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Surveillance data analysis of human rabies risk cases

B.Amgalanbayar, D.Uyanga, E.Tuvshintsetseg, Ts.Bayar

National center for zoonotic disease.

Background– Total 55,000 human rabies cases

registered worldwide annually. It’s 1 people die due rabies per15 minute.

– 99% of them occur in developing countries. (56% Asian, 44% African).

– 327,000 people get post-exposure preventive due to animal bite

– Rabies is fifth diseases by impact of economic.

– In present, there are no treatment but can 100% prevent from rabies.

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Background Total 36 rabies human cases reported in 26 soums and districts 12 province and city in Mongolia from 1972 to 2013 .

One human rabies case registered in Malchin soum of Uvs province in 2013.

• 68% of source include wolf, dog, fox of canine family in human rabies.

• It is character of epizotology for rabies reporting in Mongolia.

Objective

1.To study human rabies risk cases in 2013 year and compare with the previous years.

2. To use rabies risk assessment based this method of study.

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Methods of study

Study design:• Descriptive analyze

Data source:• The reporting forms of human rabies risk

cases in NCZD in 2013.• The first documents of suspected rabies

exposure.• The first document of vaccination of zoonotic

disease• The animal rabies of half years report State

centre for veterinary sector in Mongolia.

ResultBy September 2013, total 134 human rabies risk cases have been reported from the 58 soum of 15 province.(5 district of Ulaanbaatar, Arkhangai, Bayan-Ulgii, Bayankhongor, Bulgan, GoviAltai, Dornod, Zavkhan, Uvurkhangai, Umnugovi)

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Human rabies risk cases in 2004-2013 year, per 100000 population

0.30.9

1.20.9 1.0

2.2

3.7

4.7

3.23.8

0.0

1.0

2.0

3.0

4.0

5.0

0

20

40

60

80

100

120

140

Per

100

000

po

p

Su

spec

ted

cas

eSuspected cases per 100000 pop

– There were 2.4 times higher than 2012 situation.– There were 2.9 times higher than first 9 month of

last 10 year(2003-2012)

Human rabies risk cases and animal rabies cases in last 5 year, by month(2008-2012)

0

20

40

60

80

100

120

140

160

0

5

10

15

20

25

30

35

1 3 5 7 9 11 1 3 5 7 9 11 1 3 5 7 9 11 1 3 5 7 9 11 1 3 5 7 9 11 1 3 5 7 9

2008 2009 2010 2011 2012 2013

Rab

id a

nim

al

Su

spec

ted

cas

es

By year

Suspected cases Rabid animal

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Human rabies risk cases in 2012, 2013 year by epidemiology week

02468

10121416

1 2 3 4 5 6 7 8 9 1011 121314 1516 171819 2021 222324 2526 272829 3031 323334 3536 373839 404142 4344 454647 4849 505152

Su

spec

ted

cas

es

Week of onset

2013 year 2012 year

• Cases increased this year than previous years. • The 13-14 cases reported in 11,15 thepidemiology weeks.

Human rabies risk cases and animal rabies cases in Jan-Sep 2013

0.6

1.01.1

0.5

0.30.4

0.2

0.4

0.1 0.0

0.2

0.4

0.6

0.8

1.0

1.2

0

5

10

15

20

25

30

35

Jun Feb Mar Apr May June July Aug Sep

Pe

r 1

00

00

0 p

op

Su

sp

ec

ted

ca

se

s

By month

Suspected cases per 100000 pop

0

10

20

30

40

50

60

70

0

5

10

15

20

25

30

35

Jun Feb Mar Apr May June July Aug Sep

Rab

id a

nim

al

Su

sp

ec

ted

ca

se

s

By month

•Total 134 cases have been reported in 2013.

•56% of cases reported in Jan-Mar.

•It seems that increase of human rabies risk cases depend on animal rabies cases.

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Distribution of human rabies risk cases by soums in last 10 year(2003-2012)

2009-2010

2006-20082003-2005

2011-2012

Distribution of human rabies risk cases by soums in 2013.

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Distribution of animal rabies cases in 2013 by soums.

Location abrasion of human rabies risk cases

0 10 20 30 40

foot

To contact

Arm

Head

Beslaver

Chest

Suspected cases

Ho

w t

o c

on

tact •22.3% -Foot

•20.2% -Arm•18.6% -Head• 2.9% -Chest

Cases affected rabies risk. 34.3% of all cases have been gotten saliva, removed skin of rabies suspected animal and livestock.65.7% was bitten, attacked by domestic animal, livestock and wild animal. Including

• Bitten head- wolf, dog• Bitten arm- many type animal• Bitten foot- All case was bitten by dog

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The source of human rabies risk cases

0.70.70.71.5

3.73.75.25.2

9.714.2

54.5

0.0 20.0 40.0 60.0

CatDonkey

Wild goatWidcat

FoxHorseGoat

CamelCowWolfDog

Percent of source

An

imal

of

sou

rce

Percent

Dog 55.1%,Livestock 21.6%,Wolf 13.3%,Fox 3.7%,Other small 3.1%

98 source(bite animal ) analyzed by Veterinary laboratories.56.2% of source were confirmed.

1 source: 1.4 people risk for rabies

Animal rabies cases which tested veterinary laboratory in Jan-Jun 2013

0

100

200

300

400

500

2008 2009 2010 2011 2012 2013

Cas

e n

um

ber

By year

Case of rabid animal

Total 381 animal rabies cases confirmed in 94 soum of 17 province and 1 district of Ulaanbaatar in Mongolia. It is increased 3.3 times higher in first half years than previous 5 years.

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Kind of animal rabies cases in Jan-Jun 2013 by veterinary laboratory tests.

5 6

27 28 28 3135

69

0

10

20

30

40

50

60

70

80

Horse Sheep Camel Fox Wolf Goat Dog Cow

Cas

e n

um

ber

Type of animal

Cases of rabid animal

Age and sex group of human rabies risk

Age/sex Total population

Number of human

rabies risk

Per100,000

population

Age group

0-9 537063 23 4.310-19 409,461 14 3.420-29 597169 25 4.230-39 480861 35 7.340-49 368902 17 4.650 above 393288 20 5.1

Sex Male 1393453 84 6.0Female 1474291 50 3.4

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Human rabies risk by comparison of occupation

1.5%

4.5%

9.0%

9.0%

14.2%

61.9%

0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0

Pension

Civil staff

Jobless

Student

at home

Herder

Percent of include

Occ

upa

tion

N=134

Human rabies risk by comparison of occupation and source

Herder Jobless At home(child) Civil staff Student Pension

Dog 32.8% 12.8% 27.1% 8.5% 17.1% 1.4%

Wolf 100% 0 0 0 0 0

Livestock 91% 6% 0 0 0 3.3%

Small wild animal 88.9% 11.1% 0 0 0 0

n=134 тохиолдол

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• The 93.3% of cases get post exposure prophylaxis in 2013.

• 31.2% injected anti-rabies immune globulin.

– 76.8% Russian tissue vaccine.– 23.2%- Mongolian liquid vaccine.

12.34 ml immune globulin spend per case

Post exposure prophylaxis of rabies risk cases

Conclusion There are 2.1 times increased in 2013 than last 10 year and

3.1 times increased than 2012.

It reported in mostly western part of Mongolia including Zavkhan, Khovd, Uvs, Khentii province. It is similar with distribution of rabies animal cases.

Both human rabies risk cases and animal rabies cases have been highly reported in Jan-Mar.

About 60 percent of bite animals were confirmed rabies by laboratory tests of veterinary.

The 99.2% of rabies risk cases can prevented from rabies disease resulting post exposure prophylaxis