Background 
In Mozambique, the majority of rabies outbreaks are unreported and data on the epidemiological features of human rabies and animal bites are scarce. An outbreak of human rabies in adjacent Maputo and Matola cities in 2014 prompted us to investigate the epidemiology, clinical features and risk factors of human rabies and animal bites in the two cities.


Methodology/Principal findings 
We reviewed cases of human rabies and animal bites from April to July 2014, and carried out a community investigation in July and August in the neighborhoods where cases of human rabies resided. This investigation included collection of clinical, demographic and epidemiological information and a case control study to investigate the risk factors associated with human rabies. Fourteen cases of human rabies were detected in Maputo (n = 10) and Matola (n = 3) cities and neighbouring Boane district (n = 1) between April and August 2014, all of whom had been admitted to hospital. All had a recent history of dog bite. Of the 14 rabid dogs, only one had been immunized. 819 cases of animal bites were registered, of which 64.6% (529/819) were from Maputo City. Dogs were responsible for 97.8% (801/819) of all animal bites, but only 27.0% (126/467) were immunized. Factors significantly associated with human rabies were: age <15 years (p = 0.05), bite by stray dog (p = 0.002), deep wound (p = 0.02), bite in the head (p = 0.001), bite by unimmunized dog (p = 0.01), no use of soap and water (p = 0.001), and no post-exposure prophylaxis (p = 0.01).


Conclusions/Significance 
Implementation of control measures for rabies is poor in Maputo and Matola cities, where cases of human rabies were strongly associated with bites by stray and unvaccinated dogs and irregular implementation of post-exposure measures.

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Epidemiology, clinical features and risk factors for human rabies and animal bites during an outbreak of rabies in Maputo and Matola cities, Mozambique, 2014: Implications for public health interventions for rabies control.

Dog rabies control in West and Central Africa: A review.

Resumo Objetivo: descrever o perfil epidemiologico da raiva humana no Brasil. Metodos: estudo descritivo dos casos de raiva humana notificados em 2000-2017; estimou-se a incidencia e distribuicao espacial. Resultados: 188 casos humanos observados, na maioria homens (66,5%), residentes rurais (67,0%), menores de 15 anos de idade (49,6%), com exposicao mais frequente por mordedura (81,9%); o periodo 2000-2008 apresentou maior frequencia (85,6%), com 46,6% dos casos envolvendo caes e 45,9% morcegos; incubacao mediana de 50 dias, seguida de sintomatologia predominante de febre (92,6%), agitacao (85,2%), parestesia (66,7%) e disfagia/paralisia (51,9%); a maioria (70,2%) nao fez profilaxia, os demais (29,8%) realizaram-na de forma inoportuna e/ou incompleta; 13 pacientes foram tratados pelo Protocolo de Recife e dois sobreviveram. Conclusao: houve reducao na incidencia de raiva humana e mudanca no perfil epidemiologico, predominando casos transmitidos por morcegos; sugere-se investigar casos secundarios e viabilizar a profilaxia pre-exposicao em populacoes sob maior risco de acidentes com morcegos.

/pdf/human-rabies-in-brazil-a-descriptive-study-2000-2017-31bykbatew.pdf

Human rabies in Brazil: a descriptive study, 2000-2017.

Dog Ecology, Bite Incidence, and Disease Awareness: A Cross-Sectional Survey among a Rabies-Affected Community in the Democratic Republic of the Congo.

Introduction Rabies is one of the major public health problems mostly affecting developing countries in Africa and Asia where 99.9% of all rabies related human deaths are recorded each year. In Democratic Republic of Congo, repeated outbreaks have been reported. Despite this, there is little reliable epidemiological data about rabies in the country for the development of effective control strategies. Materials and methods A retrospective study was carried out in Kinshasa Province during a period of five years (2009-2013) to describe the proportion of rabid animals and the species involved in rabies transmission and maintenance. The survey also aimed at describing the spatial-temporal distribution of rabies. To gather information, the daily registers of institutions involved in rabies diagnosis were reviewed and each rabies case was traced back to area of occurrence for collection of geographic coordinates. Results and discussion A total of 5,053 attacks were registered involving six animal species including dog, cat, monkey, rabbit, rat, and pig. Based on clinical observations, rabies was reported in dogs and cats while data obtained from the laboratory confirmed rabies cases included dogs, cats and a goat. The annual distribution showed a significant decrease of rabies cases from 2009 up to 2011 and a later increase up to 2013. There was no difference in rabies occurrence between seasons (p = 0.721). Rabies cases were three times higher in peri-urban zone than in urban zone OR = 3.4 (95% CI: 2.3-5.1). The positive proportion of rabies was 2.6% (95% CI: 2.1-3) based on clinical evidence and 65.9% (95% CI: 50-79.5) for laboratory confirmed cases. Conclusion and suggestion This study confirms the endemicity of rabies in Kinshasa where occurrence of rabies cases was related to human population density and lifestyle. In order to control rabies, there is need to set up a surveillance program and implement efficient mass vaccination campaigns of susceptible animals.

Overview of Animal Rabies in Kinshasa Province in the Democratic Republic of Congo.

Objectives:Human rabies has recently emerged as a significant public health threat in Kinshasa, Democratic Republic of Congo (DRC). However, there is little epidemiological information on human rabies especially in children.Methods:We performed at Pediatrics Department of General Reference hospital of Kinshasa between December 2008 and July 2009, a retrospective study to assess the incidence and to describe their clinical aspects and outcome.Results:A total of 21 cases were observed, rather three cases per month. There were 12 boys (57·1%) and 9 girls (42·9%). Biting animal was found to be dog in all cases (100%). The dog was not immunized in all of cases. On admission, all patients (100%) showed furious rabies manifestations. Only two (9·5%) had their wounds treated and received an anti-rabies vaccine (ARV) after the bite incident. Two (9·5%) patients received rabies immunoglobulin (RIG). The case-fatality rate was 100%.Conclusions:The disease emerges as a new major public health problem because ...

Delphin I. Muyila

Papers

Human rabies: a descriptive observation of 21 children in Kinshasa, the Democratic Republic of Congo