Rabies Situation in Cambodia

In Cambodia, rabies still elicits fear in the communities. Since 1998 the Institut Pasteur in Cambodia (IPC), Phnom Penh has been the only source of free post-exposure prophylaxis (PEP) and post mortem diagnosis. During 1998–2007, on average ∼12,400 patients received PEP annually at IPC (range 8,907–14,475) and 63 fatal human cases presenting with encephalitis following a dog bite were reported including 73% who tested positive by fluorescent-antibody test on brain samples or/and by reverse-transcriptase polymerase chain reaction on skin, cerebrospinal fluid, or urine. In 2007, 14,475 patients received PEP (100 PEP/100,000 people in Cambodia) including 95% who resided in Phnom Penh city (615 PEP/100,000) or five neighboring provinces. Using a step-by-step probability model, we estimated that 810 human rabies deaths would occur in 2007 (95% confidence interval [CI] 394–1,607); an incidence of 5.8/100,000 (95%CI 2.8–11.5). As a result, despite high attendance at the IPC's PEP center most Cambodians living in peripheral provinces in Cambodia may not have adequate access to PEP. Finally, the model generated one of the highest incidences of rabies worldwide. A national rabies control program is needed to improve surveillance and access to PEP, and to initiate vaccination campaigns in dogs

Model parameters for estimating the probability of human deaths caused by rabies virus infection, Cambodia, 2007.

<p>Note: SRDBI: Suspected rabid dog bite injuries; PEP: Post-exposure treatment; IPC: Institut Pasteur in Cambodia.</p

Geographic distribution of rabies in dogs and humans, and incidence of post-exposure treatment, Cambodia, 1998–2007.

<p>Geographic distribution of rabies in dogs and humans, and incidence of post-exposure treatment, Cambodia, 1998–2007.</p

Probability tree for estimating the probability of death following a suspected rabid dog bite injury.

<p>Probability tree for estimating the probability of death following a suspected rabid dog bite injury.</p

Positive predictive values of suspected rabid dog characteristics when reported alone - dogs from 14 provinces in Cambodia, 2007.

<p>Positive predictive values of suspected rabid dog characteristics when reported alone - dogs from 14 provinces in Cambodia, 2007.</p