The epidemiology of animal bite injuries in Uganda and projections of the burden of rabies
The epidemiology of animal bite injuries in Uganda and projections of the burden of rabies
复制标题
DOI：
10.1111/j.1365-3156.2005.01447.x
复制
发表时间：
2005-08-01
影响因子：
3.3
通讯作者：
Cleaveland, S
中科院分区：
文献类型：
--
作者：
Fèvre, EM;Kaboyo, RW;Cleaveland, S
狂犬病是一个全球性问题，尽管在发展中国家往往报告不足。我们的目的是描述的档案，病人提出的卫生中心与动物咬伤在乌干达，并使用预测模型，以估计狂犬病的死亡率在nationallevel.METHODS我们进行了被动监测研究在乌干达的基础上，在一个随机抽样的卫生中心提供狂犬病疫苗，以确定咬伤患者的特点，并建立患者的年龄和性别概况，咬伤的部位及其严重程度、伤口处理技术和所提供的疫苗接种过程的细节。我们还采用了决策树模型的数据估计的狂犬病死亡率的咬伤数据，使用一个既定的protocol.RESULTS我们发现，大多数患者被狗咬伤，其中有相当大的比例是年幼的儿童，谁是在更大的风险发展狂犬病在没有治疗的情况下，由于他们收到的叮咬的位置。根据保守的参数估计，我们估计，在没有暴露后预防（PET）的情况下，将发生592例死亡（95%CI 345-920），并且如果一剂PET足以在狂犬病动物咬伤后提供保护，则每年将发生20例（95%CI 5-50）死亡。如果一个完整的过程中的PET是需要保护狂犬病动物咬伤后，高达210（95%CI 115-359）死亡将发生，因为41%的患者没有完成他们的过程PET.CONCLUSIONS积极的动物咬伤监测研究，需要提高我们的死亡率估计，并确定真正的负担狂犬病在乌干达人口。我们强调，需要开展小规模的主动病例检测研究，并改进关于犬狂犬病识别的数据，作为改进国家一级狂犬病死亡率估计的投入。
OBJECTIVES Rabies is a global problem, although it is often under-reported in developing countries. We aimed at describing the profile of patients presenting to health centres with animal bite injuries in Uganda, and use a predictive model to estimate the mortality of rabies at a national level.METHODS We conducted a passive surveillance study in Uganda based in a random sample of health centres supplied with rabies vaccine to determine the characteristics of bite injury patients and establish the age and sex profiles of patients, the site of bites and their severity, wound management techniques and details of the vaccination course given. We also applied a decision tree model to the data to estimate the rabies mortality from the bite injury data using an established protocol.RESULTS We found that most patients are bitten by dogs, and that a considerable proportion of these are young children, who are at greater risk of developing rabies in the absence of treatment due to the location of the bites they receive. From conservative parameter estimates, we estimate that in the absence of post-exposure prophylaxis (PET), 592 (95% CI 345-920) deaths would occur, and that if one dose of PET is sufficient for protection following a rabid animal bite, 20 (95% CI 5-50) deaths would occur annually. If a complete course of PET is required for protection following a rabid animal bite, up to 210 (95% CI 115-359) deaths would occur, as 41% of patients did not complete their course of PET.CONCLUSIONS Active animal bite surveillance studies are required to improve our mortality estimates and determine the true burden of rabies in the Ugandan population. We emphasize the need for small-scale active case detection studies and improved data on the recognition of rabies in dogs as inputs for improving national-level estimates of rabies mortality.