Navneet K. Dhand

Dog Bites in Humans and Estimating Human Rabies Mortality in Rabies Endemic Areas of Bhutan

Background Dog bites in humans are a public health problem worldwide. The issues of increasing stray dog populations, rabies outbreaks, and the risk of dogs biting humans have been frequently reported by the media in Bhutan. This study aimed to estimate the bite incidence and identify the risk factors for dog bites in humans, and to estimate human deaths from rabies in rabies endemic south Bhutan. Methods A hospital-based questionnaire survey was conducted during 2009–2010 among dog bites victims who visited three hospitals in Bhutan for anti-rabies vaccine injection. Decision tree modeling was used to estimate human deaths from rabies following dog bite injuries in two rabies endemic areas of south Bhutan. Results Three hundred and twenty four dog bite victims were interviewed. The annual incidence of dog bites differed between the hospital catchment areas: 869.8 (95% CI: 722.8–1022.5), 293.8 (240–358.2) and 284.8 (251.2–323) per 100,000 people in Gelephu, Phuentsholing and Thimphu, respectively. Males (62%) were more at risk than females (P<0.001). Children aged 5–9 years were bitten more than other age groups. The majority of victims (71%) were bitten by stray dogs. No direct fatal injury was reported. In two hospital areas (Gelephu and Phuentsholing) in south Bhutan the annual incidence of death from rabies was 3.14 (95% CI: 1.57–6.29) per 100,000 population. The decision tree model predicted an equivalent annual incidence of 4.67 (95% CI: 2.53–7.53) deaths/100,000 population at risk. In the absence of post exposure prophylaxis, the model predicted 19.24 (95% CI: 13.69–25.14) deaths/year in these two areas. Conclusions Increased educational awareness of people about the risk of dog bites and rabies is necessary, particularly for children in rabies endemic areas of Bhutan.

Spatial distribution of mortality in Pacific oysters Crassostrea gigas: reflection on mechanisms of OsHV-1 transmission

The ostreid herpesvirus OsHV-1 has the potential to devastate Pacific oyster Crassostrea gigas culture in Australia as it has done in many other countries, highlighting the need for a better understanding of disease expression and transmission. The aim of this study was to assess the spatial distribution of OsHV-1-associated mortalities in one of only two infected areas in Australia, Woolooware Bay (Botany Bay, New South Wales). In October 2011, healthy sentinel Pacific oysters were placed in 3 different locations at 3 different tidal levels, and OsHV-1 associated mortalities were closely monitored over 7 mo. The outbreak started in November 2011, and the disease remained active until April 2012. Three major mortality events were detected. Rather than being a propagating epizootic, it appeared that most oysters were infected from a common environmental source. The distribution of OsHV-1-associated mortalities was spatially clustered, highly variable and clearly dependent on the age of oysters and their position in the water column. Non-random distribution of mortalities at macro scale (sites several km apart) and micro scale (within rearing trays), and vertical clustering patterns in the water column are discussed in regard to factors known to influence mechanism of disease transmission in aquatic environments (hydrodynamics, physical disturbances, host density/distribution, and variations of environmental parameters). A new hypothesis proposing that OsHV-1 may be carried through water by particles, possibly plankton, is also suggested to explain the patchy distribution of mortalities in Woolooware Bay.

A retrospective study of admission trends of koalas to a rehabilitation facility over 30 years

To identify threats to the survival of koalas (Phascolarctos cinereus) in coastal New South Wales, Australia, we compared 3,781 admission records of koalas, admitted between 1 January 1975 and 31 December 2004 to a koala rehabilitation facility on the midnorthern coast of New South Wales, against local wild population demographics, with the use of multinomial logistic regression and chi-square analyses. Trauma, the most frequent reason for admission, affected young and male animals more frequently than other groups. Seasonal differences in the probability of males presenting as trauma cases suggest behavioral factors as an important risk factor for this group. An increasing probability of koalas presenting as a result of motor vehicle accident since 1985 strongly supports the enhanced action of local authorities to pursue traffic-calming strategies if urban koala populations are to be maintained in this area. Koalas with clinical signs of chlamydiosis made up the second most frequent admission group, and these animals were more likely to be aged. This study highlights the potential usefulness of wildlife rehabilitation centers in detailing threats to local wildlife populations, provided record keeping is efficient and focused, and the role of such studies in providing evidence for focusing threat-mitigation efforts. Continual community engagement by koala researchers is important to ensure that maximum benefit is obtained from activities of special interest groups.

The importance of location in contact networks: Describing early epidemic spread using spatial social network analysis.

This paper explores methods for describing the dynamics of early epidemic spread and the clustering of infected cases in space and time when an underlying contact network structure is influencing disease spread. A novel method of describing an epidemic is presented that applies social network analysis to characterise the importance of both spatial location and contact network position. This method enables the development of a model of how these clusters formed, incorporating spatial clustering and contact network topology. Based on data from the first 30 days of the 2007 equine influenza outbreak in Australia, clusters of infected premises (IPs) were identified and delineated using social network analysis to integrate contact-tracing and spatial relationships. Clusters identified by this approach were compared to those detected using the space-time scan statistic to analyse the same data. To further investigate the importance of network and spatial location in epidemic spread, kriging by date of onset of clinical signs was used to model the spatio-temporal spread without reference to underlying contact network structure. Leave-one-out cross-validation was used to derive a summary estimate of the accuracy of the kriged surface. Observations poorly explained by the kriged surface were identified, and their position within the contact network was explored to determine if they could be better explained through analysis of the underlying contact network. The contact network was found to lie at the core of a combined network model of spread, with infected horse movements connecting spatial clusters of infected premises. Kriging was imprecise in describing the pattern of spread during this early phase of the outbreak (explaining only 13% of the variation in date of onset of IPs), because early dissemination was dominated by network-based spread. Combined analysis of spatial and contact network data demonstrated that over the first 30 days of this outbreak local spread emanated outwards from the small number of infected premises in the contact network, up to a distance of around 15km. Consequently, when a contact network structure underlies epidemic spread, we recommend applying a method of spatial analysis that incorporates the network component of disease spread. Linking the spatial and network analysis of epidemics facilitates inference of the methods of disease transmission, providing a description of the sequence of spatial cluster formation.

Reemergence of rabies in Chhukha district, Bhutan, 2008.

TOC summary: A major outbreak affected dogs, domestic livestock, and humans.

Re-emergence of rabies in dogs and other domestic animals in eastern Bhutan, 2005-2007.

We report a major outbreak of rabies in dogs and other domestic animals that occurred in eastern Bhutan between May 2005 and November 2007. The outbreak peaked in February 2006 and subsided by the end of April 2006 with sporadic cases reported until November 2007. Rabies affected 18 of the 40 sub-districts in the three eastern districts of Bhutan. There were reportedly one human and 256 domestic animal fatalities. The outbreak affected cattle (n = 141, 55%), dogs (n = 106, 41%), horses (n = 7, 3%) and cats (n = 2, 1%). Rabies was primarily diagnosed by clinical signs but 36 cases were confirmed by fluorescent antibody test of brain samples. High densities and movements of free-roaming dogs might have been responsible for the rapid spread and persistence of the infection for a longer period than expected in dogs in eastern Bhutan.

A case-control study of risk factors for equine influenza spread onto horse premises during the 2007 epidemic in Australia

The 2007 epidemic of equine influenza in Australia provided an opportunity to investigate the effectiveness of on-farm biosecurity measures in preventing the spread of a novel pathogen in a largely naive population. We conducted a case-control study of 200 horse premises from highly affected regions of the state of New South Wales (NSW), to investigate risk factors for the spread of equine influenza onto horse premises, specifically, non-compliance with biosecurity measures recommended to horse owners by the relevant animal health authority, the NSW Department of Primary Industries. The study was restricted to cases occurring during the first seven weeks of the epidemic, a period prior to vaccination and the relaxation of some movement restrictions. Case and control premises were selected from a laboratory testing dataset and interviews were conducted with horse owners and managers on premises between July and November 2009. The proximity of premises to the nearest infected premises was the factor most strongly associated with case status. Case premises were more likely than control premises to be within 5 km and beyond 10 km of an infected premises. Having a footbath in place on the premises before any horses were infected was associated with a nearly four-fold reduction in odds of infection (odds ratio=0.27; 95% confidence interval: 0.09, 0.83). This protective association may have reflected overall premises biosecurity standards related to the fomite transmission of equine influenza. Compliance with certain on-farm biosecurity practices seemingly prevented horses on premises in high risk areas being infected with equine influenza during the 2007 outbreak in Australia. In future outbreaks, in addition to broader disease control measures, on-farm biosecurity practices should be adopted by horse owners and managers to prevent equine influenza spread.

Experimental infections of Pacific oyster Crassostrea gigas using the Australian ostreid herpesvirus-1 (OsHV-1) µVar strain.

In Australia, the spread of the ostreid herpesvirus-1 microvariant (OsHV-1 µVar) threatens the Pacific oyster industry. There is an urgent need to develop an experimental infection model in order to study the pathogenesis of the virus under controlled laboratory conditions. The present study constitutes the first attempt to use archived frozen oysters as a source of inoculum, based on the Australian OsHV-1 µVar strain. Experiments were conducted to test (1) virus infectivity, (2) the dose-response relationship for OsHV-1, and (3) the best conditions in which to store infective viral inoculum. Intramuscular injection of a viral inoculum consistently led to an onset of mortality 48 h post-injection and a final cumulative mortality exceeding 90%, in association with high viral loads (1 × 105 to 3 × 107 copies of virus mg-1) in dead individuals. For the first time, an infective inoculum was produced from frozen oysters (tissues stored at -80°C for 6 mo). Storage of purified viral inoculum at +4°C for 3 mo provided similar results to use of fresh inoculum, whereas storage at -20°C, -80°C and room temperature was detrimental to infectivity. A dose-response relationship for OsHV-1 was identified but further research is recommended to determine the most appropriate viral concentration for development of infection models that would be used for different purposes. Overall, this work highlights the best practices and potential issues that may occur in the development of a reproducible and transferable infection model for studying the pathogenicity of the Australian OsHV-1 strain in Crassostrea gigas under experimental conditions.

Community-based study on knowledge, attitudes and perception of rabies in Gelephu, south-central Bhutan.

Community knowledge, attitudes and practices are important both for prevention of human deaths due to rabies and for control of the disease in animals. This study was a cross-sectional survey investigating the level of community knowledge as well as attitudes and perceptions about rabies in Gelephu, south-central Bhutan, a region endemic for rabies. A total of 615 household respondents were interviewed, of which 224 (36%) were male and 391 (64%) were female. The majority of respondents had a high level of knowledge, attitudes and perception of rabies and had a positive attitude towards the prevention and control of rabies. Multivariate logistic regression modelling showed that better knowledge of rabies was predicted by gender, educational level and dog ownership status of respondents, whilst health-seeking behaviour of animal bite injuries was predicted by dog ownership status, presence of children in the household and occupation of the respondents. The majority of respondents believed that stray dogs are a problem in the community and felt that it was important to control the dog population in Gelephu. These findings also indicate that there exists a knowledge gap about rabies in the community that could be improved by creating an awareness education programme.

Adsorption of Mycobacterium avium subsp. paratuberculosis to Soil Particles

ABSTRACT Attachment of Mycobacterium avium subsp. paratuberculosis to soil particles could increase their availability to farm animals, as well as influence the transportation of M. avium subsp. paratuberculosis to water sources. To investigate the possibility of such attachment, we passed a known quantity of M. avium subsp. paratuberculosis through chromatography columns packed with clay soil, sandy soil, pure silica, clay-silica mixture, or clay-silica complexes and measured the organisms recovered in the eluent using culture or quantitative PCR. Experiments were repeated using buffer at a range of pH levels with pure silica to investigate the effect of pH on M. avium subsp. paratuberculosis attachment. Linear mixed-model analyses were conducted to compare the proportional recovery of M. avium subsp. paratuberculosis in the eluent between different substrates and pH levels. Of the organisms added to the columns, 83 to 100% were estimated to be retained in the columns after adjustment for those retained in empty control columns. The proportions recovered were significantly different across different substrates, with the retention being significantly greater (P < 0.05) in pure substrates (silica and clay-silica complexes) than in soil substrates (clay soil and sandy soil). However, there were no significant differences in the retention of M. avium subsp. paratuberculosis between silica and clay-silica complexes or between clay soil and sandy soil. The proportion retained decreased with increasing pH in one of the experiments, indicating greater adsorption of M. avium subsp. paratuberculosis to soil particles at an acidic pH (P < 0.05). The results suggest that under experimental conditions M. avium subsp. paratuberculosis adsorbs to a range of soil particles, and this attachment is influenced by soil pH.