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On the path to rabies elimination: The need for risk assessments to improve administration of post-exposure prophylaxis

BACKGROUND: Costs of rabies post-exposure prophylaxis (PEP) often remain high in regions where rabies has been controlled in dogs, presenting a challenge for sustaining rabies elimination programmes. We investigated the potential for bite patient risk assessments to improve PEP provision and surveil...

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Autores principales: Rysava, K., Miranda, M.E., Zapatos, R., Lapiz, S., Rances, P., Miranda, L.M., Roces, M.C., Friar, J., Townsend, S.E., Hampson, K.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier Science 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6863041/
https://www.ncbi.nlm.nih.gov/pubmed/30573356
http://dx.doi.org/10.1016/j.vaccine.2018.11.066
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author Rysava, K.
Miranda, M.E.
Zapatos, R.
Lapiz, S.
Rances, P.
Miranda, L.M.
Roces, M.C.
Friar, J.
Townsend, S.E.
Hampson, K.
author_facet Rysava, K.
Miranda, M.E.
Zapatos, R.
Lapiz, S.
Rances, P.
Miranda, L.M.
Roces, M.C.
Friar, J.
Townsend, S.E.
Hampson, K.
author_sort Rysava, K.
collection PubMed
description BACKGROUND: Costs of rabies post-exposure prophylaxis (PEP) often remain high in regions where rabies has been controlled in dogs, presenting a challenge for sustaining rabies elimination programmes. We investigated the potential for bite patient risk assessments to improve PEP provision and surveillance in settings approaching elimination of dog-mediated rabies. METHODS: We conducted a longitudinal study of patients presenting to animal bite treatment centres (ABTCs) on the island province of Bohol in the Philippines to investigate the health status of biting dogs and to quantify current expenditure on PEP. RESULTS: Incidence of bite patients presenting to ABTCs was high (>300/100,000 persons/year) and increasing, resulting in substantial health provider costs. Over $142,000 was spent on PEP in 2013 for a population of 1.3 million. From follow up of 3820 bite patients we found that  >92% were bitten by healthy dogs (alive 14 days after the bite) and just 1.4% were bitten by probable or confirmed rabid dogs. The status of dogs that bit 6% of patients could not be determined. During the course of investigations of bites by suspect dogs, we were able to obtain samples for case confirmation, identify exposed persons who had not sought PEP as well as in-contact dogs at risk of developing rabies. We calculate that expenditure on PEP could at least be halved through more judicious approaches to provision of PEP, based on the histories of biting animals determined through risk assessments with bite patients. CONCLUSIONS: We conclude that a One Health approach to surveillance based on Integrated Bite Case Management could improve the sustainability and effectiveness of rabies elimination programmes while also improving patient care by identifying those genuinely in need of lifesaving PEP.
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spelling pubmed-68630412019-11-22 On the path to rabies elimination: The need for risk assessments to improve administration of post-exposure prophylaxis Rysava, K. Miranda, M.E. Zapatos, R. Lapiz, S. Rances, P. Miranda, L.M. Roces, M.C. Friar, J. Townsend, S.E. Hampson, K. Vaccine Article BACKGROUND: Costs of rabies post-exposure prophylaxis (PEP) often remain high in regions where rabies has been controlled in dogs, presenting a challenge for sustaining rabies elimination programmes. We investigated the potential for bite patient risk assessments to improve PEP provision and surveillance in settings approaching elimination of dog-mediated rabies. METHODS: We conducted a longitudinal study of patients presenting to animal bite treatment centres (ABTCs) on the island province of Bohol in the Philippines to investigate the health status of biting dogs and to quantify current expenditure on PEP. RESULTS: Incidence of bite patients presenting to ABTCs was high (>300/100,000 persons/year) and increasing, resulting in substantial health provider costs. Over $142,000 was spent on PEP in 2013 for a population of 1.3 million. From follow up of 3820 bite patients we found that  >92% were bitten by healthy dogs (alive 14 days after the bite) and just 1.4% were bitten by probable or confirmed rabid dogs. The status of dogs that bit 6% of patients could not be determined. During the course of investigations of bites by suspect dogs, we were able to obtain samples for case confirmation, identify exposed persons who had not sought PEP as well as in-contact dogs at risk of developing rabies. We calculate that expenditure on PEP could at least be halved through more judicious approaches to provision of PEP, based on the histories of biting animals determined through risk assessments with bite patients. CONCLUSIONS: We conclude that a One Health approach to surveillance based on Integrated Bite Case Management could improve the sustainability and effectiveness of rabies elimination programmes while also improving patient care by identifying those genuinely in need of lifesaving PEP. Elsevier Science 2019-10-03 /pmc/articles/PMC6863041/ /pubmed/30573356 http://dx.doi.org/10.1016/j.vaccine.2018.11.066 Text en © 2019 The Authors http://creativecommons.org/licenses/by/4.0/ This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Rysava, K.
Miranda, M.E.
Zapatos, R.
Lapiz, S.
Rances, P.
Miranda, L.M.
Roces, M.C.
Friar, J.
Townsend, S.E.
Hampson, K.
On the path to rabies elimination: The need for risk assessments to improve administration of post-exposure prophylaxis
title On the path to rabies elimination: The need for risk assessments to improve administration of post-exposure prophylaxis
title_full On the path to rabies elimination: The need for risk assessments to improve administration of post-exposure prophylaxis
title_fullStr On the path to rabies elimination: The need for risk assessments to improve administration of post-exposure prophylaxis
title_full_unstemmed On the path to rabies elimination: The need for risk assessments to improve administration of post-exposure prophylaxis
title_short On the path to rabies elimination: The need for risk assessments to improve administration of post-exposure prophylaxis
title_sort on the path to rabies elimination: the need for risk assessments to improve administration of post-exposure prophylaxis
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6863041/
https://www.ncbi.nlm.nih.gov/pubmed/30573356
http://dx.doi.org/10.1016/j.vaccine.2018.11.066
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