Dog Bites in Humans and Estimating Human Rabies Mortality in Rabies Endemic Areas of Bhutan 英文参考文献.docVIP

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Dog Bites in Humans and Estimating Human Rabies Mortality in Rabies Endemic Areas of Bhutan 英文参考文献.doc

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Dog Bites in Humans and Estimating Human Rabies Mortality in Rabies Endemic Areas of Bhutan 英文参考文献

DogBitesinHumansandEstimatingHumanRabies MortalityinRabiesEndemicAreasofBhutan Tenzin1,2,NavneetK.Dhand1,TashiGyeltshen3,SimonFirestone1,ChhimiZangmo4,ChimiDema3, RawangGyeltshen5,MichaelP.Ward1* 1The Faculty of Veterinary Science, University of Sydney, Camden, Australia, 2Regional Livestock Development Centre, Gelephu, Bhutan, 3Phuentsholing General Hospital,Phuentsholing,Bhutan,4JigmeDorjiWangchukNationalReferralHospital,Thimphu,Bhutan,5GelephuRegionalReferralHospital,Gelephu,Bhutan Abstract Background:Dogbitesinhumansareapublichealthproblemworldwide.Theissuesofincreasingstraydogpopulations, rabiesoutbreaks,andtheriskofdogsbitinghumanshavebeenfrequentlyreportedbythemediainBhutan.Thisstudy aimedtoestimatethebiteincidenceandidentifytheriskfactorsfordogbitesinhumans,andtoestimatehumandeaths fromrabiesinrabiesendemicsouthBhutan. Methods:Ahospital-basedquestionnairesurveywasconductedduring2009–2010amongdogbitesvictimswhovisited threehospitalsinBhutanforanti-rabiesvaccineinjection.Decisiontreemodelingwasusedtoestimatehumandeathsfrom rabiesfollowingdogbiteinjuriesintworabiesendemicareasofsouthBhutan. Results: Three hundred and twenty four dog bite victims were interviewed. The annual incidence of dog bites differed betweenthehospitalcatchmentareas:869.8(95%CI:722.8–1022.5),293.8(240–358.2)and284.8(251.2–323)per100,000 people in Gelephu, Phuentsholing and Thimphu, respectively. Males (62%) were more at risk than females (P,0.001). Childrenaged5–9yearswerebittenmorethanotheragegroups.Themajorityofvictims(71%)werebittenbystraydogs. Nodirectfatalinjurywasreported.Intwohospitalareas(GelephuandPhuentsholing)insouthBhutantheannualincidence ofdeathfromrabieswas3.14(95%CI:1.57–6.29)per100,000population.Thedecisiontreemodelpredictedanequivalent annualincidenceof4.67(95%CI:2.53–7.53)deaths/100,000populationatrisk.Intheabsenceofpostexposureprophylaxis, themodelpredicted19.24(95%CI:13.69–25.14)deaths/yearinthesetwoareas. Conclusions:Increasededucationalawarenessofpeopleabouttherisk