{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,31]],"date-time":"2025-12-31T11:05:00Z","timestamp":1767179100032,"version":"build-2238731810"},"update-to":[{"DOI":"10.1371\/journal.pntd.0009564","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2021,7,16]],"date-time":"2021-07-16T00:00:00Z","timestamp":1626393600000}}],"reference-count":24,"publisher":"Public Library of Science (PLoS)","issue":"7","license":[{"start":{"date-parts":[[2021,7,6]],"date-time":"2021-07-06T00:00:00Z","timestamp":1625529600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/publicdomain\/zero\/1.0\/"}],"funder":[{"name":"China-U.S. Collaborative Program on Emerging and Re-emerging Infectious Diseases","award":["5U2GGH000961-04"],"award-info":[{"award-number":["5U2GGH000961-04"]}]},{"DOI":"10.13039\/501100002855","name":"Ministry of Science and Technology of the People's Republic of China","doi-asserted-by":"publisher","award":["2018ZX10101002-003-002"],"award-info":[{"award-number":["2018ZX10101002-003-002"]}],"id":[{"id":"10.13039\/501100002855","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004572","name":"national health and family planning commission of the people's republic of china","doi-asserted-by":"publisher","award":["Emergency Response Mechanism Operation Program-131031001000200001"],"award-info":[{"award-number":["Emergency Response Mechanism Operation Program-131031001000200001"]}],"id":[{"id":"10.13039\/501100004572","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosntds.org"],"crossmark-restriction":false},"short-container-title":["PLoS Negl Trop Dis"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Timely and appropriate administration of post-exposure prophylaxis (PEP) is an essential component of human rabies prevention programs. We evaluated patient care at rabies clinics in a high-risk county in Hunan Province, China to inform strategies needed to achieve dog-mediated human rabies elimination by 2030.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We collected information on PEP, staff capacity, and service availability at the 17 rabies clinics in the high-risk county during onsite visits and key staff interviews. Additionally, we conducted observational assessments at five of these clinics, identified through purposive sampling to capture real-time information on patient care during a four-week period. Wound categories assigned by trained observers were considered accurate per national guidelines for comparison purposes. We used the kappa statistic and an alpha level of 0.05 to assess agreement between observers and clinic staff.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In 2015, the 17 clinics provided PEP to 5,261 patients. Although rabies vaccines were available at all 17 clinics, rabies immune globulin (RIG) was only available at the single urban clinic in the county. During the assessment period in 2016, 196 patients sought care for possible rabies virus exposures. According to observers, 88 (44%) patients had category III wounds, 104 (53%) had category II wounds and 4 (2%) had category I wounds. Observers and PEP clinic staff agreed on approximately half of the assigned wound categories (kappa = 0.55, p-value&lt; 0.001). Agreement for the urban county-level CDC clinic (kappa = 0.93, p-value&lt;0.001) was higher than for the township clinics (kappa = 0.16, p-value = 0.007). Using observer assigned wound categories, 142 (73%) patients received rabies vaccinations and RIG as outlined in the national guidelines.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Rabies PEP services were available at each town of the project county; however, gaps between clinical practice and national rabies guidelines on the use of PEP were identified. We used these findings to develop and implement a training to rabies clinic staff on wound categorization, wound care, and appropriate use of PEP. Additional risk-based approaches for evaluating human rabies virus exposures may be needed as China progresses towards elimination.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pntd.0009564","type":"journal-article","created":{"date-parts":[[2021,7,6]],"date-time":"2021-07-06T13:34:41Z","timestamp":1625578481000},"page":"e0009564","update-policy":"https:\/\/doi.org\/10.1371\/journal.pntd.corrections_policy","source":"Crossref","is-referenced-by-count":2,"title":["Assessing clinicians\u2019 Post-Exposure Prophylaxis recommendations for rabies virus exposures in Hunan Province, China"],"prefix":"10.1371","volume":"15","author":[{"given":"Yu","family":"Li","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeanette J.","family":"Rainey","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hao","family":"Yang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cuc H.","family":"Tran","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yang","family":"Huai","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rongqiang","family":"Liu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hongwei","family":"Zhu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhengliang","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Di","family":"Mu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wenwu","family":"Yin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1884-8814","authenticated-orcid":true,"given":"Chun","family":"Guo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Miriam","family":"Shiferaw","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6711-2304","authenticated-orcid":true,"given":"Qiulan","family":"Chen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shixiong","family":"Hu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhongjie","family":"Li","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2021,7,6]]},"reference":[{"issue":"5","key":"pntd.0009564.ref001","first-page":"360","article-title":"Re-evaluating the burden of rabies in Africa and Asia","volume":"83","author":"DL Knobel","year":"2005","journal-title":"Bull World Health Organ"},{"issue":"11","key":"pntd.0009564.ref002","doi-asserted-by":"crossref","first-page":"e339","DOI":"10.1371\/journal.pntd.0000339","article-title":"Rabies exposures, post-exposure prophylaxis and deaths in a region of endemic canine rabies.","volume":"2","author":"K Hampson","year":"2008","journal-title":"PLoS Negl Trop Dis"},{"issue":"4","key":"pntd.0009564.ref003","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1136\/vr.i51","article-title":"Aiming for elimination of dog-mediated human rabies cases by 2030","volume":"178","author":"S Jarvis","year":"2016","journal-title":"Vet Rec"},{"key":"pntd.0009564.ref004","doi-asserted-by":"crossref","unstructured":"World Health Organization. Rabies vaccines: WHO position paper, April 2018\u2014Recommendations. Vaccine. 2018; 36(37): 5500\u20133.","DOI":"10.1016\/j.vaccine.2018.06.061"},{"key":"pntd.0009564.ref005","article-title":"Descriptive assessment of rabies post-exposure prophylaxis procurement, distribution, monitoring, and reporting in four Asian countries: Bangladesh, Bhutan, Cambodia, and Sri Lanka, 2017\u20132018","author":"AJ Li","year":"2018","journal-title":"Vaccine"},{"issue":"5","key":"pntd.0009564.ref006","doi-asserted-by":"crossref","first-page":"348","DOI":"10.1111\/jtm.12228","article-title":"Rabies Vaccine and Rabies Immunoglobulin in Cambodia: Use and Obstacles to Use.","volume":"22","author":"A Tarantola","year":"2015","journal-title":"J Travel Med"},{"key":"pntd.0009564.ref007","article-title":"The need to improve access to rabies post-exposure vaccines: Lessons from Tanzania","author":"J Changalucha","year":"2018","journal-title":"Vaccine"},{"key":"pntd.0009564.ref008","article-title":"On the path to rabies elimination: The need for risk assessments to improve administration of post-exposure prophylaxis","author":"K Rysava","year":"2018","journal-title":"Vaccine"},{"issue":"10","key":"pntd.0009564.ref009","doi-asserted-by":"crossref","first-page":"e1017","DOI":"10.1016\/S2214-109X(17)30321-2","article-title":"Effect of counselling on health-care-seeking behaviours and rabies vaccination adherence after dog bites in Haiti, 2014\u201315: a retrospective follow-up survey","volume":"5","author":"MD Etheart","year":"2017","journal-title":"Lancet Glob Health"},{"issue":"11","key":"pntd.0009564.ref010","doi-asserted-by":"crossref","first-page":"e0004245","DOI":"10.1371\/journal.pntd.0004245","article-title":"Establishment of a High Canine Rabies Burden in Haiti through the Implementation of a Novel Surveillance Program [corrected].","volume":"9","author":"RM Wallace","year":"2015","journal-title":"PLoS Negl Trop Dis."},{"issue":"13","key":"pntd.0009564.ref011","doi-asserted-by":"crossref","first-page":"1668","DOI":"10.1016\/j.vaccine.2017.02.014","article-title":"Rationale and support for a One Health program for canine vaccination as the most cost-effective means of controlling zoonotic rabies in endemic settings","volume":"35","author":"RP Lavan","year":"2017","journal-title":"Vaccine"},{"issue":"1","key":"pntd.0009564.ref012","doi-asserted-by":"crossref","first-page":"17188","DOI":"10.1038\/s41598-018-35158-0","article-title":"Exposure history, post-exposure prophylaxis use, and clinical characteristics of human rabies cases in China, 2006\u20132012.","volume":"8","author":"C Guo","year":"2018","journal-title":"Sci Rep."},{"issue":"2","key":"pntd.0009564.ref013","first-page":"139","article-title":"Technical guidelines for human rabies prevention and control (20160","volume":"37","author":"H Zhou","year":"2016","journal-title":"Zhonghua Liu Xing Bing Xue Za Zhi"},{"key":"pntd.0009564.ref014","unstructured":"WHO Expert Consultation on Rabies. Second report. World Health Organ Tech Rep Ser. 2013; (982): 1\u2013139, back cover."},{"issue":"8","key":"pntd.0009564.ref015","doi-asserted-by":"crossref","first-page":"e0004874","DOI":"10.1371\/journal.pntd.0004874","article-title":"Human Rabies in China, 1960\u20132014: A Descriptive Epidemiological Study.","volume":"10","author":"H Zhou","year":"2016","journal-title":"PLoS Negl Trop Dis"},{"key":"pntd.0009564.ref016","doi-asserted-by":"crossref","first-page":"260","DOI":"10.1111\/j.1447-0594.2006.00358.x","article-title":"Comparison of health services use by Chinese urban and rural older adults in Yunnan province.","volume":"6","author":"Y Li","year":"2006","journal-title":"Geriatr Gerontol Int"},{"issue":"5","key":"pntd.0009564.ref017","first-page":"327","article-title":"Addressing the shortage of health professionals in rural China: issues and progress.","volume":"4","author":"J Hou","year":"2015","journal-title":"Int J health Policy Manag"},{"issue":"12","key":"pntd.0009564.ref018","doi-asserted-by":"crossref","first-page":"2189","DOI":"10.1377\/hlthaff.2009.0989","article-title":"China\u2019s rural-urban care gap shrank for chronic disease patients, but inequities persist.","volume":"29","author":"W Jian","year":"2010","journal-title":"Health Aff (Millwood)."},{"issue":"1","key":"pntd.0009564.ref019","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1186\/2049-9957-2-23","article-title":"Challenges and needs for China to eliminate rabies.","volume":"2","author":"W Yin","year":"2013","journal-title":"Infect Dis Poverty"},{"issue":"RR-2","key":"pntd.0009564.ref020","article-title":"Use of a reduced (4-dose) vaccine schedule for postexposure prophylaxis to prevent human rabies: recommendations of the advisory committee on immunization practices.","volume":"59","author":"Rupprecht Charles E","year":"2010","journal-title":"MMWR Recomm Rep"},{"key":"pntd.0009564.ref021","doi-asserted-by":"crossref","unstructured":"World Health Organization. Rabies vaccines: WHO position paper\u2014recommendations. Vaccine. 2010; 28(44):7140\u20132.","DOI":"10.1016\/j.vaccine.2010.08.082"},{"key":"pntd.0009564.ref022","doi-asserted-by":"crossref","first-page":"9","DOI":"10.3389\/fvets.2017.00009","article-title":"Elimination of Dog-Mediated Human Rabies Deaths by 2030: Needs Assessment and Alternatives for Progress Based on Dog Vaccination.","volume":"4","author":"RM Wallace","year":"2017","journal-title":"Front Vet Sci"},{"issue":"1","key":"pntd.0009564.ref023","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1016\/S1473-3099(18)30606-6","article-title":"Improving the provision of rabies post-exposure prophylaxis","volume":"19","author":"S Cauchemez","year":"2019","journal-title":"Lancet Infect Dis"},{"issue":"1","key":"pntd.0009564.ref024","doi-asserted-by":"crossref","first-page":"386","DOI":"10.1186\/s12879-018-3301-8","article-title":"Vaccination demonstration zone successfully controls rabies in Guangxi Province, China.","volume":"18","author":"XK Wei","year":"2018","journal-title":"BMC Infect Dis"}],"updated-by":[{"DOI":"10.1371\/journal.pntd.0009564","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2021,7,16]],"date-time":"2021-07-16T00:00:00Z","timestamp":1626393600000}}],"container-title":["PLOS Neglected Tropical Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pntd.0009564","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,7,16]],"date-time":"2021-07-16T13:54:06Z","timestamp":1626443646000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pntd.0009564"}},"subtitle":[],"editor":[{"given":"Balaraman","family":"Sekar","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2021,7,6]]},"references-count":24,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2021,7,6]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pntd.0009564","relation":{},"ISSN":["1935-2735"],"issn-type":[{"value":"1935-2735","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,7,6]]}}}