Skip to main content
  • Research article
  • Open access
  • Published:

Human rabies post exposure prophylaxis at the Pasteur Institute of Dakar, Senegal: trends and risk factors

Abstract

Background

Rabies remains a major public health problem in developing countries. Most fatal rabies cases, especially in children, result from dog bites and occur in low-income countries, such as those in Sub-Saharan Africa. Rabies can be controlled through mass dog vaccination and human deaths prevented through timely and appropriate post-exposure prophylaxis (PEP). As access to appropriate PEP remains a serious challenge for bite-victims, the aim of this study was to understand the use of PEP, to evaluate the knowledge, attitudes and practices with respect to rabies and to identify risk factors related to non-compliance with PEP to define recommendations for improving PEP in Senegal.

Methods

This study included patients with suspicion of rabies exposure who sought PEP at the Pasteur Institute of Dakar from April 2013 to March 2014. Patients with rabies clinical symptoms, those who had already started PEP and those with exposure outside Senegal or for more than 3ā€‰months were excluded. Data on risk factors and propensity to seek and complete PEP were collected using questionnaires and phone interviews. The association between acceptability and compliance with PEP and other independent variables were evaluated using multivariate regression analysis.

Results

Among the 905 patients enrolled into the study, 67% were male (sex ratio M/F, 2) and 46%, children under 15ā€‰years of age. Exposures by animal bites represented 87%, whereas the remainder were due to scratches or contact; 76% were classified as WHO category III and 88% were due to dogs. Among these patients, 7% refused to start PEP and 54.5% completed the full schedule. Main factors reported by non-compliant patients were vaccine costs and affordability, and knowledge on status of biting animal.

Conclusion

This study shows that despite the awareness about rabies dangers and prevention, only half of the patients completed the full PEP schedule. The following recommendations, such as free of charge prophylaxis or intradermal regimens as an alternative to intramuscular regimens, should be considered to increase the adherence to PEP at the Pasteur Institute of Dakar and in Senegal.

Peer Review reports

Background

Rabies remains a major public health issue in the world, with 59,000 human deaths per year, mainly in low and middle income countries of Asia and Africa [1]. In Western and Central African countries, reporting of rabies is not mandatory, so few epidemiological data are available [2]. This has resulted in lack of prevention and control measures possibly due to under reporting, insufficient follow- up on victims of animal bites, lack of data on the public health impact of the disease, and absence of programs for effective vaccination of dogs.

Rabies is acute, progressive and is almost 100% fatal once clinical symptoms develop. However, the disease is preventable with timely implementation of vaccination after exposure to a suspected rabid animal (named Post-Exposure Prophylaxis, PEP). PEP equals more than 20 million treatments per year and has been an effective control measure to rabies for more than 100ā€‰years [3]. The WHO-recommended PEP consists of an immediate bite wound washing or flushing, administration of rabies vaccine and, when category III exposure is recognized additional injection of rabies immunoglobulin (RIG) [4, 5]. PEP should be started as soon as possible after a recognized exposure [6]. Several PEP regimens (using intramuscular or intradermal administration) are currently approved for individuals not previously vaccinated against rabies [5].

In Senegal where rabies is endemic, human rabies is a notifiable disease. Between 1995 and 2016, 79 human cases were reported by the Fann University Hospital of Dakar [7]. Although the annual reported number of human rabies cases is very low across the country [7,8,9], the number of individuals seeking PEP after suspected exposure to the virus has increased in the past years. Since 1963 in Senegal, the Pasteur Institute of Dakar is one of the major public rabies vaccination centres. Despite the recent implementation of PEP in two other hospitals (the Fann University Hospital of Dakar in 2010 and the regional hospital of Fatick in July 2013), the Pasteur Institute of Dakar remains the most reliable data source to describe the use and administration of rabies PEP in Senegal (Fig.Ā 1). Thus at the Pasteur Institute of Dakar, from 2008 to 2012, between 850 and 1000 patients have received PEP annually, but very few data on PEP use are publicly available. Moreover, the discrepancies observed between the expected number of vaccine doses that should have been delivered if all patients who have been advised to start PEP were compliant, and the observed number of administered vaccine doses suggested that the implementation of PEP at the Pasteur Institute of Dakar was not optimal.

Fig. 1
figure 1

Map of Senegal with the location of the three rabies vaccination centres (named ā€œPEP centreā€). NordNordWest [under the Creative Commons Attribution-Share Alike 3.0 Unported], from Wikimedia Commons (https://commons.wikimedia.org/wiki/File:Senegal,_administrative_divisions_-_en_-_monochrome.svg)

The aim of this study was to understand the use of human rabies PEP, to evaluate the knowledge, attitudes and practices of patients with respect to rabies, and to identify risk factors related to a partial PEP schedule, in order to propose recommendations for improving the PEP delivered to patients at the Pasteur Institute of Dakar, in Senegal.

Methods

Study design and study population

A prospective cohort study was carried out from April 1, 2013 to March 31, 2014, at the Pasteur Institute of Dakar. All patients reporting contact with suspected rabid animals and who had sought PEP at the Pasteur Institute were screened for eligibility in the study. Patients with rabies clinical signs, those who had already started PEP in another hospital and those who had been bitten more than 3ā€‰months ago or bitten outside of Senegal, were not considered eligible for this study.

When a patient was first admitted at the Pasteur Institute of Dakar, a clinical examination was performed by a physician who decided whether PEP was needed, based on WHO recommendations and the exposure context. If PEP was recommended, the physician informed the patient about the study objectives and study procedures (including potential phone calls). If the patient agreed to participate and had a mobile phone to be reachable during the study period, the physician obtained his/her consent. Children without legal representative or adults who refused to participate were excluded. For patients who signed the informed consent form, the physician completed the study questionnaire, explained the purpose of PEP and procedures and started the prophylaxis.

At the Pasteur Institute of Dakar, PEP protocol for unvaccinated individuals (Zagreb regimen) consists of injection of four intramuscular doses of a purified vero cell rabies vaccine (Verorab Sanofi Pasteur, France) at D0 (2 doses), D7 (one dose) and D21 (one dose) [4]. In case of severe wound, equine RIG (Favirab Sanofi Pasteur, France) are administered at the initiation of PEP, in addition of the two first doses of the vaccine.

At the initial visit (D0), a structured questionnaire was used to collect data including socio-demographic characteristics (education level, petsā€™ ownership, household size), description of the wound(s) (number, size, location), exposure (date and place, animal involved, WHO categories I, II, III [4]), treatment (local treatment of injuries, antibiotics administration, previous rabies vaccination), knowledge of rabies and attitudes in respect to animal bite.

At D7 (2nd visit) and D21 (3rd visit), follow-up questionnaires were completed by a nurse to collect additional data on potential occurrence of adverse effects after vaccination and current status of the suspected rabid animal. When patients didnā€™t attend the follow-up visits at the Pasteur Institute of Dakar, a phone interview was conducted within the 7ā€‰days after the planned visit in order to identify the reasons of the absence at the planned follow-up visit. For patients who came back to the Pasteur Institute of Dakar to continue PEP after the follow-up call, data were recorded, but not included in the statistical analysis.

Statistical analysis

The compliance of PEP was defined as follows: ā€œNo PEPā€ if the patient didnā€™t start the prophylaxis, ā€œPartial PEPā€ if the patient received two or three doses and ā€œComplete PEPā€ if the patient received the full 4-dose schedule.

Proportions of PEP recipients by gender, age groups, season, socio-demographic factors, type of exposure (animal bite versus non-bite) and knowledge of rabies were estimated. Among patients who started PEP, differences between partial and complete PEP were assessed with Fisherā€™s test or Mann-Whitney test of significance. A multivariate logistic regression model was developed to identify possible risk factors for partial PEP, using a forward stepwise selection approach. Odds ratios (OR) with Wald 95% confidence intervals were estimated. Variables with p-values <ā€‰0.05 (based on the likelihood-ratio chi-squared test) in the multivariable model were considered to be significantly associated with partial PEP.

The main analysis was run on all subjects enrolled in the study, and a sensitive analysis was performed on subjects not related to a cluster, to investigate potential confounders.

Analyses were performed using STATA software version 10 (StataCorp).

Ethical approval

The study protocol and the informed consent form were approved by the National Ethical Committee for Research of Senegal. The study was conducted in compliance with principles set out by the Declaration of Helsinki, and the regulatory requirements of the Senegalese government on Health Research Ethic. For children less than 16ā€‰years of age, individual written informed consent was obtained from all childrenā€™s parents or legal representatives, in the presence of an independent witness for illiterate parents/legal representative.

Results

From April 1, 2013 to March 31, 2014, 1036 patients sought a consultation at the Pasteur Institute of Dakar for suspicion of rabies exposure. Among the 1004 eligible patients who were advised to get PEP, 905 (90.1%) were included in this study (Fig.Ā 2). Among these patients, 66.8% were male (sex ratio M/Fā€‰=ā€‰2.02), and 46.2% were children under 15ā€‰years of age. The mean age was 23.5ā€‰years [range: 14ā€‰months-80ā€‰years]. Eight hundred and forty-two individuals (93.0%) were exposed in Dakar and neighbourhood (Pikine, Rufisque and Guediawaye) and 93.7% were Senegalese (TableĀ 1).

Fig. 2
figure 2

Flow chart of the patients who sought a consultation at the Pasteur Institute of Dakar for suspicion of rabies exposure, April 2013ā€“March 2014

Table 1 Characteristics of the 905 patients and family households, according to PEP compliance

The most bitten body sites were legs (39%) and hands (21%). Eighty percent of patients reported more than two lesions (up to 12). Animal bites represented 87.2% of all exposures and 75.7% were WHO category III (TableĀ 2). After exposure and before coming to the Pasteur Institute of Dakar, 496 patients went to a primary health care centre (e.g. clinic, health care centre, physician office), and 77% came the same day of the incident to receive preliminary treatment by a physician, a nurse or at a pharmacy.

Table 2 Post-exposure prophylaxis according to the site and time of exposures and characteristics of the suspected animal

Exposure occurred at home for 41% of exposures. In 77% of the exposures, only one individual was bitten. However, in January 2014, a cluster of 33 individuals, with a confirmed rabies exposure, was reported involving both children and adults living in a compound house of a non-profit organization in charge of the education of abandoned children.

Most suspected rabies exposures were due to dogs (88%), particularly domestic animals or pets (65%) (TableĀ 2); 4.3% (37/861) of them were up-to-date vaccinated against rabies.

In rare situations involving in total 51 patients (including the cluster of 33 individuals), the seven suspected animals were slaughtered or euthanized and their head were sampled by the Government veterinary services for laboratory confirmation. All animal samples were confirmed positive for rabies.

Post-exposure prophylaxis implementation

Among the 905 included patients, 467 patients (51.7%) went to the Pasteur Institute of Dakar to seek a consultation within the 24ā€‰h after the bite. Out of the 905 patients who were advised to get PEP, 840 patients (93%) received the two first doses and 66 received also immunoglobulins at D0. Sixty-five (7%) patients refused to start PEP and did not receive any vaccine mostly because of financial reasons. However, among them two patients decided to start PEP later, 17 and 30ā€‰days after the first visit at the Pasteur Institute of Dakar.

Out of the patients receiving PEP (Fig.Ā 2), 162 (18%) patients received two doses only at D0, 185 (20.5%) three doses at D0 and D7 and 493 (54.5%) completed the full 4-dose schedule. Among the 51 patients who were exposed to a confirmed rabid animal, 94.1% completed the full 4-dose schedule, one patient received 3 doses and two, only the two first doses. Most of the dose administrations were performed in time: 87.0% at D7 [range, 6ā€“14ā€‰days] and 77.7% at D21 [range, 14ā€“31ā€‰days]. After the follow-up calls, 40 (11.5%) patients came back for the follow-up visit in order to continue PEP, with a median delay of 18ā€‰days [range, 14ā€“31ā€‰days] after D0, and of 22ā€‰days [range, 19ā€“52ā€‰days] after D7. No death was reported during the study period.

The two main reasons reported by the patients or family for not being compliant to PEP regimens at D7 and D21 were: inability to afford PEP and suspected animal still alive more than two weeks after exposure (TableĀ 3). Victims often quoted several reasons: 36.4% reported two reasons and 20.5% more than 2 (up to 4). Among the 302 non-compliant patients, 62 (20.5%) reported that they didnā€™t come for the last dose because the suspected animal was still alive at the date of the planned visit (D21) and the medical staff of the Pasteur Institute mentioned at D7 that the PEP could be discontinued. However, no formal recommendation was clearly provided to the patients. Thirty-four patients or family (11.2%) reported that PEP was too expensive and they were not ill at the time of the planned visit.

Table 3 Reasons reported by the 302 non-compliant patients or family who answered to the follow-up calls

Adverse events were reported after the first two doses by 6% of the patients (42/678) (including 5 patients who also received equine RIG at D0), and after the third dose, by 3% (16/493). Most of them were minor: headache (46.5%), fever (31%) and pain at the injection site (22%), and mostly (74%) occurred on the same day of the vaccine injection (up to 7ā€‰days).

Risk factors for partial PEP course

The sensitive univariate analysis identified the following risk factors for a partial PEP, when sporadic exposure: low level of education of the family head, normal behaviour of the suspected rabid animal at the time of the exposure, no wound-cleansing with antiseptic after exposure, and no immunoglobulins administration at D0 (TableĀ 4).

Table 4 Risk factors for partial PEP vs. complete PEP (sensitive univariate analysis, p-value < 0.1)

In multivariate analysis, after adjusting for covariates (including the fact to be part of a confirmed rabies cluster), low level of education (AOR, 1.59; 95%CI [1.20ā€“2.11]) and absence of RIG administration at D0 (AOR, 3.29; 95%CI [1.72ā€“6.27]) were significantly associated with an increased risk for non-compliant PEP schedule.

Knowledge of rabies and health practices

The majority of the patients or family reported that they were aware that rabies is transmitted by bite (93%), that dogs are the main reservoir of rabies (99%) and that rabies is fatal (90%). Most of the subjects (99%) would seek treatment from a doctor or a hospital after being bitten by a dog, but only 51.5% of the respondents were aware that the Pasteur Institute of Dakar is one of the main centres where the PEP to prevent rabies is provided.

Discussion

This study confirms that the epidemiology of bite and treatment for suspected rabies exposures in Senegal is similar to what is observed in other African countries: children and young men are the most exposed [3], and dogs are the main reservoir [10,11,12]. Most of the animals involved were domesticated with identified owners, but only 4.3% of them were up-to date with rabies vaccination. The low vaccination coverage could be the result of a lack of regulations enforcement and controls for pet ownership in Senegal.

Over 93% of exposures were reported in the urban area of Dakar and the three surrounding cities that are highly populated areas. This finding could be a result of rapid urbanisation with rapid immigration of stray dogs to urban areas to find food and an increased contact interaction between human and dogs [13, 14]. However, this pattern would better reflect the catchmentā€™s area of the Pasteur Institute of Dakar, instead of the true geographic distribution of rabies exposure in Senegal.

This study shows that the compliance rate for the full PEP schedule, as recommended by WHO, is quite low (55%). Regression modelling showed that the two risk factors associated with a non-compliant PEP were the low level of education of the patient or family and the absence of RIG administration at D0. These findings are coherent with studies suggesting that education of parents plays a significant role with regards to higher child immunization rates [15, 16]. Moreover, people with higher education tend to know more about rabies [17, 18], while illiterate individuals tend to know less about rabies [19]. This might explain the low level of concern about the fatal risk and the importance of the PEP compliance. Regarding the absence of RIG administration as a potential risk factor for non-compliance, it might be explained by the fact that the administration of RIG is highly recommended in case of confirmed rabid exposure and severe wounds. In this specific situation, a more detailed counselling regarding PEP and its compliance might be performed compared to situations where RIG was not recommended.

Furthermore, the first reason highlighted by the patients who never started PEP or who were not compliant, was the high costs of the full PEP schedule. In Senegal, the costs of a full PEP schedule (excluding RIG) range from 40 to 60 euros, and according to the World Development Indicators, the average monthly disposable salary is around 160 euros [20]. In addition to the direct expenditure on PEP, costs from travel to distant PEP centres and lost income whilst seeking PEP were already reported in studies conducted in other rabies endemic countries [21,22,23]. Therefore, the true costs of PEP has been estimated to be twice as high as those reported in Africa [24] and should be considered in economic costs of rabies, as high costs might led to poor compliance with PEP regimens and increased risk of death [1]. The other main reason was the fact that the suspected animal was still alive at least 2ā€‰weeks after exposure, as reported by the patient and that the patient was informed by the Pasteur Institute of Dakar that PEP can be discontinued if, in the case of domestic dogs or cats, the animal remained healthy through a 2ā€‰weeks period of observation. With regards to this WHO recommendation, around 20% of the non-compliant patients of this study would have been considered as compliant. However, it was not possible to obtain a formal and well-documented assessment of the situation with a close follow-up of the health status of the animal after exposure because of absence of 10-day quarantine under the control of a veterinarian.

Thus, for clinicians, the decision to initiate a PEP is quite difficult, especially in a country where: i) there are large population of stray dogs, ii) no quarantine of suspected animals is implemented, and iii) laboratory testing for rabies confirmation in suspected animals is not regularly performed [25, 26]. This study estimates that around 5% of PEP was administered to patients whose risk for rabies would have been considered as low (such as exposure to healthy vaccinated dogs) based on the WHO recommendations [4, 27]. Thus, the implementation of the WHO recommendations should improve the number of patients completing PEP while reducing the unnecessary PEP for non-rabies exposures [27, 28]. However, the implementation of such recommendations in Senegal remains a challenge as the reliable data on the exposure (including epidemiological likelihood that the suspected animal was rabid, clinical features of the animal, its vaccination status or its availability for observation and laboratory testing) is currently rarely available for a full assessment of each individual case.

During this 1-year study, as observed in other Sub-Saharan African countries, the proportion of patients who received equine RIG among those patients who should have received it according to the WHO recommendations, was very low (less than 10%) mostly because of the costs [1] and the lack of supply [29, 30].

Based on the information reported by the patients or family (own perception), this study shows a good knowledge regarding the risks for rabies, how to prevent the disease, and where to receive rabies vaccination. This high level of self-reported awareness may be due to the availability of information from multiple sources, including recent government campaigns related to the national control and prevention program against rabies implemented in October 2010. However, a recent study showed measurable differences between the actual knowledge of rabies and the own perception of the patients, that raise an important issue, implying that the public may not be aware of their lack of knowledge [31]. Moreover, this high level of self-reported awareness could not be extrapolated to the general Senegalese population as the targeted population of this study was the selected patients who came to the Pasteur Institute of Dakar to seek a consultation for suspected rabies exposure.

Few patients reported adverse effects after PEP. Similar proportion of mild systemic adverse events (such as transient fever, headache) and pain at the site of injection, have been reported with rabies vaccines (5ā€“15%) [32, 33]. In general, PEP is safe and well tolerated [27].

In order to increase the adherence to PEP, a free of charge prophylaxis might be implemented as it has already been done in other countries where rabies is endemic [8, 34]. Moreover, intradermal regimens, successfully introduced in some endemic countries [22, 34,35,36], should be considered as they can reduce the cost by about 70%, compared to intramuscular regimens [37, 38]. Moreover, these intradermal regimens have been found to be equally immunogenic and as effective as the standard intramuscular regimens [33, 37, 39,40,41].

Moreover, a careful risk assessment of each individual case following the WHO guidelines [27, 42, 43] would reduce the overuse or misuse of PEP, and therefore reduce expenditure. Therefore, trainings should be conducted to support Senegalese health workers in better clinical decision-making when administering PEP. We also recommend that bitten victims should receive a counselling with documented medical providersā€™ recommendations [28] and should be closely followed to ensure the compliance of PEP, by using either follow-up calls or short message service text messages [44].

Conclusions

In Senegal, human rabies remains a major public health concern. The current prevention is accomplished by avoiding exposure to rabid animals or through PEP. Therefore, a national program for control and elimination of canine rabies was implemented in Senegal by the Ministry of Health since October 2010 with strengthening of collaboration between medical and veterinary sectors and investments in these two sectors. Regarding the PEP use and administration, this study shows that despite the public awareness about rabies dangers and prevention, only half of patients who received PEP at the Pasteur Institute of Dakar completed PEP. As PEP is a complex decision-making process for clinicians, especially when the suspected animal is not available for surveillance, recommendations such as free-of-charge prophylaxis or intradermal regimens should be considered to increase the adherence to PEP, as a complementary policy to prevent and control rabies in Senegal.

Abbreviations

OR:

Odds ratios

PEP:

Post-Exposure Prophylaxis

RIG:

Rabies immunoglobulin

WHO:

World Health Organisation

References

  1. Hampson K, Coudeville L, Lembo T, Sambo M, Kieffer A, Attlan M, et al. Estimating the global burden of endemic canine rabies. PLoS Negl Trop Dis. 2015;9(4):e0003709.

    ArticleĀ  Google ScholarĀ 

  2. Dodet B, Adjogoua EV, Aguemon AR, Amadou OH, Atipo AL, Baba BA, et al. Fighting rabies in Africa: the Africa rabies expert bureau (AfroREB). Vaccine. 2008;26(50):6295ā€“8.

    ArticleĀ  Google ScholarĀ 

  3. World Health Organization. WHO expert consultation on rabies - second report and technical report series 982. Geneva: WHO; 2013.

    Google ScholarĀ 

  4. World Health Organization. WHO Guide for rabies pre- and post-exposure prophylaxis in humans. December 15, 2014. https://www.who.int/rabies/PEP_Prophylaxis_guideline_15_12_2014.pdf. Accessed 26 Mar 2019.

  5. World Health Organization. Meeting of the Strategic Advisory Group of Experts on immunization, October 2017 ā€“ conclusions and recommendations. Rabies vaccines. WER. 2017;92(48):744ā€“6.

    Google ScholarĀ 

  6. Manning SE, Rupprecht CE, Fishbein D, Hanlon CA, Lumlertdacha B, Guerra M, et al. Advisory committee on immunization practices Centers for Disease Control and Prevention (CDC). Human rabies prevention--United States, 2008: recommendations of the advisory committee on immunization practices. MMWR Recomm Rep. 2008;57(RR-3):1ā€“28.

    PubMedĀ  Google ScholarĀ 

  7. Diop SA, Manga NM, Dia NM, Ndour CT, Seydi M, Soumare M, et al. The point on human rabies in Senegal from 1986 to 2005. Med Mal Infect. 2007;37(12):787ā€“91 French.

    ArticleĀ  CASĀ  Google ScholarĀ 

  8. Dodet B. Africa rabies bureau (AfroREB). The fight against rabies in Africa: from recognition to action. Vaccine. 2009;27(37):5027ā€“32.

    ArticleĀ  Google ScholarĀ 

  9. Sow PS, Diop BM, Faye Ndao MA, Badiane S, Coll Seck AM. Human rabies in Senegal: epidemiological and clinical aspects. Dakar Med. 1991;36(2):105ā€“11 French.

    CASĀ  PubMedĀ  Google ScholarĀ 

  10. Fooks AR, Banyard AC, Horton DL, Johnson N, McElhinney LM, Jackson AC. Current status of rabies and prospects for elimination. Lancet. 2014;384(9951):1389ā€“99.

    ArticleĀ  Google ScholarĀ 

  11. Warrell MJ, Warrell DA. Rabies: the clinical features, management and prevention of the classic zoonosis. Clin Med. 2015;15(1):78ā€“81.

    ArticleĀ  Google ScholarĀ 

  12. Rhodes CJ, Atkinson RPD, Anderson RM, Macdonald DW. Rabies in Zimbabwe: reservoir dogs and the implications for disease control. Philos Trans R Soc Lond Ser B Biol Sci. 1998;353:999ā€“1010.

    ArticleĀ  CASĀ  Google ScholarĀ 

  13. Zinsstag J, DĆ¼rr S, Penny MA, Mindekem R, Roth F, Menendez Gonzalez S, et al. Transmission dynamics and economics of rabies control in dogs and humans in an African city. Proc Natl Acad Sci U S A. 2009;106(35):14996ā€“5001.

    ArticleĀ  CASĀ  Google ScholarĀ 

  14. Akakpo AJ, Bornarel P, Sarradin P, Leye SM, Alambedji R. Socio-ethnology and role of the dog in the Pikine district (suburban zone of Dakar - Senegal). Dakar Med. 1990;35(1):99ā€“105 French.

    CASĀ  PubMedĀ  Google ScholarĀ 

  15. Kusuma YS, Kumari R, Pandav CS, Gupta SK. Migration and immunization: determinants of childhood immunization uptake among socioeconomically disadvantaged migrants in Delhi, India. Tropical Med Int Health. 2010;15(11):1326ā€“32.

    ArticleĀ  Google ScholarĀ 

  16. Mitchell S, Andersson N, Ansari NM, Omer K, Soberanis JL, Cockcroft A. Equity and vaccine uptake: a cross-sectional study of measles vaccination in Lasbela District, Pakistan. BMC Int Health Hum Rights. 2009;9(Suppl 1):S7.

    ArticleĀ  Google ScholarĀ 

  17. Palamar MB, Peterson MN, Deperno CS, Correa MT. Assessing rabies knowledge and perceptions among ethnic minorities in Greensboro, North Carolina. J Wildl Manag. 2013;77(7):1321ā€“6.

    ArticleĀ  Google ScholarĀ 

  18. Nejash A, Boru M, Jemal J, Wezir A. Knowledge, attitudes and practices towards rabies in Dedo district of Jimma zone, southwestern Ethiopia: a community based cross-sectional study. Int J Med Med Sci. 2017;9(5):61ā€“71.

    ArticleĀ  Google ScholarĀ 

  19. Herbert M, Basha SR, Thangaraj S. Community perception regarding rabies prevention and stray dog control in urban slums in India. J Infect Public Health. 2012;5(6):374ā€“80.

    ArticleĀ  Google ScholarĀ 

  20. National Agency of Statistics and Demography. National survey of employment in Senegal (ENES), Third trimester 2017. December 2017. Senegal. Frenchhttp://www.ansd.sn/ressources/publications/Rapport_ENES_TRIM3_2017.pdf. Accessed 26 Mar 2019.

  21. Romero-Sengson RF. Factors affecting compliance to rabies post-exposure prophylaxis among pediatric patients seen at the research institute for tropical medicine. Pediatr Infect Dis Soc Philipp J. 2013;14(2):56ā€“62 https://apamedcentral.org/Synapse/Data/PDFData/0015PIDSPJ/pidspj-14-56.pdf. Accessed 14 June 2018.

    Google ScholarĀ 

  22. Shankaraiah RH, Rajashekar RA, Veena V, Hanumanthaiah AN. Compliance to anti-rabies vaccination in post-exposure prophylaxis. Indian J Public Health. 2015;59(1):58ā€“60.

    ArticleĀ  Google ScholarĀ 

  23. Tarantola A, Ly S, In S, Ong S, Peng Y, Heng N, et al. Rabies vaccine and rabies immunoglobulin in Cambodia: use and obstacles to use. J Travel Med. 2015;22(5):348ā€“52.

    ArticleĀ  Google ScholarĀ 

  24. Sambo M, Cleaveland S, Ferguson H, Lembo T, Simon C, Urassa H, et al. The burden of rabies in Tanzania and its impact on local communities. PLoS Negl Trop Dis. 2013;7(11):e2510.

    ArticleĀ  Google ScholarĀ 

  25. McCombie SC. The politics of immunization in public health. Soc Sci Med. 1989;28(8):843ā€“9.

    ArticleĀ  CASĀ  Google ScholarĀ 

  26. Sriaroon C, Jaijaroensup W, Tantawichien T, Benjawongkunchai M, Supich C, Wilde H. Common dilemmas in managing rabies exposed subjects. Trav Med Infect Dis. 2005;3:1ā€“7.

    ArticleĀ  Google ScholarĀ 

  27. World Health Organization. Rabies vaccines: WHO position paper. WER. 2010;85(32):309ā€“20.

    Google ScholarĀ 

  28. Etheart MD, Kligerman M, Augustin PD, Blanton JD, Monroe B, Fleurinord L, et al. Effect of counselling on health-care-seeking behaviours and rabies vaccination adherence after dog bites in Haiti, 2014-15: a retrospective follow-up survey. Lancet Glob Health. 2017;5(10):e1017ā€“25.

    ArticleĀ  Google ScholarĀ 

  29. Hampson K, Dobson A, Kaare M, Dushoff J, Magoto M, Sindoya E, et al. Rabies exposures, post-exposure prophylaxis and deaths in a region of endemic canine rabies. PLoS Negl Trop Dis. 2008;2:e339.

    ArticleĀ  Google ScholarĀ 

  30. Mallewa M, Fooks AR, Banda D, Chikungwa P, Mankhambo L, Molyneux E, et al. Rabies encephalitis in malaria-endemic area, Malawi, Africa. Emerg Infect Dis. 2007;13:136ā€“9.

    ArticleĀ  Google ScholarĀ 

  31. Hasanov E, Zeynalova S, Geleishvili M, Maes E, Tongren E, Marshall E, et al. Assessing the impact of public education on a preventable zoonotic disease: rabies. Epidemiol Infect. 2018;146(2):227ā€“35.

    ArticleĀ  CASĀ  Google ScholarĀ 

  32. Fishbein DB, Dreesen DW, Holmes DF, Pacer RE, Ley AB, Yager PA, et al. Human diploid cell rabies vaccine purified by zonal centrifugation: a controlled study of antibody response and side-effects following primary and booster pre-exposure immunizations. Vaccine. 1989;7:437ā€“42.

    ArticleĀ  CASĀ  Google ScholarĀ 

  33. Quiambao BP, Dimaano EM, Ambas C, Davis R, Banzhoff A, Malerczyk C. Reducing the cost of post-exposure rabies prophylaxis: efficacy of 0.1 ml PCEC rabies vaccine administered intradermally using the Thai red cross post-exposure regimen in patients severely exposed to laboratory-confirmed rabid animals. Vaccine. 2005;23(14):1709ā€“14.

    ArticleĀ  CASĀ  Google ScholarĀ 

  34. Andriamandimby SF, HĆ©raud JM, Ramiandrasoa R, Ratsitorahina M, Rasambainarivo JH, Dacheux L, et al. Surveillance and control of rabies in La Reunion, Mayotte, and Madagascar. Vet Res. 2013;44:77.

    ArticleĀ  Google ScholarĀ 

  35. Ly S, Buchy P, Heng NY, Ong S, Chhor N, Bourhy H, et al. Rabies situation in Cambodia. PLoS Negl Trop Dis. 2009;3(9):e511.

    ArticleĀ  Google ScholarĀ 

  36. Mpolya EA, Lembo T, Lushasi K, Mancy R, Mbunda EM, Makungu S, et al. Toward elimination of dog-mediated human rabies: experiences from implementing a large-scale demonstration project in southern Tanzania. Front Vet Sci. 2017;4:21.

    ArticleĀ  Google ScholarĀ 

  37. Khawplod P, Wilde H, Sirikwin S, Benjawongkulchai M, Limusanno S, Jaijaroensab W, et al. Revision of the Thai red cross intradermal rabies post-exposure regimen by eliminating the 90-day booster injection. Vaccine. 2006;24:3084ā€“6.

    ArticleĀ  Google ScholarĀ 

  38. Hampson K, Cleaveland S, Briggs D. Evaluation of cost-effective strategies for rabies post-exposure vaccination in low-income countries. PLoS Negl Trop Dis. 2011;5(3):e982.

    ArticleĀ  Google ScholarĀ 

  39. Warrell MJ. Intradermal rabies vaccination: the evolution and future of pre- and post-exposure prophylaxis. Curr Top Microbiol Immunol. 2012;351:139ā€“57.

    CASĀ  PubMedĀ  Google ScholarĀ 

  40. Madhusudana SN, Anand NP, Shamsundar R. Economical multi-site intradermal regimen with purified chick embryo cell vaccine (Rabipur) prevents rabies in people bitten by confirmed rabid animals. Int J Infect Dis. 2002;6:210ā€“4.

    ArticleĀ  CASĀ  Google ScholarĀ 

  41. World Health Organization. Rabies vaccines: WHO position paper ā€“ April 2018. WER. 2018;16(93):201ā€“19.

    Google ScholarĀ 

  42. Warrell MJ. Current rabies vaccines and prophylaxis schedules: preventing rabies before and after exposure. Travel Med Infect Dis. 2012;10(1):1ā€“15.

    ArticleĀ  CASĀ  Google ScholarĀ 

  43. Moran GJ, Talan DA, Mower W, Newdow M, Ong S, Nakase JY, et al. Appropriateness of rabies post-exposure prophylaxis treatment for animal exposures. Emergency ID net study group. JAMA. 2000;284(8):1001ā€“7.

    ArticleĀ  CASĀ  Google ScholarĀ 

  44. Baron S, Goutard F, Nguon K, Tarantola A. Use of a text message-based pharmacovigilance tool in Cambodia: pilot study. J Med Internet Res. 2013;15(4):e68.

    ArticleĀ  Google ScholarĀ 

Download references

Acknowledgements

We thank the patients and their families; the staff of the Centre for human rabies post exposition prophylaxis, in particular Fatou Binetou Badji, who provided assistance with data collection; Diallo Ousseynou from the Government veterinary services for providing the lab results of animal samples; Mamadou Ndoye and Carlos ArsĆØne Akakpovi for their statistical support during their master.

Funding

Not applicable.

Availability of data and materials

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Author information

Authors and Affiliations

Authors

Contributions

EE designed the study. MKD, AOD, EE and AD participated in the collection or generation of the study data. EE, AOD, and VR were involved in the analysis or interpretation of the study results. All authors provided substantial scientific input during the manuscript development, reviewed the content and approved the final version.

Corresponding author

Correspondence to Emmanuelle EspiƩ.

Ethics declarations

Ethics approval and consent to participate

The study protocol and the informed consent form were approved by the National Ethical Committee for Research of Senegal. The study was conducted in compliance with principles set out by the Declaration of Helsinki, and the regulatory requirements of the Senegalese government on Health Research Ethic. For children less than 16ā€‰years of age, individual written informed consent was obtained from all childrenā€™s parents or legal representatives, in the presence of an independent witness for illiterate parents/legal representative.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisherā€™s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Diallo, M.K., Diallo, A.O., Dicko, A. et al. Human rabies post exposure prophylaxis at the Pasteur Institute of Dakar, Senegal: trends and risk factors. BMC Infect Dis 19, 321 (2019). https://doi.org/10.1186/s12879-019-3928-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1186/s12879-019-3928-0

Keywords