Uptake of rabies control measures by dog owners in Flores Island, Indonesia

Burden of dog bite injuries and wound management practices to prevent rabies among dog owners

Background

Despite members of dog-owning families being at a higher risk of dog bites owing to their proximity to dogs in their household, there are hardly any studies from India which focus on the burden of dog bites among them and their rabies control and prevention practices. This study aimed to estimate the burden of dog bites among dog owners and their wound management practices to prevent rabies.

Materials and Methods

A cross-sectional study was conducted among pet dog owners in a high-end housing society of National Capital Region of Delhi. A pre-tested and pre-validated schedule was used to collect data by consecutive sampling through community survey. Data were analyzed using R software. The incidence of dog bites and the status of rabies prevention practices adopted by the participants are presented as proportions. Chi-square test was applied to compare proportions.

Results

A total of 100 families were studied, which covered 355 family members. The incidence of dog bites in the past 1 year was found to be 44/355, 12.4% (95% confidence interval 9.2-16.3%). Pet dogs were responsible for 31/44 (70.5%) bites. Among 44 dog bite incidents, 30 (68.2%) reported taking any injection after the incident, and 10 (22.7%) reported receiving an anti-rabies vaccine. Only six out of 100 families reported at least one family member covered by rabies pre-exposure prophylaxis.

Conclusion

The incidence of dog bites among the dog owners was high. The rabies pre- and post-exposure prophylaxis practices adopted by the participants were found to be inadequate.

Epidemiological Associations between Rabies Vaccination and Dog Owner Characteristics

BACKGROUND

The annual rabies vaccination coverage in dogs among 47 prefectures in Japan has been reported to range from 42.3% to 92.4%, and the overall coverage has been steadily declining. Given the presence of unregistered dogs and the small number of stray dogs, the true vaccination coverage is likely to be even lower.

METHODS

We conducted a cross-sectional survey of dog owners to identify the owner characteristics associated with dog rabies vaccination. People in Japan who currently own dogs were recruited and answered a questionnaire consisting of four sections: (i) demographic characteristics, (ii) education history associated with medicine, (iii) factors related to veterinary services, and (iv) dog characteristics.

RESULTS

A total of 534 dog owners covering 629 dogs were surveyed. Vaccination within the prior 12 months was the major outcome (56.1%). The associated variables were (a) owner education level, (b) knowledge about mandatory vaccination, (c) having a family veterinary clinic, (d) frequency of visiting a veterinary clinic, and (e) having ever been advised to vaccinate their dog.

CONCLUSIONS

Although causality cannot be implied, our findings indicate improving owners' knowledge about mandatory vaccination, facilitating attachment to a veterinary clinic, and veterinarians providing vaccination advice might increase the uptake of dog rabies vaccination. The finding in Japan did not deviate from Asian and African countries with rabies, and the sample estimate of annual vaccination coverage was lower than the reported estimate among registered dogs.

Participation in mass dog vaccination campaigns in Tanzania: Benefits of community engagement

Background

Canine rabies causes about 59,000 human deaths each year globally but the disease can be eliminated by sustaining sufficient dog vaccination coverage over several consecutive years. A challenge to achieving high coverage is low participation of dog owners in vaccination campaigns. We explored whether and how previously identified contributory factors to low participation can be addressed through community engagement activities.

Methods

We engaged communities in two wards in Tanzania on dog behavior and handling, safe ways of interacting with dogs, and their perceptions of dog vaccination. We shared and elicited information from them through village meetings, video screenings, posters and leaflets and involved the leadership of one of the wards in planning and implementing a dog vaccination exercise to explore the feasibility of their participation. We assessed the impact of engagement activities with household surveys, meeting reports, observations and focus group discussions. We used a generalized linear mixed-effects model to identify predictors of knowledge and perceptions and compared knowledge amongst respondents before and after engagement activities. Qualitative data was analyzed inductively to explore perceptions of dog handling and vaccination and feasibility, opportunities and barriers to community leadership participation in organizing mass dog vaccination.

Main findings

Knowledge of dog behavior, dog handling, and safe ways of interacting with dogs was positively associated with age (p < 0.0001), dog ownership (p = 0.0203), training (p = 0.0010) and previous experience of a dog bite (p = 0.0002); and was negatively associated with being afraid of dogs (p = 0.0061) and participation in a recent dog vaccination campaign (p = 0.0077). Knowledge was low before and significantly improved after engagement activities. The majority (92%) of respondents believed dog vaccination has no negative effects on dogs. Respondents perceived lack of bonding with their dog as a limitation to the ability to restrain a dog for vaccination. The community performed most roles assigned to them in the dog vaccination exercise, but barriers such as lack of motivation for volunteering exist.

Conclusion

Engaging communities regularly on dog vaccination can improve their knowledge of dog behavior and dog handling techniques, and may help improve owner participation in dog vaccination campaigns.

Immune Response After Rabies Vaccination in Owned Free-Roaming Domestic Dogs in Flores Island, Indonesia

Vaccination is the main tool to prevent the circulation of rabies in dog populations. The development of an immune response after vaccination differs between individual dogs and depends on many factors such as dog characteristics, management, or genetics. Here, we first investigated the level of, and associated factors for, the presence of binding antibodies in 130 healthy dogs from Flores Island, Indonesia. Secondly, we identified factors associated with the development of binding antibodies within 30 days after vaccination among a subsample of dogs that had a binding antibody titre <0.5 EU/ml at the day of vaccination (D0, N = 91). Blood samples were collected from the individual dogs immediately before vaccination at D0 and 30 days after vaccination (D30). The rabies antibody titres were determined using ELISAs. Information on potential risk factors such as the dog's age and sex, history of vaccination, type and frequency of feeding, and BCS (body condition score) were gathered during interviews at D0. Regression analyses were performed to identify the risk factors associated with the presence of binding antibody titre ≥0.5 EU/ml at D0 for the 130 dogs and the development of binding antibody titre ≥0.5EU/ml at D30 for the 91 dogs. The results showed that the proportion of dogs with antibody titre ≥0.5 EU/ml was 30% (39/130) at D0. The only factors found to be significantly influencing the presence of binding antibodies titres ≥0.5 EU/ml was previous vaccination within 1 year before D0 [46.8 vs. 14.7%, Odds ratio (OR) = 3.6, 95%CI 1.5–9.3; p-value = 0.006], although the same trend was found for dogs of higher age and better BCS. Eighty-six percent (79/91) of dogs whose rabies binding antibody level was <0.5 EU/ml at D0 had developed an adequate immune response (≥0.5 EU/ml) at D30. Almost a significantly higher proportion developed an adequate immune response in dogs of good BCS compared to those of poor BCS (95.3% vs. 79.2%, OR = 4.7, 95%CI 1.1–32.5; p-value = 0.057. Twelve (13.2%) dogs retain binding antibody level <0.5 EU/ml at D30, indicating poor immune response after vaccination. A majority of them did not receive vaccine before D0 according to the owner and had poor BCS (83.3%; 10/12). Our findings show the high effectiveness of rabies vaccine in under field conditions to develop measurable immunity and the importance of a good BCS, often achievable by good dog keeping conditions, for developing efficient immunity after parenteral vaccination in dogs.

11 years of regular access to subsidized veterinary services is associated with improved dog health and welfare in remote northern communities

Access to veterinary services can have positive impacts on animal health and welfare, and on human mental and physical health and well-being; however, many communities worldwide lack access to such services. At their request, the 5 communities of the Sahtu Settlement Area, Northwest Territories, Canada, have received annual access to preventive veterinary services through the University of Calgary's Northern Community Health Rotation since 2008. To determine the reach of the program, we conducted a dog census in 2017. We then conducted a chart review of 11 years of dog medical records from 2008 to 2018 to evaluate how the reach of the program, the uptake of veterinary services, and dog population demographics, health and welfare measures changed over the duration of the program. In the chart review, we used either multi-level logistic regression or generalized linear models, to determine how seven variables, including age, sex, breed, body condition, deworming, vaccination, and sterilization status upon clinic entry, changed over the course of program delivery. Our results suggest that program reach, veterinary service uptake, and dog demographic, health and welfare measures improved over time. We observed high rabies vaccination coverage in some communities (48 %-83 % of the dog population) and moderate overall sterilization status (25 %-56 % of the dog population) with female dog sterilization more common than male (75 % of dogs leaving the 2017 clinics, compared to 43 %). Several dog demographic, health, and welfare measures, including age, body condition, and vaccination, deworming, and sterilization status, were significantly better in later years of the program (all p < 0.001). Differences among communities, both in dog population numbers from the 2017 census (40-89 dogs) and in the uptake of veterinary services in 2017 (48 %-83 % of the dog population), were notable. Vaccination uptake was directly related to clinic attendance, but sterilization was impacted by additional factors, including community members' acceptance of the procedure. Some unintended consequences were noted, however, including the potential effect of sterilization on the availability of traditional dog breeds in the communities. Overall, our study findings demonstrate that subsidized veterinary services provided over a regular and extended period of time benefit animal population demographics, health and welfare, and could have positive impacts on human well-being. The framework of community collaboration and long-term commitment developed through this program serves as a model for achieving common health goals among communities in need and veterinary service providers.

Loss of binding antibodies against rabies in a vaccinated dog population in Flores Island, Indonesia

Effective parenteral vaccines are available to control rabies in dogs. While such vaccines are successfully used worldwide, the period between vaccine boosters required to guarantee protection of the population against rabies varies between vaccines and populations. In Flores Island, Indonesia, internationally and locally produced rabies vaccines are used during annual vaccination campaigns of predominantly free-roaming owned domestic dogs. The study objective was to identify the duration of the presence and factors associated with the loss of adequate level of binding antibodies (≥0.5 EU/ml) following rabies vaccination in a domestic dog population on Flores Island. A total of 171 dogs that developed an antibody titre higher or equal to 0.5 EU/ml 30 days after vaccination (D30), were repeatedly sampled at day 90, 180, 270, and 360 after vaccination. On the day of vaccination (D0), an interview was performed with dog owners to collect information on dog characteristics (age, sex, body condition score (BCS)), history of rabies vaccination, kind of daily food, frequency of feeding, and origin of the dog. Serum samples were collected and the level of antibodies was quantitatively assessed using ELISA tests. Dogs were categorized as having an adequate level of binding antibodies (≥0.5 EU/ml) or inadequate level of binding antibodies (<0.5 EU/ml) at each time points examined. A total of 115, 72, 23, and 31 dogs were sampled at D90, D180, D270, and D360, respectively, with the highest proportion of antibodies ≥ 0.5 EU/ml (58%, 95% CI, 49-67%) at D90, which reduced gradually until D360 (35%, 95% CI, 19-52%). Multivariable logistic regression models showed that loss of adequate level of binding antibodies is significantly associated with dogs having no history of vaccination or vaccination applied more than 12 months before D0, being less than 12 months of age, and having a poor BCS. These results highlight the importance of BCS regarding the immune response duration and provide insights into frequency of vaccination campaigns required for the internationally available vaccine used on Flores Island. For dogs without vaccination history or vaccination being applied more than 12 months before D0, a booster is recommended within 3 months (a largest drop of antibodies was detected within the first 90 days) after the first vaccination to guarantee measurable protection of the population that lasts at least for one year.

Feasibility and Effectiveness Studies with Oral Vaccination of Free-Roaming Dogs against Rabies in Thailand

(1) Background: Thailand has made significant progress in reducing the number of human and animal rabies cases. However, control and elimination of the last remaining pockets of dog-mediated rabies have shown to be burdensome, predominantly as a result of the large numbers of free-roaming dogs without an owner that cannot be restrained without special efforts and therefore remain unvaccinated. To reach these dogs, the feasibility, and benefits of oral rabies vaccination (ORV) as a complementary tool has been examined under field conditions. (2) Methods: ORV of dogs was tested in five study areas of four provinces in Thailand. In these areas, sites with free-roaming dogs were identified with the support of local municipal workers and dog caretakers. ORV teams visited each of five study areas and distributed rabies vaccine (SPBN GASGAS) in three bait formats that were offered to the dogs using a hand-out and retrieval model. The three bait types tested included: egg-flavored baits, egg-flavored baits pasted with commercially available cat liquid snack, and boiled-intestine baits. A dog offered a vaccine bait was considered vaccinated when the discarded sachet was perforated or if a dog chewed vaccine bait at least 5 times before it swallowed the bait, including the sachet. (3) Results: A total of 2444 free-roaming dogs considered inaccessible for parenteral vaccination were identified at 338 sites. As not all dogs were approachable, 79.0% were offered a bait; of these dogs, 91.6% accepted the bait and subsequently 83.0% were considered successfully vaccinated. (4) Conclusion: Overall, 65.6% of the free-roaming dogs at these sites were successfully vaccinated by the oral route. Such a significant increase of the vaccination coverage of the free-roaming dog population could interrupt the rabies transmission cycle and offers a unique opportunity to reach the goal to eliminate dog-mediated human rabies in Thailand by 2030.

Rabies in Our Neighbourhood: Preparedness for an Emerging Infectious Disease

Emerging infectious disease (EID) events have the potential to cause devastating impacts on human, animal and environmental health. A range of tools exist which can be applied to address EID event detection, preparedness and response. Here we use a case study of rabies in Southeast Asia and Oceania to illustrate, via nearly a decade of research activities, how such tools can be systematically integrated into a framework for EID preparedness. During the past three decades, canine rabies has spread to previously free areas of Southeast Asia, threatening the rabies-free status of countries such as Timor Leste, Papua New Guinea and Australia. The program of research to address rabies preparedness in the Oceanic region has included scanning and surveillance to define the emerging nature of canine rabies within the Southeast Asia region; field studies to collect information on potential reservoir species, their distribution and behaviour; participatory and sociological studies to identify priorities for disease response; and targeted risk assessment and disease modelling studies. Lessons learnt include the need to develop methods to collect data in remote regions, and the need to continuously evaluate and update requirements for preparedness in response to evolving drivers of emerging infectious disease.

Comparative Study of Free-Roaming Domestic Dog Management and Roaming Behavior Across Four Countries: Chad, Guatemala, Indonesia, and Uganda

Dogs play a major role in public health because of potential transmission of zoonotic diseases, such as rabies. Dog roaming behavior has been studied worldwide, including countries in Asia, Latin America, and Oceania, while studies on dog roaming behavior are lacking in Africa. Many of those studies investigated potential drivers for roaming, which could be used to refine disease control measures. However, it appears that results are often contradictory between countries, which could be caused by differences in study design or the influence of context-specific factors. Comparative studies on dog roaming behavior are needed to better understand domestic dog roaming behavior and address these discrepancies. The aim of this study was to investigate dog demography, management, and roaming behavior across four countries: Chad, Guatemala, Indonesia, and Uganda. We equipped 773 dogs with georeferenced contact sensors (106 in Chad, 303 in Guatemala, 217 in Indonesia, and 149 in Uganda) and interviewed the owners to collect information about the dog [e.g., sex, age, body condition score (BCS)] and its management (e.g., role of the dog, origin of the dog, owner-mediated transportation, confinement, vaccination, and feeding practices). Dog home range was computed using the biased random bridge method, and the core and extended home range sizes were considered. Using an AIC-based approach to select variables, country-specific linear models were developed to identify potential predictors for roaming. We highlighted similarities and differences in term of demography, dog management, and roaming behavior between countries. The median of the core home range size was 0.30 ha (95% range: 0.17-0.92 ha) in Chad, 0.33 ha (0.17-1.1 ha) in Guatemala, 0.30 ha (0.20-0.61 ha) in Indonesia, and 0.25 ha (0.15-0.72 ha) in Uganda. The median of the extended home range size was 7.7 ha (95% range: 1.1-103 ha) in Chad, 5.7 ha (1.5-27.5 ha) in Guatemala, 5.6 ha (1.6-26.5 ha) in Indonesia, and 5.7 ha (1.3-19.1 ha) in Uganda. Factors having a significant impact on the home range size in some of the countries included being male dog (positively), being younger than one year (negatively), being older than 6 years (negatively), having a low or a high BCS (negatively), being a hunting dog (positively), being a shepherd dog (positively), and time when the dog was not supervised or restricted (positively). However, the same outcome could have an impact in a country and no impact in another. We suggest that dog roaming behavior is complex and is closely related to the owner's socioeconomic context and transportation habits and the local environment. Free-roaming domestic dogs are not completely under human control but, contrary to wildlife, they strongly depend upon humans. This particular dog-human bound has to be better understood to explain their behavior and deal with free-roaming domestic dogs related issues.

Comparative Study of Free-Roaming Domestic Dog Management and Roaming Behavior Across Four Countries: Chad, Guatemala, Indonesia, and Uganda

Dogs play a major role in public health because of potential transmission of zoonotic diseases, such as rabies. Dog roaming behavior has been studied worldwide, including countries in Asia, Latin America, and Oceania, while studies on dog roaming behavior are lacking in Africa. Many of those studies investigated potential drivers for roaming, which could be used to refine disease control measures. However, it appears that results are often contradictory between countries, which could be caused by differences in study design or the influence of context-specific factors. Comparative studies on dog roaming behavior are needed to better understand domestic dog roaming behavior and address these discrepancies. The aim of this study was to investigate dog demography, management, and roaming behavior across four countries: Chad, Guatemala, Indonesia, and Uganda. We equipped 773 dogs with georeferenced contact sensors (106 in Chad, 303 in Guatemala, 217 in Indonesia, and 149 in Uganda) and interviewed the owners to collect information about the dog [e.g., sex, age, body condition score (BCS)] and its management (e.g., role of the dog, origin of the dog, owner-mediated transportation, confinement, vaccination, and feeding practices). Dog home range was computed using the biased random bridge method, and the core and extended home range sizes were considered. Using an AIC-based approach to select variables, country-specific linear models were developed to identify potential predictors for roaming. We highlighted similarities and differences in term of demography, dog management, and roaming behavior between countries. The median of the core home range size was 0.30 ha (95% range: 0.17-0.92 ha) in Chad, 0.33 ha (0.17-1.1 ha) in Guatemala, 0.30 ha (0.20-0.61 ha) in Indonesia, and 0.25 ha (0.15-0.72 ha) in Uganda. The median of the extended home range size was 7.7 ha (95% range: 1.1-103 ha) in Chad, 5.7 ha (1.5-27.5 ha) in Guatemala, 5.6 ha (1.6-26.5 ha) in Indonesia, and 5.7 ha (1.3-19.1 ha) in Uganda. Factors having a significant impact on the home range size in some of the countries included being male dog (positively), being younger than one year (negatively), being older than 6 years (negatively), having a low or a high BCS (negatively), being a hunting dog (positively), being a shepherd dog (positively), and time when the dog was not supervised or restricted (positively). However, the same outcome could have an impact in a country and no impact in another. We suggest that dog roaming behavior is complex and is closely related to the owner's socioeconomic context and transportation habits and the local environment. Free-roaming domestic dogs are not completely under human control but, contrary to wildlife, they strongly depend upon humans. This particular dog-human bound has to be better understood to explain their behavior and deal with free-roaming domestic dogs related issues.

A cointegration analysis of rabies cases and weather components in Davao City, Philippines from 2006 to 2017

Rabies is a lethal viral disease and dogs are the major disease reservoir in the Philippines. Spatio-temporal variations in environmental factors are known to affect disease dynamics. Some rabies-affected countries considered investigating the role of weather components in driving rabies cases and it has helped them to strategize their control efforts. In this study, cointegration analysis was conducted between the monthly reported rabies cases and the weather components, such as temperature and precipitation, to verify the effect of weather components on rabies incidence in Davao City, Philippines. With the Engle-Granger cointegration tests, we found that rabies cases are cointegrated into each of the weather components. It was further validated, using the Granger causality test, that each weather component predicts the rabies cases and not vice versa. Moreover, we performed the Johansen cointegration test to show that the weather components simultaneously affect the number of rabies cases, which allowed us to estimate a vector-error correction model for rabies incidence as a function of temperature and precipitation. Our analyses showed that canine rabies in Davao City was weather-sensitive, which implies that rabies incidence could be projected using established long-run relationship among reported rabies cases, temperature, and precipitation. This study also provides empirical evidence that can guide local health officials in formulating preventive strategies for rabies control and eradication based on weather patterns.

Evaluating the role of surgical sterilisation in canine rabies control: A systematic review of impact and outcomes

Current recommendations for the elimination of canine-mediated human rabies focus on mass dog vaccination as the most feasible and cost-effective strategy. However, attempts to control rabies are often combined with canine surgical sterilisation programmes. The added value of sterilisation is widely debated. A systematic review was undertaken to compare the outcomes and impact of vaccination and sterilisation programmes with vaccination only programmes. A systematic search of three electronic databases (CAB Abstracts, Medline and Global Health) and grey literature was performed. From 8696 abstracts found, 5554 unique studies were identified, and 16 studies met the inclusion criteria. Eight described vaccination only programmes and eight described vaccination and sterilisation programmes. Indicators of impact measured were dog bites and/or doses of post-exposure prophylaxis administered; numbers of dog and/or human rabies cases; dog population demographic changes; changes in health and welfare of dogs, and indicators related to human behaviour change. The studies were contextually very diverse, programmes being implemented were complex, and there was variation in measurement and reporting of key indicators. Therefore, it was difficult to compare the two types of intervention, and impossible to make an evaluation of the role of sterilisation, using this evidence. Given the large number of vaccination and sterilisation programmes conducted globally, the lack of studies available for review highlights a gap in data collection or reporting, essential for impact assessment. There are several knowledge gaps concerning the impact of the sterilisation component alone, as well as subsequent effects on rabies transmission and control. Prospective studies comparing the outcomes and impact of the two interventions would be required in order to establish any additional contribution of sterilisation, as well as the underlying mechanisms driving any changes. In the absence of such evidence, the priority for rabies control objectives should be implementation of mass vaccination, as currently recommended by the World Health Organisation.

The impact of anthropogenic and environmental factors on human rabies cases in China

Human rabies is a public health problem in Asia, especially in less-developed regions where the disease is under-reported because of a lack of epidemiological surveillance. To address this gap, we collected data on human rabies in Yunnan Province, China, between 2005 and 2016. Using statistical mapping techniques, we correlated the occurrence of human rabies to environmental (elevation, precipitation, normalized difference vegetation index [NDVI], temperature and distance to the nearest main rivers) and anthropogenic (human and dog population density, distance to the nearest main roads and gross domestic product [GDP]) factors. We used a performance score, the average area under the receiver operator characteristic curve (0.88), to validate our risk model. Using this model, we found that environmental factors were more strongly associated with human rabies occurrence than anthropogenic factors. Areas with elevation below 2000 metres, GDP per capita between $750 and $4500/year and NDVI below 0.07 were associated with greater risk of human rabies. Rabies control in China should specifically target these areas.

Development of a Non-Meat-Based, Mass Producible and Effective Bait for Oral Vaccination of Dogs against Rabies in Goa State, India

Introduction: To achieve the global goal of canine-mediated human rabies elimination by 2030 there is an urgent need to scale-up mass dog vaccination activities in regions with large dog populations that are difficult to access; a common situation in much of India. Oral rabies vaccination may enable the vaccination of free-roaming dogs that are inaccessible to parenteral vaccination, and is considered a promising complementary measure to parenteral mass dog vaccination campaigns. WHO and OIE have published detailed minimum requirements for rabies vaccines and baits to be used for this purpose, requiring that baits must not only be well-accepted by the target population but must also efficiently release the vaccine in the oral cavity. For oral rabies vaccination approaches to be successful, it is necessary to develop baits which have a high uptake by the target population, are culturally accepted and amenable to mass production. The aim of this study was to compare the interest and uptake rates of meat-based and an egg-based prototype bait constructs by free roaming dogs in Goa, India. Methods: Three teams randomly distributed two prototype baits; an egg-flavoured bait and a commercial meat dog food (gravy) flavoured bait. The outcomes of consumption were recorded and compared between baits and dog variables. Results: A total of 209 egg-bait and 195 gravy-bait distributions were recorded and analysed. No difference (p = 0.99) was found in the percentage of dogs interested in the baits when offered. However, significantly more dogs consumed the egg-bait than the gravy-bait; 77.5% versus 68.7% (p = 0.04). The release of the blue-dyed water inside the sachet in the oral cavity of the animals was significant higher in the dogs consuming an egg-bait compared to the gravy-bait (73.4% versus 56.7%, p = 0.001). Conclusions: The egg-based bait had a high uptake amongst free roaming dogs and also enabled efficient release of the vaccine in the oral cavity, whilst also avoiding culturally relevant materials of bovine or porcine meat products.

Evaluation of Community-Based Dog Welfare and Rabies Project in Sanur, a Sub-district of the Indonesian Island Province of Bali

The Indonesian island province of Bali experienced its first rabies incursion in 2008. Mass vaccination of the dog population has proven effective and rabies cases in dogs and people have decreased, however the virus is still circulating among the dog population. Vaccination coverage must be maintained until rabies elimination. Increasing efficiency and effectiveness of vaccination campaigns is therefore desired. Community engagement leading to preventative health actions by community members can reduce disease incidence and costs of control. Here we evaluate 2 years of a novel community-based dog welfare and rabies control project (Program Dharma) in the Sanur sub-district. The project engaged the services of people living in the project area with an interest or experience in dogs or community health services. These people spoke with owners within their own community about dog welfare and health, monitored owned and unowned dogs and increased owner and carer efforts to access vaccination and further veterinary services. The evaluation focused on a sample of dogs whose owners had been regularly engaged with project. Vaccination coverage was increased and there were no dog or human rabies cases reported in the project area; the percentage of the dogs that had never been vaccinated was reduced by an average 28.3% (baseline unvaccinated 41–49%, post-project unvaccinated 11–19%). The welfare of dogs improved from an average of 20.7% of dogs with visible welfare problems at baseline to 2.7% after project implementation. Roaming dog density observed on street surveys also decreased in all project areas (24–47% reduction dependent on desa). A participatory evaluation event with a sample of Program Dharma community-based agents highlighted several additional successes, including that the community appeared to welcome and value their services and were beginning to support the cost of project activities. Conversely, challenges included identifying dogs in the database during revisits, sustaining the costs of community member time spent working on Program Dharma activities and the costs of veterinary care, whilst avoiding dependency of owners on free veterinary services. The benefits revealed by the evaluation were judged to be sufficient to extend Program Dharma to new areas, whilst evolving activities to resolve challenges.

Pet owners' awareness on RA 9482 (Anti-Rabies Act of 2007) in Magalang, Pampanga Philippines

Background

Rabies remains a significant public health problem in the Philippines. An acutely fatal viral infection, it results in the death of 200-300 Filipinos annually affecting mostly children less than 15 years old. The disease is endemic in Magalang which ranks fifth in the number of dog rabies positive cases among the 19 municipalities of Pampanga. In spite of the enactment of the Anti-Rabies Act of 2007 (RA 9482), the control of rabies in Magalang has been a major challenge for the municipality. Thus, this study investigated the awareness of pet owners in Magalang, Pampanga on the Anti-Rabies Act of 2007 (RA 9482).

Methods

This study was a cross-sectional study conducted from April-September 2017 among 380 pet owners from eight urban and rural barangays in Magalang, Pampanga. Data gathered were analyzed using STATA IC (Ver13.0); Bloom's cut-off points were used to categorize the level of knowledge of pet owners on the Anti-Rabies Act; data were further analyzed using Chi-square Test and relationship between variables was determined through logistic regression.

Results

Results revealed that pet owners in Magalang had poor knowledge of the Anti-Rabies Act (65.5%), and majority (71.3%) were unaware of its existence and of penalties imposed by the law to non-compliant pet owners. Moreover, results indicate that pet owners in urban places have higher odds of having above median knowledge on the law compared to those in rural places.

Oral bait handout as a method to access roaming dogs for rabies vaccination in Goa, India: A proof of principle study

Rabies has profound public health, social and economic impacts on developing countries, with an estimated 59,000 annual human rabies deaths globally. Mass dog vaccination is effective at eliminating the disease but remains challenging to achieve in India due to the high proportion of roaming dogs that cannot be readily handled for parenteral vaccination. Two methods for the vaccination of dogs that could not be handled for injection were compared in Goa, India; the oral bait handout (OBH) method, where teams of two travelled by scooter offering dogs an empty oral bait construct, and the catch-vaccinate-release (CVR) method, where teams of seven travel by supply vehicle and use nets to catch dogs for parenteral vaccination. Both groups parenterally vaccinated any dogs that could be held for vaccination. The OBH method was more efficient on human resources, accessing 35 dogs per person per day, compared to 9 dogs per person per day through CVR. OBH accessed 80% of sighted dogs, compared to 63% by CVR teams, with OBH accessing a significantly higher proportion of inaccessible dogs in all land types. All staff reported that they believed OBH would be more successful in accessing dogs for vaccination. Fixed operational team cost of CVR was four times higher than OBH, at 127 USD per day, compared to 34 USD per day. Mean per dog vaccination cost of CVR was 2.53 USD, whilst OBH was 2.29 USD. Extrapolation to a two week India national campaign estimated that 1.1 million staff would be required using CVR, but 293,000 staff would be needed for OBH. OBH was operationally feasible, economical and effective at accessing the free roaming dog population. This study provides evidence for the continued expansion of research into the use of OBH as a supplementary activity to parenteral mass dog vaccination activities in India.

Understanding Factors Influencing Dog Owners' Intention to Vaccinate Against Rabies Evaluated Using Health Belief Model Constructs

Ethiopia has one of the highest incidence levels of human rabies in Africa, with 3-7 deaths per 100,000 people annually. The country has no official rabies control programme, despite the availability of an effective canine vaccine to control rabies. To support effective rabies control, an understanding of the factors affecting dog owners' voluntary intentions to vaccinate their dogs is important. As such, this study examined factors influencing dog owners' intentions to vaccinate their dogs using the constructs of health belief theory. In this cross-sectional study, a questionnaire, designed based on the Health Belief Model constructs was completed by 249 dog owners in 9 randomly selected wards of Bishoftu town in central Ethiopia between October and December 2016. An ordinal regression model was then fitted to explore factors which best predict the likelihood of a dog owner's intention. A classification and regression tree (CART) model was then used for recursive partitioning of the Likert scale in the significant variables to distinctively classify ordinal categories of vaccination intention. Participants' preventive intention was associated with the six constructs of the Health Belief Model: perceived susceptibility, readiness to action, self-efficacy, perceived threat, benefits, and barriers. Dog owner's knowledge about rabies was found to be positively associated with intention to vaccinate, whereas distance from vaccination centers and difficulty of dog transportation were found to be negatively associated to intention to vaccinate. Distance from vaccination center was found to be the best predictor for the intention to vaccinate. The results of this study have policy implications for controlling rabies including increasing dog owners' knowledge about rabies, locating vaccination centers at shorter distances from dog populations and providing suitable means to transport dogs to vaccination centers.

Cost-effectiveness of mass dog rabies vaccination strategies to reduce human health burden in Flores Island, Indonesia

The cost-effectiveness of different mass dog rabies vaccination strategies, defined as the costs per year of life lost (YLL) averted was evaluated for a period of 10 years by means of a dynamic simulation study for a typical village on Flores Island. In the base strategy (no dog vaccination and no post-exposure treatment (PET) of human bite cases), the model showed that the introduction of the virus by one infectious dog into an isolated village with 1500 inhabitants and 400 dogs resulted in 881 YLLs during a 10-year simulation period, which is equivalent to 30 human rabies cases. An annual dog vaccination campaign with a coverage of 70% using a short-acting vaccine saved 832 YLLs, while the cumulative costs for the public sector were US$3646 or US$4.38 per YLL averted. Switching to a long-acting vaccine, the annual vaccination strategies with a coverage of 50% (AV_156_50) or 70% (AV_156_70) reduced the baseline YLLs from 881 to respectively 78 and 26 YLLs with cumulative costs of US$3716 and US$2264 or US$4.63 and US$2.65 per YLL averted, respectively. In general, dog vaccination was more cost-effective than PET alone (US$2.65-4.63 per YLL averted versus US$23.29 per YLL averted). Although a combination of PET with AV_156_70 was less cost-effective compared to AV_156_70 alone, this strategy was able to prevent all human deaths due to rabies. A combination of PET with annual vaccination using a short-acting vaccine at a coverage of 50% was far from being cost-effective, suggesting that the currently applied rabies control in Flores Island is not an efficient investment in reducing human rabies burden. An increased investment in either an increase in the current coverage or in a switch from the short-acting vaccine to the long-acting vaccine type would certainly pay off.

Determinants of Vaccination Coverage and Consequences for Rabies Control in Bali, Indonesia

Maintaining high vaccination coverage is key to successful rabies control, but mass dog vaccination can be challenging and population turnover erodes coverage. Declines in rabies incidence following successive island-wide vaccination campaigns in Bali suggest that prospects for controlling and ultimately eliminating rabies are good. Rabies, however, has continued to circulate at low levels. In the push to eliminate rabies from Bali, high coverage needs to be maintained across all areas of the island. We carried out door-to-door (DTD) questionnaire surveys (n = 10,352 dog-owning households) and photographic mark–recapture surveys (536 line transects, 2,597 observations of free-roaming dogs) in 2011–2012 to estimate dog population sizes and assess rabies vaccination coverage and dog demographic characteristics in Bali, Indonesia. The median number of dogs per subvillage unit (banjar) was 43 (range 0–307) for owned dogs estimated from the DTD survey and 17 (range 0–83) for unconfined dogs (including both owned and unowned) from transects. Vaccination coverage of owned dogs was significantly higher in adults (91.4%) compared to juveniles (<1 year, 43.9%), likely due to insufficient targeting of pups and from puppies born subsequent to vaccination campaigns. Juveniles had a 10–70 times greater risk of not being vaccinated in urban, suburban, and rural areas [combined odds ratios (ORs): 9.9–71.1, 95% CI: 8.6–96.0]. Free-roaming owned dogs were also 2–3 times more likely to be not vaccinated compared to those confined (combined Ors: 1.9–3.6, 95% CI: 1.4–5.4), with more dogs being confined in urban (71.2%) than in suburban (16.1%) and rural areas (8.0%). Vaccination coverage estimates from transects were also much lower (30.9%) than household surveys (83.6%), possibly due to loss of collars used to identify the vaccination status of free-roaming dogs, but these unconfined dogs may also include dogs that were unowned or more difficult to vaccinate. Overall, coverage levels were high in the owned dog population, but for future campaigns in Bali to have the highest chance of eliminating rabies, concerted effort should be made to vaccinate free-roaming dogs particularly in suburban and rural areas, with advertising to ensure that owners vaccinate pups. Long-lasting, cheap, and quick methods are needed to mark vaccinated animals and reassure communities of the reach of vaccination campaigns.

Cost-Effectiveness of Mass Dog Vaccination Campaigns against Rabies in Flores Island, Indonesia

A dynamic deterministic simulation model was developed to determine the cost-effectiveness of different mass dog vaccination strategies against rabies in a dog population representative of a typical village on Flores Island. Cost-effectiveness was measured as public cost per averted dog-rabies case. Simulations started with the introduction of one infectious dog into a susceptible dog population of 399 dogs and subsequently ran for a period of 10 years. The base scenario represented a situation without any control intervention. Evaluated vaccination strategies were as follows: annual vaccination campaigns with short-acting vaccine (immunity duration of 52 weeks) (AV_52), annual campaigns with long-acting vaccine (immunity duration of 156 weeks) (AV_156), biannual campaigns with short-acting vaccine (BV_52) and once-in-2-years campaigns with long-acting vaccine (O2V_156). The effectiveness of the vaccination strategies was simulated for vaccination coverages of 50% and 70%. Cumulative results were reported for the 10-year simulation period. The base scenario resulted in three epidemic waves, with a total of 1274 dog-rabies cases. The public cost of applying AV_52 at a coverage of 50% was US$5342 for a village. This strategy was unfavourable compared to other strategies, as it was costly and ineffective in controlling the epidemic. The costs of AV_52 at a coverage of 70% and AV_156 at a coverage of 70% were, respectively, US$3646 and US$3716, equivalent to US$3.00 and US$3.17 per averted dog-rabies case. Increasing the coverage of AV_156 from 50% to 70% reduced the number of cases by 7% and reduced the cost by US$1452, resulting in a cost-effectiveness ratio of US$1.81 per averted dog-rabies case. This simulation model provides an effective tool to explore the public cost-effectiveness of mass dog vaccination strategies in Flores Island. Insights obtained from the simulation results are useful for animal health authorities to support decision-making in rabies-endemic areas, such as Flores Island.

Development of a Novel Rabies Simulation Model for Application in a Non-endemic Environment

Domestic dog rabies is an endemic disease in large parts of the developing world and also epidemic in previously free regions. For example, it continues to spread in eastern Indonesia and currently threatens adjacent rabies-free regions with high densities of free-roaming dogs, including remote northern Australia. Mathematical and simulation disease models are useful tools to provide insights on the most effective control strategies and to inform policy decisions. Existing rabies models typically focus on long-term control programs in endemic countries. However, simulation models describing the dog rabies incursion scenario in regions where rabies is still exotic are lacking. We here describe such a stochastic, spatially explicit rabies simulation model that is based on individual dog information collected in two remote regions in northern Australia. Illustrative simulations produced plausible results with epidemic characteristics expected for rabies outbreaks in disease free regions (mean R₀ 1.7, epidemic peak 97 days post-incursion, vaccination as the most effective response strategy). Systematic sensitivity analysis identified that model outcomes were most sensitive to seven of the 30 model parameters tested. This model is suitable for exploring rabies spread and control before an incursion in populations of largely free-roaming dogs that live close together with their owners. It can be used for ad-hoc contingency or response planning prior to and shortly after incursion of dog rabies in previously free regions. One challenge that remains is model parameterisation, particularly how dogs’ roaming and contacts and biting behaviours change following a rabies incursion in a previously rabies free population.

Rabies in domestic dog populations still causes >50,000 human deaths worldwide each year. While its eradication by vaccination of the reservoir population (dogs and wildlife) was successful in many parts of the world, it is still present in the developing world and continues to spread to new regions. Theoretical rabies models supporting control plans do exist for rabies endemic regions; however these models usually provide information for long-term programs. Here, we describe a novel rabies simulation model for application in rabies-free regions experiencing an incursion. The model simulates a rabies outbreak in the free-ranging dog population in remote indigenous communities in northern Australia. Vaccination, dog density reduction and dog confinement are implemented as control strategies. Model outputs suggest that the outbreak lasts for an average of 7 months and typically spreads through all communities of the region. Dog vaccination was found to be the most effective response strategy. The model produces plausible results and can be used to provide information for ad-hoc response planning before and shortly after rabies incursion.