Baron Jerome N, Peng Yik Sik, Martínez-López Beatriz, Ly Sowath, Dussart Philippe, Chevalier Véronique
Center for Animal Disease Modeling and Surveillance (CADMS), Department of Medicine & Epidemiology, School of Veterinary Medicine, University of California, Davis, California, United States of America.
Rabies Prevention Center, Institut Pasteur du Cambodge, Phnom Penh, Cambodia.
PLoS Negl Trop Dis. 2025 Sep 5;19(9):e0013478. doi: 10.1371/journal.pntd.0013478. eCollection 2025 Sep.
Cambodia is endemic for rabies, a fatal zoonotic viral disease transmitted through dog bites. The Institut Pasteur du Cambodge through its Rabies Prevention Center is the main institution in charge of rabies prevention and surveillance in the country. Its main tool for prevention is post-exposure prophylaxis (PEP) for bite victims. Allocation of specific PEP regimen is done based on the assessment of the severity of the wound and the information collected by IPC doctors from patients regarding the attack's characteristics and the attacking animal's health status. Furthermore, a small proportion of patients bring animals for testing, 60% of which were tested positive for rabies. Using the data collected from patient interviews from 2000 to 2016, we used a Bayesian spatio-temporal regression model to identify predictors for two outcomes: i) a patient bringing an animal for testing and ii) an animal testing positive for rabies. The ultimate aim of the analysis was to provide information that could help with allocation of PEP resources. Notably non-owned animals, a large number of bite victims, and unprovoked attacks were all predictive of a positive test. A suspected rabies status assigned by doctor based on animal symptom description was also highly predictive of a rabies test, with 94.6% of tested animals that were assigned as sick being positive for rabies. Furthermore, we identified three Provinces of Cambodia with higher odds of positive tests: Kampong Cham, Kandal and Kampong Thom. This information could help allocate limited PEP resources, though this study showed IPC already a strong protocol to identify patients exposed to a rabies suspect dog.
柬埔寨是狂犬病的地方流行区，狂犬病是一种通过狗咬伤传播的致命人畜共患病毒性疾病。柬埔寨巴斯德研究所通过其狂犬病预防中心，是该国负责狂犬病预防和监测的主要机构。其主要预防手段是为咬伤受害者提供暴露后预防（PEP）。特定PEP方案的分配是根据伤口严重程度评估以及巴斯德研究所医生从患者那里收集的有关攻击特征和攻击动物健康状况的信息来进行的。此外，一小部分患者会带动物来检测，其中60%检测出狂犬病呈阳性。利用2000年至2016年患者访谈收集的数据，我们使用贝叶斯时空回归模型来确定两个结果的预测因素：i）患者带动物来检测；ii）动物狂犬病检测呈阳性。分析的最终目的是提供有助于分配PEP资源的信息。值得注意的是，非自家饲养的动物、大量咬伤受害者以及无端攻击都预示检测结果呈阳性。医生根据动物症状描述判定的疑似狂犬病状态也高度预示会进行狂犬病检测，被判定患病的检测动物中有94.6%狂犬病检测呈阳性。此外，我们确定柬埔寨有三个省检测呈阳性的几率较高：磅湛省、干丹省和磅同省。这些信息有助于分配有限的PEP资源，不过这项研究表明，巴斯德研究所已经有一个强有力的方案来识别接触过疑似感染狂犬病狗的患者。
