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.

Highlights

  • Rabies is a zoonotic disease caused by a virus transmitted through the bite of an infectious animal [1]

  • Prior to the introduction of IBCM, an average of 55.7 new bite patients presented per month in these regions, with only 26.9% indicating a risk of rabies by the health worker who completed the record (Figure 3)

  • Of the bite victims that presented to health facilities following the introduction of IBCM, most were due to bites from domestic dogs (93.0%) with only a few being bitten by wild animals (Lindi, n = 3; Morogoro, n = 1, Mtwara, n = 14, and Mara, n = 7)

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Summary

Introduction

Rabies is a zoonotic disease caused by a virus transmitted through the bite of an infectious animal [1]. The disease is entirely preventable through vaccination of dogs to eliminate infection in the reservoir population and by prompt administration of post-exposure prophylaxis (PEP) to people exposed to the virus [1, 3]. An example of One Health is the Tripartite [World Health Organization (WHO), Food and Agricultural Organization of the United Nations (FAO), and World Organization for Animal Health (OIE)]. These international organizations have united to confront the problem of rabies [5]. The practical coordination of One Health activities by frontline public health and animal health workers remains challenging and this is exemplified by the implementation of rabies surveillance

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