1
|
Swedberg C, Miranda MEG, Bautista C, Anderson D, Basa-Tulio M, Chng NR, Cruz VDD, Kundegorski M, Maestro J, Manalo D, Maniszewska K, Manzanilla DR, Mazeri S, Mellanby RJ, Pablo-Abarquez S, Quiambao B, Telmo SVM, Trotter C, Yuson M, Hampson K. Using Integrated Bite Case Management to estimate the burden of rabies and evaluate surveillance in Oriental Mindoro, Philippines. One Health Implement Res 2023; 3:77-96. [PMID: 37841079 PMCID: PMC7615207 DOI: 10.20517/ohir.2023.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
Background Despite national elimination efforts, dog-mediated rabies remains endemic in the Philippines. Free provision of post-exposure prophylaxis (PEP) through the widespread establishment of Animal Bite Treatment Centers (ABTCs) has improved accessibility; however, the resulting upsurge in PEP demand is not sustainable, and human rabies deaths continue. Dog vaccination coverage also remains inadequate, and it is unclear whether surveillance is effective. Methods Here, we used Integrated Bite Case Management (IBCM) to collect enhanced rabies surveillance data in Oriental Mindoro Province over a 3-year period (2020-2022). Adapting a probabilistic decision tree model, we estimated the burden of rabies, evaluated surveillance performance, and analyzed the costs and benefits of current rabies prevention and control practices in the province. Results The incidence of bite patients receiving PEP was high in Oriental Mindoro Province (1,246/100,000 persons/year), though < 3% of presenting patients were deemed high-risk for rabies exposure (24/100,000 persons/year). Using a decision tree model, we estimated that around 73.8% of probable rabies-exposed patients sought PEP (95% Prediction Interval, PrI: 59.4%-81.1%) and that routine surveillance confirmed < 2% of circulating animal rabies cases, whereas IBCM resulted in a nearly fourfold increase in case detection. Furthermore, we estimated that an average of 560 (95% PrI 217-1,090) dogs may develop rabies annually in the province, equating to 3-5 cases per 1,000 dogs per year. On average, 20 to 43 human deaths were averted by PEP each year in Oriental Mindoro at an annual cost of $582,110 USD (i.e., $51.44 USD per person) or $20,190 USD (95% PrI $11,565-79,400) per death averted. Conclusion While current practices for PEP provisioning in the Philippines have improved access, a large proportion of people exposed to rabies (> 26%, 95% PrI 18.8%-40.1%) are still not seeking healthcare. Integrating an intersectoral surveillance system, such as IBCM, into national policy could greatly improve case detection if well implemented, with further benefits extending to guidance for PEP administration, potentially reducing unnecessary expenditure on PEP, and situational awareness to inform control of rabies through mass dog vaccination.
Collapse
Affiliation(s)
- Catherine Swedberg
- School of Biodiversity, One Health & Veterinary Medicine, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow G12 8QQ, Scotland, United Kingdom
| | - Mary Elizabeth G. Miranda
- Field Epidemiology Training Program Alumni Foundation, Inc. (FETPAFI), Quezon City 1101, Metro Manila, Philippines
| | - Criselda Bautista
- School of Biodiversity, One Health & Veterinary Medicine, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow G12 8QQ, Scotland, United Kingdom
- Research Institute for Tropical Medicine (RITM), Muntinlupa 1781, Metro Manila, Philippines
| | - David Anderson
- School of Biodiversity, One Health & Veterinary Medicine, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow G12 8QQ, Scotland, United Kingdom
| | - Marife Basa-Tulio
- Provincial Health Office, Calapan 5200, Oriental Mindoro, Philippines
| | - Nai Rui Chng
- School of Health and Wellbeing, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow G12 8QQ, Scotland, United Kingdom
| | - Van Denn D. Cruz
- Field Epidemiology Training Program Alumni Foundation, Inc. (FETPAFI), Quezon City 1101, Metro Manila, Philippines
| | - Mikolaj Kundegorski
- School of Biodiversity, One Health & Veterinary Medicine, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow G12 8QQ, Scotland, United Kingdom
| | - Jobin Maestro
- Municipal Health Office, Alcantara 5500, Romblon, Philippines
| | - Daria Manalo
- Research Institute for Tropical Medicine (RITM), Muntinlupa 1781, Metro Manila, Philippines
| | - Klaudyna Maniszewska
- School of Biodiversity, One Health & Veterinary Medicine, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow G12 8QQ, Scotland, United Kingdom
| | - Duane R. Manzanilla
- Field Epidemiology Training Program Alumni Foundation, Inc. (FETPAFI), Quezon City 1101, Metro Manila, Philippines
| | - Stella Mazeri
- Royal (Dick) School of Veterinary Studies and the Roslin Institute, University of Edinburgh, Easter Bush Campus, Midlothian EH25 9RG, Scotland, United Kingdom
| | - Richard J. Mellanby
- Royal (Dick) School of Veterinary Studies and the Roslin Institute, University of Edinburgh, Easter Bush Campus, Midlothian EH25 9RG, Scotland, United Kingdom
| | - Sheryl Pablo-Abarquez
- Field Epidemiology Training Program Alumni Foundation, Inc. (FETPAFI), Quezon City 1101, Metro Manila, Philippines
| | - Beatriz Quiambao
- Research Institute for Tropical Medicine (RITM), Muntinlupa 1781, Metro Manila, Philippines
| | - Shynee Vee M. Telmo
- Department of Agriculture Regional Animal Disease Diagnostic Laboratory (RADDL), Naujan 5204, Oriental Mindoro, Philippines
| | - Caroline Trotter
- Departments of Veterinary Medicine and Pathology, University of Cambridge, Cambridge CB3 0ES, United Kingdom
| | - Mirava Yuson
- School of Biodiversity, One Health & Veterinary Medicine, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow G12 8QQ, Scotland, United Kingdom
- Field Epidemiology Training Program Alumni Foundation, Inc. (FETPAFI), Quezon City 1101, Metro Manila, Philippines
| | - Katie Hampson
- School of Biodiversity, One Health & Veterinary Medicine, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow G12 8QQ, Scotland, United Kingdom
| |
Collapse
|