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Severe multiple rabid dog bite injuries in a child in central China: Continuous 10-year observation and analysis on this case.

ABSTRACT: Dog bites are common in rural areas of underdeveloped countries or regions, affecting persons of different ages. Suspected rabid dog bites will lead to more severe outcomes, especially in children because injuries often occur on their heads and faces that are highly innervated parts of the body. In such circumstances, immediate and complete post-exposure prophylaxis (PEP) will be essential, though vaccine hesitancy is a problem. Herein, we report a 4-y-old girl who was seriously bitten by a confirmed rabid dog in rural China. Multiple lacerations and punctures distributed on her head, neck, face, extremities, and back after being bitten. It was in question that surgery or PEP should be performed in priority when the dog was not confirmed rabid at first, but considering the risks of rabies, immediate PEP was provided to her, along with immunogenicity tests to ensure an adequate protective immune response. Because of the severity of her injuries, medical practitioners suggested her parents to bring her to take immunogenicity tests in 1-, 5-, and 10-y intervals to ensure adequate rabies virus-neutralizing antibodies (RVNA) titers. Her parents had a good preference for medical advices, and in the 10-y interval, it was found that her RVNA titer was below protection level, so a booster vaccination was given to her, and 14 d after that, according to immunogenicity test, RVNA titer arose quickly above the protection level.

SUBMITTER: Zhu Z

PROVIDER: S-EPMC7227647 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:Rabies is a neglected zoonotic disease that causes an estimated 59,000 human deaths worldwide annually, mostly in Africa and Asia. A target of zero human deaths from dog-mediated rabies has been set for 2030, and large-scale control programs are now advocated. However, in most low-income endemic countries surveillance to guide rabies control is weak and few cases of rabies are recorded. There is an urgent need to enhance surveillance to improve timely case detection and inform rabies control and prevention, by operationalizing a "One Health" approach. Here we present data from a study piloting Integrated Bite Case Management (IBCM) to support intersectoral collaboration between health and veterinary workers in Tanzania. We trained government staff to implement IBCM, comprising risk assessments of bite patients by health workers, investigations by livestock field officers to diagnose rabid animals, and use of a mobile phone application to support integration. IBCM was introduced across 20 districts in four regions of Tanzania and results reported after 1 year of implementation. Numbers of bite patient presentations to health facilities varied across regions, but following the introduction of IBCM reporting of bite patients at high-risk for rabies more than doubled in all regions. Over 800 high-risk investigations were carried out, with 49% assessed as probable dog rabies cases on the basis of clinical signs, animal outcome, and rapid diagnostic testing. The status of a further 20% of biting animals could not be determined but rabies could not be ruled out. Livestock field officers reported that use of rapid diagnostic tests (RDTs) were useful for confirming rabies occurrence. Overall, our study provides further evidence that IBCM is a practical approach that can improve rabies detection in endemic countries, and be used to monitor the impact of mass dog vaccinations, including potential to verify rabies freedom. However, the main challenges to implementation are limited training of health workers in rabies, perceived burden of real-time recording and limited resources for livestock field officers to undertake investigations. Nonetheless, IBCM dramatically improved case detection and communication between sectors and we recommend further implementation research to establish best practice and applicability to other settings.

Dataset Information

Severe multiple rabid dog bite injuries in a child in central China: Continuous 10-year observation and analysis on this case.

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