Healthcare utilization, provisioning of post-exposure prophylaxis, and estimation of human rabies burden in Madagascar.
Healthcare utilization, provisioning of post-exposure prophylaxis, and estimation of human rabies burden in Madagascar.
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DOI：
10.1016/j.vaccine.2018.11.011
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发表时间：
2019-10-03
期刊：
影响因子：
5.5
通讯作者：
Hampson K
中科院分区：
文献类型：
--
作者：
Rajeev M;Edosoa G;Hanitriniaina C;Andriamandimby SF;Guis H;Ramiandrasoa R;Ratovoson R;Randrianasolo L;Andriamananjara M;Heraud JM;Baril L;Metcalf CJE;Hampson K
在马达加斯加，犬介导的狂犬病已经流行了世纪，但关于其发病率或影响的数据很少。我们收集了16个月内在Moramanga区的一个重点诊所提供暴露后预防（PEP）的数据，并使用临床和实验室诊断确定咬人动物的狂犬病状态。我们发现动物狂犬病病例很普遍，基于临床的分诊和调查是增加狂犬病暴露检测和排除非病例的有效方法。来自Moramanga的高比例狂犬病暴露者寻求（84%）并完成了PEP（90%的人发起了PEP），这可能反映了该地区PEP的获得和免费提供。目前的临床小瓶共享实践证明了PEP在非洲流行环境中皮内给药的潜力，与肌内给药相比，减少了50%的疫苗使用。PEP需求的高比例归因于狂犬病病例，约20%的PEP用于可能的狂犬病暴露，另外20%用于与确诊/可能的动物或人类病例的低风险或无风险接触。使用简化的决策树和我们关于狂犬病暴露状况和寻求健康行为的数据，我们估计每年每10万人中有42-110例狂犬病暴露和1-3例死亡。外推到马达加斯加，我们估计每年有282-745人死于狂犬病，而目前的PEP供应每年可避免1499-3958人死亡。需要其他诊所和地区的数据来改善这些估计，特别是考虑到PEP的可用性目前仅限于该国的31个诊所。大规模犬只疫苗接种、加强监测和扩大PEP的使用沿着更明智的管理指南的综合策略可以有效减少并最终消除马达加斯加的狂犬病负担。
In Madagascar, dog-mediated rabies has been endemic for over a century, however there is little data on its incidence or impact. We collected data over a 16-month period on provisioning of post-exposure prophylaxis (PEP) at a focal clinic in the Moramanga District and determined the rabies status of biting animals using clinical and laboratory diagnosis. We find that animal rabies cases are widespread, and clinicbased triage and investigation are effective ways to increase detection of rabies exposures and to rule out non-cases. A high proportion of rabies-exposed persons from Moramanga sought (84%) and completed PEP (90% of those that initiated PEP), likely reflecting the access and free provisioning of PEP in the district. Current clinic vial sharing practices demonstrate the potential for intradermal administration of PEP in endemic African settings, reducing vaccine use by 50% in comparison to intramuscular administration. A high proportion of PEP demand was attributed to rabies cases, with approximately 20% of PEP administered to probable rabies exposures and an additional 20% to low-to-no risk contacts with confirmed/probable animal or human cases. Using a simplified decision tree and our data on rabies exposure status and health-seeking behavior, we estimated an annual incidence of 42-110 rabies exposures and 1-3 deaths per 100,000 persons annually. Extrapolating to Madagascar, we estimate an annual burden of 282-745 human rabies deaths with current PEP provisioning averting 1499-3958 deaths each year. Data from other clinics and districts are needed to improve these estimates, particularly given that PEP availability is currently limited to only 31 clinics in the country. A combined strategy of mass dog vaccination, enhanced surveillance, and expanded access to PEP along with more judicious guidelines for administration could effectively reduce and eventually eliminate the burden of rabies in Madagascar.
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影响因子：
8.4
作者：
Sudarshan, M. K.;Madhusudana, S. N.;Gangaboraiah
通讯作者：
Gangaboraiah
影响因子：
3.8
作者：
Hampson K;Coudeville L;Lembo T;Sambo M;Kieffer A;Attlan M;Barrat J;Blanton JD;Briggs DJ;Cleaveland S;Costa P;Freuling CM;Hiby E;Knopf L;Leanes F;Meslin FX;Metlin A;Miranda ME;Müller T;Nel LH;Recuenco S;Rupprecht CE;Schumacher C;Taylor L;Vigilato MA;Zinsstag J;Dushoff J;Global Alliance for Rabies Control Partners for Rabies Prevention
通讯作者：
Global Alliance for Rabies Control Partners for Rabies Prevention
柬埔寨的狂犬病情况。
影响因子：
3.8
作者：
Ly, Sowath;Buchy, Philippe;Heng, Nay Yim;Ong, Sivuth;Chhor, Nareth;Bourhy, Herve;Vong, Sirenda
通讯作者：
Vong, Sirenda
影响因子：
9.8
作者：
Hampson K;Dushoff J;Cleaveland S;Haydon DT;Kaare M;Packer C;Dobson A
通讯作者：
Dobson A
DOI：
10.1016/s2214-109x(17)30321-2
发表时间：
2017-10
期刊：
The Lancet. Global health
影响因子：
--
作者：
Etheart MD;Kligerman M;Augustin PD;Blanton JD;Monroe B;Fleurinord L;Millien M;Crowdis K;Fenelon N;Wallace RM
通讯作者：
Wallace RM