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PubMed | Central Veterinary Hospital, National Zoonoses and Food Hygiene Research Center, Sukraraj Tropical & Infectious Disease Hospital, University of Antwerp and 6 more.
Type: Journal Article | Journal: PLoS neglected tropical diseases | Year: 2016

Rabies is a vaccine-preventable viral zoonosis belonging to the group of neglected tropical diseases. Exposure to a rabid animal may result in a fatal acute encephalitis if effective post-exposure prophylaxis is not provided. Rabies occurs worldwide, but its burden is disproportionately high in developing countries, including Nepal. We aimed to summarize current knowledge on the epidemiology, impact and control of rabies in Nepal.We performed a systematic review of international and national scientific literature and searched grey literature through the World Health Organization Digital Library and the library of the National Zoonoses and Food Hygiene Research Centre, Nepal, and through searching Google and Google Scholar. Further data on animal and human rabies were obtained from the relevant Nepalese government agencies. Finally, we surveyed the archives of a Nepalese daily to obtain qualitative information on rabies in Nepal.So far, only little original research has been conducted on the epidemiology and impact of rabies in Nepal. Per year, rabies is reported to kill about 100 livestock and 10-100 humans, while about 1,000 livestock and 35,000 humans are reported to receive rabies post-exposure prophylaxis. However, these estimates are very likely to be serious underestimations of the true rabies burden. Significant progress has been made in the production of cell culture-based anti-rabies vaccine and rabies immunoglobulin, but availability and supply remain a matter of concern, especially in remote areas. Different state and non-state actors have initiated rabies control activities over the years, but efforts typically remained focalized, of short duration and not harmonized. Communication and coordination between veterinary and human health authorities is limited at present, further complicating rabies control in Nepal. Important research gaps include the reporting biases for both human and animal rabies, the ecology of stray dog populations and the true contribution of the sylvatic cycle.Better data are needed to unravel the true burden of animal and human rabies. More collaboration, both within the country and within the region, is needed to control rabies. To achieve these goals, high level political commitment is essential. We therefore propose to make rabies the model zoonosis for successful control in Nepal.


Dhakal S.,National Zoonoses and Food Hygiene Research Center | Joshi D.D.,National Zoonoses and Food Hygiene Research Center | Ale A.,National Zoonoses and Food Hygiene Research Center | Sharma M.,National Zoonoses and Food Hygiene Research Center | And 5 more authors.
PLoS ONE | Year: 2014

Japanese encephalitis (JE) is a mosquito-borne zoonotic disease that has pigs as the major amplifying hosts. It is the most important cause of viral encephalitis in people in Nepal and is spreading in its geographic distribution in that country. Pig farming is increasing in Nepal due to reducing cultural biases against pigs and government programs to support pig farming for poverty alleviation. Major strategies for JE prevention and control include education, vector control, and immunization of people and pigs. This study used a survey of 400 pig farmers in 4 areas of Nepal with different JE and pig farming histories to explore regional variations in farmer awareness and actions towards JE, the association of awareness and actions with farm and farmer variables, and the implications of these associations for public health education. Exposure to JE risk factors was common across pig farms and pig farming districts but there were significant district level differences in knowledge and practices related to on-farm JE risk reduction. Social factors such as literacy, gender, and cultural practices were associated with farmer attitudes, knowledge and practices for JE control. JE vaccine uptake was almost non-existent and mosquito control steps were inconsistently applied across all 4 districts. Income was not a determining factor of the differences, but all farmers were very poor. The low uptake of vaccine and lack of infrastructure or financial capacity to house pigs indoors or away from people suggest that farmer personal protection should be a priority target for education in Nepal. This study re-enforces the need to attack root causes of people's personal disease prevention behaviours and take into account local variation in needs and capacities when designing health or agriculture education programs. © 2014 Dhakal et al.


Robertson C.,Wilfrid Laurier University | Pant D.K.,Tribhuvan University | Pant D.K.,National Zoonoses and Food Hygiene Research Center | Joshi D.D.,National Zoonoses and Food Hygiene Research Center | And 3 more authors.
PLoS ONE | Year: 2013

Japanese Encephalitis (JE) is a vector-borne disease of major importance in Asia. Recent increases in cases have spawned the development of more stringent JE surveillance. Due to the difficulty of making a clinical diagnosis, increased tracking of common symptoms associated with JE-generally classified as the umbrella term, acute encephalitis syndrome (AES) has been developed in many countries. In Nepal, there is some debate as to what AES cases are, and how JE risk factors relate to AES risk. Three parts of this analysis included investigating the temporal pattern of cases, examining the age and vaccination status patterns among AES surveillance data, and then focusing on spatial patterns of risk factors. AES and JE cases from 2007-2011 reported at a district level (n = 75) were examined in relation to landscape risk factors. Landscape pattern indices were used to quantify landscape patterns associated with JE risk. The relative spatial distribution of landscape risk factors were compared using geographically weighted regression. Pattern indices describing the amount of irrigated land edge density and the degree of landscape mixing for irrigated areas were positively associated with JE and AES, while fragmented forest measured by the number of forest patches were negatively associated with AES and JE. For both JE and AES, the local GWR models outperformed global models, indicating spatial heterogeneity in risks. Temporally, the patterns of JE and AES risk were almost identical; suggesting the relative higher caseload of AES compared to JE could provide a valuable early-warning signal for JE surveillance and reduce diagnostic testing costs. Overall, the landscape variables associated with a high degree of landscape mixing and small scale irrigated agriculture were positively linked to JE and AES risk, highlighting the importance of integrating land management policies, disease prevention strategies and promoting healthy sustainable livelihoods in both rural and urban-fringe developing areas. © 2013 Robertson et al.


Devleesschauwer B.,Ghent University | Devleesschauwer B.,Catholic University of Louvain | Ale A.,National Zoonoses and Food Hygiene Research Center | Torgerson P.,University of Zürich | And 13 more authors.
PLoS Neglected Tropical Diseases | Year: 2014

Background:Parasitic zoonoses (PZs) pose a significant but often neglected threat to public health, especially in developing countries. In order to obtain a better understanding of their health impact, summary measures of population health may be calculated, such as the Disability-Adjusted Life Year (DALY). However, the data required to calculate such measures are often not readily available for these diseases, which may lead to a vicious circle of under-recognition and under-funding.Methodology:We examined the burden of PZs in Nepal through a systematic review of online and offline data sources. PZs were classified qualitatively according to endemicity, and where possible a quantitative burden assessment was conducted in terms of the annual number of incident cases, deaths and DALYs.Principal Findings:Between 2000 and 2012, the highest annual burden was imposed by neurocysticercosis and congenital toxoplasmosis (14,268 DALYs [95% Credibility Interval (CrI): 5450-27,694] and 9255 DALYs [95% CrI: 6135-13,292], respectively), followed by cystic echinococcosis (251 DALYs [95% CrI: 105-458]). Nepal is probably endemic for trichinellosis, toxocarosis, diphyllobothriosis, foodborne trematodosis, taeniosis, and zoonotic intestinal helminthic and protozoal infections, but insufficient data were available to quantify their health impact. Sporadic cases of alveolar echinococcosis, angiostrongylosis, capillariosis, dirofilariosis, gnathostomosis, sparganosis and cutaneous leishmaniosis may occur.Conclusions/Significance:In settings with limited surveillance capacity, it is possible to quantify the health impact of PZs and other neglected diseases, thereby interrupting the vicious circle of neglect. In Nepal, we found that several PZs are endemic and are imposing a significant burden to public health, higher than that of malaria, and comparable to that of HIV/AIDS. However, several critical data gaps remain. Enhanced surveillance for the endemic PZs identified in this study would enable additional burden estimates, and a more complete picture of the impact of these diseases. © 2014 Devleesschauwer et al.


Yanagida T.,Asahikawa Medical College | Yuzawa I.,Kitasato University | Joshi D.D.,National Zoonoses and Food Hygiene Research Center | Sako Y.,Asahikawa Medical College | And 6 more authors.
Journal of Travel Medicine | Year: 2010

Histopathological specimen of a neurocysticercosis patient, who had been living in several endemic countries, was retrospectively analyzed for assessing the origin of the infection. Mitochondrial DNA analysis strongly suggested that the patient became infected with the parasite in Nepal at least 10 years before the onset of the disease. © 2010 International Society of Travel Medicine.


PubMed | University Utrecht, National Zoonoses and Food Hygiene Research Center, University of Zürich, Institute of Environmental Science and Research and 5 more.
Type: Journal Article | Journal: PLoS neglected tropical diseases | Year: 2014

Parasitic zoonoses (PZs) pose a significant but often neglected threat to public health, especially in developing countries. In order to obtain a better understanding of their health impact, summary measures of population health may be calculated, such as the Disability-Adjusted Life Year (DALY). However, the data required to calculate such measures are often not readily available for these diseases, which may lead to a vicious circle of under-recognition and under-funding.We examined the burden of PZs in Nepal through a systematic review of online and offline data sources. PZs were classified qualitatively according to endemicity, and where possible a quantitative burden assessment was conducted in terms of the annual number of incident cases, deaths and DALYs.Between 2000 and 2012, the highest annual burden was imposed by neurocysticercosis and congenital toxoplasmosis (14,268 DALYs [95% Credibility Interval (CrI): 5450-27,694] and 9255 DALYs [95% CrI: 6135-13,292], respectively), followed by cystic echinococcosis (251 DALYs [95% CrI: 105-458]). Nepal is probably endemic for trichinellosis, toxocarosis, diphyllobothriosis, foodborne trematodosis, taeniosis, and zoonotic intestinal helminthic and protozoal infections, but insufficient data were available to quantify their health impact. Sporadic cases of alveolar echinococcosis, angiostrongylosis, capillariosis, dirofilariosis, gnathostomosis, sparganosis and cutaneous leishmaniosis may occur.In settings with limited surveillance capacity, it is possible to quantify the health impact of PZs and other neglected diseases, thereby interrupting the vicious circle of neglect. In Nepal, we found that several PZs are endemic and are imposing a significant burden to public health, higher than that of malaria, and comparable to that of HIV/AIDS. However, several critical data gaps remain. Enhanced surveillance for the endemic PZs identified in this study would enable additional burden estimates, and a more complete picture of the impact of these diseases.


Devleesschauwer B.,Ghent University | Devleesschauwer B.,Catholic University of Louvain | Aryal A.,Central Veterinary Hospital | Joshi D.D.,National Zoonoses and Food Hygiene Research Center | And 8 more authors.
Tropical Medicine and International Health | Year: 2012

The transmission of the zoonotic pork tapeworms Taenia solium and T. asiatica depends on a combination of specific risk factors, such as open defecation, backyard pig raising and the consumption of raw or undercooked pork and viscera. A community-based survey was conducted among 289 households in south-eastern Nepal to study the heterogeneity of these risk factor frequencies as a function of the social composition of the population. The frequency of open defecation, backyard pig raising and pork consumption differed significantly (P<0.005) among the different coexisting caste and ethnic groups. In the same survey, the taeniosis prevalence was examined among the different groups. Tapeworm carriers were identified at a high prevalence among the Dum, one of the most disadvantaged communities of Nepal. A PCR-RFLP assay revealed that all collected tapeworm specimens were T. asiatica, a species thus far not known to occur in South Asia. These results can help to understand the epidemiology of T. solium in Nepal, which appears to be more complex than thought so far. © 2012 Blackwell Publishing Ltd.


Ale A.,National Zoonoses and Food Hygiene Research Center | Victor B.,Institute of Tropical Medicine | Praet N.,Institute of Tropical Medicine | Gabriel S.,Institute of Tropical Medicine | And 5 more authors.
Parasites and Vectors | Year: 2014

Taenia asiatica has made a remarkable journey through the scientific literature of the past 50 years, starting with the paradoxical observation of high prevalences of T. saginata-like tapeworms in non-beef consuming populations, to the full description of its mitochondrial genome. Experimental studies conducted in the 1980s and 1990s have made it clear that the life cycle of T. asiatica is comparable to that of T. saginata, except for pigs being the preferential intermediate host and liver the preferential location of the cysts. Whether or not T. asiatica can cause human cysticercosis, as is the case for Taenia solium, remains unclear. Given the specific conditions needed to complete its life cycle, in particular the consumption of raw or poorly cooked pig liver, the transmission of T. asiatica shows an important ethno-geographical association. So far, T. asiatica has been identified in Taiwan, South Korea, Indonesia, the Philippines, Thailand, south-central China, Vietnam, Japan and Nepal. Especially this last observation indicates that its distribution is not restricted to South-East-Asia, as was thought so far. Indeed, the molecular tools developed over the last 20 years have made it increasingly possible to differentiate T. asiatica from other taeniids. Such tools also indicated that T. asiatica is related more closely to T. saginata than to T. solium, feeding the debate on its taxonomic status as a separate species versus a subspecies of T. saginata. Furthermore, the genetic diversity within T. asiatica appears to be very minimal, indicating that this parasite may be on the verge of extinction. However, recent studies have identified potential hybrids between T. asiatica and T. saginata, reopening the debate on the genetic diversity of T. asiatica and its status as a separate species. © 2014Ale et al.; licensee BioMed Central Ltd.


Pun S.B.,Sukraraj Tropical and Infectious Disease Hospital | Shah Y.,National Zoonoses and Food Hygiene Research Center
Transactions of the Royal Society of Tropical Medicine and Hygiene | Year: 2013

Background:Dengue virus infection has become an increasingly serious threat to public health in Nepal. Detection and/or serotyping of dengue virus has been reported in the past; however, little is known about the critical phase among dengue patients in Nepal.Methods:Rapid immunochromatographic tests and reverse transcription PCR (RT-PCR) were performed in order to diagnosis dengue fever. Ultrasonographic and chest radiography were used to identify the plasma leakage phase.Results:Of the total 264 patients with dengue, 8.7% (23/264) were admitted during the critical phase; 82.6% (19/23) of the patients were between 20 and 44 years of age. Conclusion: Physicians need to be vigilant and attentive to young adult patients with dengue fever. © The Author 2013. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. All rights reserved.


Dhakal S.,National Zoonoses and Food Hygiene Research Center | Stephen C.,University of Calgary | Ale A.,National Zoonoses and Food Hygiene Research Center | Joshi D.D.,National Zoonoses and Food Hygiene Research Center
Zoonoses and Public Health | Year: 2012

Japanese encephalitis (JE) is the single largest cause of viral encephalitis in the world and has been endemic in Nepal since the early 1980s. Since then, it has spread from its origins in lowland plains to the Kathmandu Valley as well as in hill and mountain districts. Pigs are amplifying hosts for the virus. The Nepal government has been encouraging the development of pig farming as a means of poverty alleviation. Whereas other countries have reduced JE through vaccination programmes and improvements in pig husbandry, these options are not economically possible in Nepal. The objective of this study was to examine the occupational risk of pig farmers in Nepal and to determine their level of knowledge and practice of JE prevention techniques. We surveyed 100 randomly selected pig farmers in the Kathmandu District and found that pig farmers were exposed to many JE risk factors including poverty and close proximity to pigs, rice paddy fields and water birds, which are the definitive hosts for the virus. Forty-two percent of the farmers had heard of JE, 20% associated it with mosquito bites and 7% named pigs as risk factors. Few protective measures were taken. None of the farmers were vaccinated against JE nor were any pigs, despite an ongoing human vaccination campaign. This farming community had little ownership of land and limited education. JE education programmes must consider gender differences in access to public health information as there were an equal number of male and female farmers. We provide findings that can inform future JE education programmes for this vulnerable population. © 2012 Blackwell Verlag GmbH.

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