Human Rabies Death: Causes and Problems in Thailand during 2003-2009 - ปัญหาและสาเหตุของการตายด้วยโรคพิษสุนัขบ้าในประเทศไทย ปี 2546-2552

Abstract

          The purpose of this study was to identify problems related to the eradication of rabies contributed to causes of human death in Thailand.

          The study was based on the epidemiological investigation of rabies outbreaks. Data were conducted from: report cards (506) illustrating the investigation of specific diseases in the past seven years during 2003 - 2009; analysis on policies and strategies associated with complete eradication of rabies by 2020; and literature review of previous research in relation to rabies.

          Occurrences of human rabies in Thailand were identified. Evidence themes indicated effective control measures of rabies following an impressive decrease of the incidence and prevalence of disease. Results of this study highlighted risk factors in preventing the complete eradication of rabies: patient, public health service, animal disease control and local policy. Given the predicted first degree of the burden disease, causes of death in patients infected by rabies were mainly associated with the inefficiency of treatment; self-negligence on wound care; receiving no post – exposure prophylaxis vaccination; lack of knowledge in disease severity; personal beliefs regarding folk remedies (Thai medicinal formularilies); and lack of funding for transportation to hospital. Second, a shortage of supplies of rabies immunoglobulin and ineffective communication between service providers and services users were demonstrated in some levels of public health practice. Third, animal disease control issues suggested a failure of health authorities to provide rabies vaccines to people in a normal situation, and to infected individuals living within five kilometers of the area where there had been some incidence of human death caused by the disease. The prevalence of stray dogs was apparent in this study. Furthermore, a lack of accurate data on a certain number of dogs became more problematic for health authorities to implement effective control measures of disease. For instance, there was no monitoring of movement of dogs and cats in designated areas. Rabies surveillance on suspected domestic animals was less effective due to a decreasing number of brain tissue sent for examination; people lacking the knowledge on laboratory locations together with a collection of brain tissue of suspected dogs for post mortem to determine the presence of rabies; and a high cost of diagnostic test. Lastly, problems associated with the implementation of strategic policies in a regional level should be resolved. Thus, a core principle of the complete eradication of human rabies could be potentially achieved before 2020 as previously described.

Key words: epidemiology, human rabies, causes of death