Asian Pacific Journal of Tropical Medicine

483-484

Authors: Folorunso Oludayo Fasina

This issue of Asian Pacific Journal of Tropical Medicine has published a case report[1]. This report detailed an atypical fatal case of fox-mediated human rabies. It once again reemphasized the importance of zoonotic disease transmission by animals (including wildlife), and a need to look introspectively in order to consider innovative solutions aimed at reducing the burden of zoonoses. Rabies continues to significantly impact human lives, particularly in the Asian and Africa regions where fatal dogmediated rabies in humans accounts for 96% of total rabiesassociated global death annually (> 59 000)[2]. In the current case, a fox (Vulpes vulpes) had attacked a man in a farm area in Qom, Iran, inflicting injuries in the head and palms. The patient only sought wound dressing without the necessary follow-up postexposure prophylaxis. Ultimately, death supervene despite all effort at late recovery[1]. This brings to focus the importance of targeted but intense community awareness campaign on rabies and other zoonoses, especially with regards to preventive and mitigation measures that can reduce zoonotic burdens in atrisk communities. Such activities have been tested with positive outcomes in Moshi, Tanzania and elsewhere[3, 4]. Although Qom is a metropolis, south of Tehran, and it is the seventh largest city in Iran with a human population of over 1.2 million, the Qom Province has four other cities. Perhaps these cities may not be predisposed to cases of wildlife associated rabies except in rare cases of stray wildlife. However, all other human habitations in the province are classified as villages. It is a fact that villages are suitable interfaces for human-wildlife-domestic animal interactions. The wild cats, hyenas, wolves, jackals, desert foxes and foxes (all potentials reservoirs for Rabies lyssavirus), are among the rich fauna of Iran, inclusive of, in the low plain of Qom[5], and these animals may likely be involved in territorialrelated human-animal and wildlife-domestic animal conflicts. Although, sources of aggression may include provocation, entering the animal protected territories, possessiveness, response to a painful injury, fear, maternal instinct, pursuant of prey, or rabies-associated aggression[3], in the current case, the cause of the fox attack was not stated. Based on reports, dog-mediated rabies had predominated in Qom and other parts of Iran, but this should not exclude the possibility of other forms of rabies transmission. The current atypical case of fox bite associated rabies puts into perspective, that other forms of rabies transmission, not dogmediated rabies, is likely to happen. This present case should elicitate more investigation on potential causes of human deaths, especially when symptoms suggestive of rabies exist, even in the absence of histories of dog bites. Perhaps, cases of atypical human rabies have been underreported in previous circumstances.Previous work had mapped rabies at the human-dogs-wildlife interface[6], and at such interfaces, control of zoonoses are often complicated and complex. Interface communities should be targeted for intense awareness campaign, mass vaccination of domestic animals, the restriction of domestic dog-wildlife interactions, movement control of reservoir populations (wildlife) through barriers and other similar control measures[3, 6]. Where cost associated with these measures overburden the subnational government, subsidy system from the national authorities should be instituted or portions of the eco-tourism funds should be redirected at such measures. Combating infection at source remains one of the best approach to rapidly prevent escalation of infection, effectively detect pathogens and efficiently respond to and curtail outbreak situations. Given that health service deliveries are often delayed at subnational levels (villages, wards and rural areas), these locations most times also double as interfaces where the vast majority of rabies-related morbidities and mortalities occur in Asia and Africa[2]. To achieve the objective of timely and efficient delivery of health services while at the same time utilizing cost-effective options, local public, animal and agro-environmental health authorities need to define One Health working arrangements that facilitate coordination, communication and collaborations[7]. Institutionalizing such platform at subnational levels should benefit the national health systems and reduce the burden of zoonoses. It is established that dogs account for up to 99% of all cases of human rabies[2]; and with over 59 000 annual human deaths related directly to rabies, an associated loss of 3.7 million DALYs (disability-adjusted life–year: productivity losses due to mortality or morbidity) and an estimated annual global economic cost of dog-mediated rabies of US$ 8.6 billion (95% confidence interval, 2.9–21.5 billion)[2, 8], it is cost effective and discerning for nations to implement carefully designed effective dog and cat vaccinations annually to reduce the burden of human rabies and proceed towards elimination target set for the year 2030[3,4,8].

499-506

Authors: Kittipong Sornlorm1, Wongsa Loahasiriwong1, Paiboon Sithithaworn2, Wilaiphorn Thinkhamrop3

Objective: To determine the influence of geographic, knowledge and behavioral factors on Opisthorchis (O.) viverrini infection in the Northeast of Thailand. Methods: This cross-sectional study was conducted by using four datasets of years 2016 and 2017. Generalized linear mixed model was employed to analyze association between geographic, knowledge and behavioral factors and O. viverrini infection. Results: Totally there were 1 885 participants. The prevalence of O. viverrini infection was 10.03%. Geographic factors that showed statistically significant association with O. viverrini infection in the Northeast region were featured by at least a dam and reservoir (Adj. OR = 4.21, 95%CI: 2.49-7.13, P < 0.001), at least a weir (Adj. OR = 1.74, 95%CI: 1.09-2.77, P = 0.020), > 50 dogs and cats per village (Adj. OR = 3.40, 95%CI: 2.17-5.31, P < 0.001), and rice fields covered > 50% of its areas (Adj. OR = 1.91, 95%CI: 1.04-4.01, P = 0.036), as well as low to moderate levels of knowledge (Adj. OR = 1.60, 95%CI: 1.32 to 1.94, P < 0.001), consumed raw fish (Adj. OR = 1.90, 95%CI: 1.02 to 3.52, P = 0.040) and consumed processed raw fish (Adj. OR = 3.03, 95%CI: 2.20 to 4.18, P < 0.001). Other significant covariates were gender and age of the respondents. Conclusions: O. viverrini infection still remains a public health problem of the Northeast of Thailand. Geographic and demographic factors, knowledge, and consumption behaviors of raw fish products are significantly associated with O. viverrini infection.

512-519

Authors: Devi Shankar Suman

Objective: To establish an efficacious and efficient surveillance method of Armigeres (Ar.) subalbatus, a known filarial vector, surviving in forest habitats to estimate realistic population density and assess the impact of altitudinal variations on the efficacy of the trap. Methods: In the study, 12 locations in areas with an altitudinal range from 82 m to 920 m were selected in three reserve forests for night sampling of adult Ar. subalbatus mosquito using standard chemical lure based BG-Sentinel traps and CDC-light traps in pairs. Effects of locations and time were estimated on the efficacy of traps as mosquito density using multifactor analysis of variance for significant differences. Impact of altitudinal variations on the efficacy of traps was assessed using multiple regression with slope comparison. Results: BG-Sentinel trap collected significantly more adult Ar. subalbatus, 4.43 folds in Gorumara NP, 5.19 folds in Neora Valley NP and 12.10 folds in Mahananda WLS than the CDC-light trap irrespective to locations. BG-Sentinel traps were tolerant of altitudinal variations (80 m -170 m) and showed no significant relationship between density and altitudes in contrast to CDC-light traps which showed a significant negative impact on capturing efficacy with increase in altitudes (P<0.001). Conclusions: The study suggests that BG-Sentinel traps can be used effectively and efficiently to collect more Ar. subalbatus mosquitoes during night time in comparison to CDC-light trap under complex climatic conditions of forest and variable altitudes.

528-530

Authors: Seyed Abbas Hosseinalipour1, Faranak Firoozfar2, Abedin Saghafipour3, Nazanin Ziasheikholeslami4

Rationale: Rabies, as an acute viral disease of the mammal’s central nervous system (CNS), with a high mortality rate, is transmitted to humans through the bite of a rabid animals, especially canine and feline. Patient concerns: An Afghan man, aged 50 years was bitten by a fox in a farm around the Qom-Tehran road, Central Iran in 2018. The patient visited the doctor after the bite, however the period between incidence and hospital visit was not established and no indication was given whether the bite site injury was thoroughly washed. The patient was neither referred to the health center for vaccination (post-exposure prophylaxis) nor an effective therapeutic measures was applied. Forty-five days post-exposure, the patient presented with symptoms such as headache, fever, tingling and burning sensation and was referred to the Centers for Disease Control and Prevention (CDC) unit of Qom Provincial Health Center. Diagnosis: Rabies infection. Interventions: Forty-five days after the animal bite, in CDC of Qom Health Center, he received rabies post-exposure prophylaxis treatment and was referred to an infectious diseases physician. Based on the history of animal bites, the patient was classified as probable case of rabies. The clinical symptoms of rabies appeared in patient after hospitalization. Outcomes: Ultimately the patient died in hospital 4 days after hospitalization (50 days after the occurrence of animal bite). After referring the patient to the CDC, the patient's saliva (0.5-1 mL) was sampled three times every 3-6 hours and tested by PCR. Human rabies was confirmed by Department of Virology in the Pasteur Institute of Iran. Lessons: Physicians and clinicians have responsibilities to be critical in observations and take prompt actions in case of animal bites, as rabies usually develops within 7 to 14 days, and delayed intervention after the onset of symptoms, vaccine and serum injections cannot lead to the survival of the patient.