In-depth investigation of a suspected case of human rabies at Ngaoundere Central Prison, in the Ngaoundere Urban health district, Adamawa region-Cameroon

The Medical Center of the Ngaoundere Central Prison in the Adamawa region of Cameroon, notified a suspected case of human rabies. The objectives of the investigation were to describe the suspected case in Time Place Person (TPP), search for additional cases, evaluate the knowledge, attitudes, practices of health-care staff on human rabies, evaluate the rabies surveillance system in the Ngaoundere Urban health district, implement control and preventive measures. A descriptive cross-sectional study was carried out in the said district from February to March 2024. The description of the case in TPP was done by using the investigation form approved by the Cameroon Ministry of Public Health. The active search for additional cases was carried out in health facilities and in the community, using the case definition from the Technical Guide to Integrated Disease Surveillance and Response in Cameroon. A pre-tested questionnaire, encoded on Kobo Collect software, was used to assess health workers’ Knowledge, Attitudes and Practices (KAP) on rabies. The attributes (utility, simplicity, responsiveness, completeness and timeliness) of the rabies surveillance system were evaluated according to the CDC guidelines of Robert German’s 2001 working group and data were analysed using the Excel_2020 spreadsheet. Measures of central tendency were calculated for quantitative data, proportions and rates for qualitative data and the results were presented in tables and graphs. The suspect case, a 35-year-old man detained at the Ngaoundere central prison, having been unusually bitten by his unvaccinated rabies dog on February 08, 2023 in Mbilao, Touboro district, North Cameroon region. He showed signs of agitation, hypersalivation, fever, misophobia,
barking, aggressiveness and difficulty breathing. He had received no post-exposure prophylaxis, and customarily slaughtered and consumed the infected animal. Biological samples taken at the Centre Pasteur du Cameroun were negative for rabies virus. The patient was isolated at Ngaoundere Regional Hospital and no additional cases were found in health facilities or in the community. Health workers’ knowledge about the prevention and transmission of rabies were relatively good, but not all signs and symptoms were known to them. The health district’s rabies surveillance system was very comprehensive. timeliness, responsiveness and simplicity were acceptable, but utility was very low.
Public health measures consisted of briefing stakeholders on the importance of dog bite surveillance, rabies case definitions, clinical manifestations, case management and investigations of suspected human rabies cases. The study identified shortcomings in the district’s human rabies surveillance system, as well as the low level of knowledge among
healthcare workers about the signs and symptoms of the disease. We recommend strengthening staff knowledge of human rabies, using appropriate and timely surveillance tools, raising awareness at all levels, and providing anti-rabies vaccination for domestic animals.

Keyword: investigation, suspected case, rabies, surveillance, vaccination.