558 research outputs found
The impact of the first year of the COVID-19 pandemic on canine rabies control efforts: a mixed-methods study of observations about the present and lessons for the future
No full textAchieving zero human deaths from dog-mediated rabies has been set as a global target for 2030. However, the COVID-19 pandemic has disrupted essential health services across the world, with disproportionate impacts on Neglected Tropical Diseases. Through a mixed-method study using stakeholder questionnaires and in-depth interviews, we examined the scale and nature of disruption from the first year of the pandemic to rabies control programs, and reflected on lessons for the future. Study participants included practitioners and policymakers working in government, academia, international organizations, and the pharmaceutical industry across 48 countries, mainly in Africa and Asia. Mass dog vaccination, essential to rabies control, was most heavily impacted and in 2020, was carried out as planned in just 5% of surveyed countries. Access to post-exposure prophylaxis (PEP) also decreased due to fear of COVID-19 infection and difficulties in reaching health care centers. Dog vaccination and PEP delivery suffered from disruptions to the importation and distribution of vaccines. School closures affected rabies awareness activities and, when public events moved online, they could not reach the most disadvantaged groups. Surveillance, already weak, was severely disrupted by movement restrictions which, together with reduced demand for PEP, exacerbated under-reporting. Participants reported growing complaints around free-roaming dogs, with numbers likely to have increased in some settings. In some countries, dog rabies outbreaks and human rabies cases were already ascribed to the pandemic, but further impacts are likely still to be realized. Meanwhile, decreased demand for PEP from COVID-19 constraints could lead to reduced procurement in future. In the wake of post-COVID-19 demands on health services, there is an opportunity for veterinary services to show leadership in progressing the Zero by 30 agenda, particularly in scaling up mass dog vaccination within and across countries, as well as potential to make better use of community-based vaccinators. Countries must further secure stable procurement of dog and human vaccines, classifying them as essential goods prioritized for import and where needed, through sharing of stocks. Dedicated telemedicine services also show promise, for example through fostering participatory disease surveillance, including Integrated Bite Case Management, and delivering up-to-date instructions on the closest sources of PEP
WHO’s latest rabies recommendations and guidance save lives and reduce the cost of treatment
No full textRabies vaccination is a crucial part of rabies post-exposure prophylaxis (PEP), but it tends to consist of long and costly regimens of intramuscular (IM) injections. Most human rabies deaths are caused by delayed access, unaffordability or ineffective delivery of PEP. Reducing these barriers is crucial to ensure that this incurable yet preventable disease does not cost lives. In 2022, WHO published new guidance towards the introduction or expansion of rabies vaccination into national immunization programmes to systematically drive down human rabies deaths effectively and cost-efficiently. Such guidance grounds on the latest scientific recommendation provided by WHO’s Strategic Advisory Group of Experts in 2018. WHO recommends a shortened 1-week rabies vaccination schedule, with visits on days 0, 3 and 7. On each visit, a 2-site intradermal (ID) injection (using only 0.1 ml of vaccine in each site) is administered. ID administration allows for vials to be shared among several patients within a 6-8 hours timeline. Compared to IM administration, ID is cost- and dose-sparing, even in low-throughput clinics. Additionally, this regimen requires only 3 visits to the healthcare facility, improving patient compliance. However, the uptake of this shortened ID regimen remains limited. It should now be a matter of urgency for Health Ministries in rabies-endemic settings to adopt the WHO-recommended shortened ID vaccination schedule and ensure appropriate medical training to improve PEP delivery. This will enable countries to improve PEP delivery and allow underserved populations to access affordable, life-saving rabies vaccines
Accelerating programmatic progress and access to biologicals for the control of neglected tropical zoonoses
No full textThe Lion and the Mouse: An Aesop Fable Retold and Illustrated by Bernadette Watts
No full textHere is an extra copy of this book. ©2000 by Nord-Süd Verlag AG, Gossau Zürich, and first published in Switzerland under the title Der Löwe und die Maus. This lovely oversized edition starts in a new way: a playful lion cub is awakened by a mouse scampering across his paw. Making the lion young allows, I think, for a different understanding of his boast that a mouse cannot help a lion. Though the art is still done for children, Watts creates one of the most realistic nets I have seen for the lion, who roars day and night. None of the animals can help him. Watts pays special attention to the surrounding creatures, including colorful snakes and birds. My favorites are the curious and attentive mongooses.This is a hardbound book (hard cover)This book has a dust jacket (book cover)First editionFirst printingRetold and Illustrated by Bernadette Watt
Identification and treatment of white bronze monuments
No full textauthor: Bernadette Niederer, Historic Preservation Northwest.This archived document is maintained by the State Library of Oregon as part of the Oregon Documents Depository Program. It is for informational purposes and may not be suitable for legal purposes."Tips, Ideas & Preservation Recommendations from Oregon Heritage."Includes bibliographical references (page 3).Mode of access: Internet from the Oregon Government Publications Collection.Text in English
Metastatic genital tract adenocarcinoma to the vulva: a rare occurrence presenting as painful vulvar enlargement
No full textVulvar metastasis of genital tract adenocarcinoma is extremely rare, and highlights the need for liberal vulvar biopsy and knowledge of prior history.Peer reviewed
Histopathologic Alterations in Ovarian Papillary Serous Cystadenocarcinomas After Neoadjuvant Chemotherapy: Possible Clinical Significance
No full textObjectives: Neoadjuvant chemotherapy is being increasingly used prior to debulking for ovarian serous carcinoma. There can be significant histopathologic alterations, sometimes making the pathologic diagnosis challenging.
Methods: A Medline search was performed, and articles describing the histologic changes associated with neoadjuvant chemotherapy, as well as any possible clinical impact, were reviewed.
Results: The scope of histopathological changes seen after neoadjuvant chemotherapy for ovarian serous carcinoma, as well as their possible clinical significance is presented.
Conclusions: Histopathologic changes include degenerative changes, increased atypia, and alterations that may make pathologic interpretation difficult, particularly if there is a lack of familiarity with these changes and lack of available clinical history. More study is needed to assess whether there is any prognostic significance to these alterations.Peer reviewe
Rabies elimination: protecting vulnerable communities through their dogs – Authors' reply
No full textRabies post-exposure prophylaxis delivery to ensure treatment efficacy and increase compliance
No full textObjectives
Since rabies is lethal once symptoms appear, its prevention including community awareness, mass dog vaccination and post-exposure prophylaxis (PEP) is crucial. Although safe and potent rabies vaccines have long been available, the global rabies burden is still high and access to adequately-delivered PEP remains challenging. Here we offer healthcare providers up-to-date, simple, exhaustive, visual guidance on how to perform PEP steps correctly.
Protocol
PEP consists of 1) washing the wound with water and soap for 15 min, 2) assessing the need for rabies biologicals based on specific criteria; 3) administering, if required, rabies immunoglobulin or monoclonal antibodies deep in and around all wounds; 4) starting, if necessary, the WHO-recommended intradermal 1-week vaccination regimen; 5) informing patients adequately throughout the PEP process to increase compliance and avoid dangerous misconceptions about animal bite treatment and rabies risk.
Discussion
The intradermal 1-week vaccination regimen recommended by WHO is as safe as other regimens but carries important cost-, dose- and time-sparing benefits. As fundamental as the correct administration of rabies biologicals is clear doctor-patient communication and sharing of up-to-date knowledge among healthcare professionals.
Conclusions
This resource will help ensuring that no life is lost to rabies, an incurable yet preventable disease
- …
