Over 8000 macaque bites since 2014 but no herpes B virus infection reported from Shimla, India
Notice bibliographique
Résumé
Sir, Shimla is an international tourist destination in the sub-Himalayan region of northern India. It was the summer capital of British India, and people visit here to have a glimpse of the heritage from that era. The 2017 figures show that Shimla sees a large influx of tourists both domestic (over 3.4 million/year) and foreign (0.16 million/year).[1] According to a tourism survey by the Ministry of Tourism in Himachal Pradesh, the foreign tourists (0.16 million/year) visiting Shimla are from the United Kingdom (15%), the United States (9%), France (6%), the UAE (6%), Spain (5%), Germany (5%), Australia (5%), and Canada (5%).[12] The rhesus macaque monkeys are a major attraction for the tourists visiting Shimla. Macaques move freely among the local crowd and attract the eyes of all tourists [Figure 1]. They are, however, quite aggressive when disturbed and bite anyone who messes with them. Every year, our hospital receives over 600 cases of macaque bites, 75% of which are of category III bites, and over 35% of these victims are tourists.[3] Combining data from other hospitals in Shimla town, the total monkey bites every year are on average 1326 since 2014, an average of 3.6 macaque bites/day.[4] Rabies has been established in dead macaques, and rabies prophylaxis is, therefore, recommended in all cases of macaque bites.[5] Internationally, herpes B virus infection is another major concern after macaque bites.[6] The first case of fatal human infection with herpes B virus from a macaque exposure was reported in 1997 in a 22-year-old female worker at a primate center, who possibly acquired infection through a splash of fecal matter into her right eye. She got cured of herpes B virus infection after antivirals but developed post viral encephalitis and succumbed to this complication.[7] After this incident, the center for disease control convened a working group in 1999 and issued guidelines for antiviral prophylaxis after macaque bite.[6] Thereafter, the published literature expresses a great concern for herpes B virus infection and thus covers all macaque bites with antivirals such as acyclovir or ganciclovir. In our experience with over 8000 rhesus macaque bites since 2014, we have not encountered even a single case of herpes B virus infection after macaque bite. The World Health Organization also does not mention postexposure prophylaxis with antivirals after a macaque bite.[8] In our hospital, we have also never used antivirals for postexposure prophylaxis in macaque bites. Given the incubation period of 2 days to 5 weeks, we are yet to see our first case of herpes B virus infection after a macaque bite. We are, however, routinely giving tetanus vaccination and antibiotic oral co-amoxiclav to cover for bacterial infections to all victims.Figure 1: Rhesus macaque with a goggle snatched from a tourist to be returned in lieu of eatablesSince 35% of the bites occur in tourists who may return to their countries after the bite, we believe that physicians across the world should be aware of this possibility and must start antivirals if the victims show signs suggestive of herpes B infection after the monkey bite. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.
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Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,002 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
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