A Century Spent Combating Rabies in Morocco (1911-2015): How Much Longer?

Impact and mitigation of sampling bias to determine viral spread: Evaluating discrete phylogeography through CTMC modeling and structured coalescent model approximations

Bayesian phylogeographic inference is a powerful tool in molecular epidemiological studies, which enables reconstruction of the origin and subsequent geographic spread of pathogens. Such inference is, however, potentially affected by geographic sampling bias. Here, we investigated the impact of sampling bias on the spatiotemporal reconstruction of viral epidemics using Bayesian discrete phylogeographic models and explored different operational strategies to mitigate this impact. We considered the continuous-time Markov chain (CTMC) model and two structured coalescent approximations (Bayesian structured coalescent approximation [BASTA] and marginal approximation of the structured coalescent [MASCOT]). For each approach, we compared the estimated and simulated spatiotemporal histories in biased and unbiased conditions based on the simulated epidemics of rabies virus (RABV) in dogs in Morocco. While the reconstructed spatiotemporal histories were impacted by sampling bias for the three approaches, BASTA and MASCOT reconstructions were also biased when employing unbiased samples. Increasing the number of analyzed genomes led to more robust estimates at low sampling bias for the CTMC model. Alternative sampling strategies that maximize the spatiotemporal coverage greatly improved the inference at intermediate sampling bias for the CTMC model, and to a lesser extent, for BASTA and MASCOT. In contrast, allowing for time-varying population sizes in MASCOT resulted in robust inference. We further applied these approaches to two empirical datasets: a RABV dataset from the Philippines and a SARS-CoV-2 dataset describing its early spread across the world. In conclusion, sampling biases are ubiquitous in phylogeographic analyses but may be accommodated by increasing the sample size, balancing spatial and temporal composition in the samples, and informing structured coalescent models with reliable case count data.

A Regional Analysis of the Progress of Current Dog-Mediated Rabies Control and Prevention

This study aimed to assess the current progress of dog-mediated rabies control and the level of political commitment among 88 rabies-endemic countries and to provide further recommendations for the elimination of dog-mediated rabies by 2030. A correlational study was conducted using data and relevant regulations from the websites of international organizations and NGOs. In general, rabies was yet to be considered a priority disease and only one out of five countries and territories has prepared a national strategic plan for rabies control and prevention. Likewise, scores of dog-mediated rabies control indicators such as dog vaccination rate and the number of post-exposure prophylaxis per 1000 people remained minimal. There were also regional differences in preparation for dog-mediated rabies control and progress towards elimination. In particular, more efforts are needed for Pan-African Rabies Control Network (PARACON) member countries. In order to meet the goal of global dog-mediated zero rabies by 2030, both dog-mediated rabies control activities such as dog vaccination and strong political commitment should be strengthened and promoted in all rabies-endemic regions of the world.

Owned and free-roaming dogs in the North West of Tunisia: estimation, characteristics and application for the control of dog rabies

Understanding the structure of dog population and the evaluation of the accessibility of dogs to vaccination is essential to succeed in the fight against dog rabies and to adapt the strategy of its control. We studied the characteristics of the unowned and owned dogs using the beck method during a rabies vaccination campaign in randomly selected sectors (urban and rural sites) in the North West of Tunisia. During a door-to-door investigation of households, data on owned dogs were collected to describe the owned population dog. A photographic-recapture method was used to characterize and estimate the size of the unowned dogs. A total of 1432 households accounting for 5403 inhabitants were interviewed during the survey (1298 (90.6%) in the urban site and 134 (9.3%) in the rural site). The dog-owning households were significantly higher in the rural site (76.1% (102/134)) compared to the urban site (17.8% (231/1298)) (P < 0.000000). Of the 17.8% dog-owning households in urban site, 58.4% owned one dog and 9% between 4 and 8 dogs. While, of the 76.1% dog-owning households in rural site, 24.5% owned one dog and 32.3% owned between 4 and 10 dogs. The dog: human ratio was 1:11 in the urban site and 1:1.6 in the rural site. The dog population density was estimated at 16 dogs/km2 and 4 dogs/km2 in the urban and rural sites, respectively. The confinement practices varied significantly among the urban and rural sites (P < 0.000000). The percentage of free-roaming owned dogs was 51.1% in the rural site and 31.4% in the urban site. More than 60.0% of the owned dogs in the urban site were confined. The majority of dogs in the rural site were born in the house, although, a high percentage (56.7%) of owned dogs in the urban site was adopted from neighbours, others sectors, or countries. The vaccination coverage findings indicated that 77.8% and 84.2% of the owned dog were vaccinated in the urban and rural sites, respectively. The estimated size of the free-roaming dogs was 72 dogs in the urban site (Kalaat Senan) and 16 dogs in the rural site (Sod el Khir).

Role of Oral Rabies Vaccines in the Elimination of Dog-Mediated Human Rabies Deaths

Domestic dogs are responsible for nearly all the »59,000 global human rabies deaths that occur annually. Numerous control measures have been successful at eliminating dog-mediated human rabies deaths in upper-income countries, including dog population management, parenteral dog vaccination programs, access to human rabies vaccines, and education programs for bite prevention and wound treatment. Implementing these techniques in resource-poor settings can be challenging; perhaps the greatest challenge is maintaining adequate herd immunity in free-roaming dog populations. Oral rabies vaccines have been a cornerstone in rabies virus elimination from wildlife populations; however, oral vaccines have never been effectively used to control dog-mediated rabies. Here, we convey the perspectives of the World Organisation for Animal Health Rabies Reference Laboratory Directors, the World Organisation for Animal Health expert committee on dog rabies control, and World Health Organization regarding the role of oral vaccines for dogs. We also issue recommendations for overcoming hesitations to expedited field use of appropriate oral vaccines.

Temporal and spatial distributions of animal and human rabies cases during 2012 and 2018, in Tunisia

Rabies is one of the most important zoonosis in Tunisia. In the last 6 years, a dramatic increase in the number of cases in animals had raised concern about the transmission dynamics of rabies and the effectiveness of established control measures. For a better understanding of the epidemiological features of rabies in Tunisia, data on animal and human rabies cases and post-exposure prophylaxis (PEP) protocol, for the period from 2012 to 2018, were analysed to describe the spatial and the temporal distributions of the disease and to guide targeted rabies control measures. Thus, the analysed data have shown that 2,642 animal and 25 human rabies cases were recorded between 2012 and 2018; only few case numbers were reported in wildlife. Time-related distribution showed that the incidence of dog rabies increases over the period of study, from 24,8/100,000 dog population in 2012 to 35,2/100,000 dog population in 2018. Dog seems to be the main reservoir of rabies as it accounted for more than 59% of the animal confirmed cases and the source for more than 80% of the human confirmed cases. Geographical distribution of animal rabies cases revealed the presence of clusters in the North and the Center of Tunisia; only a little number of animal cases were reported in the South. In contrast, the overall human rabies incidence was 0.03 per 100,000 population, during the period of the study. We have found that the incidence of human rabies increases by 13.6% from 2012 to 2015 and drops steadily by 23.41% over the second period (2015 to 2018). A high number of PEP was recorded during the 7-year period, with an average of 360 PEP per 100,000 inhabitants per year. Spatial analysis revealed the presence of clusters of PEP in the Northern and Central governorates. The present study pointed out the need to review the control strategy of rabies in Tunisia and conduct further studies on dog population to provide the basis for a new and efficacious policy of interventions and control program for rabies.

Practices in research, surveillance and control of neglected tropical diseases by One Health approaches: A survey targeting scientists from French-speaking countries

One health (OH) approaches have increasingly been used in the last decade in the fight against zoonotic neglected tropical diseases (NTDs). However, descriptions of such collaborations between the human, animal and environmental health sectors are still limited for French-speaking tropical countries. The objective of the current survey was to explore the diversity of OH experiences applied to research, surveillance and control of NTDs by scientists from French-speaking countries, and discuss their constraints and benefits. Six zoonotic NTDs were targeted: echinococcoses, trypanosomiases, leishmaniases, rabies, Taenia solium cysticercosis and leptospiroses. Invitations to fill in an online questionnaire were sent to members of francophone networks on NTDs and other tropical diseases. Results from the questionnaire were discussed during an international workshop in October 2019. The vast majority (98%) of the 171 respondents considered OH approaches relevant although only 64% had implemented them. Among respondents with OH experience, 58% had encountered difficulties mainly related to a lack of knowledge, interest and support for OH approaches by funding agencies, policy-makers, communities and researchers. Silos between disciplines and health sectors were still strong at both scientific and operational levels. Benefits were reported by 94% of respondents with OH experience, including increased intellectual stimulation, stronger collaborations, higher impact and cost-efficiency of interventions. Recommendations for OH uptake included advocacy, capacity-building, dedicated funding, and higher communities' involvement. Improved research coordination by NTD networks, production of combined human-animal health NTD impact indicators, and transversal research projects on diagnostic and reservoirs were also considered essential.

Using geostatistics to better understand the epidemiology of animal rabies in Morocco: what is the contribution of the predictive value?

This study aims to characterize the spatial distribution of animal rabies in Morocco in order to provide appropriate control approaches. Descriptive analyses of the epidemiological data show that the number of reported canine rabies cases greatly underestimates the true incidence of the disease. Underreporting subsequently affects the coherence of its spatial distribution. To perform accurate geographic distribution mapping of the disease based on interpolation methods, a data set was created using data between 2000 and 2018 to compare the derived disease cases with known true values in order to identify disease clusters. The subsequent interpolation was conducted using Ordinary Kriging regression methods and the semi variogram to focus on short distances and reduce uncertainty. The estimated clusters of rabies were evaluated using a cross validation step which revealed predicted cases close to the true values. To improve the precision of analysis, the authors displayed georeferenced dog and human rabies cases reported during the last three years, demonstrating reliable results that correspond to the estimated cluster areas similar to the true disease incidence on the field. This work highlights a strong correlation between infrastructure projects (i.e. railways, roads, facilities) and rabies epizootics for several specific locations. This study is the first attempt to use geostatistics to build upon the understanding of animal rabies in Morocco and shed light on the most appropriate strategies to sustainably reduce and mitigate the risk of rabies. There has been little literature on the use of kriging methods in animal health research. Thus, this study also aimed to explore a novel method in the veterinary sciences to establish kriging as a valid and coherent analysis tool to identify the extent to which the geostatistic area can objectively support understanding on animal rabies and saw it as being highly instrumental in coping with gaps in the data.

Tackling the Threat of Rabies Reintroduction in Europe

Rabies is one of the oldest, most important zoonoses worldwide due to its extreme and inevitably lethal nature, causing one death every 9 min worldwide. Recent reports have demonstrated that the Lyssavirus continues more alive than ever, despite the control carried out against the virus throughout Europe. In this context, this work reviews the main immunological implications, transmission risk factors and current prevention measures for virus control in Europe, and especially in Spain.

The World Rabies Day 2020: Collaborate and Vaccinate

Rabies constantly kills 59,000 people annually, mostly in Asia and Africa. Rabies, which is responsible for 99% of human rabies cases, is totally preventable by standard vaccinations. In 2015, a global call for action was made by the World Health Organization, World Organization for Animal Health, Food and Agriculture Organization of the United Nations, and the Global Alliance for Rabies Control to join forces toward the elimination of dog-transmitted human rabies by the year 2030. All the tools and protocols to reach that target are readily available, and the feasibility of dog rabies elimination has been proven. Countries should drive the changes needed to engage into this global movement. Certainly, countries in the Eastern Mediterranean Region require taking more critical steps to reach the rabies elimination target by 2030. The international awareness campaign of the World Rabies Day is an excellent occasion to assess challenges and opportunities toward rabies elimination.

Knowledge, Attitudes, and Practices Regarding Rabies in El Jadida Region, Morocco

The aim of this study was to evaluate the knowledge, attitudes, and practices regarding rabies in the El Jadida region, Morocco. We conducted a cross-sectional survey using a structured questionnaire among randomly selected residents across 24 study sites. In total, 407 respondents took part in the survey. The majority (367, 92%) were male and had no formal education (270, 66%). Some (118, 29%) believed that rabies does not affect humans. Most respondents (320, 79%) were aware that vaccination could prevent rabies, but nevertheless did not vaccinate their dogs (264, 64.9%) and allowed their dogs to roam freely in search of food. Some (52.8%) would visit traditional healers for treatment in the event of a dog bite incident. Age and educational level were found to be significantly associated with knowledge, attitudes, and practices (p < 0.05). Although respondents demonstrated some level of knowledge about rabies, overall this study reveals critical gaps in their attitudes and practices. These shortcomings may be associated with a low level of education. Therefore, decision-makers need a new approach to control rabies, with a special focus on public awareness and health education, in order to sustain rabies control programs.

The epidemiology of dog rabies in Algeria: Retrospective national study of dog rabies cases, determination of vaccination coverage and immune response evaluation of three commercial used vaccines

Rabies is a neglected zoonotic disease. Several animal species can transmit rabies, but domestic dogs are the main reservoir implicated in rabies transmission to human and other susceptible animals. There is a scarcity of data regarding canine rabies in Algeria. Hence, this report is the first study that attempts to understand the epidemiology of dog rabies through a retrospective national study of rabies cases between 2010 and 2016, determination of canine vaccination coverage and evaluation of immune response of three rabies commercial vaccines used in Algeria. Our results revealed the persistent nature of dog rabies in Algeria; with a mean of 131 positive cases per year. The vaccination coverage findings indicated that 30.81% (126/409) of the reported vaccinated dog and 47.98% (261/544) of all studied dogs presented low level of rabies antibodies titres (less than 0.5 IU), and were therefore considered not immune to rabies. Additionally, our vaccine evaluation findigs showed a weak immune response of inactivated vaccine without adjuvant. Even with adjuvanted inactivated and attenuated live vaccines, several vaccinated dogs did not develop vaccine protection. Therefore, our results recommend further studies to test the efficiency of adding a booster vaccine shot, especially in primo-vaccinated dogs to optimize the vaccination protocol; rabies is potentially fatal zoonosis, tolerating no vaccine failure. Moreover, the present study establish the necessity to re-examine the national rabies control program, implemented in 1996, particularly concerning population education, vaccination strategy, surveillance and campaigns monitoring.

Oral vaccination of dogs: a well-studied and undervalued tool for achieving human and dog rabies elimination

The mass vaccination of dogs is a proven tool for rabies prevention. Besides parenteral delivery of inactivated vaccines, over the past several decades, several self-replicating biologics, including modified-live, attenuated and recombinant viruses, have been evaluated for the oral vaccination of dogs against rabies. Vaccines are included within an attractive bait for oral consumption by free-ranging dogs. Due to the high affinity between dogs and humans, such biologics intended for oral vaccination of dogs (OVD) need to be efficacious as well as safe. Baits should be preferentially attractive to dogs and not to non-target species. Although many different types have been evaluated successfully, no universal bait has been identified to date. Moreover, high bait acceptance does not necessarily mean that vaccine efficacy and programmatic success is predictable. The use of OVD in the laboratory and field has demonstrated the safety and utility of this technology. Within a One Health context, OVD should be considered as part of a holistic plan for the global elimination of canine rabies.

Socioecology of the Canine Population in the Province of El Jadida, Morocco

Understanding the socioecology of domestic dog populations is essential for effective disease control, especially canine rabies. In Morocco, since 1986, the control efforts and plans put in place by the government have failed to eradicate this disease; this is because the management of the canine population was not taken into account during the establishment of these plans. It is against the background that this study was designed to estimate the dog population and determine its socioecological characteristics, as well as investigate the attitude of the inhabitants towards the dogs. A stratified random sampling was conducted using a structured questionnaire from May to December 2016. A total of 1931 households were interviewed, comprising 27.4% in urban areas and 72.6% in rural areas. A total of 3719 dogs were counted alongside a human population of 11302 for a dog : human ratio of 1 : 2.42 in rural areas and 1 : 46.58 in urban areas. The majority of dogs (92%) in rural areas were not vaccinated against rabies. In urban areas, about 88.5% were vaccinated against rabies. In addition, 78.5% of dogs in rural areas were free roaming, with more than 53% of births being abandoned by their owners, resulting in a large stray and feral dog population and increasing the potential for continued transmission of rabies virus. There was strong association between breed and rabies vaccination (p<0.05) and confinement with body condition score.