Human rabies in Côte d'Ivoire 2014-2016: Results following reinforcements to rabies surveillance.

Issaka Tiembré,Mathilde Tetchi,Sophie Druelles,Maïna L’Azou,Joseph Bénié,Anaïs Broban,Charles E Rupprecht

doi:10.1371/journal.pntd.0006649

Abstract

In Côte d’Ivoire, rabies is endemic and remains largely uncontrolled. The numbers of human exposures and rabies cases are unknown and are probably much higher than reported. Data on human rabies cases are collected by the National Institute of Public Health (NIPH) Anti-rabies Center in Abidjan through a network of 28 NIPH local units, which cover the population of the entire country. During 2014, the NIPH initiated a program to reinforce the human rabies surveillance system in those 28 NIPH local units, with specific goals of improving the infrastructure, training, communication, and government involvement. Here, we report the progress and findings during 2014–2016. The reinforced system recorded 50 cases of human rabies (15–18 cases/year; annual incidence = 0.06−0.08 per 100,000) and more than 30,000 animal exposures (annual incidence = 41.8−48.0 per 100,000). Almost one-half of the human rabies cases were in children ≤15 years old. All were fatal and dog bites were the most common route by which rabies virus was transmitted. In the 32 cases where samples of sufficient quality for analysis were available, rabies was confirmed by reverse transcription-polymerase chain reaction RT-PCR. Post-exposure prophylaxis with rabies vaccine was administered to all animal exposure victims presenting at the NIPH local units, although only about 57% completed the full immunization schedule. All available reports were provided by the NIPH local units, indicating effective communication between them and the NIPH Anti-rabies Center. These findings indicate that the reinforcements resulted in highly specific detection of human rabies, provided detailed epidemiological data about these cases, and improved estimates of animal exposure numbers. These represent substantial advances, but further improvements to the surveillance system are needed to increase disease awareness and capture cases that are currently missed by the system. In the future, better communication between local health centers and the NIPH units, surveillance at the local health center level, and increased veterinarian engagement will help provide a more complete picture of the rabies burden in Côte d’Ivoire.

Highlights

Rabies is a fatal viral infection, transmitted mostly by dog bites, that continues to be a substantial public health problem, especially in developing nations [1,2]
Data on human rabies cases in Cote d’Ivoire are collected by the National Institute of Public Health through a network of 28 NIPH local units. These NIPH local units provide rabies vaccine to people that may have been exposed to rabies virus
This study confirmed the suspicion that many people who receive rabies prophylaxis do not finish the full set of vaccinations, putting them at unnecessary risk

Summary

Introduction

Rabies is a fatal viral infection, transmitted mostly by dog bites, that continues to be a substantial public health problem, especially in developing nations [1,2]. The most recent estimate, based on the number of dog bites and the probability of infection, is 59,000 human rabies deaths per year, most of which are in Africa and Asia [1]. Rabies control has been especially hindered by a “vicious cycle of indifference and lack of information” [3]. The World Health Organization (WHO) has set a goal of eliminating dog-mediated rabies by 2030, but it has not been pursued in many developing nations [5]. PEP has greatly reduced human rabies cases, but full compliance with the required multi-dose vaccination regimens and RIG has been poor [3]

Objectives

Results

Discussion

Conclusion