Household exposure and animal-bite surveillance following human rabies detection in Southern Ghana.
BACKGROUND
Rabies remains a neglected tropical zoonotic disease with 100% case fatality rate and estimated 6,000 global mortality annually, and yet vaccine preventable. In Ghana, rabies outbreaks receive poor response. We investigated rabies in a 5-year old boy to find the source of infection, identify exposed persons for post-exposure prophylaxis and describe animal-bite surveillance in Manya-Krobo District of Ghana.


METHODS
We actively searched for cases and exposures by interviewing household members of the victim, schoolmates, and health professionals using WHO case definition, interview guide and checklist. We reviewed health and veterinary records and reports, and interviewed stakeholders. Descriptive data analyses were carried out and presented using tables and charts. Recorded responses were transcribed into thematic areas and analysed.


RESULTS
Child had dog-bite at the wrist, and developed hyperactivity, hydrophobia and hyperventilation 2 months post bite. He was hospitalised and died from respiratory failure day 3 after admission. Thirty-three persons were exposed to rabies infectious material. Females were 66%, age-groups 5-15yrs and 30-59 yrs were 33.3% and 39.4% respectively. A third (11/33) were category II exposure by WHO classification and were recommended for post-exposure prophylaxis. Surveillance records showed ninety-two animal-bite cases were reported for past 12 months. Half were females, and 18-59yrs age-group was 43%. Surveillance data quality was poor.


CONCLUSIONS
Rabies remains a public health burden inGhana with domestic dog as reservoir of the virus and females more vulnerable to secondary exposures. Health education on rabies should be intensified, and robust animal-bite surveillance system put in place.
Ghana Field Epidemiology and Laboratory Training Programme, Accra, Ghana; School of Veterinary Medicine, University of Ghana, Accra, Ghana.
Kofi
K
Afakye
School of Public Health, University of Ghana, Accra, Ghana.
Ernest
E
Kenu
Ghana Field Epidemiology and Laboratory Training Programme, Accra, Ghana; Ghana Health Service, Accra, Ghana.
Kofi Mensah
KM
Nyarko
Ghana Field Epidemiology and Laboratory Training Programme, Accra, Ghana; School of Veterinary Medicine, University of Ghana, Accra, Ghana.
Sherry Ama Mawuko
SA
Johnson
Eastern Regional Hospital, Koforidua, Ghana.
Florence
F
Wongnaah
Ghana Health Service, Accra, Ghana.
George Kwame
GK
Bonsu
D000293:Adolescent; D000328:Adult; D000818:Animals; D001733:Bites and Stings / Q000150:complications*; D002648:Child; D002675:Child, Preschool; D016358:Contact Tracing; D004283:Dog Diseases / Q000453:epidemiology / Q000821:virology; D004285:Dogs; D017809:Fatal Outcome; D005260:Female; D005869:Ghana / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D056990:Post-Exposure Prophylaxis / Q000379:methods*; D011818:Rabies / Q000453:epidemiology / Q000503:physiopathology / Q000517:prevention & control*; D011819:Rabies Vaccines / Q000008:administration & dosage*; D055815:Young Adult
D011819:Rabies Vaccines
Ghana; Human-rabies; Investigation; Post-exposure prophylaxis; animal-bite surveillance