Rabies control in N'Djamena, Chad

Abstract

Rabies is a viral disease that induces invariably fatal encephalitis. Most affected by the disease are resource poor countries. Worldwide burden estimates reveal that the disease claims about one human victim every ten minutes. Transmission of the virus to humans occurs in over 95% through a bite of an infected dog. The only method for sustainable control of canine rabies and elimination at the source is dog vaccination. Since the year 2000 Swiss TPH works in close partnership with the Institut de Recherche en Elevage pour le Developpement (IRED) and the Centre de Support en Sante Internationale (CSSI) on the control of rabies in N’Djamena, the capital city of Chad. The project phase from 2012-2015 has led to my doctoral thesis, which spans over many aspects of rabies control. Two mass vaccination campaigns have been conducted in 2012 and 2013 that covered the whole town and reached consecutively over 70% of the canine population. The intervention led to a drastic drop of dog rabies incidence. Data on animal rabies incidence, bite exposure incidence and Post-Exposure Prophylaxis (PEP) demand were used to validate a dog to human transmission model and to update the cost-effectiveness analysis of dog vaccination. The thesis also includes the validation of a rapid, simple rabies diagnostic test that has the potential to enhance surveillance in resource poor settings. On the national level economic aspects of a countrywide control program, a dog demographic survey and a Knowledge Attitude and Practices (KAP) study among the Chadian population are presented. Finally, social determinants of accessibility and effectiveness of rabies vaccination campaigns are discussed, by comparing the results from N’Djamena with a similar study in Bamako, Mali.