Explore the vast range of titles available.

Background Zoonotic diseases pose an increasing threat to human, animal and environmental health, and identifying the zoonoses of greatest public health concern is key to address them effectively. Despite high ongoing risks from zoonotic diseases, Bhutan has never conducted a zoonotic disease prioritization exercise. Therefore, the present study aimed to prioritize the top 10 zoonotic diseases in Bhutan and develop action plans to support targeted resource allocation, coordinated surveillance, and strategic planning through the One Health framework. Methods The current study used a literature review of peer-reviewed publications and grey literature, expert knowledge, followed by a workshop to prioritize zoonoses in Bhutan. The workshop was convened in April 2024, and 42 participants from 20 different organizations from human, animal, wildlife, environmental, and food safety sectors participated in the workshop. Zoonotic disease prioritization was conducted using a mixed-method approach that combined an expert consensus approach with the U.S. Centers for Disease Control and Prevention One Health Zoonotic Disease Prioritization (OHZDP) tool. Results The initial literature review listed 55 zoonotic diseases for prioritization in the country. The workshop prioritized the top 10 zoonotic diseases viz., Rabies; Influenza A H5N1; Leptospirosis; Brucellosis; Escherichia coli infections; Dengue; Scrub Typhus; Bovine tuberculosis; Anthrax; and Salmonellosis. Joint action areas for the top five zoonotic diseases were developed to effectively address each disease through the One Health approach in the country. Conclusion The prioritized zoonoses in Bhutan should be used for strengthening One Health coordination. Key recommendations from the OHZDP workshop emphasized strengthening disease surveillance, building laboratory diagnostic capacity, enhancing intersectoral collaboration, and developing a harmonized, interoperable system for information sharing and reporting. These measures aim to improve real-time data exchange, facilitate joint outbreak investigations, and support evidence-based decision-making for the prevention and control of zoonotic diseases.

Background Rabies is endemic in southern Bhutan, associated with 1–2 human deaths and high post exposure prophylaxis (PEP) costs annually. Evaluation of clinicians’ management of human cases potentially exposed to rabies could contribute to improving PEP prescribing practices to both reduce unnecessary costs associated with PEP and reach the target of zero human deaths due to rabies by 2023. Methods A cross-sectional survey of 50 clinicians’ management of human cases potentially exposed to rabies was conducted in 13 health centers in high-rabies-risk areas of Bhutan during February–March 2016. Results Data were collected on clinicians’ management of 273 human cases potentially exposed to rabies. The 50 clinicians comprised health assistants or clinical officers (55%) and medical doctors (45%) with a respective median of 19, 21 and 2 years’ experience. There was poor agreement between clinicians’ rabies risk assessment compared with an independent assessment for each case based on criteria in the National Rabies Management Guidelines (NRMG). Of the 194 cases for which clinicians recorded a rabies risk category, only 53% were correctly classified when compared with the NRMG. Clinicians were more likely to underestimate the risk of exposure to rabies and appeared to prescribe PEP independently of their risk classification.. Male health assistants performed the most accurate risk assessments while female health assistants performed the least accurate. Clinicians in Basic Health Units performed less accurate risk assessments compared with those in hospitals. Conclusions This study highlights important discrepancies between clinicians’ management of human cases potentially exposed to rabies and recommendations in the NRMG. In particular, clinicians were not accurately assessing rabies risk in potentially exposed cases and were not basing their PEP treatment on the basis of their risk assessment. This has significant implications for achieving the national goal of eliminating dog-mediated human rabies by 2030 and may result in unnecessary costs associated with PEP. Recommendations to improve clinician’s management of human cases potentially exposed to rabies include: reviewing and updating the NRMG, providing clinicians with regular and appropriately targeted training about rabies risk assessment and PEP prescription, and regularly reviewing clinicians’ practices.

Background Rabies kills approximately 59,000 people each year worldwide. Rapid and accurate diagnosis of rabies is important for instituting rapid containment measures and for advising the exposed people for postexposure treatment. The application of a rapid diagnostic tests in the field can greatly enhance disease surveillance and diagnostic activities, especially in resource poor settings. In this study, a total of 179 brain tissue samples collected from different rabies suspect animal species (113 dogs, 50 cattle, 10 cats, 3 goats, 2 horses, and 1 bear) were selected and tested using both rapid immunochromatographic kit and the reference standard fluorescent antibody test (FAT). We evaluated the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of a rapid antigen detection test kit produced by BioNote, Inc. (Hwaseong-si, Korea) relative to a FAT for its fit-for-purpose for confirmation of clinical cases of rabies for early response and enhancing rabies surveillance. Results Among 179 samples examined in this study, there was a concordance in results by the rapid test and FAT in 115 positive samples and 54 negative samples. Test results were discordant in 10 samples which were positive by FAT, but negative (false negative) by rapid kit. The rapid test kit showed a sensitivity of 92% (95% CI: 85.9–95.6) and specificity of 100% (95% CI: 93.4–100) using FAT as the reference standard. The positive and negative predictive values were found to be 100% (95% CI:96.7–100) and 84.4% (95% CI: 73.6–91.3), respectively. Overall, there was 94.4% (95% CI: 90–96.9) test agreement between rapid test and FAT (Kappa value = 0.874) with a positive percent agreement and negative percent agreement of 92 and 100%, respectively. Conclusions Our finding demonstrated that the rapid test kit (BioNote) can be used for rabies surveillance and confirming clinical case of rabies in animals for making rapid decisions particularly controlling rabies outbreaks in resource poor settings.

The investigation was undertaken to measure the epidemiological features and antimicrobial sensitivity patterns of Escherichia coli among different breeds of goats in Cox's Bazar, Bangladesh. A total of 150 rectal swab samples were collected from selected goats. The samples were subjected for the isolation of E. coli through a series of conventional bacteriological and biochemical techniques. The isolated E. coli were used for assessing antimicrobial susceptibility by disk diffusion method. Besides prevalence study, nine risk factors were studied; the risk factors were breed, age, hygienic status, sex, history of recent transportation, season, diarrhea, body condition score, and source of drinking water. The overall prevalence of E. coli in the rectal swabs of goats was 52% (n=78/150). The young goats were highly susceptible (65.0%; n=52/80) to E. coli infection as compared to adults (37.1%; n=26/70). The prevalence was higher (66.7%; n=42/63) in the goats that was reared in poor hygienic condition as compared to the goats that were reared under good hygienic condition. The influence of the source of drinking water on E. coli prevalence was found to be higher both in pond (63.6%; n=7/11) and municipality (61.4%; n=51/83) supplied water as compared to tube-well (35.7%; n=20/56). The goats having recent transportation history showed higher prevalence (64.8%; n=35/54). The prevalence was higher in diarrheic goats (62.0%; n=49/79) than non-diarrheic goats. Among the E. coli isolates (n=78), 31 were found to be multidrug resistant (MDR) to 3 to 8 subclasses of antimicrobials. Presence of MDR E. coli in the studied goats suggest the probable acquisition, development and transmission of MDR E. coli through a number of influencing factors to other animals and potentially to human.

Background: Rabies is endemic in southern Bhutan, associated with 1 2 human deaths annually and accounting for about 6% of annual national expenditure on essential medicines. A WHO-adapted National Rabies Management Guidelines (NRMG) is available to aid clinicians in PEP prescription. An understanding of clinical practice in the evaluation of rabies risk in endemic areas could contribute to improve clinicians PEP decision-making. Methods: A cross-sectional survey of clinicians was conducted in 13 health centers in high-rabies-risk areas of Bhutan during February March 2016. Data were collected from 273 patients examined by 50 clinicians. Results: The majority (69%) of exposure was through dog bites. Half the patients were children under 18 years of age. Consultations were conducted by health assistants or clinical officers (55%), or by medical doctors (45%), with a median age of clinicians of 31 years. Rabies vaccines were prescribed in 91% of exposure cases. The overall agreement between clinician s rabies risk assessment and the NRMG for the corresponding exposure was low (kappa =0.203, p<0.001). Clinicians were more likely to underestimate the risk of exposure than overestimate it. Male health assistants were the most likely to make an accurate risk assessment and female health assistants were the least likely. Clinicians from district or regional hospitals were more likely to conduct accurate risk assessments compared to clinicians in Basic Health Units (Odds Ratios of 7.8 and 17.6, respectively). Conclusions: This study highlighted significant discrepancies between clinical practice and guideline recommendations for rabies risk evaluation. Regular training about rabies risk assessment and PEP prescription should target all categories of clinicians. An update of the NRMG with more specific criterions for the prescription of RIG might contribute to increase the compliance, along with a regular review of decision-making criteria to monitor adherence to the NRMG.