Epidemiology, Impact and Control of Rabies in Nepal: A Systematic Review.
Epidemiology, Impact and Control of Rabies in Nepal: A Systematic Review.
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尼泊尔狂犬病的流行病学，影响和控制：系统评价。
DOI：
10.1371/journal.pntd.0004461
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发表时间：
2016-02
影响因子：
3.8
通讯作者：
Speybroeck N
中科院分区：
文献类型：
--
作者：
Devleesschauwer B;Aryal A;Sharma BK;Ale A;Declercq A;Depraz S;Gaire TN;Gongal G;Karki S;Pandey BD;Pun SB;Duchateau L;Dorny P;Speybroeck N
狂犬病是一种疫苗可预防的人畜共患病，属于被忽视的热带疾病组。如果不提供有效的暴露后预防措施，接触狂犬病动物可能会导致致命的急性脑炎。狂犬病在世界范围内发生，但其负担在包括尼泊尔在内的发展中国家高得不成比例。我们的目的是总结目前关于尼泊尔狂犬病的流行病学、影响和控制的知识。我们通过世界卫生组织数字图书馆和尼泊尔国家人畜共患病和食品卫生研究中心图书馆，以及通过搜索谷歌和谷歌学者，对国际和国内科学文献进行了系统审查，并搜索了灰色文献。从尼泊尔有关政府机构获得了关于动物和人类狂犬病的进一步数据。最后，我们调查了一家尼泊尔日报的档案，以获得关于尼泊尔狂犬病的定性信息。到目前为止，关于狂犬病在尼泊尔的流行病学和影响的原创性研究很少。据报道，每年约有100头牲畜和10-100人死于狂犬病，而据报道，约有1,000头牲畜和35,000人在暴露后接受狂犬病预防。然而，这些估计很可能严重低估了真正的狂犬病负担。在以细胞培养为基础的抗狂犬病疫苗和狂犬病免疫球蛋白的生产方面取得了重大进展，但供应和供应仍然是一个令人关切的问题，特别是在偏远地区。多年来，不同的国家和非国家行为者发起了狂犬病控制活动，但努力通常集中、持续时间短且不协调。目前兽医和人类卫生当局之间的沟通和协调有限，使尼泊尔的狂犬病控制进一步复杂化。重要的研究空白包括对人类和动物狂犬病的报道偏差、流浪狗种群的生态以及森林周期的真正贡献。需要更好的数据来揭开动物和人类狂犬病的真正负担。为了控制狂犬病，需要在国内和该地区进行更多的合作。要实现这些目标，高水平的政治承诺至关重要。因此，我们建议将狂犬病作为尼泊尔成功控制的模式人畜共患病。几十年来，狂犬病一直被认为是尼泊尔的一种致命疾病，但有关流行病学、影响和控制的信息仍然零星。我们从各种来源收集和总结信息，包括科学文献和政府机构。在尼泊尔，关于狂犬病的流行病学和影响的原创性研究很少，留下了许多悬而未决的问题。官方报告显示，每年有100头牲畜和10-100人死于狂犬病，但这些数字很可能低估了狂犬病的真实负担。抗狂犬病疫苗的可获得性和供应量仍然不佳，狂犬病控制活动因缺乏合作和全面而受到阻碍。高级别的政治承诺对于克服这些问题和减轻狂犬病的负担至关重要。因此，我们建议将狂犬病作为尼泊尔成功控制的模式人畜共患病。
Rabies is a vaccine-preventable viral zoonosis belonging to the group of neglected tropical diseases. Exposure to a rabid animal may result in a fatal acute encephalitis if effective post-exposure prophylaxis is not provided. Rabies occurs worldwide, but its burden is disproportionately high in developing countries, including Nepal. We aimed to summarize current knowledge on the epidemiology, impact and control of rabies in Nepal. We performed a systematic review of international and national scientific literature and searched grey literature through the World Health Organization Digital Library and the library of the National Zoonoses and Food Hygiene Research Centre, Nepal, and through searching Google and Google Scholar. Further data on animal and human rabies were obtained from the relevant Nepalese government agencies. Finally, we surveyed the archives of a Nepalese daily to obtain qualitative information on rabies in Nepal. So far, only little original research has been conducted on the epidemiology and impact of rabies in Nepal. Per year, rabies is reported to kill about 100 livestock and 10–100 humans, while about 1,000 livestock and 35,000 humans are reported to receive rabies post-exposure prophylaxis. However, these estimates are very likely to be serious underestimations of the true rabies burden. Significant progress has been made in the production of cell culture-based anti-rabies vaccine and rabies immunoglobulin, but availability and supply remain a matter of concern, especially in remote areas. Different state and non-state actors have initiated rabies control activities over the years, but efforts typically remained focalized, of short duration and not harmonized. Communication and coordination between veterinary and human health authorities is limited at present, further complicating rabies control in Nepal. Important research gaps include the reporting biases for both human and animal rabies, the ecology of stray dog populations and the true contribution of the sylvatic cycle. Better data are needed to unravel the true burden of animal and human rabies. More collaboration, both within the country and within the region, is needed to control rabies. To achieve these goals, high level political commitment is essential. We therefore propose to make rabies the model zoonosis for successful control in Nepal. Rabies has been known as a deadly disease in Nepal for decades, but information on epidemiology, impact and control remains scattered. We collected and summarized information from a variety of sources, including scientific literature and government agencies. Only little original research has been conducted on the epidemiology and impact of rabies in Nepal, leaving many questions unanswered. Official reports show that each year 100 livestock and 10–100 humans die of rabies, but these numbers very likely underestimate the true rabies burden. Availability and supply of anti-rabies vaccines have remained suboptimal and rabies control activities have been hampered by a lack of collaboration and comprehensiveness. High level political commitment is essential to overcome these problems and to reduce the burden of rabies. We therefore propose to make rabies the model zoonosis for successful control in Nepal.