Outbreak of rabies among humans, dogs and livestock, Awutu-Senya East Municipality, Ghana, 2019

Abstract

Introduction: Rabies is a neglected zoonotic disease caused by the Rabies virus (RABV). Ninety-percent of human rabies are dog-mediated. Globally there are 59,000 human rabies annually. On June 16 2019, a 4-year-old girl from the Awutu-Senya East Municipal of Ghana, died following symptoms of aggression, hyper-salivation and hydrophobia. She had a dog scratch five weeks prior. We confirmed the outbreak, determined its magnitude, identified associated factors and implemented control measures. Methods: We interviewed community members to understand potential exposures to RABV. We reviewed the animal bite records, clinical notes of human rabies cases and initial line-list. We conducted community-based rabies surveillance for animal bites and confirmed RABV by Polymerase Chain Reaction of brain tissue of dead human and animals. We updated the line-list with demographic, exposure, and outcome variables of bite victims. Quantitative data was analyzed descriptively, and findings presented as frequencies and proportions. Results: Overall, 155 dog bites were identified, among which six human rabies deaths were recorded (Attack rate=3.9%). Males were 51.6% (80/155) of bite victims, whiles children 5-14 years constituted 27% (40/147). About 86.5% (134/155) of bites were by unvaccinated dogs, and stray dogs bit 80.6% (125/155) of individuals. Category III bites were 35% (50/141). RABV was isolated from 16.7% (1/6) of human deaths and 30% (3/10) of rabid dog. We suspected rabies infection in a goat. Dogs roamed unattended within communities. Conclusion: This rabies outbreak was dog-mediated. Poor pet ownership and limited vaccination of dogs were associated factors. Mass dog vaccination, prompt post-exposure prophylaxis and risk communication were critical interventions implemented.