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PubMed1999

Article I: Prevention and education regarding rabies in human beings. National Working Group on Rabies Prevention and Control.

Substantial changes in the epizootic characteristics of rabies have transpired in the United States during the past 50 years. Traditional veterinary practices and public health recommendations have effectively controlled rabies in dogs and prevented associated human fatalities; however, they have been unable to adequately address the problem of rabies in wildlife. Attributable in part to a renewed focus on emerging infectious diseases, a conference was held at the Centers for Disease Control and Prevention in 1993 to begin discussion focused on the reemergence of rabies and to formulate new suggestions for prevention and control of rabies in the United States. Three major working groups were formed from a national committee of professionals representing a broad array of biomedical disciplines. These groups concentrated on prevention of rabies in human beings, education, laboratory diagnosis of rabies, and rabies control in animals. The groups described the perceived minimum requirements to promote prevention and control of rabies in the United States into the next century. The following article describes the needs and recommendations identified by the prevention and education working group. Two other articles, scheduled for the Nov 15 and Dec 1, 1999 issues of JAVMA, will relay the needs and recommendations of the working groups on laboratory diagnosis of rabies and rabies in wildlife.

Animals↗
PubMed1986

Incidence of rabies and post-exposure treatment in developing countries.

The results are reported of a ranking analysis of epidemiological data of reservoirs of canine rabies in 30 countries. For those countries where combined antibody and vaccine are not routinely administered and the control of canine rabies is inadequate, "standard conditions" of 2000 human post-exposure treatments per million population per annum and 3 cases of human rabies per million population were derived. These parameters can be used to predict the cost-effectiveness of various strategies of rabies prevention and control.

Animals↗
PubMedDate not supplied

Human rabies postexposure prophylaxis during a raccoon rabies epizootic in New York, 1993 and 1994.

We describe the epidemiology of human rabies postexposure prophylaxis (PEP) in four upstate New York counties during the 1st and 2nd year of a raccoon rabies epizootic. We obtained data from records of 1,173 persons whose rabies PEP was reported to local health departments in 1993 and 1994. Mean annual PEP incidence rates were highest in rural counties, in summer, and in patients 10 to 14 and 35 to 44 years of age. PEP given after bites was primarily associated with unvaccinated dogs and cats, but most (70%) was not attributable to bites. Although pet vaccination and stray animal control, which target direct exposure, remain the cornerstones of human rabies prevention, the risk for rabies by the nonbite route (e. g., raccoon saliva on pet dogs' and cats' fur) should also be considered.

Adolescent↗
PubMed1991

Rabies.

Human rabies is extremely rare and canine rabies is largely controlled in the United States. Wild animals are now responsible for most of the rabies prevention costs and postexposure treatments in the United States, either by direct exposure of humans or by exposure of domestic animals. Although the situation is similar in most other developed countries, canine rabies remains widespread and a substantial risk to persons traveling in developing countries, where millions of people are exposed and tens of thousands die of rabies each year. People living in the United States should be advised to avoid contact with wild animals and stray or ill-appearing domestic animals. Travelers to rabies enzootic countries can substantially reduce the risk of rabies exposures by avoiding all dogs as well as wild animals; those persons whose risk of exposure cannot be reduced should be educated about rabies and should receive preexposure vaccination.

Animals↗
PubMed1996

[Rabies control in Brazil from 1980 to 1990].

The epidemiological situation of rabies in Brazil at the period of 1980 to 1990, when the National Program for Rabies Prevention was implemented on a national scale, and which yielded positive results, is presented. The main controlling actions carried out in order to achieve these results are also described. Rabies in Brasil registered a considerable decrease in human and canine cases (78% and 90%, respectively), half way through the series of analyses undertaken for this study. Towards the end of the decade, the disease began to recrudesce, several cases occurring in some parts of the country, mainly in the northeastern region, where 70% of the total number of infections for 1990 was recorded. Moreover, human rabies transmitted by bats experienced a considerable increase, accounting for 15.1% of the total. The Program, which is implemented by State and Municipal authorities. Covers the 350,000 people who are attacked by animals, and vaccinates approximately 9,000,000 animals every annually year. Epidemiological control is considered to be of basic importance, so that indicators for the definition of the areas of risk have been developed.

Animals↗
PubMed1991

Rabies control in the Republic of the Philippines: benefits and costs of elimination.

We compared the benefits and costs of eliminating animal and human rabies in the Philippines. If rabies had been eliminated in 1988, economic benefits would total P52.8 (US$2.5) million in 1989. These benefits would largely arise from the abolition of expenses associated with rabies prevention: P29.7 (US$1.4) million for animal vaccination, P21.6 (US$1.0) million for human postexposure prophylaxis, and P0.3 (US$0.02) million for animal rabies examinations. Benefits also included P1.2 (US$0.06) million in additional earnings of humans whose death due to rabies would be prevented. Nationwide elimination was estimated to cost between P88.1 (US$4.2) million and P317.2 (US$15.0) million, assuming a canine-to-human ratio of 1:10, vaccine coverage of 60%, and a cost per vaccination of no less than P25 (US$1.19) and no more than P90 (US$4.27). These costs would be recouped 4.1-11.0 years after the initiation of a one-year elimination campaign. A sensitivity analysis showed that an elimination programme would be economically beneficial in all but the most extreme cases.

Animals↗
PubMedDate not supplied

Royal Society of Tropical Medicine and Hygiene meeting at Manson House, London, 20 March 1997. Epidemiology and control of rabies. The growing problem of rabies in Africa.

Although rabies in Africa is relatively insignificant in terms of human mortality, the disease is still relevant because of the high costs of rabies prevention. Over the past 2 decades, demographic, economic and sociopolitical trends in Africa have increasingly favoured the persistence and spread of rabies, while limiting the effectiveness of control measures. Dog rabies predominates throughout most of Africa; the domestic dog is the principal reservoir host as well as the most important source of infection for people. However, wild-life rabies is increasingly a concern, both as a threat to endangered wildlife populations and because of the possible emergence of new maintenance hosts.

Africa↗
PubMed1997

Progress and achievement of rabies control in Thailand.

The breakthrough in production of highly efficacious human and animal rabies vaccines has led to successful rabies control in developed countries, but rabies is still a major health problem in many developing countries. In Thailand, the new cell culture vaccines-purified chick embryo cell (PCEC), purified Vero cell (PVRV), purified duck embryo (PDEV) and human diploid cell (HDCV) are available, and since 1993 have completely replaced the nervous tissue vaccines. The impact of these cell culture vaccines has been considerable, with the number of human rabies deaths decreasing from 200-300 in the early 1980s to 74 in 1995. Rabies prevention has also focused on the vaccination of dogs, and since 1992, the year the Rabies Prevention Act was announced, every owned dog has to be vaccinated at 2-4 months of age annually thereafter. However, only about 20% of dogs have been vaccinated. In 1995, the Ministry of Agriculture and Cooperation collaborated with the Ministry of Public Health to set up a target of no human rabies deaths in 1996, and a rabies-free Thailand by the year 2000. An extensive educational campaign is underway.

Animals↗
PubMed1987

Rabies prevention in primary care. A four-step approach.

Although most physicians in the United States have not seen a person with rabies, the primary care physician is often confronted with a patient who has been bitten by an animal capable of transmitting rabies virus. Rabies is almost always transmitted by a bite; licks and other nonbite exposures hardly ever cause the disease. The control of rabies in domestic animals has greatly reduced the risk of human disease following the bite of a dog or cat, but rabies in wild animals (especially skunks and raccoons) remains a constant threat. By obtaining epidemiologic information about animal rabies in the area where the exposure occurred, the physician can determine whether the animal in question may have been rabid. If any question remains, owned dogs and cats should be observed for ten days and any other animal should be killed and its brain examined for rabies virus. When postexposure prophylaxis is indicated, it should be administered exactly as recommended herein.

Algorithms↗
PubMed1992

Benefits and costs of using an orally absorbed vaccine to control rabies in raccoons.

In November 1989, the epizootic of rabies affecting raccoons in the mid-Atlantic states reached New Jersey. An economic evaluation was conducted in 2 counties first affected by the epizootic to estimate the costs of the epizootic and to assess the costs and benefits of orally administering a newly developed recombinant rabies vaccine to prevent further spread of the disease. Data on expenditures associated with prevention of rabies in human beings and domestic animals and laboratory testing of suspect animals were collected and analyzed for 1988 (before the epizootic) and 1990 (first full year of the epizootic). Benefit-cost ratios were calculated and used to evaluate the economic advisability of the vaccine at various vaccination program alternatives. Two indices of capital investment analysis, payback period and net present value, were used to evaluate the economic benefits of the rabies vaccine. Expenditures were estimated to be $1,952,014 in 1990 (primarily for pet animal vaccinations), compared with $768,488 in 1988. Benefit-cost ratios ranged from 2.21 for the most expensive vaccination program alternative to 6.80 for the least expensive alternative. The payback period varied from 0.69 to 2.11 years, and the net present value ranged from $2,105,453 to $4,877,452. The high costs of this epizootic necessitated the reallocation of scarce public health resources to various rabies prevention activities, particularly the vaccination of dogs. This study also demonstrated the usefulness of benefit-cost analysis in developing public health strategies. Although the mass application of this recombinant vaccine was found to be economically beneficial, other qualitative considerations must be used to supplement these findings.

Administration, Oral↗
PubMed1985

[Rabies prevention in the Netherlands. Study on the ingestion of bait by foxes].

A review of the history of the rabies situation in Europe, and specifically The Netherlands, is followed by a discussion of the measures so far adopted to control rabies among foxes. The ingestion of bait by foxes is then studied in view of possible oral vaccination against rabies. The Veluwe, situated in the middle of The Netherlands, was selected as a trial field. Boars live next to foxes here, and their food is comparable. Over sixty per cent of the foxes studied took the bait. Oral rabies vaccination can therefore also be carried out in foxes in the Veluwe area if required.

Animals↗
PubMedDate not supplied

Current issues in rabies prevention in the United States health dilemmas. Public coffers, private interests.

OVER THE LAST 100 years, rabies in the United States has changed dramatically. More than 90% of all animal rabies cases reported annually to the CDC now occur in wildlife, whereas before 1960 the majority were in domestic animals. The principal rabies hosts today are wild carnivores and bats infected with several viral variants. Annual human deaths have fallen from more than a hundred at the turn of the century to one to two per year despite major outbreaks of animal rabies in several geographic areas. Modern day prophylaxis has proven nearly 100% successful; most human fatalities now occur in people who fail to seek medical treatment, usually because they do not recognize a risk in the animal contact leading to the infection. Although these human rabies deaths are rare, the estimated public health costs associated with disease detection, prevention, and control have risen, exceeding millions of dollars each year. Cost considerations must be weighed along with other factors in addressing issues such as the appropriate handling of nontraditional and exotic pets, future guidelines for rabies prophylaxis, and novel methods of disease prevention.

Animals↗