Molecular characterisation of human rabies in East Africa - a case series report and phylogenetic investigation.

Abstract

<title>Abstract</title> <bold>Background: </bold>Rabies remains a major public health problem in low- and middle-income countries. However, human rabies deaths are rarely laboratory-confirmed, especially in Africa. Here, we use rabies virus sequence data to enhance investigations for a series of 5 human rabies deaths in East Africa and discuss the implications of these at individual, healthcare, and societal-level. <bold>Case presentation: </bold>The epidemiological context and care of these cases is contrasting: three of the bite victims did not receive any post-exposure vaccinations to prevent the fatal onset of disease, despite one attending a health facility on the day of exposure; one received only their first post-exposure vaccination; while the last received timely post-exposure vaccination but following a vaccination timeline that is not recommended by WHO. These differences raise concerns about health-seeking behaviour, competency of healthcare professionals in handling rabies exposures and accessibility and effectiveness of post-exposure prophylaxis as it is administered in these settings. <bold>Result and conclusion:</bold> Our investigation confirms dog-mediated rabies as the cause of each of these deaths. The viral genomic data highlight the transboundary circulation of rabies within domestic dog populations across the region. We conclude that urgent action is needed to improve awareness around the need for emergency post-exposure prophylaxis that should be accessible in local communities and administered appropriately, as well as investment in coordinated dog vaccination to control dog-mediated rabies, the underlying cause of these deaths.