Conference abstract

The challenge of the biological diagnosis of human rabies in Africa

Pan African Medical Journal - Conference Proceedings. 2019:10(22).29 Dec 2019.
doi: 10.11604/pamj-cp.2019.10.22.854

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Keywords: Biological confirmation, rabies diagnosis, reference laboratory, validated techniques
Plenary

The challenge of the biological diagnosis of human rabies in Africa

Laurent Dacheux

1Institut Pasteur, Unité Dynamique des Lyssavirus et Adaptation à l’Hôte, Centre National de Référence de la Rage, Centre Collaborateur de l’Organisation Mondiale de la Santé de Référence et de Recherche pour la Rage, Paris Cedex, France

&Corresponding author
Laurent Dacheux, Institut Pasteur, Unité Dynamique des Lyssavirus et Adaptation à l’Hôte, Centre National de Référence de la Rage, Centre Collaborateur de l’Organisation Mondiale de la Santé de Référence et de Recherche pour la Rage, Paris Cedex, France

Abstract

Introduction: the lack of reliable data concerning the number of human deaths from rabies is one of the major constraints on a proper assessment of the global importance of this disease, which has led to its underestimation and neglect. Priority should therefore be given to establishing a diagnosis for the confirmation of human rabies based on biological results. Indeed, only a laboratory diagnosis can properly validate infection, because clinical diagnosis remains difficult to interpret and is insufficiently specific. Thus, the purpose of this presentation will be to describe the diagnosis techniques currently available for human rabies, the samples requested for this purpose and the final decisional algorithm, all based on the recent updating of the recommendations of WHO and OIE.

Methods: review of the history of rabies diagnosis, based solely on post-mortem analysis of cerebral biopsy using immunofluorescence techniques and major problems with human rabies diagnosis, including the implementation and accessibility of such validated techniques in centralized reference laboratories located in low-income enzootic countries. Review of trends in development of easy, fast and low-cost diagnostic methods that can be used in rural and remote areas in peripheral laboratories, and ideally at the patient's bedside.

Results: considerable progress has been made with the advent of new molecular techniques and the evaluation of new, less invasive sampling methods that are more easily accepted by the patient's family and friends. Intra vitam diagnosis of human rabies is now possible using reliable, robust, validated techniques that can be used everywhere, including in regions with limited resources, using minimally invasive or non-invasive sampling (such as saliva or skin biopsies).

Conclusion: the constraints related to implementation of technological advances that gives opportunity to obtain confirmation for each suspected case of rabies in low-income areas of Africa are highlighted.