Faculty of Health Sciences, Institute of Tropical & Infectious Diseases, University of Nairobi, Nairobi, 00202, Kenya.
School of Biodiversity, One Health & Veterinary Medicine, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, G12 8QQ, UK.
Infect Dis Poverty. 2024 Oct 28;13(1):79. doi: 10.1186/s40249-024-01245-w.
Rabies remains a major public health problem in low- and middle-income countries. However, human rabies deaths are rarely laboratory-confirmed or sequenced, especially in Africa. Five human rabies deaths from Tanzania and Kenya were investigated and the causative rabies viruses sequenced, with the aim of identifying implications for rabies control at individual, healthcare and societal levels.
The epidemiological context and care of these cases was contrasting. Four had a clear history of being bitten by dogs, while one had an unclear biting history. Two individuals sought medical attention within a day of being bitten, whereas three sought care only after developing rabies symptoms. Despite seeking medical care, none of the cases received complete post-exposure prophylaxis: one patient received only tetanus vaccination, one did not complete the post-exposure vaccination regimen, one followed an off-label vaccination schedule, and two did not receive any post-exposure vaccinations before the onset of symptoms. These cases highlight serious gaps in health-seeking behaviour, and in health systems providing appropriate care following risky exposures, including in the accessibility and effectiveness of post-exposure prophylaxis as it is administered in the region.
The viral genomic and epidemiological data confirms dog-mediated rabies as the cause of each of these deaths. The phylogenetic investigation highlights the transboundary circulation of rabies within domestic dog populations, revealing distinct rabies virus clades with evidence of regional spread. These findings underscore the importance of coordinated cross-border control efforts between the two countries. Urgent action is needed to improve awareness around the need for emergency post-exposure vaccines that should be accessible in local communities and administered appropriately, as well as investment in coordinated dog vaccination to control dog-mediated rabies, the underlying cause of these deaths.
狂犬病仍然是中低收入国家的一个主要公共卫生问题。然而，在非洲，很少有人类狂犬病死亡病例经过实验室确认或测序。对来自坦桑尼亚和肯尼亚的 5 例人类狂犬病死亡病例进行了调查，并对致病的狂犬病病毒进行了测序，目的是确定对个人、医疗保健和社会层面的狂犬病控制的影响。
这些病例的流行病学背景和护理情况截然不同。其中 4 例有明确的被狗咬伤史，而 1 例咬伤史不清楚。2 例患者在被咬伤后 1 天内寻求医疗，而 3 例患者仅在出现狂犬病症状后才寻求治疗。尽管寻求了医疗，但这些病例均未接受完整的暴露后预防：1 例患者仅接种了破伤风疫苗，1 例未完成暴露后疫苗接种方案，1 例遵循了非标签疫苗接种时间表，2 例在出现症状前未接受任何暴露后疫苗接种。这些病例突出了寻求医疗行为、以及提供适当护理的卫生系统方面存在的严重差距，包括在该地区实施的暴露后预防的可及性和有效性方面。
病毒基因组和流行病学数据证实，这些死亡病例均由犬介导的狂犬病引起。系统进化分析突出了国内犬群中狂犬病的跨界传播，揭示了不同的狂犬病病毒分支，并有证据表明存在区域性传播。这些发现强调了两国之间协调跨境控制努力的重要性。需要采取紧急行动，提高人们对紧急暴露后疫苗的需求的认识，这些疫苗应该在当地社区中可及并得到适当使用，并投资于协调的犬类疫苗接种，以控制犬介导的狂犬病，这是这些死亡病例的根本原因。
