Tóm Tắt Ncs Lâm. Bản Dịch.pdf

Chapters MINISTRY OF EDUCATION AND TRAINING MINISTRY OF HEALTH NATIONAL INSTITUTE OF MALARIOLOGY PARASITOLOGY AND ENTOMOLOGY NGO QUY LAM STUDY ON SOME EPIDEMIOLOGICAL CHARACTERISTICS OF HUMAN RABIES I[.]

MINISTRY OF EDUCATION

AND TRAINING

MINISTRY OF HEALTH

NATIONAL INSTITUTE OF

MALARIOLOGY-PARASITOLOGY AND ENTOMOLOGY

NGO QUY LAM

STUDY ON SOME EPIDEMIOLOGICAL CHARACTERISTICS

OF HUMAN RABIES IN GIA LAI, DAK LAK, AND THE EFFECTIVENESS OF INTERVENTIONS (2015-2022)

Major: Epidemiology Code: 972 01 17

SUMMARY OF DOCTORAL DISSERTATION

HA NOI - 2023

THIS DISSERTATION HAS BEEN COMPLETED AT NATIONAL INSTITUTE OF MALARIOLOGY- PARASITOLOGY AND ENTOMOLOGY

Supervisors:

1 Assoc.Prof.Dr Nguyen Xuan Kien

2 Assoc.Prof.Dr Cao Ba Loi

This doctoral dissertation can be found at:

- National Library of Vietnam

- Library …

ABSTRACT

Rabies is a deadly, acute infectious disease caused by the rabies virus that can readily expand into community epidemics Rabies is spread to warm-blooded animals and people by bites, scratches, licks

on the skin, and broken mucous membranes from infected animals Rabies is the top cause of death among infectious diseases in Vietnam and ranks 14th globally In recent years, the number of rabies deaths has risen According to General Department of Preventive Medicine, there were 846 rabies deaths in the United States between 2006 and 2015

Although there have not been many rabies deaths in the Central Highlands, the number of rabies deaths between 2016 and 2020 has increased by more than 4 times compared to 2010 to 2015 In order

to give additional scientific support for rabies control in this region,

a study of the situation of rabies in Gia Lai and Dak Lak is required from a scientific and practical standpoint

Raising public awareness has been demonstrated to increase the effectiveness of campaigns to eliminate canine rabies Numerous earlier studies have shown that communication strategies improve people's understanding of rabies prevention However, effective public education campaigns to lower rabies risk are frequently region-specific and necessitate extensive local adaptation To improve its chances of success, an intervention program should consider variables including ethnicity, religion, and culture

1 Objectives:

1.1 Describe some characteristics of human rabies epidemiology and prevention activities in Gia Lai and Dak Lak provinces (2015-2021) 1.2 Evaluation of the effectiveness of some interventions in the prevention of rabies in Gia Lai (2021-2022)

2 Significance of the study

- A map of the rabies risk in the community of the investigated provinces will be built using the survey data There isn't yet a map

depicting the rabies risk in Vietnam

- It offers for an update on the recent rabies prevention situation

in Gia Lai and Dak Lak The effectiveness of rabies prevention in the community can be increased by following scientific and useful recommendations based on the study of rabies prevention initiatives

3 Strucure of the study: The thesis consists of 149 pages, including

parts and 4 chapters:

Question: 02 pages

Chapter 1 Literature review: 33 pages

Chapter 2 Research subjects and methods: 28 pages

Chapter 3 Research results: 44 pages

Chapter 4 Discussion: 36 pages

According to a report by the World Health Organization (WHO), rabies is widespread around the world Each year, more than 10 million people are bitten by rabid or suspected rabies animals need to receive rabies vaccine prophylaxis, about 60,000 - 70,000 people have died from rabies, most of which are reported from countries in the tropics

Vaccination and anti-rabies serum for persons who have been bitten

by animals are two distinct control strategies that can be used in conjunction to prevent rabies

1.2 Situation of rabies virus infection in humans and animals

Except for a few island countries, rabies is currently prevalent in every country on earth Around 59,000 people in more than 150 countries contract rabies annually, with 95% of cases occurring in Asia and Africa, according to the WHO

According to fragmentary data, there were 2,600 domestic animal rabies cases (dogs and cats) between 1991 and 1995 In 1996, there were 587 cases, which resulted in the deaths of 16,800 animals,

of which 97% were dogs and 3% were cats and other livestock The overall canine population's real rabies vaccination rate has remained low (less than 50%) over time In 2015, there were almost 9 million domestic dogs in the country, according to statistics from the provinces and cities, but only 3.89 million of those canines had received rabies vaccinations, or 42.9% of the total There haven't been any wild animals in Vietnam that have the rabies virus or are currently carrying it, like other nations in Southeast Asia and Asia where dogs are the main carriers of the disease

In order to strengthen rabies prevention, the Prime Minister issued Directive No 92/TTg in 1996 Since then, authorities at all levels have given rabies prevention more priority, and a large-scale rabies vaccination program for persons who have been bitten by dogs

is established across many districts Beginning in January 2007, there were 936 rabies vaccination sites across the nation At the injection sites, there were books to record, manage, and report on a regular basis in accordance with the Preventive Medicine Centers system In the entire nation of 2015, rabies claimed 78 lives

1.3 Rabies prevention activities

Health services are crucial in lowering the number of fatalities when the source of rabies transmission in animals is not fully under control Numerous studies have demonstrated that those who pass away with rabies either lack access to post-exposure prophylaxis (PEP) or receive treatment too late PEP prevents an estimated 330,000 rabies-related deaths annually worldwide

In Vietnam, dogs make up between 96 and 97 percent of the virus' reservoirs In the Central Highlands provinces, there are still very few domestic animals that have received rabies vaccinations Gia Lai, Dak Lak had a less than 15% rabies vaccination rate for dogs in 2015–2016 In comparison to the entire nation, the Central Highlands' post-exposure rabies prophylaxis rate for the years 2016

to 2020 remains low Gia Lai has the fewest cases of rabies prevention and treatment per 100,000 residents

Data from the Ministry of Health's rabies prevention and control project show that 90% of those exposed to the disease receive the vaccine within the first three days, and 10% wait until three days after being bitten

1.4 The primary methods to prevent rabies

Domestic dog management: To support and monitor the effectiveness of the commune's rabies vaccination program, the People's Committees of communes, wards, and townships (referred

to collectively as commune level) organize the control of dog breeding in the area

Dogs are vaccinated against rabies every year, with the main phase taking place in March–April and a follow-up injection taking place in September–October This is done by a concentrated vaccination campaign (in wards and towns) and successive injection method or visiting to each household to inject

Post-exposure prophylaxis for those bitten by dogs and cats: Develop a nationwide strategy for the distribution and administration of rabies vaccines for those bitten by dogs and those who are at high risk of exposure to the disease

Completing legal documents and policies of the State: the system

of legal documents, which includes the Law on Veterinary Medicine and the documents guiding its implementation; approved programs and projects; the Law on Prevention and Control of Infectious Diseases and its guiding documents; and the Ministry of Health's Decision No 1622/QD-BYT issued on May 8, 2014, regarding Guidelines for surveillance and prevention of human rabies

Media: Public awareness-building through propaganda about the risks of rabies and ways to prevent it in humans

Chapter 2 RESEARCH SUBJECTS AND METHODOLOGY 2.1 Subjects, location, time of research

2.1.1 Subjects

- All records and medical records of rabies cases and deaths

- People died from rabies

- Householders

- People exposed to rabies

- Medical staff at vaccination facilities

- Local people in interventional group

- Medical staff, relevant veterinary staff

2.1.2 Location:

Situational study: two provinces Gia Lai, Dak Lak

Interventional study: Ia Dom, Ia Nan and Ia Pnon communes of Duc Co district, Gia Lai province

Control group: Ia Glai, Ia Hlop and Ia Blang communes in Chu

Se district, Gia Lai province

2.1.3 Time of research

The study was conducted for 3 years from 2020-2023

- Retrospective secondary data analysis: gathering rabies statistics from two provinces compiled by the Centers for Disease Control between January 1, 2015 and December 31, 2019

- Cross-sectional descriptive analysis: all patients from January

2020 to December 2021 who had rabies or a rabies-related injury Examine the current state of rabies prevention efforts and the potential for human rabies in the 2 provinces under study in 2021

- Interventional research: Pre-intervention investigation: 8/2021 Intervention time: 8/2021-8/2022 Post-intervention investigation: September 2022-October 2022

6/2021-2.2 Research design

- Retrospective and cross-sectional study (in 2021): Describe some epidemiological characteristics of human rabies and the current status of rabies prevention in Gia Lai, Dak Lak

- Controlled trial of a community intervention (2021-2022): Evaluation of the effectiveness of some measures in preventing rabies in Gia Lai

2.3 Content and method of data collection:

2.3.1 Descriptive study:

2.3.1.1 Sample size

- Retrospective secondary data analysis: All statistics on rabies cases, deaths and factors related to rabies in Gia Lai, Dak Lak are compiled by the Centers for Disease Control between January 1,

2015 and December 31, 2019

- Cross-sectional descriptive study in 2020-2021: Deaths due to rabies: The sample size is made up of all patients who contracted the disease and died from it between January 2020 and December 2021

in the two studied provinces

- Sample size of the household survey to gauge rabies risk and local awareness and use of rabies prevention

Where:

n: Study’s sample size

α = 0,05 (Statistical significance level)

Z 1- α/2 = 1,96 (corresponding to α = 0,05)

p: percentage of homes using effective rabies prevention techniques Nguyen Thi Thang's research indicates that in the province of Phu Yen (2019), 0.702 people correctly practice rabies prevention; therefore, choose p = 0.702

d = 0,05 (Absolute error)

DE (Design effect): Choose DE = 2,0

- Sample size of rabies vaccine and antirabies serum recipients who have been exposed to rabies: All exposed individuals who received the rabies vaccine or antirabies serum, or both at the injection sites of district/city health centers, and preventive medicine centers in two provinces between January 1, 2020, and December 31,

2021, comprise the sample size

- Size of the steering committee for rabies prevention survey

sample: surveying 34 steering committees (32 district steering committees and 2 provincial steering committees) to determine the current state of rabies prevention and control

2.3.1.2 Evaluation indicators and data collection methods:

a, Evaluation indicators

- Indicators of death due to rabies::

+ The percentage of deaths over time

+ Mortality per 100,000 (%) population

+ Average mortality rate in percentage

- Indicators on the epidemiological characteristics of rabies:

+ Personal traits of rabies patients and rabies-related fatalities + Percentage of exposed animals (dogs, cats, and others)

+ Percentage of the quantity of bites and the body parts where they were inflicted

+ Percentage of those who received wound care, post-exposure anti-rabies serum, and rabies vaccination in the group of those who contracted the disease or died from it

+ Percentage of prompt immunization (15 days or less after exposure)

+ Clinical symptom frequency in rabies deaths

- Indicators on the status of rabies vaccination:

+ Determining the level of dog vaccination against rabies + Percentage of personal traits of those receiving the anti-rabies vaccine and serum

+ Percentage of animal bites that expose humans; the ratio of bites to where they were placed on the body of the exposed person after receiving rabies vaccine or antirabies serum

+ Percentage of people accessing to rabies vaccine, anti-rabies serum after exposure within ≤ 15 days and after 15 days from exposure

- Indicators of knowledge - attitude - practice on rabies prevention of the community:

+ Percentage of people who are aware that rabies is a serious infectious disease

+ Percentage of those who are aware that the rabies virus is what causes rabies

+ Percentage of persons who are aware that rabies can spread through bites or scratches brought on by animal bites or licks

+ Percentage of persons who are aware that they must seek medical attention after being bitten by a rabid dog

+ Percentage of people who obtain rabies vaccine and antirabies serum after being bitten by a rabid dog

+ Percentage of people willing to be vaccinated if exposed to rabies

+ Percentage of persons who have cats and/or dogs registered + Percentage of people registering to vaccinate dogs and cats

b, Research technique

- Gather secondary data from the Ministry of Health's database

- Case collection: Each patient, who was diagnosed to have died from rabies was examined and recorded by trained medical personnel

in the printed questionnaires with the relevant information

- Using a pre-made questionnaire to get data from the patient's family

- Investigate the status of rabies vaccination in animals and in the community

- Utilize surveys to look at neighborhood rabies prevention initiatives

- Utilizing a set of household interview questions to determine the knowledge, attitudes, and practices of the community on rabies prevention

2.3.2 Interventional study

2.3.2.1 Sample size

- Sample size pre and post inventional trials:

Where:

n1: Sample size pre-post test in the intervention group

n2: Sample size pre-post test in the control group

Z1-/2: Reliability coefficient (probability threshold α = 0,05; Z

1-/2 = 1,96)

Z(1-): Power coefficient (with power β = 90%;Z(1-) = 1,28)

p1: Percentage of households receiving rabies vaccination for pets in 3 communes Ia Dom, Ia Nan and Ia Pnon at the baseline survey (p1 = 30,0%)

p2: Proportion of households receiving rabies vaccination for pets

in 3 intervention communes is estimated to be achieved at the time of survey completion (p2= 45,0%, dự kiến tăng 15,0% sau can thiệp)

(p1 + p2)/2

The recommended sample size for the intervention group and control group is 217, although we actually used 356 household heads for the study n1 = n2 = 356 persons In order to assess before-after changes

in the intervention group, a minimum sample size of 356 people (356 homes) is required In the control group, a minimum sample size of

356 participants (representing 356 households) is required

in the intervention and control groups

Percentage of study participants in the intervention and control groups who had good knowledge of rabies prevention in the pre-post

interventional tests

Percentage of study participants in the intervention and control groups that correctly practiced rabies prevention and control in livestock (registering dogs, using dog leashes, and vaccinating dogs for the disease) before and after the intervention

Percentage of study participants in the intervention and control groups that correctly practiced rabies prophylaxis while exposed to animals (wound treatment, rabies vaccination, post-exposure anti-rabies serum), before and after the intervention

+ Effective policy advocacy and encouraging all levels and

sectors to participate

Results achieved (ratings: excellent, good, average, weak) through surveying the current status of rabies prevention and control activities in the intervention and control communes, before and after the intervention

+ Effective professional training and medical-veterinary

coordination in response to rabies before and after intervention; effective delivery of medical and veterinary services

Percentage of health professionals and veterinary employees in the intervention and control communes who have received training in

rabies prevention, before and after the intervention

Percentage of patients exposed to rabies receiving rabies vaccine, antirabies serum per 1000 individuals in intervention and control communes before and after the intervention

Graph 2.2 Study design diagram

Study design

Retrospective study of

secondary data

Cross-sectional descriptive study

Interventional Research

Epidemiological characteristics

of human rabies in 2 provinces

Gia Lai and Dak Lak

Rabies prevention in Gia Lai, Dak Lak

Controlled community intervention: evaluating the effectiveness of some interventions in rabies control in Gia Lai

- Complete rabies data of 2

disease control centers,

- Investigate 2 provincial steering committees and 32 district steering committees on rabies prevention

- Intervention trials: reinforce communication strategies together with the national rabies prevention program's protective measures; advocate for government engagement; and provide professional training for medical and veterinary workers

- A 12-month intervention in three communes with three control communes

- Effectiveness of intervention tests: Compare the before and after of the intervention with that of the control group

(1) Some epidemiological characteristics of human rabies in Gia Lai, Dak Lak

(2) Current situation of rabies prevention in Gia Lai, Dak Lak

(3) Evaluation of the effectiveness of some measures to prevent rabies in Gia Lai

Chapter 3 RESEARCH RESULTS 3.1 Some characteristics of human rabies epidemiology and

rabies control activities in Gia Lai and Dak Lak (2015-2021)

3.1.1 Some epidemiological traits of rabies in humans in Gia Lai, Dak Lak between 2015 and 2021

Table 3.1 Some individual traits of patients who passed away

from rabies in Gia Lai and Dak Lak (n=56)

Individual traits Classification Frequency Percentage

Table 3.2 Some exposure characteristics of rabies deaths in Gia

Lai, Dak Lak (n=56) Exposure characteristics Classification Frequency Percentag

100% of the animals who contracted rabies had never received a vaccination In 22/56 (39.3%) of the patients, the wound or exposure site was treated after being bitten The remaining 60.7% did nothing and allowed things to happen naturally In particular, no preventative care was given in 100% of post-exposure deaths

3.1.2 Current status of rabies prevention activities in Gia Lai and Dak Lak

Table 3.3 Some characteristics of those who had rabies

vaccinations after being exposed in the 2 investigated provinces

conditions

Poor households 2.447 8,82 Non-poor

The majority of dog and cat bites among children under the age

of 15 occurred in this age group (42.62%; p 0.001); 91.18% of those who received vaccinations do not come from low-income households Between poor and non-poor households, there is a statistically significant difference in immunization rates (8.825 versus 91.18%, p 0.01)

Table 3.4 Results of an analysis of some rabies vaccine

time-related parameters (n=27.732) Variables Classification > 15

< 0,001 Non- poor 6.007 19.278