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Lushasi K, Hayes S, Ferguson EA, Changalucha J, Cleaveland S, Govella NJ, Haydon DT, Sambo M, Mchau GJ, Mpolya EA, Mtema Z, Nonga HE, Steenson R, Nouvellet P, Donnelly CA, Hampson K. Reservoir dynamics of rabies in south-east Tanzania and the roles of cross-species transmission and domestic dog vaccination. J Appl Ecol 2021; 58:2673-2685. [PMID: 35221371 PMCID: PMC7612421 DOI: 10.1111/1365-2664.13983] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 06/24/2021] [Indexed: 12/27/2022]
Abstract
Understanding the role of different species in the transmission of multi-host pathogens, such as rabies virus, is vital for effective control strategies. Across most of sub-Saharan Africa domestic dogs Canis familiaris are considered the reservoir for rabies, but the role of wildlife has been long debated. Here we explore the multi-host transmission dynamics of rabies across south-east Tanzania.Between January 2011 and July 2019, data on probable rabies cases were collected in the regions of Lindi and Mtwara. Hospital records of animal-bite patients presenting to healthcare facilities were used as sentinels for animal contact tracing. The timing, location and species of probable rabid animals were used to reconstruct transmission trees to infer who infected whom and the relative frequencies of within- and between-species transmission.During the study, 688 probable human rabies exposures were identified, resulting in 47 deaths. Of these exposures, 389 were from domestic dogs (56.5%) and 262 from jackals (38.1%). Over the same period, 549 probable animal rabies cases were traced: 303 in domestic dogs (55.2%) and 221 in jackals (40.3%), with the remainder in domestic cats and other wildlife species.Although dog-to-dog transmission was most commonly inferred (40.5% of transmission events), a third of inferred events involved wildlife-to-wildlife transmission (32.6%), and evidence suggested some sustained transmission chains within jackal populations.A steady decline in probable rabies cases in both humans and animals coincided with the implementation of widespread domestic dog vaccination during the first 6 years of the study. Following the lapse of this program, dog rabies cases began to increase in one of the northernmost districts. Synthesis and applications. In south-east Tanzania, despite a relatively high incidence of rabies in wildlife and evidence of wildlife-to-wildlife transmission, domestic dogs remain essential to the reservoir of infection. Continued dog vaccination alongside improved surveillance would allow a fuller understanding of the role of wildlife in maintaining transmission in this area. Nonetheless, dog vaccination clearly suppressed rabies in both domestic dog and wildlife populations, reducing both public health and conservation risks and, if sustained, has potential to eliminate rabies from this region.
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Affiliation(s)
- Kennedy Lushasi
- Ifakara Health Institute, Ifakara, Tanzania
- Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, UK
- Nelson Mandela African Institution of Science and Technology, Arusha, Tanzania
| | - Sarah Hayes
- Department of Infectious Disease Epidemiology, Faculty of Medicine, School of Public Health, Imperial College London
| | - Elaine A. Ferguson
- Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, UK
| | | | - Sarah Cleaveland
- Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, UK
| | - Nicodem J. Govella
- Ifakara Health Institute, Ifakara, Tanzania
- Nelson Mandela African Institution of Science and Technology, Arusha, Tanzania
| | - Daniel T. Haydon
- Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, UK
| | | | - Geofrey J. Mchau
- Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, Tanzania
| | - Emmanuel A. Mpolya
- Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, UK
- Nelson Mandela African Institution of Science and Technology, Arusha, Tanzania
| | | | - Hezron E. Nonga
- Ministry of Livestock Development and Fisheries, Dodoma, Tanzania
| | - Rachel Steenson
- Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, UK
| | | | - Christl A. Donnelly
- Department of Infectious Disease Epidemiology, Faculty of Medicine, School of Public Health, Imperial College London
- Department of Statistics, University of Oxford, Oxford, UK
| | - Katie Hampson
- Ifakara Health Institute, Ifakara, Tanzania
- Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, UK
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Lushasi K, Steenson R, Bernard J, Changalucha JJ, Govella NJ, Haydon DT, Hoffu H, Lankester F, Magoti F, Mpolya EA, Mtema Z, Nonga H, Hampson K. One Health in Practice: Using Integrated Bite Case Management to Increase Detection of Rabid Animals in Tanzania. Front Public Health 2020; 8:13. [PMID: 32117850 PMCID: PMC7034360 DOI: 10.3389/fpubh.2020.00013] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 01/15/2020] [Indexed: 12/25/2022] Open
Abstract
Rabies is a neglected zoonotic disease that causes an estimated 59,000 human deaths worldwide annually, mostly in Africa and Asia. A target of zero human deaths from dog-mediated rabies has been set for 2030, and large-scale control programs are now advocated. However, in most low-income endemic countries surveillance to guide rabies control is weak and few cases of rabies are recorded. There is an urgent need to enhance surveillance to improve timely case detection and inform rabies control and prevention, by operationalizing a “One Health” approach. Here we present data from a study piloting Integrated Bite Case Management (IBCM) to support intersectoral collaboration between health and veterinary workers in Tanzania. We trained government staff to implement IBCM, comprising risk assessments of bite patients by health workers, investigations by livestock field officers to diagnose rabid animals, and use of a mobile phone application to support integration. IBCM was introduced across 20 districts in four regions of Tanzania and results reported after 1 year of implementation. Numbers of bite patient presentations to health facilities varied across regions, but following the introduction of IBCM reporting of bite patients at high-risk for rabies more than doubled in all regions. Over 800 high-risk investigations were carried out, with 49% assessed as probable dog rabies cases on the basis of clinical signs, animal outcome, and rapid diagnostic testing. The status of a further 20% of biting animals could not be determined but rabies could not be ruled out. Livestock field officers reported that use of rapid diagnostic tests (RDTs) were useful for confirming rabies occurrence. Overall, our study provides further evidence that IBCM is a practical approach that can improve rabies detection in endemic countries, and be used to monitor the impact of mass dog vaccinations, including potential to verify rabies freedom. However, the main challenges to implementation are limited training of health workers in rabies, perceived burden of real-time recording and limited resources for livestock field officers to undertake investigations. Nonetheless, IBCM dramatically improved case detection and communication between sectors and we recommend further implementation research to establish best practice and applicability to other settings.
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Affiliation(s)
- Kennedy Lushasi
- Environmental Health and Ecological Sciences Department, Ifakara Health Institute, Ifakara, Tanzania.,Boyd Orr Centre for Population and Ecosystem Health, College of Medical, Institute of Biodiversity, Animal Health and Comparative Medicine, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom.,Global Health and Biomedical Sciences, School of Life Sciences and Bioengineering, Nelson Mandela African Institution of Science and Technology, Arusha, Tanzania
| | - Rachel Steenson
- Boyd Orr Centre for Population and Ecosystem Health, College of Medical, Institute of Biodiversity, Animal Health and Comparative Medicine, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Jubilate Bernard
- Department of Epidemiology, Ministry of Health, Community Development, Gender, Elderly and Children (MoHCDGEC), Dodoma, Tanzania
| | - Joel Jackson Changalucha
- Environmental Health and Ecological Sciences Department, Ifakara Health Institute, Ifakara, Tanzania
| | - Nicodem James Govella
- Environmental Health and Ecological Sciences Department, Ifakara Health Institute, Ifakara, Tanzania
| | - Daniel T Haydon
- Boyd Orr Centre for Population and Ecosystem Health, College of Medical, Institute of Biodiversity, Animal Health and Comparative Medicine, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Husna Hoffu
- Environmental Health and Ecological Sciences Department, Ifakara Health Institute, Ifakara, Tanzania
| | - Felix Lankester
- Paul G. Allen School for Global Animal Health, Washington State University, Washington, DC, United States.,Global Animal Health Tanzania, Arusha, Tanzania
| | - Frank Magoti
- Environmental Health and Ecological Sciences Department, Ifakara Health Institute, Ifakara, Tanzania
| | - Emmanuel Abraham Mpolya
- Global Health and Biomedical Sciences, School of Life Sciences and Bioengineering, Nelson Mandela African Institution of Science and Technology, Arusha, Tanzania
| | - Zacharia Mtema
- Environmental Health and Ecological Sciences Department, Ifakara Health Institute, Ifakara, Tanzania
| | - Hesron Nonga
- Director of Veterinary Services, Ministry of Livestock Development and Fisheries, Dodoma, Tanzania
| | - Katie Hampson
- Environmental Health and Ecological Sciences Department, Ifakara Health Institute, Ifakara, Tanzania.,Boyd Orr Centre for Population and Ecosystem Health, College of Medical, Institute of Biodiversity, Animal Health and Comparative Medicine, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
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Smith L, Therrien MS, Harley KG, Mbuyita S, Mtema Z, Kinyonge I, Tillya R, Mbaruku G, Miller S. Differences in Life-Saving Obstetric Hemorrhage Treatments for Women with Abortion Versus Nonabortion Etiologies in Tanzania. Stud Fam Plann 2019; 50:375-393. [PMID: 31506958 DOI: 10.1111/sifp.12101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Complications from unsafe abortion are among the major causes of preventable maternal morbidity and mortality, which may be compounded by delays and disparities in treatment. We conducted a secondary analysis of women with symptoms of hypovolemic shock secondary to severe obstetric hemorrhage in Tanzania. We compared receipt of three lifesaving interventions among women with abortions versus other maternal hemorrhage etiologies. Interventions included: non-pneumatic anti-shock garment (NASG) (N = 393), blood transfusion (N = 249), and referral to a higher-capacity facility (N = 131). After controlling for severity of disease and other confounders, women with abortion-related hemorrhage and shock had 78 percent decreased odds of receiving NASG (p < 0.001) and 77 percent decreased odds of receiving a blood transfusion (p < 0.001) compared to women with hemorrhage and shock from other etiologies. Our findings suggest that, in Tanzania, women with abortion-related hemorrhage received lower quality of care than women with other hemorrhage etiologies.
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Mbaruku G, Therrien MS, Tillya R, Mbuyita S, Mtema Z, Kinyonge I, Godfrey R, Temu S, Miller S. Implementation project of the non-pneumatic anti-shock garment and m-communication to enhance maternal health care in rural Tanzania. Reprod Health 2018; 15:177. [PMID: 30340602 PMCID: PMC6194579 DOI: 10.1186/s12978-018-0613-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 09/26/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Obstetric hemorrhage (OH) remains one of the leading causes of maternal mortality, particularly in rural Africa. Tanzania has a high maternal mortality ratio, and approximately 80% of the population accesses health care lower level facilities, unable to provide Comprehensive Emergency Obstetric Care (CEmOC). The non-pneumatic anti-shock garment (NASG) has been demonstrated to reduce mortality as it buys time for women in shock to be transported to or to overcome delays at referral facilities. METHODS This report describes one component of an ongoing maternal health improvement project, Empower, implemented in 280 facilities in four regions in rural Tanzania. The NASG along with a Closed User Group (CUG) mobile phone network were implemented within the overall EmOC project. Simulation trainings, repeated trainings, and close hands-on supportive supervision via site visits and via the CUG network were the training/learning methods. Data collection was conducted via the CUG network, with a limited data collection form, which also included free text options for project improvement. One-to-one interviews were also conducted. Outcome Indicators included appropriate use of NASG for women with hypovolemic shock We also compared baseline case fatality rates (CFR) from OH with endline CFRs. Data were analyzed using cohort study Risk Ratio (RR). Qualitative data analysis was conducted by content analysis. RESULTS Of the 1713 women with OH, 419 (24.5%) met project hypovolemic shock criteria, the NASG was applied to 70.8% (n = 297), indicating high acceptability and utilization. CFR at baseline (1.70) compared to CFR at endline (0.76) showed a temporal association of a 67% reduced risk for women during the project period (RR: 0.33, 95% CI = .19, .60). Qualitative feedback was used to make course corrections during the project to enhance training and implementation. CONCLUSIONS This implementation project with 280 facilities and over 1000 providers supported via CUG demonstrated that NASG can have high uptake and appropriate use for hypovolemic shock secondary to OH. With the proper implementation strategies, NASG utilization can be high and should be associated with decreased mortality among mothers at risk of death from obstetric hemorrhage.
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Affiliation(s)
| | - Michelle Skaer Therrien
- University of California, San Francisco, School of Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, Safe Motherhood Program, California, USA
| | | | | | | | | | | | - Silas Temu
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Suellen Miller
- University of California, San Francisco, School of Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, Safe Motherhood Program, California, USA
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Changalucha J, Steenson R, Grieve E, Cleaveland S, Lembo T, Lushasi K, Mchau G, Mtema Z, Sambo M, Nanai A, Govella NJ, Dilip A, Sikana L, Ventura F, Hampson K. The need to improve access to rabies post-exposure vaccines: Lessons from Tanzania. Vaccine 2018; 37 Suppl 1:A45-A53. [PMID: 30309746 PMCID: PMC6863039 DOI: 10.1016/j.vaccine.2018.08.086] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 08/22/2018] [Accepted: 08/31/2018] [Indexed: 12/25/2022]
Abstract
Prompt post-exposure vaccination is extremely effective in preventing human rabies. Intradermal post-exposure vaccination is easily adopted by health workers in Tanzania. High costs of PEP to government affect the supply chain and limit its availability. Limited PEP supply results in higher out-of-pocket payments and increased risks. Investment to facilitate free PEP provision would reduce rabies deaths.
Background Rabies is preventable through prompt administration of post-exposure prophylaxis (PEP) to exposed persons, but PEP access is limited in many rabies-endemic countries. We investigated how access to PEP can be improved to better prevent human rabies. Methods Using data from different settings in Tanzania, including contact tracing (2,367 probable rabies exposures identified) and large-scale mobile phone-based surveillance (24,999 patient records), we estimated the incidence of rabies exposures and bite-injuries, and examined health seeking and health outcomes in relation to PEP access. We used surveys and qualitative interviews with stakeholders within the health system to further characterise PEP supply and triangulate these findings. Results Incidence of bite-injury patients was related to dog population sizes, with higher incidence in districts with lower human:dog ratios and urban centres. A substantial percentage (25%) of probable rabies exposures did not seek care due to costs and limited appreciation of risk. Upon seeking care a further 15% of probable rabies exposed persons did not obtain PEP due to shortages, cost barriers or misadvice. Of those that initiated PEP, 46% did not complete the course. If no PEP was administered, the risk of developing rabies following a probable rabies exposure was high (0.165), with bites to the head carrying most risk. Decentralized and free PEP increased the probability that patients received PEP and reduced delays in initiating PEP. No major difficulties were encountered by health workers whilst switching to dose-sparing ID administration of PEP. Health infrastructure also includes sufficient cold chain capacity to support improved PEP provision. However, high costs to governments and patients currently limits the supply chain and PEP access. The cost barrier was exacerbated by decentralization of budgets, with priority given to purchase of cheaper medicines for other conditions. Reactive procurement resulted in limited and unresponsive PEP supply, increasing costs and risks to bite victims. Conclusion PEP access could be improved and rabies deaths reduced through ring-fenced procurement, switching to dose-sparing ID regimens and free provision of PEP.
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Affiliation(s)
- Joel Changalucha
- Ifakara Health Institute, P.O. Box 78373, Dar es Salaam, Tanzania.
| | - Rachel Steenson
- Boyd Orr Centre for Population and Ecosystem Health, Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, UK
| | - Eleanor Grieve
- Health Economics and Health Technology Assessment (HEHTA), Institute of Health and Wellbeing, 1 Lilybank Gardens, University of Glasgow, UK
| | - Sarah Cleaveland
- Boyd Orr Centre for Population and Ecosystem Health, Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, UK
| | - Tiziana Lembo
- Boyd Orr Centre for Population and Ecosystem Health, Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, UK
| | - Kennedy Lushasi
- Ifakara Health Institute, P.O. Box 78373, Dar es Salaam, Tanzania
| | - Geofrey Mchau
- Ministry of Health, Community Development, Gender, Elderly and Children, P.O. Box 573 Dodoma, Tanzania
| | - Zacharia Mtema
- Ifakara Health Institute, P.O. Box 78373, Dar es Salaam, Tanzania
| | - Maganga Sambo
- Ifakara Health Institute, P.O. Box 78373, Dar es Salaam, Tanzania; Boyd Orr Centre for Population and Ecosystem Health, Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, UK
| | - Alphoncina Nanai
- World Health Organization, Tanzania Country Office, P.O. Box 9292, Dar es Salaam, Tanzania
| | | | - Angel Dilip
- Ifakara Health Institute, P.O. Box 78373, Dar es Salaam, Tanzania
| | - Lwitiko Sikana
- Ifakara Health Institute, P.O. Box 78373, Dar es Salaam, Tanzania
| | - Francesco Ventura
- Boyd Orr Centre for Population and Ecosystem Health, Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, UK
| | - Katie Hampson
- Boyd Orr Centre for Population and Ecosystem Health, Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, UK
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Sambo M, Hampson K, Changalucha J, Cleaveland S, Lembo T, Lushasi K, Mbunda E, Mtema Z, Sikana L, Johnson PCD. Estimating the Size of Dog Populations in Tanzania to Inform Rabies Control. Vet Sci 2018; 5:vetsci5030077. [PMID: 30205470 PMCID: PMC6164483 DOI: 10.3390/vetsci5030077] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 08/31/2018] [Accepted: 09/03/2018] [Indexed: 12/25/2022] Open
Abstract
Estimates of dog population sizes are a prerequisite for delivering effective canine rabies control. However, dog population sizes are generally unknown in most rabies-endemic areas. Several approaches have been used to estimate dog populations but without rigorous evaluation. We compare post-vaccination transects, household surveys, and school-based surveys to determine which most precisely estimates dog population sizes. These methods were implemented across 28 districts in southeast Tanzania, in conjunction with mass dog vaccinations, covering a range of settings, livelihoods, and religious backgrounds. Transects were the most precise method, revealing highly variable patterns of dog ownership, with human/dog ratios ranging from 12.4:1 to 181.3:1 across districts. Both household and school-based surveys generated imprecise and, sometimes, inaccurate estimates, due to small sample sizes in relation to the heterogeneity in patterns of dog ownership. Transect data were subsequently used to develop a predictive model for estimating dog populations in districts lacking transect data. We predicted a dog population of 2,316,000 (95% CI 1,573,000–3,122,000) in Tanzania and an average human/dog ratio of 20.7:1. Our modelling approach has the potential to be applied to predicting dog population sizes in other areas where mass dog vaccinations are planned, given census and livelihood data. Furthermore, we recommend post-vaccination transects as a rapid and effective method to refine dog population estimates across large geographic areas and to guide dog vaccination programmes in settings with mostly free roaming dog populations.
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Affiliation(s)
- Maganga Sambo
- Ifakara Health Institute, P.O. Box 53, Ifakara, Tanzania.
- Boyd Orr Centre for Population and Ecosystem Health, Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow G12 8QQ, UK.
| | - Katie Hampson
- Boyd Orr Centre for Population and Ecosystem Health, Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow G12 8QQ, UK.
| | | | - Sarah Cleaveland
- Boyd Orr Centre for Population and Ecosystem Health, Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow G12 8QQ, UK.
| | - Tiziana Lembo
- Boyd Orr Centre for Population and Ecosystem Health, Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow G12 8QQ, UK.
| | - Kennedy Lushasi
- Ifakara Health Institute, P.O. Box 53, Ifakara, Tanzania.
- Nelson Mandela African Institution of Science and Technology, P.O. Box 447, Arusha, Tanzania.
| | - Eberhard Mbunda
- Department of Epidemiology, Ministry of Livestock and Fisheries, P.O. Box 2870, Dodoma, Tanzania
| | - Zacharia Mtema
- Ifakara Health Institute, P.O. Box 53, Ifakara, Tanzania.
| | - Lwitiko Sikana
- Ifakara Health Institute, P.O. Box 53, Ifakara, Tanzania.
- Nelson Mandela African Institution of Science and Technology, P.O. Box 447, Arusha, Tanzania.
| | - Paul C D Johnson
- Boyd Orr Centre for Population and Ecosystem Health, Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow G12 8QQ, UK.
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Sambo M, Johnson PCD, Hotopp K, Changalucha J, Cleaveland S, Kazwala R, Lembo T, Lugelo A, Lushasi K, Maziku M, Mbunda E, Mtema Z, Sikana L, Townsend SE, Hampson K. Comparing Methods of Assessing Dog Rabies Vaccination Coverage in Rural and Urban Communities in Tanzania. Front Vet Sci 2017; 4:33. [PMID: 28352630 PMCID: PMC5348529 DOI: 10.3389/fvets.2017.00033] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 02/20/2017] [Indexed: 11/13/2022] Open
Abstract
Rabies can be eliminated by achieving comprehensive coverage of 70% of domestic dogs during annual mass vaccination campaigns. Estimates of vaccination coverage are, therefore, required to evaluate and manage mass dog vaccination programs; however, there is no specific guidance for the most accurate and efficient methods for estimating coverage in different settings. Here, we compare post-vaccination transects, school-based surveys, and household surveys across 28 districts in southeast Tanzania and Pemba island covering rural, urban, coastal and inland settings, and a range of different livelihoods and religious backgrounds. These approaches were explored in detail in a single district in northwest Tanzania (Serengeti), where their performance was compared with a complete dog population census that also recorded dog vaccination status. Post-vaccination transects involved counting marked (vaccinated) and unmarked (unvaccinated) dogs immediately after campaigns in 2,155 villages (24,721 dogs counted). School-based surveys were administered to 8,587 primary school pupils each representing a unique household, in 119 randomly selected schools approximately 2 months after campaigns. Household surveys were conducted in 160 randomly selected villages (4,488 households) in July/August 2011. Costs to implement these coverage assessments were $12.01, $66.12, and $155.70 per village for post-vaccination transects, school-based, and household surveys, respectively. Simulations were performed to assess the effect of sampling on the precision of coverage estimation. The sampling effort required to obtain reasonably precise estimates of coverage from household surveys is generally very high and probably prohibitively expensive for routine monitoring across large areas, particularly in communities with high human to dog ratios. School-based surveys partially overcame sampling constraints, however, were also costly to obtain reasonably precise estimates of coverage. Post-vaccination transects provided precise and timely estimates of community-level coverage that could be used to troubleshoot the performance of campaigns across large areas. However, transects typically overestimated coverage by around 10%, which therefore needs consideration when evaluating the impacts of campaigns. We discuss the advantages and disadvantages of these different methods and make recommendations for how vaccination campaigns can be better monitored and managed at different stages of rabies control and elimination programs.
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Affiliation(s)
- Maganga Sambo
- Environmental Health and Ecological Sciences Thematic Group, Ifakara Health Institute, Ifakara, Tanzania; Boyd Orr Centre for Population and Ecosystem Health, Institute of Biodiversity, Animal Health and Comparative Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Paul C D Johnson
- Boyd Orr Centre for Population and Ecosystem Health, Institute of Biodiversity, Animal Health and Comparative Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow , Glasgow , UK
| | - Karen Hotopp
- Boyd Orr Centre for Population and Ecosystem Health, Institute of Biodiversity, Animal Health and Comparative Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow , Glasgow , UK
| | - Joel Changalucha
- Environmental Health and Ecological Sciences Thematic Group, Ifakara Health Institute, Ifakara, Tanzania; Boyd Orr Centre for Population and Ecosystem Health, Institute of Biodiversity, Animal Health and Comparative Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Sarah Cleaveland
- Boyd Orr Centre for Population and Ecosystem Health, Institute of Biodiversity, Animal Health and Comparative Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow , Glasgow , UK
| | - Rudovick Kazwala
- College of Veterinary and Medical Sciences, Sokoine University of Agriculture , Morogoro , Tanzania
| | - Tiziana Lembo
- Boyd Orr Centre for Population and Ecosystem Health, Institute of Biodiversity, Animal Health and Comparative Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow , Glasgow , UK
| | - Ahmed Lugelo
- College of Veterinary and Medical Sciences, Sokoine University of Agriculture , Morogoro , Tanzania
| | - Kennedy Lushasi
- Environmental Health and Ecological Sciences Thematic Group, Ifakara Health Institute , Ifakara , Tanzania
| | - Mathew Maziku
- Ministry of Agriculture, Livestock and Fisheries Development , Dar Es Salaam , Tanzania
| | - Eberhard Mbunda
- Ministry of Agriculture, Livestock and Fisheries Development , Dar Es Salaam , Tanzania
| | - Zacharia Mtema
- Environmental Health and Ecological Sciences Thematic Group, Ifakara Health Institute , Ifakara , Tanzania
| | - Lwitiko Sikana
- Environmental Health and Ecological Sciences Thematic Group, Ifakara Health Institute , Ifakara , Tanzania
| | - Sunny E Townsend
- Boyd Orr Centre for Population and Ecosystem Health, Institute of Biodiversity, Animal Health and Comparative Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow , Glasgow , UK
| | - Katie Hampson
- Environmental Health and Ecological Sciences Thematic Group, Ifakara Health Institute, Ifakara, Tanzania; Boyd Orr Centre for Population and Ecosystem Health, Institute of Biodiversity, Animal Health and Comparative Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
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8
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Mpolya EA, Lembo T, Lushasi K, Mancy R, Mbunda EM, Makungu S, Maziku M, Sikana L, Jaswant G, Townsend S, Meslin FX, Abela-Ridder B, Ngeleja C, Changalucha J, Mtema Z, Sambo M, Mchau G, Rysava K, Nanai A, Kazwala R, Cleaveland S, Hampson K. Toward Elimination of Dog-Mediated Human Rabies: Experiences from Implementing a Large-scale Demonstration Project in Southern Tanzania. Front Vet Sci 2017; 4:21. [PMID: 28321400 PMCID: PMC5337520 DOI: 10.3389/fvets.2017.00021] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 02/08/2017] [Indexed: 12/25/2022] Open
Abstract
A Rabies Elimination Demonstration Project was implemented in Tanzania from 2010 through to 2015, bringing together government ministries from the health and veterinary sectors, the World Health Organization, and national and international research institutions. Detailed data on mass dog vaccination campaigns, bite exposures, use of post-exposure prophylaxis (PEP), and human rabies deaths were collected throughout the project duration and project areas. Despite no previous experience in dog vaccination within the project areas, district veterinary officers were able to implement district-wide vaccination campaigns that, for most part, progressively increased the numbers of dogs vaccinated with each phase of the project. Bite exposures declined, particularly in the southernmost districts with the smallest dog populations, and health workers successfully transitioned from primarily intramuscular administration of PEP to intradermal administration, resulting in major cost savings. However, even with improved PEP provision, vaccine shortages still occurred in some districts. In laboratory diagnosis, there were several logistical challenges in sample handling and submission but compared to the situation before the project started, there was a moderate increase in the number of laboratory samples submitted and tested for rabies in the project areas with a decrease in the proportion of rabies-positive samples over time. The project had a major impact on public health policy and practice with the formation of a One Health Coordination Unit at the Prime Minister's Office and development of the Tanzania National Rabies Control Strategy, which lays a roadmap for elimination of rabies in Tanzania by 2030 by following the Stepwise Approach towards Rabies Elimination (SARE). Overall, the project generated many important lessons relevant to rabies prevention and control in particular and disease surveillance in general. Lessons include the need for (1) a specific unit in the government for managing disease surveillance; (2) application of innovative data collection and management approaches such as the use of mobile phones; (3) close cooperation and effective communication among all key sectors and stakeholders; and (4) flexible and adaptive programs that can incorporate new information to improve their delivery, and overcome challenges of logistics and procurement.
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Affiliation(s)
- Emmanuel Abraham Mpolya
- Global Health and Biomedical Sciences, School of Life Sciences and Bioengineering, Nelson Mandela African Institution of Science and Technology, Arusha, Tanzania
- Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, UK
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, WA, USA
| | - Tiziana Lembo
- Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, UK
| | - Kennedy Lushasi
- Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, UK
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Rebecca Mancy
- Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, UK
| | - Eberhard M. Mbunda
- Department of Epidemiology, Ministry of Agriculture, Livestock and Fisheries, Dar es Salaam, Tanzania
| | - Selemani Makungu
- Department of Epidemiology, Ministry of Agriculture, Livestock and Fisheries, Dar es Salaam, Tanzania
| | - Matthew Maziku
- Department of Epidemiology, Ministry of Agriculture, Livestock and Fisheries, Dar es Salaam, Tanzania
| | | | - Gurdeep Jaswant
- Preventive Veterinary Medicine, Sokoine University of Agriculture (SUA), Morogoro, Tanzania
| | - Sunny Townsend
- Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, UK
| | - François-Xavier Meslin
- Food Safety Zoonoses and Food-Borne Diseases, World Health Organization (former WO staff), Geneva, Switzerland
| | | | - Chanasa Ngeleja
- Tanzania Veterinary Laboratory Agency (TVLA), Ministry of Agriculture, Livestock and Fisheries, Dar es Salaam, Tanzania
| | - Joel Changalucha
- Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, UK
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | | | - Maganga Sambo
- Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, UK
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Geofrey Mchau
- Department of Epidemiology, Ministry of Health, Community Development, Gender, Elderly and Children (MoHCDGEC), Dar es Salaam, Tanzania
| | - Kristyna Rysava
- Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, UK
| | - Alphoncina Nanai
- Department of Neglected Tropical Diseases, World Health Organization – Country Office of Tanzania, Dar es Salaam, Tanzania
| | - Rudovick Kazwala
- Preventive Veterinary Medicine, Sokoine University of Agriculture (SUA), Morogoro, Tanzania
| | - Sarah Cleaveland
- Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, UK
| | - Katie Hampson
- Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, UK
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Mtema Z, Changalucha J, Cleaveland S, Elias M, Ferguson HM, Halliday JEB, Haydon DT, Jaswant G, Kazwala R, Killeen GF, Lembo T, Lushasi K, Malishee AD, Mancy R, Maziku M, Mbunda EM, Mchau GJM, Murray-Smith R, Rysava K, Said K, Sambo M, Shayo E, Sikana L, Townsend SE, Urassa H, Hampson K. Mobile Phones As Surveillance Tools: Implementing and Evaluating a Large-Scale Intersectoral Surveillance System for Rabies in Tanzania. PLoS Med 2016; 13:e1002002. [PMID: 27070315 PMCID: PMC4829224 DOI: 10.1371/journal.pmed.1002002] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Katie Hampson and colleagues describe their experience of developing and deploying a large-scale rabies surveillance system based on mobile phones in southern Tanzania.
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Affiliation(s)
- Zacharia Mtema
- Ifakara Health Institute, Ifakara, Morogoro, Tanzania
- Boyd Orr Centre for Population and Ecosystem Health, Institute of Biodiversity, Animal Health and Comparative Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
- School of Computing Science, University of Glasgow, Glasgow, United Kingdom
| | | | - Sarah Cleaveland
- Boyd Orr Centre for Population and Ecosystem Health, Institute of Biodiversity, Animal Health and Comparative Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Martin Elias
- Ministry of Health and Social Welfare, Dar es Salaam, Tanzania
| | - Heather M. Ferguson
- Ifakara Health Institute, Ifakara, Morogoro, Tanzania
- Boyd Orr Centre for Population and Ecosystem Health, Institute of Biodiversity, Animal Health and Comparative Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Jo E. B. Halliday
- Boyd Orr Centre for Population and Ecosystem Health, Institute of Biodiversity, Animal Health and Comparative Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Daniel T. Haydon
- Boyd Orr Centre for Population and Ecosystem Health, Institute of Biodiversity, Animal Health and Comparative Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Gurdeep Jaswant
- Sokoine University of Agriculture, Department of Preventative Veterinary Medicine, Morogoro, Tanzania
| | - Rudovick Kazwala
- Sokoine University of Agriculture, Department of Preventative Veterinary Medicine, Morogoro, Tanzania
| | - Gerry F. Killeen
- Ifakara Health Institute, Ifakara, Morogoro, Tanzania
- Liverpool School of Tropical Medicine, Department of Vector Biology, Liverpool, United Kingdom
| | - Tiziana Lembo
- Boyd Orr Centre for Population and Ecosystem Health, Institute of Biodiversity, Animal Health and Comparative Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Kennedy Lushasi
- Ifakara Health Institute, Ifakara, Morogoro, Tanzania
- Boyd Orr Centre for Population and Ecosystem Health, Institute of Biodiversity, Animal Health and Comparative Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | | | - Rebecca Mancy
- Boyd Orr Centre for Population and Ecosystem Health, Institute of Biodiversity, Animal Health and Comparative Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
- School of Computing Science, University of Glasgow, Glasgow, United Kingdom
| | - Matthew Maziku
- Ministry of Agriculture, Livestock and Fisheries, Dar es Salaam, Tanzania
- World Health Organization, Country Office, Dar es Salaam, Tanzania
| | - Eberhard M. Mbunda
- Ministry of Agriculture, Livestock and Fisheries, Dar es Salaam, Tanzania
| | | | | | - Kristyna Rysava
- Boyd Orr Centre for Population and Ecosystem Health, Institute of Biodiversity, Animal Health and Comparative Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Khadija Said
- Sokoine University of Agriculture, Department of Preventative Veterinary Medicine, Morogoro, Tanzania
| | - Maganga Sambo
- Ifakara Health Institute, Ifakara, Morogoro, Tanzania
- Boyd Orr Centre for Population and Ecosystem Health, Institute of Biodiversity, Animal Health and Comparative Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Elizabeth Shayo
- Ministry of Agriculture, Livestock and Fisheries, Dar es Salaam, Tanzania
| | | | - Sunny E Townsend
- Boyd Orr Centre for Population and Ecosystem Health, Institute of Biodiversity, Animal Health and Comparative Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | | | - Katie Hampson
- Ifakara Health Institute, Ifakara, Morogoro, Tanzania
- Boyd Orr Centre for Population and Ecosystem Health, Institute of Biodiversity, Animal Health and Comparative Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
- * E-mail:
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10
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Hatch B, Anderson A, Sambo M, Maziku M, Mchau G, Mbunda E, Mtema Z, Rupprecht CE, Shwiff SA, Nel L. Towards Canine Rabies Elimination in South-Eastern Tanzania: Assessment of Health Economic Data. Transbound Emerg Dis 2016; 64:951-958. [PMID: 26916104 DOI: 10.1111/tbed.12463] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Indexed: 12/25/2022]
Abstract
An estimated 59 000 people die annually from rabies, keeping this zoonosis on the forefront of neglected diseases, especially in the developing world. Most deaths occur after being bitten by a rabid dog. Those exposed to a suspect rabid animal should receive appropriate post-exposure prophylaxis (PEP) or risk death. However, vaccination of dogs to control and eliminate canine rabies at the source has been implemented in many places around the world. Here, we analysed the vaccination and cost data for one such campaign in the area surrounding and including Dar es Salaam, Tanzania and estimated the cost per dog vaccinated. We also estimated the cost of human PEP. We found that the cost per dog vaccinated ranged from $2.50 to $22.49 across districts and phases, with the phase average ranging from $7.30 to $11.27. These figures were influenced by over purchase of vaccine in the early phases of the programme and the significant costs associated with purchasing equipment for a programme starting from scratch. The cost per human PEP course administered was approximately $24.41, with the average patient receiving 2.5 of the recommended four vaccine doses per suspect bite. This study provides valuable financial insights into programme managers and policymakers working towards rabies elimination.
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Affiliation(s)
- B Hatch
- National Wildlife Research Center, USDA APHIS Wildlife Services, Fort Collins, CO, USA.,Global Alliance for Rabies Control, Manhattan, KS, USA
| | - A Anderson
- National Wildlife Research Center, USDA APHIS Wildlife Services, Fort Collins, CO, USA
| | - M Sambo
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | - M Maziku
- World Health Organization, Dar es Salaam, Tanzania
| | - G Mchau
- Tanzania Ministry of Health and Social Welfare, Dar es Salaam, Tanzania
| | - E Mbunda
- Tanzania Ministry of Livestock Development and Fisheries, Dar es Salaam, Tanzania
| | - Z Mtema
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | - C E Rupprecht
- Global Alliance for Rabies Control, Manhattan, KS, USA.,The Wistar Institute, Philadelphia, PA, USA
| | - S A Shwiff
- National Wildlife Research Center, USDA APHIS Wildlife Services, Fort Collins, CO, USA
| | - L Nel
- Global Alliance for Rabies Control, Manhattan, KS, USA.,Department of Microbiology, Natural and Agricultural Sciences, University of Pretoria, Pretoria, South Africa
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11
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Cleaveland S, Beyer H, Hampson K, Haydon D, Lankester F, Lembo T, Meslin FX, Morters M, Mtema Z, Sambo M, Townsend S. The changing landscape of rabies epidemiology and control. ACTA ACUST UNITED AC 2014; 81:E1-8. [PMID: 25005807 PMCID: PMC7612516 DOI: 10.4102/ojvr.v81i2.731] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Accepted: 12/05/2013] [Indexed: 11/17/2022]
Abstract
Over the past 20 years, major progress has been made in our understanding of critical aspects of rabies epidemiology and control. This paper presents results of recent research, highlighting methodological advances that have been applied to burden of disease studies, rabies epidemiological modelling and rabies surveillance. These results contribute new insights and understanding with regard to the epidemiology of rabies and help to counteract misperceptions that currently hamper rabies control efforts in Africa. The conclusion of these analyses is that the elimination of canine rabies in Africa is feasible, even in wildlife-rich areas, through mass vaccination of domestic dogs and without the need for indiscriminate culling to reduce dog population density. Furthermore, the research provides valuable practical insights that support the operational planning and design of dog vaccination campaigns and rabies surveillance measures.
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Affiliation(s)
- Sarah Cleaveland
- Boyd Orr Centre for Population and Ecosystem Health, Institute of Biodiversity, Animal Health and Comparative Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Scotland.
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12
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Halliday J, Daborn C, Auty H, Mtema Z, Lembo T, Bronsvoort BMD, Handel I, Knobel D, Hampson K, Cleaveland S. Bringing together emerging and endemic zoonoses surveillance: shared challenges and a common solution. Philos Trans R Soc Lond B Biol Sci 2013; 367:2872-80. [PMID: 22966142 PMCID: PMC3427560 DOI: 10.1098/rstb.2011.0362] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Early detection of disease outbreaks in human and animal populations is crucial to the effective surveillance of emerging infectious diseases. However, there are marked geographical disparities in capacity for early detection of outbreaks, which limit the effectiveness of global surveillance strategies. Linking surveillance approaches for emerging and neglected endemic zoonoses, with a renewed focus on existing disease problems in developing countries, has the potential to overcome several limitations and to achieve additional health benefits. Poor reporting is a major constraint to the surveillance of both emerging and endemic zoonoses, and several important barriers to reporting can be identified: (i) a lack of tangible benefits when reports are made; (ii) a lack of capacity to enforce regulations; (iii) poor communication among communities, institutions and sectors; and (iv) complexities of the international regulatory environment. Redirecting surveillance efforts to focus on endemic zoonoses in developing countries offers a pragmatic approach that overcomes some of these barriers and provides support in regions where surveillance capacity is currently weakest. In addition, this approach addresses immediate health and development problems, and provides an equitable and sustainable mechanism for building the culture of surveillance and the core capacities that are needed for all zoonotic pathogens, including emerging disease threats.
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Affiliation(s)
- Jo Halliday
- Boyd Orr Centre for Population and Ecosystem Health, College of Medicine, Veterinary Medicine and Life Sciences, University of Glasgow, Glasgow G12 8QQ, UK.
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