Use of partial N-gene sequences as a tool to monitor progress on rabies control and elimination efforts in Ethiopia

Ethiopia is one of the African countries most affected by rabies. A coarse catalog of rabies viruses (RABV) was created as a benchmark to assess the impact of control and elimination activities. We evaluated a 726 bp amplicon at the end of the N-gene to infer viral lineages in circulation using maximum likelihood and Bayesian methods for phylogenetic reconstruction. We sequenced 228 brain samples from wild and domestic animals collected in five Ethiopian regions during 2010-2017. Results identified co-circulating RABV lineages that are causing recurrent spillover infections into wildlife and domestic animals. We found no evidence of importation of RABVs from other African countries or vaccine-induced cases in the area studied. A divergent RABV lineage might be involved in an independent rabies cycle in jackals. This investigation provides a feasible approach to assess rabies control and elimination efforts in resource-limited countries.

Rabies on the Indian subcontinent

The Indian subcontinent comprises Afghanistan, Bangladesh, Bhutan, India, Nepal, the Maldives, Myanmar, Pakistan and Sri Lanka. In all of these countries, except the Maldives, rabies is endemic. An estimated 59,000 people die from rabies each year; 45% of these deaths occur on the Indian subcontinent and approximately 33% take place in India. The majority of these deaths are attributable to dog bites, and those most affected are children and the poor. Access to post-exposure prophylaxis is limited and costly, the supply of immunoglobulins and vaccines can be irregular and public awareness of rabies is low. Moreover, the vaccination of domestic dogs is not widely implemented. There is a need for increased laboratory capacity and expertise across the continent, as well as better data, improved surveillance and more user-friendly and economical diagnostic tests. An animal birth control programme has met with mixed success in India. However, a greater focus on mass dog vaccination could eliminate the disease at its source, reducing the large burden of mortality for at-risk communities. In this paper, the authors examine the situation in each of the countries on the Indian subcontinent, discuss current needs, obstacles and progress, and examine future strategies, with the objective of eliminating dog-mediated rabies from the subcontinent by 2030.

Rabies control in Europe: an overview of past, current and future strategies

Europe's step-by-step approach to tackling canine and wildlife-mediated rabies has proven that the disease can be controlled and eliminated at the animal source. A decade of development work and support by the European Union has resulted in a successful oral rabies vaccination campaign for foxes and raccoon dogs, and provided the blueprint for eliminating wildlife-mediated rabies. In this paper, the authors examine the historical stages of animal rabies control and its eventual elimination in parts of Europe, particularly Western Europe. In addition, they consider current control measures and predict future challenges, many of which are faced by the vast and sparsely populated, rabies-endemic areas of Eastern Europe.

Rabies control in North America - past, present and future

In the first half of the 20th century, rabies in dogs affected Canada, Mexico and the United States of America (USA). However, the role of wildlife in the transmission of the rabies virus was also recognised and outbreaks affecting both wildlife and domestic animals were documented. Canine rabies has since been eliminated from Canada and the USA, and is now only found sporadically in a few southern states of Mexico. Wildlife variant rabies viruses, found throughout the continent and geographically associated with specific reservoir species, have notable public and animal health, as well as economic, impacts. Early rabies control efforts included legislated dog management strategies and wildlife population reduction, which met with varying success. In the last 30 years, programmes for the control of rabies in dogs and wildlife have benefited from an 'Integrated Management Approach', combining education, vaccination (parenteral and oral), strategic population control, responsible pet ownership and effective stewardship of natural resources, in addition to cooperation and collaboration among local, national and international stakeholders. Looking ahead, the goal of eliminating specific wildlife virus variants will be challenged by the potential range expansion of reservoir species, due to climate change and other factors, and the risk of re-introducing eliminated virus variants. To be successful, programmes must be sustained and accompanied by advances in vaccines, enhanced distribution strategies, monitoring in the field and effective modelling of disease spread. They should also be informed by robust case surveillance, phylogenetics and an increased knowledge of vector ecology.

Evaluating human rabies control in Asia: using 'One Health' principles to assess control programmes for rabies

Rabies is a global issue, and kills tens of thousands of people every year, despite being a preventable disease. The goal of the World Health Organization (WHO) and the World Organisation for Animal Health (OIE) to eliminate dog-mediated rabies by 2030 requires serious collaborative efforts across Ministries and countries. This cross-sector cooperation includes, but is not limited to, physicians, veterinarians, local authorities, local communities and the media; in other words, a 'One Health' approach. Countries where human rabies has been successfully eliminated still require constant vigilance, in terms of regulations on companion animal ownership and vaccination, the movement of animals from countries where the disease still exists, and the continued raising of public awareness. Rabies-endemic countries need to refocus their efforts towards eliminating the disease once and for all, by working together and sharing their knowledge, experiences and efforts. Rabies control programmes require the efficient management of resources, and surveillance programmes do not need to be specific to one disease. Governments must play a more proactive role by enforcing legislation and allocating funds and resources to help to eliminate human rabies by 2030 throughout the world.

Proof of concept of mass dog vaccination for thecontrol and elimination of canine rabies

For more than 100 years, canine rabies vaccination has been available as a tool for rabies control and elimination. However, domestic dogs still remain a major reservoir for rabies, and although canine rabies has been eliminated through mass dog vaccination in some parts of the world, the disease continues to kill tens of thousands of people every year in Africa and Asia. This review focuses on the situation on those two continents, presenting evidence to show that canine rabies elimination is both epidemiologically and operationally feasible, and could be achieved across a wide range of settings in Africa and Asia. The challenges of achieving the large-scale, comprehensive dog vaccination coverage that is required are discussed, and opportunities for developing new strategies that generate multiple benefits for human and animal health and welfare are highlighted. Finally, the substantial progress that has been made in developing the tools, partnerships and frameworks needed to move towards global canine rabies elimination is outlined.

Low coverage of central point vaccination against dog rabies in Bamako, Mali

Canine rabies remains an important public-health problem in Africa. Dog mass vaccination is the recommended method for rabies control and elimination. We report on the first small-scale mass dog vaccination campaign trial in Bamako, Mali. Our objective was to estimate coverage of the vaccination campaign and to quantify determinants of intervention effectiveness. In September 2013, a central point vaccination campaign--free of cost for dog owners--was carried out in 17 posts on three consecutive days within Bamako's Commune 1. Vaccination coverage and the proportion of ownerless dogs were estimated by combining mark-recapture household and transect surveys using Bayesian modeling. The estimated vaccination coverage was 17.6% (95% Credibility Interval, CI: 14.4-22.1%) which is far below the World Health Organization (WHO) recommended vaccination coverage of 70%. The Bayesian estimate for the owned dog population of Commune 1 was 3459 dogs (95% CI: 2786-4131) and the proportion of ownerless dogs was about 8%. The low coverage observed is primarily attributed to low participation by dog owners. Dog owners reported several reasons for not bringing their dogs to the vaccination posts. The most frequently reported reasons for non-attendance were lack of information (25%) and the inability to handle the dog (16%). For 37% of respondents, no clear reason was given for non-vaccination. Despite low coverage, the vaccination campaign in Bamako was relatively easy to implement, both in terms of logistics and organization. Almost half of the participating dog owners brought their pets on the first day of the campaign. Participatory stakeholder processes involving communities and local authorities are needed to identify effective communication channels and locally adapted vaccination strategies, which could include both central-point and door-to-door vaccination.