Rabies in Haiti

Last updated
Rabies in Haiti
Haitian clinic where solar power is used to refrigerate rabies vaccine.jpg
Haitian clinic where solar power is used to refrigerate the rabies vaccine
Specialty Infectious disease
Symptoms Fever, fear of water, confusion [1]
Causes Rabies virus
Prevention Rabies vaccine, animal control, rabies immunoglobulin [1]
Prognosis Nearly always death [1]
Deaths17,400 (2015) [2]

Rabies is a viral disease that exists in Haiti and throughout the world. It often causes fatal inflammation of the brain in humans and other mammals, such as dogs and mongooses in Haiti. [1] The term "rabies" is derived from a Latin word that means "to rage"; [3] rabid animals sometimes appear to be angry. Early symptoms can include fever and tingling at the site of exposure, [1] followed by one or more of the following symptoms: violent movements, uncontrolled excitement, fear of water, an inability to move parts of the body, confusion, and loss of consciousness. [1] Once symptoms appear, death is nearly always the outcome. [1] The time period between contracting the disease and showing symptoms is usually one to three months; however, this time period can vary from less than a week to more than a year. [1] The time between contraction and the onset of symptoms is dependent on the distance the virus must travel to reach the central nervous system. [1] [4]

Contents

Haiti is one of five remaining countries in the Americas where canine rabies is still a problem, and it has the highest rate of human rabies deaths in the Western Hemisphere. Following the 2010 earthquake, rabies caused an estimated two deaths per week. Only a small number of these rabies deaths were reported to health authorities due to the impact of the earthquake, limitations in testing capacity, and lack of awareness and education about the disease among Haitians. [5]

Epidemiology

Globally, 59,000 people die from rabies each year. This is the equivalent of one person dying every nine minutes, with half of the people who die from rabies being under the age of 15. [3] The Pan American Health Organization (PAHO) and the Pan American Center of foot-and-mouth disease (PANAFTOSA) led a mission to eliminate dog-mediated rabies in the American region by 2015. These organizations are cognizant of the regional control of rabies. The PAHO and PANAFTOSA visited Haiti in early December, 2013, and the objectives of the mission were to assess the status of Haiti's rabies program as delivered by the Haitian Ministry of Agriculture, Natural Resources and Rural Development (MARNDR) and the Ministry of Health (MSPP). The mission was to seek opportunities for collaboration between Haiti, Brazil, and the Centers for Disease Control and Prevention (CDC) in Haiti. [4]

Even in 2017, rabies in Haiti is still identified as a national problem, even with PEP proposed. [6]

Treatment

In Haiti, few cases of human rabies are reported to health authorities. [7] In 2016, a report of a woman who had been exposed to rabies three months prior and was showing symptoms went to the hospital where no treatment was administered to her. Even after being reported to both the CDC and the national Department of Epidemiology and Laboratory Research (DELR), as required by Haiti's surveillance program, the woman died. This goes to show the lack of communication and effectiveness in caring for human subjects in Haiti, and the continued focus is on eliminating dog-mediated rabies altogether. [7]

Human diploid cell culture rabies vaccine (HDCV) and purified chick embryo cell culture rabies vaccine (PCEC) are used to treat post-exposure immunization against a human rabies infection. [8] [9] Recommendations for treatment are given by governmental health care organizations and in health literature. Health care providers are encouraged to administer a regimen of four 1-mL doses of HDCV or PCEC vaccines. According to the CDC, these injections should be administered intramuscularly to persons who have not yet been vaccinated for rabies. [9]

For those who are unvaccinated, the first of four doses is administered immediately after exposure to the rabies virus. Additional doses are given three, seven, and fourteen days after the first vaccination. Exposure usually means a bite from a rabid animal. [9]

At an individual patient level, post-exposure prophylaxis (PEP) consists of local treatment of the wound, vaccination, and administration of immunoglobulin, if necessary [3]. At the program level, several components are critical, including: adequate and prompt recognition of the need for PEP by the public, if exposed, and by health officials, prompt and sufficient availability of high-quality PEP, and adequate follow-up of PEP use. Health officials' awareness of the need for PEP after a dog bite can only be achieved if the exposure is attended to immediately and communicated effectively. [10]

Animal treatment

Dog vaccination is most effective for controlling dog-mediated rabies. This can be seen throughout the region of the Americas where medical authorities have achieved rabies control.

In Haiti, the United States Centers for Disease Control (CDC) is mainly focusing on dog-mediated rabies. Specifically in collaboration with the NGO Christian Veterinary Mission, the CDC has trained, to date, more than 20 MARNDR laboratory personnel in rabies diagnostic methods (Direct Fluorescent Antibody [DFA] and Direct Rapid Immunohistochemistry Test [dRIT]). The organizations have also improved a diagnostic laboratory in Port-au-Prince by providing it with advanced equipment. The surveillance system is a bite-reporting model where the public and medical providers report bite events to rabies control officers. In addition, more than 30 field veterinary and health agents were trained in rabies surveillance, in support of this effort. [10]

In 2011, the CDC along with MARNDR initiated a five-year rabies infrastructure improvement program that focused on surveillance, diagnostics, and education. The MSPP also helped out by improving public education on rabies. Because Haiti has a gross national income per capita of US$1,035, it is the only country in the American region that is part of the group of low-income countries. The World Bank has classified 33 other low-income countries in Africa and Asia, where dog-mediated rabies is a major problem and results in thousands of deaths annually. The persistence of dog rabies is connected to limited resources and weak governance. [10]

In conducting a rabies assessment, rabies control officers try to locate the offending animal. Animals that have bitten a victim are either euthanized and tested or quarantined for 14 days while remaining in their owner's residence. In addition, animals who show signs of rabies are tested, regardless of human exposure. This surveillance program is restricted to two of the ten geographical departments of the country (West and Artibonite) for security reasons. The area includes approximately 50 percent of the Haitian population. The CDC and the NGO Christian Veterinary Mission support the mission by maintaining four Haitian staff in the West Department and three in the Artibonite Department, respectively. Results of this mission showed the level of under-reporting of canine rabies. Specifically, six cases of rabid dogs in early December, 2012, were reported for the country. [10]

During the first nine months of the surveillance mission, 42 rabid dogs were identified in just three communities in Port-au-Prince during the first nine months in 2012. That being said, no laboratory-based surveillance exists for the human population that is exposed to rabies and all diagnoses are based on clinical history. This is because of the lack of laboratory facilities, making it difficult to identify evidence for the virus in humans and shed light on the disease as a whole for them, in Haiti. There are insufficient numbers of pathologists to collect samples for human rabies, as well. There do exist other methods for viral antigen detection that may merit study. [10]

In 2013, the CDC and its partners began an animal rabies surveillance program in several regions of Haiti and saw an 18-fold rise in detection of rabid animals. In 2015, the CDC evaluated Haiti's canine rabies vaccination program and found that only 45 percent of dogs were vaccinated, far short of the 70 percent needed to stop the spread of rabies in the dog population. In addition, the researchers found that Haiti had nearly 1,000,000 dogs, twice as many as previously thought. [5]

The CDC and its partners had already begun a dog vaccination trial in evaluating the best vaccination methods for dogs in Haiti. As a part of this effort, they vaccinated 3,000 dogs in just four days during the summer of 2016 and planned to vaccinate a total of 8,000 dogs as part of this campaign. [5]

Challenges

In Haiti, the control of dog rabies is led by the MARNDR while the MSPP manages health-care and rabies prevention in the human population. The separation of these ministries makes it easier for responsibilities to be divided among them. Communication about finding the source of exposure and implementing control methods to prevent further cross-species transmission is also more effective. This task is difficult enough within departments of the same ministry, (e.g., health care and epidemiology), which can be seen in experiences elsewhere. This is why a comprehensive evaluation of Haiti's rabies program should heavily consider the costs and benefits of this separation of responsibilities between the two ministries early on. [10]

Despite a planned mass vaccination for dogs in 2013, no campaign was actually conducted. Authorities in Haiti relied on funds donated by the World Bank for the purchase of approximately 500,000 doses of inactivated, injectable vaccine (IMRAB by Merial). [11] Although the funds were awarded in April 2013, the vaccine itself did not arrive until 2014 when the dog vaccination finally went underway in September 2014. The process as a whole was expected to terminate in January 2015. The lack of manpower needed to deliver faster implementation made it impossible for the campaign to be completed in less than four months. [10]

Another challenge presented is vaccination failure, which usually leads to recurrent rabies in dogs and inconsistent control of the disease. The failures that disrupt annual campaigns or have insufficient coverage, for example, are seen as the main cause for this problem. Another factor is that in Haiti, dog vaccinations have been inconsistently applied. Back in 2012 when the last mass vaccination was led by the MARNDR, approximately 400,000 dogs were vaccinated. With this in mind, considering a current human population of approximately 10,000,000, a relation of one dog per ten people, and aiming to attain 70 percent of vaccine coverage, 700,000 dogs would have to be vaccinated. Assessing the effectiveness of this vaccination campaign is difficult because the dog population figures are unreliable (estimates range from 800,000 to 1,200,000 dogs), and though the overall success seems to be limited. [10]

The number of rabid dogs detected by the MARNDR, MSPP, and CDC is a huge risk to people and is not accurately reflected in their surveillance figures. Although international support is common in both technical help and donations, it is not comprehensive. In addition, the MARNDR, MSPP, and other actors do not communicate effectively because of human resource limitations. That being said, the 2015 elimination goal in the region was compromised and control of the disease could not yet be achieved, despite the efforts of resolute national officials. In conclusion, rabies in the dog population is still a problem and major threat to the Haitian population. [10]

[12] [1]

Further reading

Related Research Articles

<span class="mw-page-title-main">Vaccination</span> Administration of a vaccine to protect against disease

Vaccination is the administration of a vaccine to help the immune system develop immunity from a disease. Vaccines contain a microorganism or virus in a weakened, live or killed state, or proteins or toxins from the organism. In stimulating the body's adaptive immunity, they help prevent sickness from an infectious disease. When a sufficiently large percentage of a population has been vaccinated, herd immunity results. Herd immunity protects those who may be immunocompromised and cannot get a vaccine because even a weakened version would harm them. The effectiveness of vaccination has been widely studied and verified. Vaccination is the most effective method of preventing infectious diseases; widespread immunity due to vaccination is largely responsible for the worldwide eradication of smallpox and the elimination of diseases such as polio and tetanus from much of the world. According to the World Health Organization (WHO), vaccination prevents 3.5–5 million deaths per year. A WHO-funded study by The Lancet estimates that, during the 50-year period starting in 1974, vaccination prevented 154 million deaths, including 146 million among children under age 5. However, some diseases have seen rising cases due to relatively low vaccination rates attributable partly to vaccine hesitancy.

<span class="mw-page-title-main">Mpox</span> Viral disease of humans and animals

Mpox is an infectious viral disease that can occur in humans and other animals. Symptoms include a rash that forms blisters and then crusts over, fever, and swollen lymph nodes. The illness is usually mild, and most infected individuals recover within a few weeks without treatment. The time from exposure to the onset of symptoms ranges from three to seventeen days, and symptoms typically last from two to four weeks. However, cases may be severe, especially in children, pregnant women, or people with suppressed immune systems.

<i>Influenza A virus</i> Species of virus

Influenza A virus (IAV) is the only species of the genus Alphainfluenzavirus of the virus family Orthomyxoviridae. It is a pathogen with strains that infect birds and some mammals, as well as causing seasonal flu in humans. Mammals in which different strains of IAV circulate with sustained transmission are bats, pigs, horses and dogs; other mammals can occasionally become infected.

Post-exposure prophylaxis, also known as post-exposure prevention (PEP), is any preventive medical treatment started after exposure to a pathogen in order to prevent the infection from occurring.

<span class="mw-page-title-main">Kennel cough</span> Upper respiratory infection affecting dogs

Kennel cough is an upper respiratory infection affecting dogs. There are multiple causative agents, the most common being the bacterium Bordetella bronchiseptica, followed by canine parainfluenza virus, and to a lesser extent canine coronavirus. It is highly contagious; however, adult dogs may display immunity to reinfection even under constant exposure. Kennel cough is so named because the infection can spread quickly among dogs in the close quarters of a kennel or animal shelter.

<span class="mw-page-title-main">Swine influenza</span> Infection caused by influenza viruses endemic to pigs

Swine influenza is an infection caused by any of several types of swine influenza viruses. Swine influenza virus (SIV) or swine-origin influenza virus (S-OIV) refers to any strain of the influenza family of viruses that is endemic in pigs. As of 2009, identified SIV strains include influenza C and the subtypes of influenza A known as H1N1, H1N2, H2N1, H3N1, H3N2, and H2N3.

<span class="mw-page-title-main">Tick-borne encephalitis</span> Medical condition

Tick-borne encephalitis (TBE) is a viral infectious disease involving the central nervous system. The disease most often manifests as meningitis, encephalitis or meningoencephalitis. Myelitis and spinal paralysis also occurs. In about one third of cases sequelae, predominantly cognitive dysfunction, persist for a year or more.

<span class="mw-page-title-main">Canine influenza</span> Influenza occurring in canines

Canine influenza is influenza occurring in canine animals. Canine influenza is caused by varieties of influenzavirus A, such as equine influenza virus H3N8, which was discovered to cause disease in canines in 2004. Because of the lack of previous exposure to this virus, dogs have no natural immunity to it. Therefore, the disease is rapidly transmitted between individual dogs. Canine influenza may be endemic in some regional dog populations of the United States. It is a disease with a high morbidity but a low incidence of death.

<span class="mw-page-title-main">Varicella vaccine</span> Vaccine to prevent chickenpox

Varicella vaccine, also known as chickenpox vaccine, is a vaccine that protects against chickenpox. One dose of vaccine prevents 95% of moderate disease and 100% of severe disease. Two doses of vaccine are more effective than one. If given to those who are not immune within five days of exposure to chickenpox it prevents most cases of disease. Vaccinating a large portion of the population also protects those who are not vaccinated. It is given by injection just under the skin. Another vaccine, known as zoster vaccine, is used to prevent diseases caused by the same virus – the varicella zoster virus.

<span class="mw-page-title-main">World Rabies Day</span> International awareness campaign about rabies

World Rabies Day is an international awareness campaign coordinated by the Global Alliance for Rabies Control, a non-profit organization with headquarters in the United States. It is a United Nations Observance and has been endorsed by international human and veterinary health organizations such as the World Health Organization, the Pan American Health Organization, the World Organisation for Animal Health and the US Centers for Disease Control and Prevention.

<span class="mw-page-title-main">Rabies vaccine</span> Vaccines to prevent rabies in humans and animals

The rabies vaccine is a vaccine used to prevent rabies. There are several rabies vaccines available that are both safe and effective. Vaccinations must be administered prior to rabies virus exposure or within the latent period after exposure to prevent the disease. Transmission of rabies virus to humans typically occurs through a bite or scratch from an infectious animal, but exposure can occur through indirect contact with the saliva from an infectious individual.

<span class="mw-page-title-main">Rabies</span> Deadly viral disease, transmitted through animals

Rabies is a viral disease that causes encephalitis in humans and other mammals. It was historically referred to as hydrophobia because its victims would panic when offered liquids to drink. Early symptoms can include fever and abnormal sensations at the site of exposure. These symptoms are followed by one or more of the following symptoms: nausea, vomiting, violent movements, uncontrolled excitement, fear of water, an inability to move parts of the body, confusion, and loss of consciousness. Once symptoms appear, the result is virtually always death. The time period between contracting the disease and the start of symptoms is usually one to three months but can vary from less than one week to more than one year. The time depends on the distance the virus must travel along peripheral nerves to reach the central nervous system.

The prevalence of rabies, a deadly viral disease affecting mammals, varies significantly across regions worldwide, posing a persistent public health problem.

<span class="mw-page-title-main">Rabies in animals</span> Deadly zoonotic disease

In animals, rabies is a viral zoonotic neuro-invasive disease which causes inflammation in the brain and is usually fatal. Rabies, caused by the rabies virus, primarily infects mammals. In the laboratory it has been found that birds can be infected, as well as cell cultures from birds, reptiles and insects. The brains of animals with rabies deteriorate. As a result, they tend to behave bizarrely and often aggressively, increasing the chances that they will bite another animal or a person and transmit the disease.

Influenza prevention involves taking steps that one can use to decrease their chances of contracting flu viruses, such as the Pandemic H1N1/09 virus, responsible for the 2009 flu pandemic.

<span class="mw-page-title-main">Global Alliance for Rabies Control</span> American non-profit organization

The Global Alliance for Rabies Control (GARC) is a non-profit organization that aims to eliminate deaths from canine rabies by 2030. Rabies is a neglected disease of poverty, which is almost 100% fatal, but can also be prevented with available vaccines. The Global Alliance for Rabies Control's work centers around the One Health Approach where vaccinating dogs stops the disease at its source and protects the whole community. Where the funding and political will exist, canine rabies has been eliminated. Inequality in access to preventive health care and proven control methods means that around 59,000 people, almost all in Africa and Asia, die every year.

<span class="mw-page-title-main">Monkeypox virus</span> Species of double-stranded DNA virus

The monkeypox virus is a species of double-stranded DNA virus that causes mpox disease in humans and other mammals. It is a zoonotic virus belonging to the Orthopoxvirus genus, making it closely related to the variola, cowpox, and vaccinia viruses. MPV is oval, with a lipoprotein outer membrane. The genome is approximately 190 kb. Smallpox and monkeypox viruses are both orthopoxviruses, and the smallpox vaccine is effective against mpox if given within 3–5 years before the disease is contracted. Symptoms of mpox in humans include a rash that forms blisters and then crusts over, fever, and swollen lymph nodes. The virus is transmissible between animals and humans by direct contact to the lesions or bodily fluids. The virus was given the name monkeypox virus after being isolated from monkeys, but most of the carriers of this virus are smaller mammals.

Rabies immunoglobulin (RIG) is a medication made up of antibodies against the rabies virus. It is used to prevent rabies following exposure. It is given after the wound is cleaned with soap and water or povidone-iodine and is followed by a course of rabies vaccine. It is given by injection into the site of the wound and into a muscle. It is not needed in people who have been previously vaccinated against rabies.

<span class="mw-page-title-main">Cat bite</span> Medical condition

Cat bites are bites inflicted upon humans, other cats, and other animals by the domestic cat. Data from the United States show that cat bites represent between 5–15% of all animal bites inflicted to humans, but it has been argued that this figure could be the consequence of under-reporting as bites made by cats are considered by some to be unimportant. Though uncommon, cat bites can sometimes transmit rabies, cause health complications, and even, though very rarely, lead to death.

<span class="mw-page-title-main">Animal vaccination</span> Process

Animal vaccination is the immunisation of a domestic, livestock or wild animal. The practice is connected to veterinary medicine. The first animal vaccine invented was for chicken cholera in 1879 by Louis Pasteur. The production of such vaccines encounter issues in relation to the economic difficulties of individuals, the government and companies. Regulation of animal vaccinations is less compared to the regulations of human vaccinations. Vaccines are categorised into conventional and next generation vaccines. Animal vaccines have been found to be the most cost effective and sustainable methods of controlling infectious veterinary diseases. In 2017, the veterinary vaccine industry was valued at US$7 billion and it is predicted to reach US$9 billion in 2024.

References

  1. 1 2 3 4 5 6 7 8 9 10 "Rabies". World Health Organization. Retrieved 7 May 2017.
  2. ↑ GBD 2015 Mortality and Causes of Death Collaborators (8 October 2016). "Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015". Lancet. 388 (10053): 1459–1544. doi:10.1016/S0140-6736(16)31012-1. PMC   5388903 . PMID   27733281.
  3. 1 2 "Get the Facts - CDC Rabies and Kids". www.cdc.gov. Retrieved 9 May 2017.PD-icon.svg This article incorporates public domain material from websites or documents of the Centers for Disease Control and Prevention .
  4. 1 2 Rupprecht, Charles E; Millien, Max F.; Pierre-Louis, Jocelyne B.; Wallace, Ryan; Caldas, Eduardo; Rwangabgoba, Jean M.; Poncelet, Jean L.; Cosivi, Ottorino; Del Rio Vilas, Victor J. (2015). "Control of Dog Mediated Human Rabies in Haiti: No Time to Spare". PLOS Neglected Tropical Diseases. 9 (6): e0003806. doi: 10.1371/journal.pntd.0003806 . ISSN   1935-2735. PMC   4481514 . PMID   26110845.PD-icon.svg This article incorporates text from this source, which is in the public domain .
  5. 1 2 3 "Rabies in Haiti - World Rabies Day - CDC". www.cdc.gov. Retrieved 8 May 2017.PD-icon.svg This article incorporates public domain material from websites or documents of the Centers for Disease Control and Prevention .
  6. ↑ "In this month's Bulletin" (PDF). Bulletin of the World Health Organization. 95 (3): 165. 2017. doi:10.2471/BLT.17.000317 (inactive 5 December 2024). ISSN   0042-9686. PMC   5328116 .{{cite journal}}: CS1 maint: DOI inactive as of December 2024 (link)
  7. 1 2 Wallace, Ryan M.; Etheart, Melissa D.; Doty, Jeff; Monroe, Ben; Crowdis, Kelly; Augustin, Pierre Dilius; Blanton, Jesse; Fenelon, Natael (2016). "Dog-Mediated Human Rabies Death, Haiti, 2016". Emerging Infectious Diseases. 22 (11): 1963–1965. doi:10.3201/eid2211.160826. PMC   5088043 . PMID   27767911.
  8. ↑ Dietzschold, B.; Hooper, D. C. (1 October 1998). "Human diploid cell culture rabies vaccine (HDCV) and purified chick embryo cell culture rabies vaccine (PCECV) both confer protective immunity against infection with the silver-haired bat rabies virus strain (SHBRV)". Vaccine. 16 (17): 1656–1659. doi:10.1016/s0264-410x(98)00064-4. PMID   9713943.
  9. 1 2 3 "CDC - Medical Care: Rabies Vaccine - Rabies" . Retrieved 8 May 2017.PD-icon.svg This article incorporates public domain material from websites or documents of the Centers for Disease Control and Prevention .
  10. 1 2 3 4 5 6 7 8 9 Millien, Max F.; Pierre-Louis, Jocelyne B.; Wallace, Ryan; Caldas, Eduardo; Rwangabgoba, Jean M.; Poncelet, Jean L.; Cosivi, Ottorino; Del Rio Vilas, Victor J. (2015-06-25). "Control of Dog Mediated Human Rabies in Haiti: No Time to Spare". PLOS Neglected Tropical Diseases. 9 (6): e0003806. doi: 10.1371/journal.pntd.0003806 . ISSN   1935-2727. PMC   4481514 . PMID   26110845.
  11. ↑ "The Benefits of IMRAB | IMRAB® The world's leading rabies vaccine". imrab.us.merial.com. Retrieved 2017-11-09.
  12. ↑ Fenelon, N.; Dely, P.; Katz, M. A.; Schaad, N. D.; Dismer, A.; Moran, D.; Laraque, F.; Wallace, R. M. (2017). "Knowledge, attitudes and practices regarding rabies risk in community members and healthcare professionals: Pétionville, Haiti, 2013". Epidemiology and Infection. 145 (8): 1624–1634. doi:10.1017/S0950268816003125. ISSN   0950-2688. PMC   5426290 . PMID   28290915.

PD-icon.svg This article incorporates public domain material from Rabies in Haiti. Centers for Disease Control and Prevention . Retrieved 8 May 2017.

This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.