Improving systematic rabies surveillance in Cameroon: A pilot initiative and results for 2014-2016

Identification of risk factors on rabies vaccine efficacy from censored data: Pre-travel tests for dogs and cats from Yaoundé (2005-2015)

Little research is available on acquired immunity to rabies in dogs and cats from Central Africa, particularly regarding the legal movements of pets. Movement of domestic animals from rabies-endemic countries like Cameroon to rabies free areas poses one of the main risks for rabies introduction into rabies-free areas. Thus, the aim of this study was to assess the effect of various risk factors on rabies vaccine efficacy in Cameroonian. Since the dependent variable, rabies neutralizing titres, were censored from above (right-censoring), Generalized Additive Model for Location, Scale and Shape (GAMLSS) was used in the analysis. Overall, 85.7% of dogs and 100% of cats had titres greater than or equal to 0.5 IU/mL, which is considered protective. Additionally, compared to cats, the value of the rabies-neutralizing serum titres in dogs was on average smaller by 2.3 IU/mL. For each additional year of age, the value of the rabies-neutralizing serum titre, on average, increased by approximately 0.14 IU/mL. Finally, for each 30 additional days between the date of the last rabies vaccination and the date of the sampling, the value the rabies neutralizing titre, on average, decreased by approximately 0.10 IU/mL, given the species and age at sampling were equivalent. These results are useful for assessing risk and improving surveillance to prevent the introduction of rabies into a country via the international movement of animals.

Rabies incidence and burden in three cities of Cameroon (2004-2013)

Rabies is a fatal disease occurring worldwide and especially in almost all the countries in Asia and Africa including Cameroon. Though animal and human rabies is prevalent in Cameroon, the epidemiology and socio-economic burden of the disease in the country is not known. Therefore, a 10-year (October 2004-April 2013) retrospective study on the incidence of animal and human rabies and its burden in Garoua, Ngaoundéré and Yaoundé in Cameroon was carried out. Records of human cases were extracted from the database of the regional hospitals, and animal cases from the databases of Centre Pasteur and National Veterinary Laboratory. The burden of the disease was assessed through the estimation of costs linked to preventive measures (vaccination), corrective procedures (Post Exposure Treatment), Disability-Adjusted Life Year (DALY) and overall societal cost of the disease. Overall, 56 rabies-suspected human deaths, corresponding to an incidence of 0.02 ± 0.00 ‱ and Animal Rabies Incidence (ARI) of 0.37 ± 0.00 % among 1844 suspected animal cases were recorded. The economic loss due to preventive measures of 326,046 ± 28,130.85 USD, related to corrective procedures of 806,741.25 ± 2,466.08 USD, and DALY of 1690.28 ± 4.76 years were estimated. This is the first study that highlights the enormous socio-economic burden associated with animal and human rabies in endemic parts of Cameroon and emphasizes on enhancing rabies eradication strategy focusing on the One Health approach.

Update on laboratory data of animal rabies at the Centre Pasteur of Cameroon from 2014 to 2021

Rabies is a worldwide zoonotic disease mainly transmitted to humans by an infected dog bite. Despite the endemicity of rabies in dogs and few documented cases in Cameroon, there is still not enough data on frequency of rabies cases in animals. The present study aims to update data on the circulation of rabies in animals screened at the Centre Pasteur of Cameroon (CPC) between 2014 and 2021. The detection of rabies in animals was based on passive surveillance. Animal rabies cases were confirmed on brain biopsies using fluorescent antibody test and SYBR green based real-time RT-PCR for negative results confirmation. The total nucleoprotein (N) gene of animal-derived RABV isolated were amplified by hemi nested RT-PCR and subjected to phylogenetic analyses. From 2014 to 2021, a total of 92 animals including 86 dogs (93.5%), 3 cats, 2 pigs and 1 chiropteran were screened for rabies at the CPC. From the 86 dog sampled, 62.3% (54/86) were tested positive for rabies and 1 out of 3 cat samples was also tested positive. The PEP demand was very high (59,371) during the study period. Phylogenetic analyses assigned all 15 studied isolates successfully sequenced to the Africa-1a lineage belonging to the Cosmopolitan clade. The study highlights the frequent circulation of rabies in Cameroon and the role of dogs and cat as main reservoir and vector of rabies.

Prophylactic treatment abandonment in people bitten by suspected rabid animals, El Salvador, 2013-2017

Introduction

Around the world 60,000 people die from rabies each year. The main form of exposure to rabies is by the bite of animals infected with the virus. More than 20,000 cases of rabies-transmitting animal bites are reported each year, in El Salvador, a country located in Central America. People exposed should be managed with rabies prophylaxis.

Objective

To determine the abandonment of post-exposure prophylaxis (PEP) cumulative incidence (CI) in humans bitten by suspected rabid animals in El Salvador from 2013 to 2017.

Methodology

This is an ecological study based on the cases of bites by suspected rabid animals reported between 2013 and 2017 in the public health system of El Salvador. Descriptive and correlation analysis was performed using Statistical Package for the Social Sciences (SPSS) version 24. The municipality CI, expressed per 100,000 inhabitants.

Results

The national CI of abandonment PEP in humans bitten by suspected rabid animals was 25.6 × 100,000 inhabitants. Simple bivariate correlation analysis shows that the departments with the highest CI of bites caused by cats, wild animals, and bites on the neck (R ² = 0.99 P < 0.05) are mostly associated with dropping out of the PEP.

Conclusion

In El Salvador, the abandonment CI of PEP is lower than other countries, however, bites by rabid suspected animal are frequent, this represents a public health problem due to the presence of the rabies virus in wild animals and the high lethality of the disease. Municipalities where head bites are common are the most related to the abandonment of PEP.

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.

Incidence and seroprevalence of rabies virus in humans, dogs and other animal species in Africa, a systematic review and meta-analysis

Rabies is transmitted to humans mainly by dogs but also by other animal species. Reliable data on the incidence of Rabies virus (RABV) in humans, dogs, and other animal species in Africa, could be essential in the implementation of a global strategic plan to eliminate the RABV by 2030 as adopted by the WHO, OIE, and FAO. We searched the Pubmed, Embase, Scopus, African Journal Online, and African Index Medicus databases for relevant studies that report data on the incidence of RABV in Africa up to February 17, 2020. Information on active and past RABV exposures in various categories of dogs, humans and other animal species were extracted. Incidence and seroprevalence estimates were pooled using a random-effect meta-analysis. We included 73 articles which provided 142 RABV incidence and seroprevalence records in 21 African countries. The estimated incidence of RABV in 222 humans, 15,600 dogs, and 12,865 other animal species was 83.4% (95% CI = 64.6-96.5), 44.1% (95% CI = 35.1-53.4), and 41.4% (95% CI = 29.6-53.8), respectively. The estimated seroprevalence of RABV in 420 humans, 3577 dogs, and 8,55 other animal species was 33.8% (95% CI = 21.9-46.8), 19.8% (95% CI = 13.3-27.3), and 3.6% (95% CI = 0.3-9.2), respectively. The incidence of RABV in general was higher in suspected rabid dogs, other animal species of the Orders Perissodactyla, Artiodactyla and Carnivora. The incidence of RABV was higher for humans in regions of West and East Africa, for dogs in urban areas and in regions of Central and South Africa, and for animals of the order Perissodactyla in urban areas. This meta-analysis demonstrated a high incidence of RABV in Africa. Itis necessary to improve surveillance system to provide reliable data on RABV in Africa, essential for the implementation of an effective control strategy.

Evaluating Surveillance for and Estimating Administration of Rabies Postexposure Prophylaxis in the United States, 2012-2018

BACKGROUND

An evaluation of postexposure prophylaxis (PEP) surveillance has not been conducted in over 10 years in the United States. An accurate assessment would be important to understand current rabies trends and inform public health preparedness and response to human rabies.

METHODOLOGY/PRINCIPLE FINDINGS

To understand PEP surveillance, we sent a survey to public health leads for rabies in 50 U.S. states, Puerto Rico, Washington DC, Philadelphia, and New York City. Of leads from 54 jurisdictions, 39 (72%) responded to the survey; 12 reported having PEP-specific surveillance, five had animal bite surveillance that included data about PEP, four had animal bite surveillance without data about PEP, and 18 (46%) had neither. Although 12 jurisdictions provided data about PEP use, poor data quality and lack of national representativeness prevented use of this data to derive a national-level PEP estimate. We used national-level and state specific data from the Healthcare Cost & Utilization Project (HCUP) to estimate the number of people who received PEP based on emergency department (ED) visits. The estimated annual average of initial ED visits for PEP administration during 2012-2017 in the United States was 46,814 (SE: 1,697), costing upwards of 165 million USD. State-level ED data for initial visits for administration of PEP for rabies exposure using HCUP data was compared to state-level surveillance data from Maryland, Vermont, and Georgia between 2012-2017. In all states, state-level surveillance data was consistently lower than estimates of initial ED visits, suggesting even states with robust PEP surveillance may not adequately capture individuals who receive PEP.

CONCLUSIONS

Our findings suggest that making PEP a nationally reportable condition may not be feasible. Other methods of tracking administration of PEP such as syndromic surveillance or identification of sentinel states should be considered to obtain an accurate assessment.

Background and descriptive features of rabies-suspected animals in Central Luzon, Philippines

Background

The Philippines is one of the major endemic countries for canine rabies in Southeast Asia. However, detailed description and analysis of laboratory-confirmed animal rabies are limited. Highly accurate surveillance requires a thorough understanding of the target area-specific problems and obstacles. Therefore, we aim to describe and analyze the rabies suspect animals in Central Luzon, Philippines, to clarify the characteristics of management and clinical signs by conducting interviews with the owners.

Methods

We prospectively collected information on the rabies suspect animals submitted to the Regional animal laboratory in Central Luzon through passive laboratory-based rabies surveillance between 1st April 2019 and 30th September 2020. We performed active interviews directly or telephonically with the owner. The direct fluorescent antibody test was performed on the hippocampus, brain stem, and cerebellum for laboratory confirmation. Descriptive statistics were used to characterize the number of rabies cases according to management methods and characteristics of suspected animals during the observation period. Clinical symptoms of suspected rabid animals were analyzed by univariate logistic regression analysis.

Results

There were 292 sample submissions during the study period. Of these, 160 were positive for dFAT. Samples of pet animals (85.3%) provided by owners or their acquaintances (59.2%) accounted for the majority of laboratory confirmed cases. Case mapping showed that more rabies-suspected cases were sent from areas near the regional laboratory than from those far from the laboratory, despite the incidence of rabies being high in these areas. The management and clinical symptoms of 227 animal cases showed that most owners were managing their animals at home and were allowing them to roam outside (69.6%) and be unvaccinated (78.9%). Rabid animals were more likely to manifest aimless running, restlessness, and agitation.

Conclusions

Our study provided some features of animals with laboratory-confirmed rabies in Central Luzon. However, most of the samples were submitted from areas near the rabies diagnosis laboratory, and the number of samples submitted from remote areas was low. To improve the surveillance capacity, it is necessary to increase sample submissions from remote areas.

Supplementary Information

The online version contains supplementary material available at 10.1186/s41182-021-00351-x.

The Role of Waste Management in Control of Rabies: A Neglected Issue

Despite being vaccine preventable, the global burden of dog rabies remains significant, and historically it is the rural and marginalized communities in developing countries of Africa and Asia that are most threatened by the disease. In recent years, the developing world has been experiencing unprecedented increases in urbanization, with a correspondingly massive increase in municipal solid waste generation, among other things. Inefficient and inadequate waste collection and management, due to lack of resources and planning, led to significant increases in the volumes of waste on the streets and in open dumps, where it serves as food sources for free-roaming dogs. In this commentary, we discuss examples of poor waste management and the likely impact on rabies control efforts through the sustenance of free-roaming dogs in some dog rabies-endemic countries. We aim to stress the importance of implementing strategies that effectively address this particular issue as an important component of humane dog population management, as it relates to aspirations for the control and elimination of dog rabies per se.

Risk factors for rabies in Côte d'Ivoire

Rabies affects more than 150 countries worldwide. Côte d'Ivoire is one of the rabies-endemic countries that has recorded deaths every year since 2006. The evolution of these deaths is almost constant with an average of 18 annual deaths (annual incidence = 0.06-0.08 per 100,000). Children predominate among these victims. However, prevention measures exist in anti-rabies centers distributed throughout the country. The objective of this study was to determine the factors related to rabies risk in Côte d'Ivoire through Gavi rabies project entitled 'Impact of rabies and immunization in Central and West Africa'. The implementation was conducted from 2016 to 2018 in two departments of Côte d'Ivoire (Bouake and San Pedro). The study population was dog-bite victims vaccinated in anti-rabies centers of project sites from January to December 2016. Two non-free rabies immunization protocols are used in the country (Essen and Zagreb). Information was collected from bites victims for an adequate follow-up. It was to apprciate the risk of developing rabies through access to care, the immunization status of biting animal, the category of exposure and the result of rabies post exposure prophylaxis (compliance). Local program implementers responsible for these bite-management activities and veterinary staff had receved training and the necessary material. The public health education and information dissemination activities were carried out in support of promoting a wide spread of rabies prevention messages. Household surveys were conducted by sociology students in 4002 households each in urban and in rural areas. This activity helped to find people exposed by dogs and who did not receive any Post Exposure Prophylaxis (PEP). The study registered 1,263 bite victims in pilot anti-rabies centers in 2016, 51% of them were children. People living in urban areas were strongly represented (87%) because of anti-rabies centers proximity. Dog was the most animal associated to exposure (94%). Seventy-two percent (72%) of them had owners, but only 14% were vaccinated against rabies. More than half of dog bite victims had category III of exposure (58%). PEP compliance record was very low (37%), which means that 63% of bite victims have not completed the protocol. This study conducted in Bouaké and San Pedro showed somes factors responsible for rabies deaths evolution in Côte d'Ivoire. Main issues identified are the geographical accessibility of anti-rabies centers, frequent bites caused by unvaccinated dogs, often category III of exposure and many non-completions of rabies PEP in ignorance context. The establishment of national comprehensive and integrated rabies control program is needed in Côte d'Ivoire. It must take into account all these factors by focusing on public awareness, dog vaccination and adoption of modern intradermal vaccination regimens to better manage rabies situation in Côte d'Ivoire.

A systematic review on integration mechanisms in human and animal health surveillance systems with a view to addressing global health security threats

BACKGROUND

Health surveillance is an important element of disease prevention, control, and management. During the past two decades, there have been several initiatives to integrate health surveillance systems using various mechanisms ranging from the integration of data sources to changing organizational structures and responses. The need for integration is caused by an increasing demand for joint data collection, use and preparedness for emerging infectious diseases.

OBJECTIVE

To review the integration mechanisms in human and animal health surveillance systems and identify their contributions in strengthening surveillance systems attributes.

METHOD

The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-P) 2015 checklist. Peer-reviewed articles were searched from PubMed, HINARI, Web of Science, Science Direct and advanced Google search engines. The review included articles published in English from 1900 to 2018. The study selection considered all articles that used quantitative, qualitative or mixed research methods. Eligible articles were assessed independently for quality by two authors using the QualSyst Tool and relevant information including year of publication, field, continent, addressed attributes and integration mechanism were extracted.

RESULTS

A total of 102 publications were identified and categorized into four pre-set integration mechanisms: interoperability (35), convergent integration (27), semantic consistency (21) and interconnectivity (19). Most integration mechanisms focused on sensitivity (44.1%), timeliness (41.2%), data quality (23.5%) and acceptability (17.6%) of the surveillance systems. Generally, the majority of the surveillance system integrations were centered on addressing infectious diseases and all hazards. The sensitivity of the integrated systems reported in these studies ranged from 63.9 to 100% (median = 79.6%, n = 16) and the rate of data quality improvement ranged from 73 to 95.4% (median = 87%, n = 4). The integrated systems were also shown improve timeliness where the recorded changes were reported to be ranging from 10 to 91% (median = 67.3%, n = 8).

CONCLUSION

Interoperability and semantic consistency are the common integration mechanisms in human and animal health surveillance systems. Surveillance system integration is a relatively new concept but has already been shown to enhance surveillance performance. More studies are needed to gain information on further surveillance attributes.