From 2007 to 2017 sixty-three (63) new cases of human rabies have been identified in Mali on an estimated total population in 2017 of 17,650,195 inhabitants. This is an incidence of 0.32 cases for 100,000 inhabitants. All these cases occurred in urban areas and involved the two sexes. The age group most affected was the one less than 20 years old. The majority of the victims (73.1%) were pre-schools, school-aged pupils and housewives. In 97% of the cases, the animal in question was a dog and the type of exposure of the bite. Eighty-two percent (82%) of the victims had received no local medical treatment or the post exposure quasi prophylaxis treatment. The median duration between the first symptoms and death among the cases of human rabies was 3 to 7 days. The median duration between the occurrence of the first signs and death was four (4) days. No virological confirmation had been conducted on the patients. The rage disease is retained as a priority disease, since the adoption of the strategy of “integrated monitoring of the disease and response” in 2008. However, in spite of the efforts made, progress still remains to be effected to assess the actual impact of rabies in Mali.
Rabies is a zoonosis accidentally transmitted to man which, once declared, is constantly threatening. In fact, despite the existence of very effective vaccines for human and veterinary use, it remains a major public health problem, with 55,000 deaths in the world each year, of which 99% occur in Africa and Asia. It is the tenth (10th) cause of death by infection in humans. Africa is paying a heavy price for this disease, with 26,000 fatal cases annually, according to the recent estimates of the World Health Organization (WHO) [
It is a cosmopolitan affection which produced a range of meningoencephalitis cases with fatal outcome of the etiological agents that are grouped within the Lyssavirus genus. Vaccination in pre-exposure or prophylaxis post-exposure (PPP) is the only effective measures against this disease. After exposure, the rabies vaccine should be administered as soon as possible following the protocols recommended by the WHO with, hopefully, a success rate of close to 100%. In Western countries, human rabies has been eliminated thanks to the Pasteurian treatment. This disease is an endemical epidemic to be fought in the developing countries considered as regions at high risk due to the existence of the enzootic or incursion zones of canine rabies.
In Mali the rage disease is retained as a priority disease since the adoption of the strategy of “integrated monitoring of the disease and response” in 2008, but this integration is not yet effective.
Our goal in this work is to do an analysis of the epidemiological aspects of new human rabies cases in the Bamako district from 2007 to 2017.
To describe the epidemiological profile of new human rabies cases in the Bamako district for the period between January 1, 2007 and 31 December 2017.
- Determine the incidence of human rabies cases;
- Describe the socio-demographic characteristics and clinical trials of persons infected with human rabies;
- Describe the animals complained of and the type of exposure to rabies in the District of Bamako;
- Make suggestions for improvement of the monitoring of human rabies cases.
The study was done on the basis of the national database, implemented in the prevention division to combat the disease (DPLM) of the Mali National Directorate of Health (DNS).
Located in the neighborhood of the river, the rabies center is in cohabitation with the national vaccination center. This is the national reference center for the support and monitoring of the rage disease in Mali. The cases of human rabies are referred before being transferred to the service of infectious and tropical diseases of the CHU of Point G.
The study consisted of a transversal study with a retrospective screening of data from January 2007 to December 2017.
The population sample studied was composed of people of all ages and of both sexes, from Bamako, exposed to the risk of rabies infection by contact, bite, scratch or licking on mucous membranes or skin eroded by a warm-blooded animal, domestic or wild, presenting obvious signs or not of the rage disease.
We analyzed the records of the patients received at the DPLM and we have included the records of patients who met the definition of cases of human rabies.
Definition of cases of human rabies
We have considered as cases of human rabies any deceased person in
Data on characteristics of the persons assaulted by animals were collected from registers kept by the Center dealing with the rabies disease.
The information collected was related:
- To the socio-demographic characteristics of the patients (gender, age, profession, place of residence, contact);
- On the reasons of medical consultation (bite, scratch, or licking and the circumstances of the incident);
- To the description of the injuries (place, aspect and date of the incident);
- The gender and the origin of the animal in question;
- The treatment received (treatment of lesions, anti-rabies vaccine and other treatment received);
- To the veterinary supervision of the animal in question (number and date of the veterinary certificates issued, decision of continuation or cessation of the anti-rabies vaccine by the patient;
- To the evolution of the patient until death occurred.
The data analysis was carried out by the Epi Info software version.
Year | ||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
2007 | 2008 | 2009 | 2010 | 2011 | 2012 | 2013 | 2014 | 2015 | 2016 | 2017 | Total | |
Staff | 9 | 6 | 8 | 5 | 3 | 9 | 5 | 1 | 2 | 8 | 7 | 63 |
Percentage | 14.3% | 9.6% | 12.7% | 7.9% | 4.8% | 14.2% | 7.9% | 1.6% | 3.2% | 12.7% | 11.1% | 100% |
Sex | Year | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
2007 | 2008 | 2009 | 2010 | 2011 | 2012 | 2013 | 2014 | 2015 | 2016 | 2017 | Total | |
Male | 6 | 4 | 7 | 4 | 3 | 6 | 4 | 1 | 2 | 5 | 5 | 47 |
Female | 3 | 2 | 1 | 1 | 0 | 3 | 1 | 0 | 0 | 3 | 2 | 16 |
Total | 9 | 6 | 8 | 5 | 3 | 9 | 5 | 1 | 2 | 7 | 2 | 63 |
AGE | Staff | Percentage |
---|---|---|
0 - 19 years | 49 | 77.8% |
≥20 years | 14 | 22.2% |
PROFESSION | ||
Pre-school | 3 | 4.7% |
School | 30 | 47.8% |
Housewife | 13 | 20. 6% |
Other | 17 | 26.9% |
LOCATION OF THE BITE | ||
Lower limb | 35 | 55.6% |
Upper limb | 15 | 23.8% |
Multiple bites | 13 | 20.6% |
NATURE OF THE BITE | ||
Superficial | 44 | 63.4% |
Deep | 19 | 36.6% |
LOCAL CARE | ||
Yes | 8 | 12.7% |
No | 55 | 87.3% |
INCUBATION PERIOD |
21 - 30 days | 6 | 15% |
---|---|---|
31 - 60 days | 52 | 82.5% |
≥61 days | 5 | 12.5% |
DURATION BETWEEN FIRST SYMPTOMS AND DEATH | ||
<3 days | 10 | 15.8% |
3 to 7 days | 46 | 73% |
>7 days | 7 | 11.2% |
BITING ANIMAL IN QUESTION | ||
Dog | 61 | 97% |
Cat | 1 | 1.5% |
Unknown | 1 | 1.5% |
ORIGIN OF THE ANIMAL | ||
On the run | 45 | 71.4% |
Shot | 18 | 38.6% |
Other* maneuver, apprentice driver, carpenter, bricklayer, civil servant, artisans, farmer, gardener, merchant.
From January 2007 to December 2017, sixty-three (63) new cases of human rabies have been observed in Bamako on a population of 1,809,106 inhabitants [
These results exposed above do not reflect the true iceberg of rabies inoculation. They must be multiplied by at least 10 to give a realistic idea of this iceberg of rabies inoculation [
Two age groups were particularly affected by death resulting from human rabies with a pre-dominance in the infection rate at age 20 (80%) (
Students and women in the home and their household maids were the occupations most affected, with respectively 47.5% and 27.5% (
All the patients have been exposed to the disease in the urban areas of Bamako. These patients were mostly domiciled in commune VI (17 patients or 42.5%), followed by the commune I (11 patients 27.5%) then at the same time as commune IV and commune V with 4 patients or 10% of the cases (
Seven patients (17.5%) had consulted a health center and none had received a post exposure prophylaxis, according to the Essen Protocol of the WHO, in force in Mali (
The bites were located in 80% (32/40) of our patients at the level of the body limbs (upper and lower) including 57.5% (23/40) of the cases only at the level of the lower limbs (
The first symptoms were observed 20 days after the bite and the patients died three days after the occurrence of the first symptoms (
In 95% of the cases of human rabies the type of exposure was the bite in the same proportion (
This study has allowed us to see that the rage disease is an unknown and underestimated reality in Mali. The implementation of an efficient system of epidemiological surveillance is essential to measure its real impact and take appropriate action for its elimination.
Aïchatou Margueritte Diarra—MBA in Small and Medium Enterprise Management and Entrepreneurship—for the correction of the article.
The authors declare no conflicts of interest regarding the publication of this paper.
Traoré, A.K., Kaya, A.S., Koné, O., Fofana, Y., Cissoko, M., Kéïta, Z., Fofana, M. and Diarra, A.M. (2019) Human Rabies Still Exists in Urban and Peri-Urban Areas in Mali—National Data-Base Analysis of the Capital of Mali from 2007 to 2017. Open Journal of Internal Medicine, 9, 19-25. https://doi.org/10.4236/ojim.2019.92004