Abstract
The direct fluorescent antibody test (dFAT) using brain sample after opening the skull is the standard rabies diagnostic test in animal rabies. However, it is not feasible in many resource-limited settings. Lateral flow devices (LFD) combined with a simple sampling methodology is quicker, simpler, and less hazardous than the standard test and can be a useful tool. We conducted a prospective on-site study to evaluate the diagnostic accuracy of the LFD with the straw sampling method compared with that of the dFAT with the skull opening procedure for post-mortem canine rabies diagnosis. We collected 97 rabies-suspected animals between December 1, 2020 and March 31, 2021. Among the 97 samples, 53 and 50 cases were positive tests for dFAT and LFD, respectively. The sensitivity and specificity of LFD with straw sampling method were 94.3% (95% confidence interval [CI], 84.3–98.8%) and 100% (95% CI, 92.0–100%), respectively. The performance of LFD by the straw sampling method showed relatively high sensitivity and 100% specificity compared with that of dFAT performed on samples collected after opening the skull. This methodology can be beneficial and is a strong tool to overcome limited animal surveillance in remote areas. However, because of our limited sample size, more data using fresh samples on-site and the optimizations are urgently needed for the further implementation in endemic areas.
Highlights
Limited surveillance for animal rabies often leads to underestimation of its burden in most endemic countries [1]
To the best of our knowledge, this is the first report comparing the performance of Lateral flow devices (LFD) using a simplified sampling method with that of direct fluorescent antibody test (dFAT) performed on samples obtained after opening the skull
We showed that the performance of LFD in detecting rabies using brain samples collected by the straw sampling method showed relatively high sensitivity and 100% specificity compared with that of dFAT performed on samples collected after opening the skull
Summary
Limited surveillance for animal rabies often leads to underestimation of its burden in most endemic countries [1]. One of the barriers in most endemic areas is that the standard diagnostic test, namely, the direct fluorescent antibody test (dFAT), can only be performed in a limited number of laboratories because it requires technical expertise for the interpretation of results and complex laboratory equipment such as fluorescence microscopes and incubators. The standard sampling method to collect brain samples requires the skull to be opened, and this carries a biohazard risk because the procedure can generate aerosols or cause injuries Considering these factors, skull opening can often only be performed in central laboratories in low- and middle-income countries [2]. A simple sampling methodology using a drinking straw, clamp, or plastic pipette has been recommended as an alternative sampling method by WHO and OIE since the 1980s [2,3,4] This sampling procedure is simple and easy and carries a low risk of contamination to the examiner or environment. More data and studies using fresh samples on-site are necessary to assess the further implementation of LFD in endemic countries
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