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"Rabies Treatment History"
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Rabid : a cultural history of the world's most diabolical virus
The most fatal virus known to science, rabies -- a disease that spreads avidly from animals to humans -- kills nearly one hundred percent of its victims once the infection takes root in the brain. Journalist Bill Wasik and veterinarian Monica Murphy chart four thousand years of the history, science, and cultural mythology of rabies. From Greek myths to zombie flicks, from the laboratory heroics of Louis Pasteur to the contemporary search for a lifesaving treatment, Rabid is a fresh and often irreverent look at one of humankind's oldest and most fearsome foes.
Book
Rabies Reemergence, Central Europe, 2022–2024
Oral rabies vaccination campaigns helped eliminate rabies from parts of Europe, but rabies appears to be reemerging. We analyzed 2022-2024 data, which demonstrated reemergence of 2 virus variants; both were detected in Ukraine, Moldova, Poland, and Romania. Our findings highlight the need to strengthen rabies control efforts in the region.
Journal Article
Metagenomic next-generation sequencing for etiological diagnosis of an unexpected rabies case with unclear exposure history
Background
Rabies is an acute and lethal zoonotic disease caused by the rabies virus (RABV). After onset, there are no effective drugs or treatment methods.
Case presentation
A 49-year-old female from Hefei, Anhui Province, China, presented to a local hospital with fever, pruritus, chest distress, and shortness of breath. During the consultation, the patient exhibited agitation and was later admitted to the intensive care unit (ICU) in the local hospital for endotracheal intubation and mechanical ventilation due to worsened agitation and dyspnea. Cerebrospinal fluid (CSF) and blood samples were collected and pathogenic microorganism identification was performed by culture and mNGS. However, all results were negative. In addition, the patient did not display typical rabies-specific symptoms such as aerophobia, hydrophobia or photophobia from onset to admission. Subsequently, saliva samples were collected for mNGS detection following consultation with experts at our hospital. Nucleic acid sequences uniquely aligned to the rabies virus (RABV) were identified in these samples. The result was further confirmed by local Center for Disease Control and Prevention (CDC) through RT-qPCR which detected part of the N gene of RABV in the saliva sample. The patient was then transferred to the ICU for isolation. Unfortunately, the patient died on the 10th day of admission due to multiple organ failure. The detection of human rabies virus IgG antibodies reported positive during the advanced stage of the disease during the hospitalization. We consistently verified with the patient’s family member that there was no clear history of animal bites and no history of RABV vaccination. Furthermore, we performed phylogenetic analysis of partial L and G gene sequences of RABV obtained by mNGS (designated HFG23-L and HFG23-G, respectively), the results showed that both HFG23-L and HFG23-G belonged to the China I lineage, and shared 99.7% similarity with the Fengtai strain isolated from dogs in Beijing.
Conclusions
The identification of unique RABV sequence through mNGS in the patient’s saliva sample suggested that mNGS could serve as a valuable screening tool for the etiological diagnosis of rabies, especially when timely laboratory testing was unavailable or when patients lacked non-specific prodromal symptom and clear exposure history.
Journal Article
The rise and fall of rabies in Japan: A quantitative history of rabies epidemics in Osaka Prefecture, 1914–1933
Japan has been free from rabies since the 1950s. However, during the early 1900s several large-scale epidemics spread throughout the country. Here we investigate the dynamics of these epidemics between 1914 and 1933 in Osaka Prefecture, using archival data including newspapers. The association between dog rabies cases and human population density was investigated using Mixed-effects models and epidemiological parameters such as the basic reproduction number (R0), the incubation and infectious period and the serial interval were estimated. A total of 4,632 animal rabies cases were reported, mainly in dogs (99.0%, 4,584 cases) during two epidemics from 1914 to 1921, and 1922 to 1933 respectively. The second epidemic was larger (3,705 cases) than the first (879 cases), but had a lower R0 (1.50 versus 2.42). The first epidemic was controlled through capture of stray dogs and tethering of pet dogs. Dog mass vaccination began in 1923, with campaigns to capture stray dogs. Rabies in Osaka Prefecture was finally eliminated in 1933. A total of 3,805 rabid dog-bite injuries, and 75 human deaths were reported. The relatively low incidence of human rabies, high ratio of post-exposure vaccines (PEP) and bite injuries by rabid dogs (minimum 6.2 to maximum 73.6, between 1924 and 1928), and a decline in the proportion of bite victims that developed hydrophobia over time (slope = -0.29, se = 3, p < 0.001), indicated that increased awareness and use of PEP might have prevented disease. Although significantly more dog rabies cases were detected at higher human population densities (slope = 0.66, se = 0.03, p < 0.01), there were fewer dog rabies cases detected per capita (slope = -0.34, se = 0.03, p < 0.01). We suggest that the combination of mass vaccination and restriction of dog movement enabled by strong legislation was key to eliminate rabies. Moreover, the prominent role of the media in both reporting rabies cases and efforts to control the disease likely contributed to promoting the successful participation required to achieve rabies elimination.
Journal Article
Rabies post-exposure prophylaxis in the emergency department: A monocentric retrospective observational study
Emergency departments (ED) are frequently visited after suspected rabies exposure (SRE) and the potential need for rabies post-exposure prophylaxis (R-PEP). However, data on the number of visits, patients' demographics, travel history and the medical treatment is still rare. Therefore, the aim of this study was to assess the number of R-PEP and the appropriateness of medical management including wound treatment, vaccination regime and immunoglobulin application following SRE in a university hospital ED.
We conducted a monocentric retrospective observational study on emergency patients treated in the ED of the LMU University Hospital, Ludwig-Maximilians-University Munich, Germany, between June 1st, 2023 and January 31st, 2024. Patients requiring post-exposure prophylaxis due to SRE abroad or in Germany were included. Demographic data, travel history, clinical findings, wound treatment, and R-PEP vaccination regimen were recorded.
During the observation period of 245 days 43 patients presented to our ED for R-PEP. There was a total of 51 presentation appointments, as 5 patients returned for further treatment. Most patients (27, 52.9 %) presented at the ED on a Saturday, Sunday, or a public holiday. 17 (39.5 %) patients had a category II exposure, and 26 (60.5 %) had a category III exposure. In our ED, there were 28 (55.0 %) active vaccinations and 23 (45.0 %) both active and passive vaccinations.
Our data show that patients frequently present for R-PEP in ED. Therefore, there is a high need for education on indication for R-PEP and for implementation of precise R-PEP treatment guidelines in daily clinical practice.
Journal Article
Treatment of rabies in the 21st century: curing the incurable?
Despite the extreme case fatality attributable to rabies, reports of survivors provide a faint glimpse of a possibility of overcoming this deadly disease, even after clinical symptoms manifest. At present, no existing approach fulfills modern medical criteria for the optimal therapy of rabies. Until new efficacious antiviral compounds and optimized treatment protocols are developed, animal population management and vaccination of major reservoirs and vectors, minimization of the risk of viral exposures, and appropriate and early postexposure prophylaxis, remain the hallmarks of modern public health intervention.
Journal Article
Protective efficacy of the recombinant, live-attenuated, CYD tetravalent dengue vaccine in Thai schoolchildren: a randomised, controlled phase 2b trial
Roughly half the world's population live in dengue-endemic countries, but no vaccine is licensed. We investigated the efficacy of a recombinant, live, attenuated tetravalent dengue vaccine.
In this observer-masked, randomised, controlled, monocentre, phase 2b, proof-of-concept trial, healthy Thai schoolchildren aged 4–11 years were randomly assigned (2:1) to receive three injections of dengue vaccine or control (rabies vaccine or placebo) at months 0, 6, and 12. Randomisation was by computer-generated permuted blocks of six and participants were assigned with an interactive response system. Participants were actively followed up until month 25. All acute febrile illnesses were investigated. Dengue viraemia was confirmed by serotype-specific RT-PCR and non-structural protein 1 ELISA. The primary objective was to assess protective efficacy against virologically confirmed, symptomatic dengue, irrespective of severity or serotype, occurring 1 month or longer after the third injection (per-protocol analysis). This trial is registered at ClinicalTrials.gov, NCT00842530.
4002 participants were assigned to vaccine (n=2669) or control (n=1333). 3673 were included in the primary analysis (2452 vaccine, 1221 control). 134 cases of virologically confirmed dengue occurred during the study. Efficacy was 30·2% (95% CI −13·4 to 56·6), and differed by serotype. Dengue vaccine was well tolerated, with no safety signals after 2 years of follow-up after the first dose.
These data show for the first time that a safe vaccine against dengue is possible. Ongoing large-scale phase 3 studies in various epidemiological settings will provide pivotal data for the CYD dengue vaccine candidate.
Sanofi Pasteur.
Journal Article
Epidemiological Associations between Rabies Vaccination and Dog Owner Characteristics
Background: The annual rabies vaccination coverage in dogs among 47 prefectures in Japan has been reported to range from 42.3% to 92.4%, and the overall coverage has been steadily declining. Given the presence of unregistered dogs and the small number of stray dogs, the true vaccination coverage is likely to be even lower. Methods: We conducted a cross-sectional survey of dog owners to identify the owner characteristics associated with dog rabies vaccination. People in Japan who currently own dogs were recruited and answered a questionnaire consisting of four sections: (i) demographic characteristics, (ii) education history associated with medicine, (iii) factors related to veterinary services, and (iv) dog characteristics. Results: A total of 534 dog owners covering 629 dogs were surveyed. Vaccination within the prior 12 months was the major outcome (56.1%). The associated variables were (a) owner education level, (b) knowledge about mandatory vaccination, (c) having a family veterinary clinic, (d) frequency of visiting a veterinary clinic, and (e) having ever been advised to vaccinate their dog. Conclusions: Although causality cannot be implied, our findings indicate improving owners’ knowledge about mandatory vaccination, facilitating attachment to a veterinary clinic, and veterinarians providing vaccination advice might increase the uptake of dog rabies vaccination. The finding in Japan did not deviate from Asian and African countries with rabies, and the sample estimate of annual vaccination coverage was lower than the reported estimate among registered dogs.
Journal Article
Dr. Abolghasem Bahrami (1894–1950): Physician, Pasteurian, and a Pioneer of Microbiology and Public Health Planning in Iran
Dr. Abolghasem Bahrami was among the generation of Iranian scientists in the early twentieth century who gained most of their knowledge through resources available inside the country. Educated at Dar-ul-Funun Medical School, he was a physician with a great talent in learning, especially self-teaching natural sciences and European languages. He joined the Pasteur Institute of Iran (IPI) at the early days of its foundation and became an integral contributor to this institution during the first twenty-five years of its mission. One of his first assignments at IPI was to help initiating an anti-rabies department by bringing back the rabies vaccine and its manufacturing equipment from Institut Pasteur of Paris. During his IPI years, aside from managerial tasks, he actively participated in upgrading the medical treatments and protocols used for controlling many infectious diseases. He functioned twice as the provisional director of IPI (1925-1926 and 1937-1946) and is considered as the first Iranian director of the Institute. Meanwhile, Dr. Bahrami was a significant contributor to the public health system and assumed several responsibilities such as Chief Quarantine Medical Officer, Chief of Public Health, and the Head of Public Health Administration, in order to improve public health planning throughout the country.
Journal Article
Traditional knowledge and practice of the Triassic variegated clay from Silesia (Krasiejów), Poland, in human medicine
Background
Krasiejów clay (in German: Krascheow) became famous following the discovery of numerous fossilised bones of Upper Triassic amphibians and reptiles, which have been extracted from clay deposits since the 1980s. These organic remnants remained in Krasiejów clay due to the large amount of slime deposits and the optimal concentration of basal mineral salts.
The main aims of the paper are to determine the historical evolution of the use of clay in Silesia for therapeutic purposes and to provide a summary of the historical uses of Krasiejów clay as a medical treatment, based on the knowledge of the local population.
Methods
The mode of utilisation of Triassic variegated claystone treatment from Krasiejów was surveyed based on oral communication with local people. This information was collected over the last 35 years (1982–2017) by interviewing those who used clay as a traditional remedy, especially the eldest residents. Each resident was interviewed several times regarding the healing properties of Krasiejów clay, including the causes and symptoms of the ailments treated, mode of clay preparation, application methods, and dosage through semistructured interviews.
Results
Clay from Krasiejów was used in medicine after proper preparation. The clay underwent a complicated preparation process before the use in wraps, compresses, poultices, and baths as a skin peeling agent and even as a potion to be drunk. All recorded applications, diseases, and ailments to which it were applied are described here in detail, divided into treatments with warm, and cold clay.
Conclusions
Krasiejów variegated claystone had different benefits depending on the form in which it was used; different diseases were treated with warm and cold clay. According to informants, many of these diseases have been successfully treated, in particular eczema of various origins, purulent ulcers on the skin, and following internal use, digestive ailments. According to informants, in cases where the disease could not be cured, for instance, psoriasis, a significant improvement in the condition of the skin was visible in a short period of time. Clay from Krasiejów should be subjected to more detailed physicochemical analyses to determine its exact chemical composition and healing properties.
Journal Article