Cost-estimate and proposal for a development impact bond for canine rabies elimination by mass vaccination in Chad

A complex fuzzy decision model for analysing the post-pandemic immuno-sustainability

The post-effects of the COronaVIrus Disease (COVID-19) vary depending on socioeconomic and biological factors. Similarly, the effects of vaccination on people's immunity vary across several factors. After the pandemic, real-life post-vaccination anomalies significantly impact women's health, access to medical treatments and medications, mental well-being, and daily physical activities. However, there has been scant investigation into the physical, psychological, social, and economic ramifications of vaccine effects on women in the post-pandemic era. Therefore, conducting a comprehensive risk assessment is crucial to safeguard women from the post-vaccination effects.To address this issue, the research encompasses complex bipolar spherical fuzzy ℵ-soft set, which has two-sided periodic ambiguous data due to its parametric properties as an adaptable ℵ-soft set and distinguishing criteria as a complex bipolar spherical fuzzy set. In addition, some fundamental operations and properties are presented in a complex bipolar spherical fuzzy ℵ-soft environment. Furthermore, the robust assessment of a real-world application demonstrate the efficacy of the Technique for Order Preference by Similarity to Ideal Solution (TOPSIS) approach to optimise the decision result. Finally, the provided decision-making approach is compared with existing techniques to illustrate their remarkable credibility and integrity.

Benefit-cost analysis of coordinated strategies for control of rabies in Africa

Previous research suggests that dog mass vaccination campaigns can eliminate rabies locally, resulting in large human and animal life gains. Despite these demonstrated benefits, dog vaccination programs remain scarce on the African continent. We conducted a benefit-cost analysis to demonstrate that engaging into vaccination campaigns is the dominant strategy for most countries even in the absence of coordinated action between them. And quantify how coordinated policy measures across countries in Africa could impact rabies incidence and associated costs. We show that coordinated dog mass vaccination between countries and PEP would lead to the elimination of dog rabies in Africa with total welfare gains of USD 9.5 billion (95% CI: 8.1 - 11.4 billion) between 2024 and 2054 (30 years). Coordinated disease control between African countries can lead to more socially and ecologically equitable outcomes by reducing the number of lost human lives to almost zero and possibly eliminating rabies.

General insights on obstacles to dog vaccination in Chad on community and institutional level

Domestic dogs are responsible for 95% of all human rabies cases worldwide and continue to be the main reservoir for this fatal virus in African and Asian countries. Interrupting the spread of the disease in the domestic dog population is therefore necessary for long-term, sustainable rabies control. Chad has been recognized as a rabies-endemic country since 1961, but no national control strategy is in place to date and dog vaccination coverage is very low. This qualitative, descriptive study aims to describe the main barriers to dog vaccination on both the community and the institutional level from a socio-anthropological point of view in Chad. The study was embedded in an overall project conducted from 2016 to 2018, to determine rabies burden and vaccine demand in West and Central Africa, funded by GAVI, the vaccine alliance. Data collection was conducted on the occasion of the project's closing workshops with stakeholders organized between August to September 2018 in the four (4) project areas: Logone Occidental, Ouaddaï, Hadjer Lamis and Chari Baguirmi. We conducted interviews and focus group discussions (FGD) among veterinary officers and dog owners. Participants were selected purposively based on their place of residence (dog owners) or work place (veterinary officers) and their previous contact with the project through reporting (dog owner) or management (veterinary officers) of a suspect dog rabies case. In each region, one FGD was organized with dog owners, and one FGD with heads of veterinary posts. At the end of the FGDs, a few participants were randomly selected for interviews. In addition, in each region an interview was conducted with the head of the livestock sector, the chief district medical officers and the head of a civil society association. The identified barriers to dog vaccination access are grouped into three main aspects: the economic, the socio-cultural and the institutional level. Economic constraints encountered relate to the cost of the vaccine itself and the expenses for transporting the dogs to the vaccination site. The cultural belief that the vaccine will have an impact on the therapeutic properties of dog meat for consumers (observed in Southern Chad), and the fact that dogs are considered impure animals in Muslim faith, which prohibits handling of dogs, are obstacles identified on the sociocultural level. At the institutional level, the unavailability of vaccines in veterinary services, the lack of communication about the law on dog vaccination, the absence of rabies in the training curricula of veterinary agents, and the lack of intersectoral collaboration limit vaccination coverage. In order to improve vaccination coverage and rabies surveillance with a view to eradicate rabies by 2030, communication strategies that are adapted to the context and that take cultural obstacles into account must be put in place in a synergy of interdisciplinary action. In addition, factors such as affordability, geographical access and availability of dog rabies vaccines needs to be addressed throughout the country. Although our study design did not allow a detailed analysis of obstacles related to socio-economic level, gender and age the broad insights gained can provide general guidance for future interventions in Chad and similar countries.

Elimination of human rabies in Goa, India through an integrated One Health approach

Dog-mediated rabies kills tens of thousands of people each year in India, representing one third of the estimated global rabies burden. Whilst the World Health Organization (WHO), World Organization for Animal Health (OIE) and the Food and Agriculture Organization of the United Nations (FAO) have set a target for global dog-mediated human rabies elimination by 2030, examples of large-scale dog vaccination programs demonstrating elimination remain limited in Africa and Asia. We describe the development of a data-driven rabies elimination program from 2013 to 2019 in Goa State, India, culminating in human rabies elimination and a 92% reduction in monthly canine rabies cases. Smartphone technology enabled systematic spatial direction of remote teams to vaccinate over 95,000 dogs at 70% vaccination coverage, and rabies education teams to reach 150,000 children annually. An estimated 2249 disability-adjusted life years (DALYs) were averted over the program period at 526 USD per DALY, making the intervention 'very cost-effective' by WHO definitions. This One Health program demonstrates that human rabies elimination is achievable at the state level in India.

Preparing liberia for rabies control: Human-dog relationship and practices, and vaccination scenarios

To reach zero dog-related human rabies deaths by 2030, Liberia must prioritize rabies as a public health threat. Understanding dog demography parameters are imperative and sets the basis for planning cost-effective and sustainable mass dog vaccination programs nationwide. We conducted a cross-sectional household survey in eleven rural districts of Bong and one urban district of Montserrado County to gather baseline information on the canine population, human-mediated dog movements, people's relationships and practices towards dogs, and further information to estimate costs for a nationwide campaign. In total, 1282 respondents were interviewed (612 rural and 670 urban). About 34% of the rural and 37% of the urban households owned at least one dog. The canine: human ratios were 1:6.1 in the rural and1:5.6 in the urban area and did not differ notably among both counties. The estimated canine population for Liberia is 594,640. The majority of respondents (55%) reported poor waste disposal. Muslims were less likely to own a dog than Christians (39% vs 19% OR: 0.4 95% CI: 0.2-0.6) (p< 0.001). Six percent of respondents mentioned that a family member was exposed to a dog bite in the past year, and most victims were adult males. Four of the victims reportedly died after showing rabies compatible symptoms. Twenty-seven percent of dog-owning households in rural areas reported that at least one dog originated from urban areas, and 2% of urban households brought in dogs from another country. In addition, 43% of respondents consumed dog meat at least once. Fifty percent of the respondents claimed knowledge of rabies but only 5.7% and 1.9% mentioned rabies transmission through rabies-infected saliva and rabies-infected mucus on broken skin. Forty percent of the respondents did not know whether rabies was incurable in humans once clinical signs appear. Assuming 30 vaccinators could vaccinate 50 dogs per day for eighteen months (371 working days), the total cost for the vaccination of the national Liberian canine population is estimated at 1.6 million (USD) for one vaccination round. Our study reveals an overall poor disease knowledge and the potential for spread of rabies in the study areas. A nationwide rabies awareness is crucial to enhance rabies prevention and control through mass dog vaccination.

Evidence mapping of current status, impact, prevention and control measures from rabies research in Bangladesh (2010-2021): a scoping review protocol

INTRODUCTION

Rabies is one of the priority zoonotic diseases in Bangladesh. Though the rabies cases have been reduced over the years due to the mass dog vaccination programme since 2011 throughout the country, it is still a major health problem in Bangladesh with an annual estimated 200 000 animal bite cases and over 2000 human deaths. This article presented a scoping review protocol for published literature on rabies in Bangladesh and believes to create impact in Bangladesh by identifying the research gap and guiding the evidence-informed policy adaptation from its findings in the future which will strongly underscore the elimination of Rabies and reduce preventable mortalities. We will attempt to synthesise evidence descriptively on burden and impact of rabies in human population as well as the awareness level and effective control and preventive measures from the available studies on rabies from 2010 to 2021 in Bangladesh.

METHODS

The scoping review is planned following the Joanna Briggs Institute methodology and the major guiding steps are: defining the research questions, determining the eligibility criteria with population, concept and context strategy, stating the plan for evidence searching, selection and data collection, searching for evidence and selection of literature by the inclusion criteria, data collection, descriptive analysis and presentation of the data and reporting of the findings. Search will be conducted for both published and grey literature in English language. Blinded screening processes will be adapted to prevent bias among reviewers.

ETHICS AND DISSEMINATION

A scoping review synthesises existing knowledge and does not necessitate ethical approval. Results of this scoping review will be submitted to a journal for publication, presented in relevant conferences and disseminated on social media platforms (eg, Twitter) among the global health stakeholders.

Rabies mortality and morbidity associated with animal bites in Africa: a case for integrated rabies disease surveillance, prevention and control: a scoping review

OBJECTIVE

The objective of this scoping review was to map the current situation and available evidence and gaps on rabies morbidity, mortality, integrated rabies surveillance programmes, and existing prevention and control strategies in Africa.

METHODS

We conducted a systematic scoping review following the Joanna Briggs methodology and Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews checklist. Medline, Embase, CINAHL (EBSCOHost), Scopus, Web of Science and rabies web conferences were used to search for peer-reviewed publications between January 1946 and May 2020. Two researchers reviewed the studies and extracted data based on author (year) and region, study design and data collection duration, participants/comparators, interventions, control conditions/exposures and outcomes (rabies mortality and morbidity) and key findings/gaps/challenges. The results were reported narratively using Arksey and O'Malley's methodological framework.

RESULTS

Electronic search yielded 2775 records, of which 43 studies were included. A total of 543 714 bite victims were censored through the included studies. Most of the victims were less than 15 years of age. The studies included rabies morbidity (21) and mortality (15) fluctuating in space and time across Africa depending on countries' rabies prevention and control practices (16). Others were surveillance (nine studies); surveillance and prevention (five studies); management and control (seven studies); and surveillance, prevention and control (six studies). We found challenges in rabies reporting, existing dog vaccination programmes and post-exposure prophylaxis availability or compliance.

CONCLUSION

This study found challenges for dog rabies control and elimination in Africa and the need for a policy to drive the goal of zero dog-transmitted rabies to humans by 2030.This is an open-access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build on this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated and the use is non-commercial (see http://creativecommons.org/licenses/by-nc/4.0/).

Dog rabies control in West and Central Africa: A review

Rabies is a neglected but preventable zoonotic disease that predominantly affects the most vulnerable populations living in remote rural areas of resource-limited countries. To date, every country on the African mainland is considered endemic for dog-mediated rabies with an estimated 21'500 human rabies deaths occurring each year. In 2018, the United Against Rabies collaboration launched the Global Strategic Plan to end human deaths from dog-mediated rabies by 2030. The epidemiology of rabies from most Western and Central African countries remains poorly defined, making it difficult to assess the overall rabies situation and progress towards the 2030 goal. In this review, we attempt to provide an overview of the current rabies situation in 22 West and Central African countries based on published scientific literature and information obtained from rabies focal points. To this end, information was collected on i) established surveillance, ii) diagnostic capacity, iii) post-exposure prophylaxis (PEP) availability and coverage, iv) dog population estimates, v) dog vaccination campaigns, vi) animal and human health communication (One Health), vii) molecular studies, viii) Knowledge, Attitude and Practices (KAP), ix) cost estimates and x) national control strategies. Although rabies is a notifiable disease in the majority of the studied countries, national surveillance systems do not adequately capture the disease. A general lack of rabies diagnostic capacity has an additional negative impact on rabies surveillance and attempts to estimate rabies burden. Recurrent shortages of human rabies vaccine are reported by all of the countries, with vaccine availability usually limited to major urban centers but no country has yet adopted the new WHO-recommended 1-week intradermal vaccination regimen. Most countries carry out subsidized mass dog vaccination campaigns on World Rabies Day. Such activities are indispensable to keep rabies in the public consciousness but are not of the scale and intensity that is required to eliminate rabies from the dog population. Countries will need to scale up the intensity of their campaigns, if they are to progress towards the 2030 goal. But more than half of the countries do not yet have reliable figures on their dog populations. Only two countries reached stage 2 on the Stepwise Approach towards Rabies Elimination ladder - indicating that their national governments have truly prioritized rabies elimination and are thus providing the necessary support and political buy-in required to achieve success. In summary, the sub-region of West and Central Africa seems to be divided into countries which have accepted the challenge to eliminate rabies with governments committed to pushing forward rabies elimination, while other countries have achieved some progress, but elimination efforts remain stuck due to lacking government commitment and financial constraints. The possibility to meet the 2030 goal without international solidarity is low, because more than two-thirds of the countries rank in the low human development group (HDI ≤ 152). Leading countries should act as role models, sharing their experiences and capacities so that no country is left behind. Unified and with international support it is possible to reach the common goal of zero human rabies deaths by 2030.

Challenges to improved animal rabies surveillance: Experiences from pilot implementation of decentralized diagnostic units in Chad

Better surveillance is desperately needed to guide rabies prevention and control to achieve the goal of zero dog-mediated human rabies by 2030, defined by the World Health Organization (WHO) and partners in 2015. With the help of funding from the Vaccine Alliance (GAVI) learning agenda, we implemented animal rabies surveillance based on One Health communication, improved accessibility of diagnostic testing and facilitated sample transport to increase case detection in three regions of Chad. Through the project, rabies surveillance, previously only available in N'Djaména, was extended to selected provincial rural and urban areas. Nine decentralized diagnostic units (DDU) were established, hosted by veterinary district agencies (VDA) in four different administrative regions. Four additional VDAs in the study area were reinforced with facilitation of sample collection and transport. Staff from all these 13 veterinary facilities were trained in sample collection and diagnostics. DDUs performed Rapid Immunodiagnostic Tests (RIDT) providing a preliminary result before samples were sent to the central laboratory in N'Djamena for confirmation with the standard Florescent Antibody Test (FAT). Within the project period from June 2016 to March 2018, 115 samples were reported by veterinary facilities in the study areas compared to 63 samples received from outside the study area, the vast majority of them originating from the capital city N'Djaména (N=61). Eighty nine percent of all 178 samples reported to IRED during the project period tested positive. Most of the samples originated from dogs (92%). Other confirmed rabies positive animals observed were cats, a donkey and a pig. Although surveillance of animal rabies was the focus, four human saliva samples were also submitted for diagnosis. We observed high differences in reporting rates between the four study regions. This could be attributable to differences in rabies epidemiology but are also influenced by the distance to the central laboratory in N'Djaména, the cultural background and the level of public awareness. The possibility for local testing through RIDT was very welcomed by local veterinary staff and preliminary insights suggest a positive influence on One Health communication and PEP initiation. However, these aspects as well as the relative impact of local testing on sample collection in comparison to reinforcement of sample collection and transport alone, need to be further investigated. Challenges encountered related to poor infrastructure (buildings, appliances, materials) and low logistic capacity (lacking means and material for transport and communication) of veterinary services in Chad. In addition, veterinary personnel lack experience in data management. Together with staff turnover, this leads to a need for repeated training. Major shortcoming of the approach was the high cost per sample and limited sustainability beyond the project timeframe.

Rabies control in Liberia: Joint efforts towards zero by 30

Despite declaration as a national priority disease, dog rabies remains endemic in Liberia, with surveillance systems and disease control activities still developing. The objective of these initial efforts was to establish animal rabies diagnostics, foster collaboration between all rabies control stakeholders, and develop a short-term action plan with estimated costs for rabies control and elimination in Liberia. Four rabies diagnostic tests, the direct fluorescent antibody (DFA) test, the direct immunohistochemical test (dRIT), the reverse transcriptase polymerase chain reaction (RT-PCR) assay and the rapid immunochromatographic diagnostic test (RIDT), were implemented at the Central Veterinary Laboratory (CVL) in Monrovia between July 2017 and February 2018. Seven samples (n=7) out of eight suspected animals were confirmed positive for rabies lyssavirus, and molecular analyses revealed that all isolates belonged to the Africa 2 lineage, subgroup H. During a comprehensive in-country One Health rabies stakeholder meeting in 2018, a practical workplan, a short-term action plan and an accurately costed mass dog vaccination strategy were developed. Liberia is currently at stage 1.5/5 of the Stepwise Approach towards Rabies Elimination (SARE) tool, which corresponds with countries that are scaling up local-level interventions (e.g. dog vaccination campaigns) to the national level. Overall an estimated 5.3 - 8 million USD invested over 13 years is needed to eliminate rabies in Liberia by 2030. Liberia still has a long road to become free from dog-rabies. However, the dialogue between all relevant stakeholders took place, and disease surveillance considerably improved through implementing rabies diagnosis at the CVL. The joint efforts of diverse national and international stakeholders laid important foundations to achieve the goal of zero dog-mediated human rabies deaths by 2030.

Increasing rabies data availability: The example of a One Health research project in Chad, Côte d'Ivoire and Mali

Rabies is a fatal but preventable disease that remains notoriously underreported. Weak data availability hampers advocacy, constitutes a barrier to resource allocation and inhibits effective prevention and control. To gain better insight into the global rabies burden and human vaccine demand several studies were funded through the Vaccine Alliance (GAVI) learning agenda. With the help of this funding, Swiss TPH and local in country partner organizations implemented a One Health research project in Chad, Côte d'Ivoire and Mali to collect data at household, public health facility and veterinary level. This paper describes the implementation of this research project and evaluates its success on amount of information gained, achieved capacity building, impact on knowledge creation and influence on national and international policies. The project was based on the One Health concept and guided by the principles of transboundary research partnerships formulated by the Swiss Academy of Sciences. Data was collected on bite incidents and health seeking from over 24'000 households, on access to treatment of over 8'800 bite cases registered in public health facilities and on the status of over 1'800 rabies suspect animals. Selected country specific datasets have contributed to more than 10 scientific articles so far. On the international level, the multi-level data collection provided a unique set of indicators to inform, along with results from other studies, new WHO rabies immunization recommendations and a vaccine investment case scenario to prevent human rabies. New rabies burden estimates based on the data gathered are published for Mali and will be modelled for the whole West and Central African region. On the national level, the project facilitated communication between animal health and human health workers catalyzing creation of local and national committees and formulation of national action plans for Mali and Côte D'Ivoire. Major challenges arose from lack of data collection and documentation experience of human health and veterinary workers and weak infrastructural capacities of the veterinary and human health systems of the project countries. Through adherence to the principles of transboundary research partnerships, project team members acquired valuable research and networking skills despite language barriers, enabling them to play key roles in the future agenda towards national, regional and global canine rabies elimination. Project external collaborations with local public institutions was facilitated through long-term local partnerships. Both factors enabled success in project implementation and outcomes by identifying and mitigating risks in advance, resolving challenges amiably and enabling mutual knowledge creation as a fructuous ground for sustained commitment. Lack of immediate follow-up funding did not allow to maintain activities beyond the project timeframe. However, the national and international policy changes triggered, as well as the strengthened local disease control and research capacities provides sustainable basis for the elimination of dog transmitted human rabies.

Identification of risk factors for rabies exposure and access to post-exposure prophylaxis in Chad

Rabies remains a global public health problem, with Africa as one of the most affected continents. Endemic transmission in the unvaccinated domestic dog population of developing countries leads to many exposures with subsequent death in humans due to lack of access to existing effective prevention tools. The presented study identifies factors of exposure and rabies risk in Chad on the household and health facility levels and highlights the challenges of access to Post Exposure Prophylaxis (PEP). Data on bite exposure and prevention was collected through a representative cross-sectional survey in rural and urban households and through a continuous bite reporting survey in public health facilities. During the household survey 8000 homes were visited, including 3241 (41%) in urban areas and 4759 (59%) in rural areas. The frequency of dog ownership was similar in both rural and urban areas, with around 24% households owning at least one dog. Knowledge of rabies as a disease transmitted mainly from dogs to humans was generally good, but higher in urban (86%) compared to rural areas (73%). The need for early prevention and medical care after a bite was less well known with 35% of respondents believing that rabies is curable after onset of symptoms and only one in three bite victims seeking help in a health facility. Exposure risk based on bite incidence on the population level was increased for Christian compared to Muslim predominant religious context. During the health facility study, 1540 bite cases were registered, of which 58% originated from urban areas and 42% from rural areas. Demographic characteristics of the health facility data subset matched the household survey data subset for the majority of parameters. Only bites from known animals (same household or from neighbourhood) and bites from animals known to be alive were underrepresented, suggesting that such bites are regarded as less dangerous than bites from unknown animals and animals that died, were killed or disappeared. Since human vaccine was provided free of charge during the study, most victims received PEP (84%). However, not all patients completed treatment, with a higher risk of non-compliance observed in rural areas. Access to vaccine before the study was alarmingly low, with only 8.5% accessing PEP. Despite facilitated collaboration between human health and veterinary services through the project, consultation with veterinary services remained generally low. The observed challenges can inform future rabies control programmes on the national level to effectively increase access to PEP exceeding the expected improved availability of human vaccine through the upcoming GAVI investment.

Reviewing Solutions of Scale for Canine Rabies Elimination in India

Canine rabies elimination can be achieved through mass vaccination of the dog population, as advocated by the WHO, OIE and FAO under the 'United Against Rabies' initiative. Many countries in which canine rabies is endemic are exploring methods to access dogs for vaccination, campaign structures and approaches to resource mobilization. Reviewing aspects that fostered success in rabies elimination campaigns elsewhere, as well as examples of largescale resource mobilization, such as that seen in the global initiative to eliminate poliomyelitis, may help to guide the planning of sustainable, scalable methods for mass dog vaccination. Elimination of rabies from the majority of Latin America took over 30 years, with years of operational trial and error before a particular approach gained the broad support of decision makers, governments and funders to enable widespread implementation. The endeavour to eliminate polio now enters its final stages; however, there are many transferrable lessons to adopt from the past 32 years of global scale-up. Additionally, there is a need to support operational research, which explores the practicalities of mass dog vaccination roll-out and what are likely to be feasible solutions at scale. This article reviews the processes that supported the scale-up of these interventions, discusses pragmatic considerations of campaign duration and work-force size and finally provides an examples hypothetical resource requirements for implementing mass dog vaccination at scale in Indian cities, with a view to supporting the planning of pilot campaigns from which expanded efforts can grow.

Dog Ecology, Bite Incidence, and Disease Awareness: A Cross-Sectional Survey among a Rabies-Affected Community in the Democratic Republic of the Congo

Despite the existence of safe and efficacious human and animal rabies vaccines, millions of people remain at risk of exposure to this deadly zoonotic disease through bites of infected dogs. Sub-Saharan African countries, such as the Democratic Republic of the Congo (DRC), bear the highest per capita death rates from rabies where dog vaccination and availability of lifesaving post-exposure prophylaxis (PEP) is scarce. Mass dog vaccination is the most cost-effective and sustainable approach to prevent human rabies deaths. We conducted a cross-sectional household survey in a rabies-affected community in Matadi, DRC, to estimate the size of the owned dog population and dog bite incidence and assess knowledge and practices regarding rabies, as preparation for future mass dog vaccination campaigns. Our study revealed that the owned dog population in Matadi was almost ten times larger than assumed by local veterinary officials, with a large proportion of free-roaming unvaccinated dogs. The annual dog bite incidence of 5.2 per 1000 person years was high, whereas community rabies knowledge was low resulting in poor practices. Given these findings, human rabies deaths are likely to occur in this community. Lack of disease awareness could negatively affect participation in future mass dog vaccination campaigns. A public sensitization campaign is needed to promote appropriate rabies prevention (washing bite wounds and PEP) and control (dog vaccination) measures in this community.

Bovine rabies: economic loss and its mitigation through antirabies vaccination

ABSTRACT: Rabies is among the most common neurological disease in cattle in Brazil, causing significant economic losses. Data on the economic impact of rabies in livestock are available in several countries. However, in Brazil, these data focus mainly on the public health point o view, emphasizing the costs related to the prevention of rabies in humans, in dogs, or wildlife. Specific studies carried out in different regions of Brazil indicate critical economic losses caused by rabies in cattle in this country. However, the studies on the losses caused by the disease in cattle lack a detailed analysis of the affected rural properties based on data from official disease control agencies. The objective of this work was to evaluate the economic impact of bovine rabies, and its mitigation through antirabies vaccination in rural properties in Mato Grosso do Sul, Midwestern Brazil.

Canine rabies control and human exposure 1951-2015, Guangzhou, China

Objective

To describe changes in rabies surveillance and management in Guangzhou, China between 1951 and 2015, and to analyse human rabies cases over that period.

Methods

Rabies control policies and strategies implemented by the Guangzhou government were reviewed for three periods: 1951 to 1978, 1979 to 2000 and 2001 to 2015. Data on human rabies deaths and exposure were obtained from Guangzhou and national health and disease records. The demographic characteristics of human cases are reported using descriptive statistics.

Findings

Between 1951 and 2015, the number of organizations cooperating on rabies control increased: there were two between 1951 and 1978, six between 1979 and 2000, and nine between 2001 and 2015. The number of human rabies cases reported in these periods was 331, 422 and 60, respectively. Organizations involved included city and district centres for disease control and prevention, rabies outpatient clinics, medical institutions and police. Overall, 88% (713/813) of cases occurred in rural districts, though, between 1951 and 2015, the distribution shifted from being predominantly rural to being both urban and rural. The number of people exposed to rabies increased annually. The biggest increases were among those injured by a pet dog or other animal: 3.26 and 4.75 times, respectively, between 2005 and 2015.

Conclusion

Increased cooperation on rabies control between civil organizations in Guangzhou over decades was associated with a marked decrease in the number of human rabies cases. The Guangzhou experience could thereby provide guidance for other cities experiencing similar rabies epidemics.

Vaccination of dogs in an African city interrupts rabies transmission and reduces human exposure

Despite the existence of effective rabies vaccines for dogs, dog-transmitted human rabies persists and has reemerged in Africa. Two consecutive dog vaccination campaigns took place in Chad in 2012 and 2013 (coverage of 71% in both years) in the capital city of N'Djaména, as previously published. We developed a deterministic model of dog-human rabies transmission fitted to weekly incidence data of rabid dogs and exposed human cases in N'Djaména. Our analysis showed that the effective reproductive number, that is, the number of new dogs infected by a rabid dog, fell to below one through November 2014. The modeled incidence of human rabies exposure fell to less than one person per million people per year. A phylodynamic estimation of the effective reproductive number from 29 canine rabies virus genetic sequences of the viral N-protein confirmed the results of the deterministic transmission model, implying that rabies transmission between dogs was interrupted for 9 months. However, new dog rabies cases appeared earlier than the transmission and phylodynamic models predicted. This may have been due to the continuous movement of rabies-exposed dogs into N'Djaména from outside the city. Our results show that canine rabies transmission to humans can be interrupted in an African city with currently available dog rabies vaccines, provided that the vaccination area includes larger adjacent regions, and local communities are informed and engaged.

Cost-effectiveness of dog rabies vaccination programs in East Africa

BACKGROUND

Dog rabies annually causes 24,000-70,000 deaths globally. We built a spreadsheet tool, RabiesEcon, to aid public health officials to estimate the cost-effectiveness of dog rabies vaccination programs in East Africa.

METHODS

RabiesEcon uses a mathematical model of dog-dog and dog-human rabies transmission to estimate dog rabies cases averted, the cost per human rabies death averted and cost per year of life gained (YLG) due to dog vaccination programs (US 2015 dollars). We used an East African human population of 1 million (approximately 2/3 living in urban setting, 1/3 rural). We considered, using data from the literature, three vaccination options; no vaccination, annual vaccination of 50% of dogs and 20% of dogs vaccinated semi-annually. We assessed 2 transmission scenarios: low (1.2 dogs infected per infectious dog) and high (1.7 dogs infected). We also examined the impact of annually vaccinating 70% of all dogs (World Health Organization recommendation for dog rabies elimination).

RESULTS

Without dog vaccination, over 10 years there would a total of be approximately 44,000-65,000 rabid dogs and 2,100-2,900 human deaths. Annually vaccinating 50% of dogs results in 10-year reductions of 97% and 75% in rabid dogs (low and high transmissions scenarios, respectively), approximately 2,000-1,600 human deaths averted, and an undiscounted cost-effectiveness of $451-$385 per life saved. Semi-annual vaccination of 20% of dogs results in in 10-year reductions of 94% and 78% in rabid dogs, and approximately 2,000-1,900 human deaths averted, and cost $404-$305 per life saved. In the low transmission scenario, vaccinating either 50% or 70% of dogs eliminated dog rabies. Results were most sensitive to dog birth rate and the initial rate of dog-to-dog transmission (Ro).

CONCLUSIONS

Dog rabies vaccination programs can control, and potentially eliminate, dog rabies. The frequency and coverage of vaccination programs, along with the level of dog rabies transmission, can affect the cost-effectiveness of such programs. RabiesEcon can aid both the planning and assessment of dog rabies vaccination programs.

Ecohealth research in Africa: Where from-Where to?

Epidemiological mapping and risk profiling build on the idea that diseases are tied to social-ecological systems that govern the distribution and abundance of transmissible pathogens, vectors and hosts. This is the heart of the emerging field of ecohealth, which examines how biological, cultural, demographic, economic, physical, political and social environments change and how these changes affect the health and wellbeing of humans, animals and ecosystems and the services they provide. This paper is an overview of a special issue of Acta Tropica, whose 15 publications reflect a geographically and epidemiologically diverse landscape of ecohealth. Nowhere is an ecohealth approach better suited than in Africa and its myriad of landscapes that include contexts varying from profuse expanses of tropical rain forests to the world's greatest desert. The publication of African ecohealth-related projects displays a biological, cultural and social diversity in health system contexts and a wide variety of contributions pertaining to different, often neglected, tropical diseases, including brucellosis, Buruli ulcer, fascioliasis, malaria, Q fever, rabies, Rift Valley fever and schistosomiasis. Pursuing an ecohealth approach provides a platform that brings together community members, decision makers, scientists and other stakeholders with a view to understand how ecosystem changes affect health conditions. Taken together, the presentation of this variety of papers dealing with environmental variables associated with health inaugurates the vital concept of ecohealth. By emphasizing that all organisms are part of social-ecological systems, the long-term wellbeing of both people and animals depending on healthy and productive ecosystems is highlighted.

Evaluation of immune responses in dogs to oral rabies vaccine under field conditions

During the 20th century parenteral vaccination of dogs at central-point locations was the foundation of successful canine rabies elimination programs in numerous countries. However, countries that remain enzootic for canine rabies have lower infrastructural development compared to countries that have achieved elimination, which may make traditional vaccination methods less successful. Alternative vaccination methods for dogs must be considered, such as oral rabies vaccine (ORV). In 2016, a traditional mass dog vaccination campaign in Haiti was supplemented with ORV to improve vaccination coverage and to evaluate the use of ORV in dogs. Blisters containing live-attenuated, vaccine strain SPBNGAS-GAS were placed in intestine bait and distributed to dogs by hand. Serum was collected from 107 dogs, aged 3-12 months with no reported prior rabies vaccination, pre-vaccination and from 78/107 dogs (72.9%) 17 days post-vaccination. The rapid florescent focus inhibition test (RFFIT) was used to detect neutralizing antibodies and an ELISA to detect rabies binding antibodies. Post-vaccination, 38/41 (92.7%) dogs that received parenteral vaccine had detectable antibody (RFFIT >0.05 IU/mL), compared to 16/27 (59.3%, p < 0.01) dogs that received ORV or 21/27 (77.8%) as measured by ELISA (>40% blocking, p < 0.05). The fate of 291 oral vaccines was recorded; 283 dogs (97.2%) consumed the bait; 272 dogs (93.4%) were observed to puncture the blister, and only 14 blisters (4.8%) could not be retrieved by vaccinators and were potentially left in the environment. Pre-vaccination antibodies (RFFIT >0.05 IU/mL) were detected in 10/107 reportedly vaccine-naïve dogs (9.3%). Parenteral vaccination remains the most reliable method for ensuring adequate immune response in dogs, however ORV represents a viable strategy to supplement existing parental vaccination campaigns in hard-to-reach dog populations. The hand-out model reduces the risk of unintended contact with ORV through minimizing vaccine blisters left in the community.

Cost Description and Comparative Cost Efficiency of Post-Exposure Prophylaxis and Canine Mass Vaccination against Rabies in N'Djamena, Chad

Rabies claims approximately 59,000 human lives annually and is a potential risk to 3.3 billion people in over 100 countries worldwide. Despite being fatal in almost 100% of cases, human rabies can be prevented by vaccinating dogs, the most common vector, and the timely administration of post-exposure prophylaxis (PEP) to exposed victims. For the control and prevention of human rabies in N'Djamena, the capital city of Chad, a free mass vaccination campaign for dogs was organized in 2012 and 2013. The campaigns were monitored by parallel studies on the incidence of canine rabies based on diagnostic testing of suspect animals and the incidence of human bite exposure recorded at selected health facilities. Based on the cost description of the campaign and the need for PEP registered in health centers, three cost scenarios were compared: cumulative cost-efficiency of (1) PEP alone, (2) dog mass vaccination and PEP, (3) dog mass vaccination, PEP, and maximal communication between human health and veterinary workers (One Health communication). Assuming ideal One Health communication, the cumulative prospective cost of dog vaccination and PEP break even with the cumulative prospective cost of PEP alone in the 10th year from the start of the calculation (2012). The cost efficiency expressed in cost per human exposure averted is much higher with canine vaccination and One Health communication than with PEP alone. As shown in other studies, our cost-effectiveness analysis highlights that canine vaccination is financially the best option for animal rabies control and rabies prevention in humans. This study also provides evidence of the beneficial effect of One Health communication. Only with close communication between the human and animal health sectors will the decrease in animal rabies incidence be translated into a decline for PEP. An efficiently applied One Health concept would largely reduce the cost of PEP in resource poor countries and should be implemented for zoonosis control in general.

Rabies Control: Could Innovative Financing Break the Deadlock?

The neglected zoonotic diseases (NZDs) have been all but eradicated in wealthier countries but remain major causes of ill-health and mortality in over 80 countries across Africa, Asia, and Latin America. The nature of neglect for the NZDs has been ascribed, in part, to underreporting resulting in an underestimation of their global burden that, together with a lack of advocacy, downgrades their relevance to policy-makers and funding agencies. While this may be the case for many NZDs, for rabies this is not the case. The global burden estimates for rabies (931,600 DALYs) more than justify prioritizing rabies control building on the strong advocacy platforms, functioning at local, regional, and global levels (including the Global Alliance for Rabies Control), and commitments from WHO, OIE, and FAO. Simple effective tools for rabies control exist together with blueprints for operationalizing control, yet, despite elimination targets being set, no global affirmative action has been taken. Rabies control demands activities both in the short term and over a long period of time to achieve the desired cumulative gains. Despite the availability of effective vaccines and messaging tools, rabies will not be sustainably controlled in the near future without long-term financial commitment, particularly as disease incidence decreases and other health priorities take hold. While rabies control is usually perceived as a public good, public private partnerships could prove equally effective in addressing endemic rabies through harnessing social investment and demonstrating the cost-effectiveness of control. It is acknowledged that greater attention to navigating local realities in planning and implementation is essential to ensuring that rabies, and other neglected diseases, are controlled sustainably. In the shadows of resource and institutional limitations in the veterinary sector in low- and middle-income countries, sufficient funding is required so that top-down interventions for rabies can more explicitly engage with local project organization capacity and affected communities in the long term. Development Impact Bonds have the potential to secure the financing required to deliver effective rabies control.