Incentives Increase Participation in Mass Dog Rabies Vaccination Clinics and Methods of Coverage Estimation Are Assessed to Be Accurate

Abel B. Minyoo,Melissa Steinmetz,Imam Mzimbiri,Felix Lankester,Machunde Bigambo,Anna Czupryna,George Powell,Paul Gwakisa,Charles E Rupprecht

doi:10.1371/journal.pntd.0004221

Abstract

In this study we show that incentives (dog collars and owner wristbands) are effective at increasing owner participation in mass dog rabies vaccination clinics and we conclude that household questionnaire surveys and the mark-re-sight (transect survey) method for estimating post-vaccination coverage are accurate when all dogs, including puppies, are included. Incentives were distributed during central-point rabies vaccination clinics in northern Tanzania to quantify their effect on owner participation. In villages where incentives were handed out participation increased, with an average of 34 more dogs being vaccinated. Through economies of scale, this represents a reduction in the cost-per-dog of $0.47. This represents the price-threshold under which the cost of the incentive used must fall to be economically viable. Additionally, vaccination coverage levels were determined in ten villages through the gold-standard village-wide census technique, as well as through two cheaper and quicker methods (randomized household questionnaire and the transect survey). Cost data were also collected. Both non-gold standard methods were found to be accurate when puppies were included in the calculations, although the transect survey and the household questionnaire survey over- and under-estimated the coverage respectively. Given that additional demographic data can be collected through the household questionnaire survey, and that its estimate of coverage is more conservative, we recommend this method. Despite the use of incentives the average vaccination coverage was below the 70% threshold for eliminating rabies. We discuss the reasons and suggest solutions to improve coverage. Given recent international targets to eliminate rabies, this study provides valuable and timely data to help improve mass dog vaccination programs in Africa and elsewhere.

Highlights

Canine rabies has been reported as one of the neglected diseases of the developing world [1,2]
With highly effective vaccines and a single species of reservoir host rabies is entirely preventable through mass dog vaccination
These disease burden statistics, and the evidence that dog vaccination is highly effective at eliminating human rabies, have led the World Health Organisation (WHO), together with the Food and Agriculture Organization (FAO) and the World Organization for Animal Health (OIE), to unite in their joint commitment to the global elimination of canine rabies

Summary

Introduction

Canine rabies has been reported as one of the neglected diseases of the developing world [1,2]. Caused by Lyssavirus, it is a zoonotic infection of the central nervous system that invariably leads to death. The disease is transmitted through the saliva of the infected carrier with domestic dogs being the principle infectious source and reservoir of the disease [3]. Endemic in Tanzania, studies show that approximately 1,500 rabies deaths occur annually [4,5]. Many societies develop associations with dogs for different purposes ranging from security, companionship, food acquisition and religious beliefs. Despite these benefits, keeping dogs can pose a risk to human health through bite injuries and the transmission of pathogens such as the rabies virus [6]

Methods

Results

Discussion

Conclusion