This study aims to evaluate the implementation of a hospital-based integrated bite case management system (IBCM) in Phnom Penh to identify potential improvements and assess the risk of rabies in ...human victims to help guide animal health interventions and post-exposure treatment.
The surveillance programme was initiated from human dog-bite patients presented to the Institute Pasteur du Cambodge (IPC) Vaccination Unit in Phnom Penh for post-exposure prophylactic treatment, or through public reports between October 2020 and June 2021. All identified individuals with knowledge of a biting dog were engaged during the investigation. The standardised questionnaires were administered by phone, or in-person where deemed necessary. Each case was assigned with a rabies status; rabid, probable, suspect/inconclusive, and non-case depending on the outcome of an investigation. Univariate logistic regression was performed with all inputs except for inconclusive cases to evaluate the risk factors in case demographics associated with rabid animals.
During the study period, 5,035 investigations were conducted. The surveillance system detected 17 rabid cases associated with human dog-bite patients, and 2 cases through other reports. Fifty-seven cases were defined as probable, and 2,745 biting dogs were considered not rabid at the time of the incidents. A definitive conclusion was not drawn in 2,214 cases. The vaccination rate of known biting dogs was 18.6%. Univariate analyses showed that case demographics from the earliest stage of an investigation including animals showing signs of sickness (OR: 135.8, 95%CI: 42.0 – 439.3), animals’ death described as spontaneous (OR: 111.2, 95%CI: 26.3 – 469.9), animals that were killed (OR: 126.3, 95%CI: 42.4 – 545.3), ownerless animals (OR: 33.5, 95%CI: 11.5 – 97.4), patients older than 15 years old (OR: 5.3, 95%CI: 1.5 – 18.9), and multiple bite victims in a case (OR: 6.8, 95%CI: 2.3 – 20.2) were associated with confirmed rabid cases.
The study identified barriers to successful sample collection and thorough follow-up with patients which could impact on the system competency. The results of the study indicated that the initial case demographics could be used to assist not only prioritise cases for the IBCM investigation, but also spare PEP prescription for cases of low risk.
The problem of stray dogs Gamble, L; Gibson, A D; Shervell, K ...
Revue scientifique et technique (International Office of Epizootics)
37, Številka:
2
Journal Article
Recenzirano
The effective management of stray dogs is critically important in any rabies vaccination programme. In many rabies-endemic countries, stray dogs represent a significant proportion of both the ...free-roaming and total dog populations, and to ensure that rabies elimination programmes are successful, it is essential that this portion of the dog population (stray dogs) is vaccinated at high coverage. However, there are a number of challenges to managing and delivering rabies vaccinations to stray dogs. This paper will review the most pertinent issues relating to the problem of stray dogs and rabies elimination, focusing on the challenges relating to the estimation of population size, vaccination administration and vaccine coverage assessment in stray dog populations. The authors will highlight how these challenges can be overcome, notably by reviewing the census techniques that have been employed to assess stray dog populations, which then facilitate the planning and design of vaccination programmes. In addition, they discuss the range of vaccination strategies that are available and that have been used to vaccinate stray dogs and review how vaccination coverage can be assessed in this population. Finally, the benefits of population management in stray dogs through neutering programmes are reviewed. In short, this paper highlights the importance of ensuring that stray dogs, as well as owned dogs, are included in vaccination programmes and emphasises that many of the challenges related to protecting stray dogs from rabies can be overcome.
Highlights • Machine learning tool for replanning and adaptive RT. • Multicenter investigation of predictive methods in Head and Neck cancer. • Support decision making tool to support physician ...activities. • Re-planning approach and benefit based on information acquirable by IGRT.
To investigate the feasibility and the clinical response of a stereotactic single-dose radiation treatment for liver tumors.
Between April 1997 and September 1999, a stereotactic single-dose ...radiation treatment of 60 liver tumors (four primary tumors, 56 metastases) in 37 patients was performed. Patients were positioned in an individually shaped vacuum pillow. The applied dose was escalated from 14 to 26 Gy (reference point), with the 80% isodose surrounding the planning target volume. Median tumor size was 10 cm(3) (range, 1 to 132 cm(3)). The morbidity, clinical outcome, laboratory findings, and response as seen on computed tomography (CT) scan were evaluated.
Follow-up data could be obtained from 55 treated tumors (35 patients). The median follow-up period was 5.7 months (range, 1.0 to 26.1 months; mean, 9.5 months). The treatment was well tolerated by all patients. There were no major side effects. Fifty-four (98%) of 55 tumors were locally controlled after 6 weeks at the initial follow-up based on the CT findings (22 cases of stable disease, 28 partial responses, and four complete responses). After a dose-escalating and learning phase, the actuarial local tumor control rate was 81% at 18 months after therapy. A total of 12 local failures were observed during follow-up. So far, the longest local tumor control is 26.1 months.
Stereotactic single-dose radiation therapy is a feasible method for the treatment of singular inoperable liver metastases with the potential of a high local tumor control rate and low morbidity.
Despite successful eradication programmes in many regions, rabies remains responsible for approximately 60,000 human deaths annually, and no country in Africa is rabies-free. Dogs are the principal ...reservoir of the virus in Africa and the World Health Organisation recommends that at least 70% of the dog population be vaccinated in order to break the transmission cycle. Most attempts at mass rabies vaccinations in Africa have failed to vaccinate high numbers of dogs at a high coverage. Successful studies have often used a door-to-door (DTD) approach, which is logistically challenging and expensive compared to a static point (SP) approach. Mission Rabies has successfully implemented a combined SP and DTD method in cities in India and Malawi. This campaign used a combined methodology in rural Uganda, starting with a SP campaign, followed by a DTD campaign, and then subsequent transect surveys to assess vaccination coverage. This was facilitated by the use of a smartphone application which recorded all vaccinations and survey responses along with their Global Positioning System location.
A total of 4172 dogs were vaccinated in 7 days, attaining an estimated 88.4% coverage. This campaign is of particular note as 95.9% of the vaccinations were performed at SPs. The human-to-dog ratio was 4.9 with a mean dogs per house of 1.2. Most dogs were owned (93.7%). This demonstrates that high-number, high-coverage vaccination is achievable in rural Uganda and provides data that may refine future campaign approaches.
Introduction
Salvage radiotherapy (SRT) after radical prostatectomy for prostate cancer (PCa) is recommended as soon as PSA rises above 0.20 ng/ml, but many patients (pts) still experience local ...macroscopic relapse. The aim of this multicentric retrospective analysis was to evaluate the role of SRT in pts with macroscopic relapse.
Materials and methods
From 2001 to 2016, 105 consecutive pts with macroscopic PCa relapse underwent SRT ± androgen deprivation therapy (ADT). Mean age was 72 years. At time of relapse, 29 pts had a PSA value < 1.0 ng/mL, 50 from 1.1 to 5, and 25 pts > 5. Before SRT, 23 pts had undergone 18F-choline PET and 15 pts pelvic MRI. Ninety-four pts had prostatic bed relapse only, and four nodal involvement. Fifty-one pts were previously submitted to first-line ADT, while 6 pts received ≥ 2 lines.
Results
At a median follow-up of 52 months, 89 pts were alive, while 16 were dead. Total RT dose to macroscopic lesions was > 70 Gy in 58 pts, 66–70 Gy in 43, and < 66 Gy in 4 pts. In 72 pts, target volume encompassed only the prostatic bed with sequential boost to macroscopic site; 33 pts received prophylactic pelvic RT. Ten-year overall survival was 76.1%, while distant metastasis-free survival was 73.3%. No grade 4–5 toxicities were found.
Conclusions
SRT ± ADT for macroscopic relapse showed a favorable oncological outcome supporting its important role in this scenario. Data from this series suggest that SRT may either postpone ADT or improve results over ADT alone in appropriately selected pts.
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