Driving progress towards canine rabies elimination – a critique of the recent Pan-African Rabies Control Network and WHO joint meeting

In addition, new recommendations on human rabies immunisation and different studies undertaken by the ‘Gavi Learning Agenda’ was presented in the meeting to better understand the human post exposure prophylaxis needs and gaps.

The OIE presented the animal health situation on rabies reported by countries through the World Animal Health Information System (WAHIS), showing the outbreaks as well as the surveillance and control measures reported. Reports of rabies outbreaks should include the affected species, the geographical distribution and the control measures applied as, for instance, vaccinations. The timing in the notifications and follow up reports was highlighted to show its importance as countries progress in the elimination of dog-mediated rabies.

The presentation also described the mission shared by the OIE and WHO to disseminate rabies data globally. The OIE international Standards setting process for Terrestrial Animal Health Codes and Manuals was explained and the Chapter 1 of the Code on ‘Animal disease diagnosis, surveillance and notification’ was summarised indicating that Member Countries, through the OIE Delegate, should make available the needed information to minimise the spread of rabies and to help in controlling the disease worldwide. The upcoming WAHIS+ was presented as well as its potential for data sharing.

The Namibian Rabies Elimination Project coordinator, Dr Rauna Athingo, presented on how to improve quality of data for monitoring the progress on rabies programmes.

The data collected in the Namibian Rabies Elimination Project covers its main activities: capacity building, education and awareness, mass dog vaccination campaigns and stakeholder engagement. While quality data is necessary to assess the project interventions and to plan future activities, base line data is also needed to evaluate the impact of the project. Monitoring the incidence of animal and human rabies cases is paramount and requires good surveillance and laboratory diagnosis capacities. During the pilot phase of the project, in the Oshana region in 2016, a “Knowledge, Attitudes and Practices (KAP)” study was conducted to better understand why people kept dogs and from where information about diseases like rabies is obtained (radio, newspaper, social media). Stakeholder engagement has been pivotal to the success of the project, as community leaders are aware of the project and actively support the awareness and mass dog vaccination campaigns. On the occasion of the World Rabies Day 2018, a new poster has been developed in collaboration with the OIE Sub-regional Representation in Southern Africa. This poster includes photos from the Namibia rabies project, where children in the Kunene region are learning about how to prevent rabies through vaccination of their dogs and how to stay safe around dogs.

At the meeting, Dr Kallo from the Veterinary Services of Cote d’Ivoire presented the mechanism to access to the OIE Rabies Vaccine Bank. Cote d’Ivoire has recently acquired 37,000 doses of rabies vaccines for a pilot mass dog vaccination project in San Pedro and Bouake. Prior to accessing these vaccines, the OIE Delegate had presented a short summary of the Cote d’Ivoire national dog-mediated rabies elimination strategy and a description on how they would utilise the rabies vaccines from the OIE Bank. In both communities, local rabies control committees have been established following a household survey where very low dog rabies vaccination levels (7-12%) were found. Teams of vaccinators were trained and a 5-day mass dog vaccination campaign was conducted with collars placed on vaccinated animals to identify them. Post vaccination coverage survey was conducted in households and through random street sampling. Plans are in place to scale up the campaign to other areas.

The impact of surveillance, data collection and reporting activities was presented by Dr Athman Mwatondo from the Kenyan Zoonotic Disease Unit, where another OIE supported rabies project has been running. The current surveillance activities in the pilot areas include: toll-free number to report suspect rabies cases, hospital based surveillance, dog cohort study, community surveillance, contact tracing after given alert and sample collection of suspect cases. Given the incidence of missing rabies encephalitis cases in malaria endemic areas, it was highlighted the need of case base reporting of human cases. It is expected that the new WHO rabies post-exposure prophylaxis recommendations and the increased use of intradermal human vaccines will help to reduce the number of human rabies cases.

Dr Terence Scott from GARC presented the Rabies Epidemiological Bulletin (REB), a dedicated real-time One Health rabies surveillance system with human and animal data from countries. This regional rabies-specific disease surveillance platform is available on the GARC website.

In addition to this system, a Global Dog Rabies Elimination Pathway (GDREP) planning tool was presented by the US CDC. This tool helps to provide needs assessment for rabies control through mass dog vaccination. The tool focuses on four key factors: country development, cost of dog vaccination programme, potential demand for dog rabies vaccine and available vaccinators.

Dr Emily Pieracci from US-CDC described the Integrated Bite Case Management (IBCM) intervention-based surveillance system. The system requires the reporting of dog bites from health centres to animal rabies surveillance officers as a way to trigger animal rabies and victim bite investigation. Trace back and forward investigations occur to find any other bite cases either animal or human. The major benefits of this surveillance is finding rabid animals and removing them from the community.