Description
Introduction
Rabies is a neglected tropical disease that is endemic to Malawi, killing almost 500 people every year. Domestic dogs are implicated as the main reservoir for rabies. However, there is limited capacity to detect canine rabies in the country, particularly in urban areas where there are high dog densities. The Lilongwe Society for the Protection and Care of Animals designed and implemented a canine community-based rabies surveillance (CBRS) in Lilongwe city between January and June 2020. This study assessed the effectiveness of the CBRS program in canine rabies detection compared to the traditional passive routine surveillance data of the years between 2015 and 2019. Furthermore, the study determined rabies Post-Exposure Prophylaxis (PEP) issuance trends in emergent cases.
Methods
The study was conducted between January and June 2020. Cases of rabies suspicion in animals was based on bites, and/or being a Post-Exposure Prophylaxis recommended patient. In addition all cases involving sudden animal behavioral changes reported through tool-free telephone calls were equally treated as rabies suspected cases. Suspected cases were recorded and followed. The dogs that were found alive were quarantined for 10 days for observation. Brain samples were collected postmortem for antigen detection using a direct-fluorescent antibody test. We collected demographic and information on PEP uptake. We calculated descriptive statistics, and odds ratios (OR) to examine probability of showing the different signs of rabies across the rabies definitions.
Results
There were 610 suspected cases, and only 217 (39.2%) were followable. Out of these, 150 (62.8%) were followed. A total of 9 dogs (6%) tested positive, and there were 11 (7.3%) probable cases. This represents a 4.97-fold increase in detected rabies cases compared to the pre-surveillance period, with a resultant of 3.33 cases/month from 0.67 cases/month. Hydrophobia (OR = 13.158(CI: 6.757-25.64)), hypersalivation (OR = 14.706 (CI: 2.994-71.4)), anorexia (OR = 11.628 (CI: 2.105-62.5)), abnormal vocalization (OR = 5.263 (CI:.86-32.258)) and lethargy (OR = 13.158(CI: 6.758-29.4)) were significantly associated with being a confirmed rabies case. There were 141 bite victims and 136 (96.5%) reported for PEP. Out of these, 89 (65.4%) were from healthy bites and 33 (24.4%) from suspect cases indicating a 63.1-87.6% rate of irrelevant PEP issuance. 5 indivuals who were exposed individuals were advised to seek PEP treatment immediately.
Conclusion
The CBRS program established relevance in increasing canine rabies detection and subsequent prevention of related human infections. Despite this success, the high rate of PEP issuance, particularly in response to healthy bites, underscores the need for optimized usage. Consequently, we advocate for intensified multi-sectoral collaboration to enhance rabies detection and ensure judicious PEP utilization.
| Contact Geneva Health Forum | I would like to receive information about the GHF 2024 conference and other GHF activities / Je souhaite recevoir des informations sur la conférence GHF 2024 et d'autres activités du GHF. |
|---|
