitude, Perception, Rabies, Cross-sectional survey, Bhuta

Rabies virus strains circulating in Bhutan: implications for control.

postprintWe report a molecular epidemiological study of rabies virus strains circulating in animal populations in Bhutan, and investigate potential origins of these viruses. Twenty-three rabies virus isolates originating from dogs and other domestic animals were characterized by sequencing the partial nucleoprotein (N) gene (395 bp). Phylogenetic analysis was conducted and the Bhutanese isolates were compared with rabies viruses originating from other parts of the world. Phylogenetic analysis showed that Bhutanese isolates were highly similar and were closely related to Indian strains and South Asian Arctic–like–1 viruses. Our study suggests that the rabies viruses spreading in southern parts of Bhutan have originated from a common ancestor, perhaps from the Indian virus strain. Keywords: molecular epidemiology, rabies, Arctic–like virus, BhutanThailand Research Fund (grant No.DBG5180026

Rabies virus strains circulating in Bhutan: implications for control.

We report a molecular epidemiological study of rabies virus strains circulating in animal populations in Bhutan, and investigate potential origins of these viruses. Twenty-three rabies virus isolates originating from dogs and other domestic animals were characterized by sequencing the partial nucleoprotein (N) gene (395 bp). Phylogenetic analysis was conducted and the Bhutanese isolates were compared with rabies viruses originating from other parts of the world. Phylogenetic analysis showed that Bhutanese isolates were highly similar and were closely related to Indian strains and South Asian Arctic–like–1 viruses. Our study suggests that the rabies viruses spreading in southern parts of Bhutan have originated from a common ancestor, perhaps from the Indian virus strain. Keywords: molecular epidemiology, rabies, Arctic–like virus, BhutanThailand Research Fund (grant No.DBG5180026