PDF(Pubmed)
Abstract：
Dog-mediated rabies is enzootic in Vietnam, resulting in at least 70 reported human deaths and 500,000 human rabies exposures annually. In 2016, an integrated bite cases management (IBCM) based surveillance program was developed to improve knowledge of the dog-mediated rabies burden in Phu Tho Province of Vietnam.
The Vietnam Animal Rabies Surveillance Program (VARSP) was established in four stages: (1) Laboratory development, (2) Training of community One Health workers, (3) Paper-based-reporting (VARSP 1.0), and (4) Electronic case reporting (VARSP 2.0). Investigation and diagnostic data collected from March 2016 to December 2019 were compared with historical records of animal rabies cases dating back to January 2012. A risk analysis was conducted to evaluate the probability of a rabies exposure resulting in death after a dog bite, based on data collected over the course of an IBCM investigation.
Prior to the implementation of VARSP, between 2012 and 2015, there was an average of one rabies investigation per year, resulting in two confirmed and two probable animal rabies cases. During the 46 months that VARSP was operational (2016 - 2019), 1048 animal investigations were conducted, which identified 79 (8%) laboratory-confirmed rabies cases and 233 (22%) clinically-confirmed(probable) cases. VARSP produced a 78-fold increase in annual animal rabies case detection (one cases detected per year pre-VARSP vs 78 cases per year under VARSP). The risk of succumbing to rabies for bite victims of apparently healthy dogs available for home quarantine, was three deaths for every 10,000 untreated exposures.
A pilot IBCM model used in Phu Tho Province showed promising results for improving rabies surveillance, with a 26-fold increase in annual case detection after implementation of a One Health model. The risk for a person bitten by an apparently healthy dog to develop rabies in the absence of rabies PEP was very low, which supports the WHO recommendations to delay PEP for this category of bite victims, when trained animal assessors are available and routinely communicate with the medical sector. Recent adoption of an electronic IBCM system is likely to expedite adoption of VARSP 2.0 to other Provinces and improve accuracy of field decisions and data collection.
The Vietnam Animal Rabies Surveillance Program (VARSP) was established in four stages: (1) Laboratory development, (2) Training of community One Health workers, (3) Paper-based-reporting (VARSP 1.0), and (4) Electronic case reporting (VARSP 2.0). Investigation and diagnostic data collected from March 2016 to December 2019 were compared with historical records of animal rabies cases dating back to January 2012. A risk analysis was conducted to evaluate the probability of a rabies exposure resulting in death after a dog bite, based on data collected over the course of an IBCM investigation.
Prior to the implementation of VARSP, between 2012 and 2015, there was an average of one rabies investigation per year, resulting in two confirmed and two probable animal rabies cases. During the 46 months that VARSP was operational (2016 - 2019), 1048 animal investigations were conducted, which identified 79 (8%) laboratory-confirmed rabies cases and 233 (22%) clinically-confirmed(probable) cases. VARSP produced a 78-fold increase in annual animal rabies case detection (one cases detected per year pre-VARSP vs 78 cases per year under VARSP). The risk of succumbing to rabies for bite victims of apparently healthy dogs available for home quarantine, was three deaths for every 10,000 untreated exposures.
A pilot IBCM model used in Phu Tho Province showed promising results for improving rabies surveillance, with a 26-fold increase in annual case detection after implementation of a One Health model. The risk for a person bitten by an apparently healthy dog to develop rabies in the absence of rabies PEP was very low, which supports the WHO recommendations to delay PEP for this category of bite victims, when trained animal assessors are available and routinely communicate with the medical sector. Recent adoption of an electronic IBCM system is likely to expedite adoption of VARSP 2.0 to other Provinces and improve accuracy of field decisions and data collection.
摘要：
■狗介导的狂犬病在越南是地方性疾病，导致每年至少70例报告的人类死亡和500,000例人类狂犬病暴露。2016年，制定了基于综合咬伤病例管理（IBCM）的监测计划，以提高对越南PhuTho省的狗介导狂犬病负担的了解。
■越南动物狂犬病监测计划（VARSP）分四个阶段建立：（1）实验室开发，(2)培训社区一卫生工作者，(3)纸质报告(VARSP1.0)，和(4)电子病例报告(VARSP2.0)。将2016年3月至2019年12月收集的调查和诊断数据与2012年1月动物狂犬病病例的历史记录进行比较。进行了风险分析，以评估狂犬病暴露导致狗咬伤后死亡的可能性，基于IBCM调查过程中收集的数据。
■在实施VARSP之前，在2012年至2015年之间，平均每年有一次狂犬病调查，导致两例确诊和两例可能的动物狂犬病病例。在VARSP运营的46个月(2016-2019年)，进行了1048次动物调查，该研究确定了79例(8%)实验室确诊的狂犬病病例和233例(22%)临床确诊(可能)病例。VARSP每年在动物狂犬病病例检测中增加了78倍（VARSP前每年检测1例，VARSP下每年检测78例）。可供家庭隔离的看似健康的狗被咬伤的受害者有死于狂犬病的风险，是每10000次未经治疗的暴露中有3人死亡。
■PhuTho省使用的IBCM试点模型显示出改善狂犬病监测的有希望的结果，实施“一个健康”模式后，每年的病例检测量增加了26倍。在没有狂犬病PEP的情况下，被表面健康的狗咬伤的人患上狂犬病的风险非常低，这支持世卫组织关于推迟此类咬伤受害者的PEP的建议，当训练有素的动物评估员可用时，并定期与医疗部门沟通。最近采用电子IBCM系统可能会加快VARSP2.0在其他省份的采用，并提高现场决策和数据收集的准确性。
■越南动物狂犬病监测计划（VARSP）分四个阶段建立：（1）实验室开发，(2)培训社区一卫生工作者，(3)纸质报告(VARSP1.0)，和(4)电子病例报告(VARSP2.0)。将2016年3月至2019年12月收集的调查和诊断数据与2012年1月动物狂犬病病例的历史记录进行比较。进行了风险分析，以评估狂犬病暴露导致狗咬伤后死亡的可能性，基于IBCM调查过程中收集的数据。
■在实施VARSP之前，在2012年至2015年之间，平均每年有一次狂犬病调查，导致两例确诊和两例可能的动物狂犬病病例。在VARSP运营的46个月(2016-2019年)，进行了1048次动物调查，该研究确定了79例(8%)实验室确诊的狂犬病病例和233例(22%)临床确诊(可能)病例。VARSP每年在动物狂犬病病例检测中增加了78倍（VARSP前每年检测1例，VARSP下每年检测78例）。可供家庭隔离的看似健康的狗被咬伤的受害者有死于狂犬病的风险，是每10000次未经治疗的暴露中有3人死亡。
■PhuTho省使用的IBCM试点模型显示出改善狂犬病监测的有希望的结果，实施“一个健康”模式后，每年的病例检测量增加了26倍。在没有狂犬病PEP的情况下，被表面健康的狗咬伤的人患上狂犬病的风险非常低，这支持世卫组织关于推迟此类咬伤受害者的PEP的建议，当训练有素的动物评估员可用时，并定期与医疗部门沟通。最近采用电子IBCM系统可能会加快VARSP2.0在其他省份的采用，并提高现场决策和数据收集的准确性。
