Rabies, Canine, Human - Indonesia (08) : Comment on Vaccination

RABIES, CANINE, HUMAN - INDONESIA (08): COMMENT ON VACCINATION
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A ProMED-mail post

ProMED-mail is a program of the
International Society for Infectious Diseases


Date: Sat 4 Apr 2009
From: Allan Grill

The regimen for an individual receiving rabies pre-exposure
prophylaxis consists of 3 intramuscular doses of rabies vaccine on
days 0, 7 and 21. This is usually recommended for certain groups who
may be at higher risk of exposure to the rabies virus (e.g.
veterinarians, individuals traveling to rabies endemic areas). Should
these individuals have a subsequent exposure to the rabies virus
(e.g. bite from a suspected rabid animal), they would require a
post-exposure prophylaxis regimen consisting of 2 intramuscular doses
of rabies vaccine on days 0 and 3 post-exposure. Rabies immune
globulin (RabIg) would not be required in this case.

For individuals who have not received rabies pre-exposure
prophylaxis, their 1st suspected rabies exposure would require 5
intramuscular doses of rabies vaccine on days 0, 3, 7, 14, and 28
days post-exposure. They would also require a dose of RabIg on day 0
post-exposure as well (given at a different anatomical site from the
1st dose of vaccine). Should these individuals ever have subsequent
suspected rabies exposures requiring post-exposure prophylaxis, the
regimen would be the same as the one mentioned above for individuals
who had received pre-exposure prophylaxis: 2 intramuscular doses of
rabies vaccine on days 0 and 3 post-exposure.

I believe it was mentioned in the previous posting [Rabies, canine,
human - Indonesia (07): comment on vaccination 20090404.1300] that
individuals who have had pre-exposure prophylaxis in the past require
3 doses of rabies vaccine post-exposure. As mentioned above, they
would only need 2 doses.

Communicated by:
Allan Grill, M.D., C.C.F.P., M.P.H.
Medical Consultant
Toronto Public Health
Toronto, Ontario, Canada


[ProMED-mail thanks Dr. Allan Grill for this additional
clarification. - Mod.CP]

Rabies, Canine, Human - Angola (05) : Luanda

RABIES, CANINE, HUMAN - ANGOLA (05): LUANDA)
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A ProMED-mail post

ProMED-mail is a program of the
International Society for Infectious Diseases


Date: Wed 11 Mar 2009
Source: ReliefWeb [edited]


One of the most severe rabies epidemics to hit Angola has claimed the
lives of at least 93 children within 3 months in the capital, Luanda.
"The 93 children were brought to our hospital and are the only ones
we know of, so the number could be higher," said Luis Bernardino,
head of the Hospital Pediatrico David Bernardino in Luanda, the
country's largest referral hospital. "The number of cases has,
however, started declining now." He said the hospital was unable to
save any of the children, as it had run out of doses of rabies
vaccine; in some instances, the children were brought in too late.
"It is a sad moment for us," said Bernardino.

Francois Meslin, the rabies expert at the World Health Organisation
(WHO) headquarters in Geneva, said in the last severe rabies
outbreak, from 1998 to 2003 in Indonesia's Flores Island, 100 people
had died within a year. "The high number of deaths in Luanda within
the short period of time is a cause for serious concern and calls for
a thorough investigation."

Rabies is an incurable viral disease transmitted by close contact
with saliva from infected animals, usually canines or rodents. It can
be prevented by vaccination, either pre-exposure or as part of
post-exposure treatment. However, once the symptoms of the disease
develop, it is fatal in both animals and humans.

Post-exposure treatment comprises 5 doses of the vaccine and has to
start "as soon as possible" to prevent the symptoms from developing,
Meslin said. The disease attacks the respiratory, gastrointestinal
and/or central nervous systems, leading to paralysis followed by coma
and death in all cases, usually due to respiratory failure.

Luanda's large stray dog population has been identified as causing
the spread of the disease. "We have had some sporadic cases in other
provincial capitals in the country; we think the virus was brought
into Luanda and then spread through the dogs; Angolans love dogs,"
said Bernardino.

The capital was built to accommodate around 400 000 people but now
has a population of more than 4.5 million, most of whom live in
unhygienic conditions in "musseques" or slums.

The outbreak has raised concerns over the slow reaction of the
Angolan authorities. "When the 1st 10 deaths were reported in
December 2008, we alerted the authorities, but we do not have
veterinary services in the city, no kennels [to keep and observe the
animals] and vaccinate them," said Bernardino. There were also not
enough vaccines available. "I think it was probably that no one was
prepared for such a high case load," he said. A vaccination campaign
is underway. "We now also have enough vaccines in stock. The cases
have started dropping now; we have 12 cases in one week, it dropped
to 4 cases, and this week, it is down to 3," Bernardino told IRIN.

Developing countries are often unable to afford rabies treatment,
which is prohibitively expensive, said Melvin. "One dose costs about
USD 10, and 5 of those have to be administered, which makes the total
cost of treatment USD 50, which is more than what a family can earn
in a month in most developing countries." Besides the vaccine, "in
instances where the person has been heavily exposed, with multiple
bites in the head," that person also has to be given rabies
immunoglobulin to prevent death, which can cost another USD 50. "The
treatment can be a huge drain on public health services, especially
in countries where the vaccines are given free."

Melvin said there was a global shortage of the vaccines. "As there
are few registered manufacturers who meet the WHO guidelines, the
supply cannot keep up with the demand." At least 55 000 people die
from rabies every year in Asia and Africa; most of the victims are children.

[This article does not necessarily reflect the views of the United
Nations or its agencies.]

Communicated by:
ProMED-mail Rapporteur Brent Barrett

[The number of child deaths in this rabies outbreak in Luanda, the
capital city of Angola, has risen from 63 on 18 Feb 2009 to at least
93 known child deaths on 10 Mar 2009. The number of adult deaths is
not reported. The outbreak is now thought to be in decline, as judged
by the number of children admitted to the main referral hospital per
week. Unfortunately, none of the children admitted to hospital has
been saved due to the lack of vaccine and immunoglobulin for
post-exposure treatment, in part due to the global shortage of
vaccine and its high cost. Control of the urban dog population
remains unresolved due to the absence of appropriate veterinary
services, although adequate supplies of canine vaccine are said to be
available. Until progress is achieved in control of the dog
population, it is unlikely that there will be an early end to this outbreak.

The HealthMap/ProMED-mail interactive map of Angola showing the
location of Luanda in the north of the country can be accessed at:
. - Mod.CP]

Rabies, Fox, Human - Russia: (Moscow Region)

RABIES, FOX, HUMAN - RUSSIA: (MOSCOW REGION)
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A ProMED-mail post

ProMED-mail is a program of the
International Society for Infectious Diseases


Date: Mon 12 Jan 2009
Source: Life.ru News Agency [in Russian, trans. & summ. Corr.BA, edited]


Fatal rabies case in the Moscow region
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An emergency situation has been declared in the Noginsk area of the Moscow
region [oblast] where a fatal case of rabies has been reported. All those
who have had contact with the fatal case are under observation.

It is inferred that the deceased patient, a 42 year old man, contracted
rabies in August 2008 when he was bitten by a sick fox. He did not
immediately seek medical treatment and was admitted to hospital only much
later, when his condition had deteriorated. He died on 31 Dec 2008.

communicated by:
ProMED-RUS


[There has been an increase in the number of human cases of rabies in
several Russian regions. According to official statistics the number of
[fatal] cases of rabies virus infection increased from 5 during 11 months
of 2007 to 15 for the same period of 2008. - Mod.NP

An interactive map of the regions of Russia can be accessed at
. The HealthMap/ProMED-mail interactive map
of Russia is available at
- Mod.CP]

Rabies - China : (Shandong)

RABIES - CHINA: (SHANDONG)
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A ProMED-mail post

ProMED-mail is a program of the
International Society for Infectious Diseases


Date: Mon 12 Jan 2009
Source: GoogleNewsZH [Chinese, trans. Angela Song-En Huang, edited]


According to the Yantai City Disease Control Center, the number of
infectious diseases reported in Yantai [Shandong Province] continues to
fall steadily. But there has been a rise in the number rabies cases.

For the 9 years following 1998, Yantai City reported no locally-acquired
rabies cases. With the keeping of pets becoming more and more popular after
2007, there has been much trading and exchange of animals between cities.
Yentai began to report rabies occasionally, resulting in an expansion of
affected areas.

In addition, the rat population has increased, resulting in increases of
[hantaviral] hemorrhagic fevers. Although cases of AIDS and tuberculosis
are falling, they may increase in the future. Experts warn that people must
continue to protect themselves from infectious diseases.

communicated by:
ProMED-mail via
HealthMap

[Further information on measures being taken to control the spread of urban
rabies in Yantai city and Shandong province, such as the policy regarding
vaccination of household pets, would be welcomed.

A map of Shandong province, showing the city of Yantai on the north coast,
is available at . The
HealthMap/ProMED-mail interactive map of China can be accessed at
. - Mod.CP]