Network for Improving Critical Care Systems and Training, 2nd Floor, YMBA Building, Colombo 08, Sri Lanka.
Public Health Veterinary Services, Colombo, Sri Lanka.
Bull World Health Organ. 2017 Sep 1;95(9):646-651. doi: 10.2471/BLT.16.188060. Epub 2017 May 19.
In Sri Lanka, rabies prevention initiatives are hindered by fragmented and delayed information-sharing that limits clinicians' ability to follow patients and impedes public health surveillance.
In a project led by the health ministry, we adapted existing technologies to create an electronic platform for rabies surveillance. Information is entered by trained clinical staff, and both aggregate and individual patient data are visualized in real time. An automated short message system (SMS) alerts patients for vaccination follow-up appointments and informs public health inspectors about incidents of animal bites.
The platform was rolled out in June 2016 in four districts of Sri Lanka, linking six rabies clinics, three laboratories and the public health inspectorate.
Over a 9-month period, 12 121 animal bites were reported to clinics and entered in the registry. Via secure portals, clinicians and public health teams accessed live information on treatment and outcomes of patients started on post-exposure prophylaxis (9507) or receiving deferred treatment (2614). Laboratories rapidly communicated the results of rabies virus tests on dead mammals (328/907 positive). In two pilot districts SMS reminders were sent to 1376 (71.2%) of 1933 patients whose contact details were available. Daily SMS reports alerted 17 public health inspectors to bite incidents in their area for investigation.
Existing technologies in low-resource countries can be harnessed to improve public health surveillance. Investment is needed in platform development and training and support for front-line staff. Greater public engagement is needed to improve completeness of surveillance and treatment.
在斯里兰卡，狂犬病预防措施受到信息碎片化和延迟共享的阻碍，这限制了临床医生跟踪患者的能力，并阻碍了公共卫生监测。
在卫生部领导的一个项目中，我们对现有技术进行了调整，创建了一个狂犬病监测电子平台。信息由经过培训的临床工作人员输入，汇总和个别患者数据实时可视化。自动短信系统（SMS）提醒患者进行疫苗接种随访预约，并向公共卫生检查员通报动物咬伤事件。
该平台于 2016 年 6 月在斯里兰卡的四个地区推出，连接了六个狂犬病诊所、三个实验室和公共卫生检查员。
在 9 个月的时间里，有 12121 起动物咬伤事件报告给诊所，并在登记册中输入。通过安全门户，临床医生和公共卫生团队可以实时访问开始接触后预防（9507 例）或接受延迟治疗（2614 例）的患者的治疗和结果信息。实验室迅速就死亡哺乳动物的狂犬病病毒检测结果（328/907 例阳性）进行了沟通。在两个试点地区，向可提供联系方式的 1376 名（71.2%）患者发送了短信提醒。每日短信报告提醒 17 名公共卫生检查员注意其所在地区的咬伤事件进行调查。
在资源有限的国家，可以利用现有技术来改善公共卫生监测。需要投资于平台开发以及对一线工作人员的培训和支持。需要加强公众参与，以提高监测和治疗的完整性。
