Research Paper on "History and Importance of Rabies Surveillance"

Research Paper 5 pages (1554 words) Sources: 15

[EXCERPT] . . . .

Rabies Surveillance

A central surveillance system is pivotal in approaching large-scale health issues. Thanks to comprehensive reports that cover the breadth of North America, epidemiologists can draw out larger trends about disease. However, the wealth of information that researchers can access puts us in a bad mood, since the facts are grim. While we have excellent theories and strategies for disease prevention, fifty thousand deaths a year by rabies infection is a sign of failure in practice. Annual reports on domestic rabies infection have brought us plenty of data about the animal rabies itself, while a scarcity of human rabies reports prioritizes international human health. Within Florida, raccoon rabies is slightly higher in proportion to the rest of the U.S.

INTRODUCTION

Rabies is caused by the development of a Lyssavirus of the Rhabdoviridae family. Seven genotypes and four serotypes include variants between hosts, which include the dog, fox, cat, and bat. Birds do not host rabies. Once the rabies strain has infected a warm-blooded animal, it causes encephalitis, expressed by symptoms including behavioral change, muscular incoordination, paralysis, and aggressiveness (Tibayrenc 41). A rabid animal cannot transmit rabies by merely licking a person (Category I exposure), but only by nibbling uncovered skin making minor abrasions or scratches (Category II). The virus is in the infected animal's saliva but a friendly lick will not transmit it. For Category II and any more severe exposure (Category III), immediate postexposure vaccination is necessary. Postexposure vaccination is usually administered to human subjects, but in humans the virus is extremely lytic, so once the symptoms appear in humans, rabies is almost always fatal. For subjects who have been vaccinated, the deadline is extended to 3 days (WHO 319). Where available, Rabies immunoglobulin should also be administered to category II and III exposures (WHO 316). In developing countries, only an inexpensive, intradermal vaccine may be available.

Preventative measures include terminal isolation of infected animals and preventative vaccination of animals and humans (Tibayrenc 41). People who are at an elevated risk for rabies infections, who work outdoors in wild areas or abroad in high-risk countries, for example, are advised to get CCV vaccinations. These may be administered intradermally or intramuscularly. When an individual is placed at a continual risk for exposure, periodic booster shots are recommended. Even laboratory technicians who work close to rabies samples are recommended to take antibody blood tests every six months (WHO 318).

BACKGROUND

Rabies has been under surveillance since ancient Egyptian times, and consistent data on infections is now available worldwide. Rabies has been around for a long time, but we have never been closer to wiping it out altogether. Whereas rabies claimed just 4 people in the United States in 2009 (Blanton 2010), ninety-nine percent of the 55,000 human rabies deaths occur in Asia and Africa, with India and the Philippines being sore areas. Half of these fatalities are children under 15 (Briggs 161). The WHO estimates that 1.74 million Disability-Adjusted Life Years were lost to rabies annually. The annual cost of Rabies exceeds U.S.$1.5 billion, two-thirds of which is spent on prevention and the rest on postexposure vaccination (316). The World Health Organization has declared September 28th to be World Rabies Day, so that the international community may gain awareness of the massive scale and scope of this global disease and the danger of not taking action against it in the developing nations of Asia and Africa.

Several strategies to control canine rabies have been instrumental in lowering the death rate in the United States and parts of Latin America, which can be implemented in Africa and Asia as well. In Harper Lee's novel To Kill a Mockingbird, Atticus Finch sets an example of good citizenship by shooting a "mad" or "furious" rabid dog that was endangering his children. Indeed, an attitude of public service and active prevention are the key ingredients to substantial development towards disease prevention. Dog vaccination is the most cost-effective way to prevent rabies, but compulsory notification of infections, post-mortem examinations of infected subjects, and interagency communication are keys to eliminating the disease this century (WHO 320).

LITERATURE REVIEW

1. Blanton, Jesse D.; Palmer, Dustyn; Rupprecht, Charles E. Rabies surveillance in the United States during 2009. J Am Vet Med Assoc 2010; 237: 646-657.

In 2009, 6,690 rabid animals and 4 human rabies cases appeared in United States patients, according to the CDC. Two of the human cases were associated to bat rabies variants. One virus variant was acquired while traveling in India and brought to the United States (646). One case was exceptional, in which the patient recovering after the onset of symptoms lasting two weeks (653). Most rabid raccoons and cats in Florida were found in the central and western areas of the state (650, 653). Since the year 2000, only one Florida rabies death has been reported. A dog bite victim carrying a Haiti-derived rabies virus died on February 152, 2004 (654). A coordinated effort in the United States to bring rabies under control has been met by great success, and the next step is to take these lessons on the road to global public health.

2. Blanton, Jesse D; Robertson, Kis; Palmer, Dustyn; Rupprecht, Charles E. Rabies surveillance in the United States during 2008. J Am Vet Med Assoc 2009; 235: 676-690.

In 2008, 6,841 cases of rabies appeared in animals and 2 cases in humans, according to the Centers for Disease Control. Most of the cases were in wildlife rather than domestic animals. 84.5% of which are raccoons, skunks, and bats. Surprisingly, the only two cases of human rabies are associated with virus variants in bats.

In Florida, the CDC received 128 reports of animal rabies in 2007 and 151 cases in 2008 (Blanton 679).

3. Briggs, Deborah J. Commentary: Reducing the global burden of rabies. International Health 2010; 2(3): 161-162.

Rabies is a serious international concern. With the expansion of international trade and transportation, canine rabies outbreaks cause panic. The success in virtually eliminating rabies deaths in the United States can be attributed to two factors: canine inoculation and postexposure prophylaxis. In countries that cannot afford the intramuscular prophylaxis, they can use a lower-cost intradermal version, introduced in the 1980s (162). Multi-faceted coalitions between public health and ministries can make powerful strides towards prevention.

4. CDC. Translocation of coyote rabies -- Florida, 1994. MMWR Morb Mortal Wkly Rep 1995;44:580 -- 581, 587.

In 1994, five dogs from two kennels were diagnosed with rabies, a strain only found in coyotes (Canis larans) in South Texas. The story of this translocation could do for further investigation.

5. Compendium of animal rabies prevention and control, 2007. J Am Vet Med Assoc 2010; 230: 833-840.

This document provides a reference for data on rabies control in the United States. It details the legal and medical concerns of preventing the virus's entry into the country, the procedures of vaccinating animals, and responding to outbreaks.

6. Haider, Shariq. Rabies: old disease, new challenges. Canadian Medical Association Journal 2008; 178(5): 562-563.

Fifty thousand deaths a year is no small problem, but a global emergency. Bringing the mortality rate down in the United States has come against the challenges of increasing urbanization, long incubation periods, and unspecific early prodromal symptoms. A 1983 campaign to reduce infection in Latin America, free vaccination of 44 million dogs, investment in surveillance systems, and education in epidemiology created a dramatic decrease in cases (562). Rabies vaccine is recommended to travelers en route to countries where postexposure prophylaxis is not readily available. For non-vaccinated subjects, post-exposure dosage of intramuscular vaccine is 1.0mL given five times: specifically, on days 0, 3, 7, 14, and 28. In addition, a dosage of 20 IU/kg of immunoglobulin should be administered within the first seven days whenever possible (563).

7. Sawhney, I.M.S. Book Review: Rabies. Brain 2004;… READ MORE

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