Dog-mediated rabies kills tens of thousands of people each year in India, representing one third of the estimated global rabies burden. Whilst the World Health Organization (WHO), World Organization ...for Animal Health (OIE) and the Food and Agriculture Organization of the United Nations (FAO) have set a target for global dog-mediated human rabies elimination by 2030, examples of large-scale dog vaccination programs demonstrating elimination remain limited in Africa and Asia. We describe the development of a data-driven rabies elimination program from 2013 to 2019 in Goa State, India, culminating in human rabies elimination and a 92% reduction in monthly canine rabies cases. Smartphone technology enabled systematic spatial direction of remote teams to vaccinate over 95,000 dogs at 70% vaccination coverage, and rabies education teams to reach 150,000 children annually. An estimated 2249 disability-adjusted life years (DALYs) were averted over the program period at 526 USD per DALY, making the intervention 'very cost-effective' by WHO definitions. This One Health program demonstrates that human rabies elimination is achievable at the state level in India.
Background
The use of optical surface positioning to support or replace X-ray-based image-guided radiotherapy (IGRT) may reduce patient exposure to extra dose. In specifically designed phantom tests, ...we analyzed the potential of a new scanning device preclinically. The system’s clinical performance was evaluated in comparison to cone-beam computed tomography (CBCT) in a prospective study.
Materials and methods
We first evaluated the scanning performance in terms of accuracy and reproducibility using phantom tests. An institutional review board (IRB)-approved clinical evaluation encompassing 224 fractions in 13 patients treated in three different regions (head and neck, thorax, pelvis) was then performed. Patients were first positioned using CBCT and then scanned with the Catalyst
TM
(C-RAD, Uppsala, Sweden) optical system to define the resulting difference vector.
Results
Individual system settings are necessary for different scanning conditions. Reproducibility tests with phantoms showed a mean difference of 0.25 ± 0.21 cm. Accuracy tests showed a mean difference of less than 0.52 ± 0.41 cm. Considering all patients, clinical data showed residual target position differences between Catalyst
TM
(surface-driven) and CBCT (target-driven) systems within 0.07 ± 0.28 cm/− 0.13 ± 0.40 cm/0.15 ± 0.36 cm/0.11 ± 1.57°/− 0.43 ± 1.68/− 0.10 ± 1.67° (lateral/longitudinal/vertical/rotation/roll/pitch).
Conclusion
Scanning quality depends on the color and shape of the scanned surface. Upon prospective clinical evaluation, excellent agreement between target- and contour driven positioning was observed. Catalyst
TM
may reduce CBCT scan frequency in patients where tumor location is fixed relative to the surface.
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
Odprti dostop
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.
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