Abstract
An increasing number of countries are committing to meet the global target to eliminate human deaths from dog-mediated rabies by 2030. Mass dog vaccination is central to this strategy. To interrupt rabies transmission from dogs to humans, the World Health Organization recommends that vaccination campaigns should be carried out every year in all dog-owning communities vaccinating 70% of their susceptible dogs. Monitoring and evaluation of dog vaccination campaigns are needed to measure progress towards elimination. In this study, we measured the delivery performance of large-scale vaccination campaigns implemented in 25 districts in south-east Tanzania from 2010 until 2017. We used regression modelling to infer the factors associated with, and potentially influencing the successful delivery of vaccination campaigns. During 2010–2017, five rounds of vaccination campaigns were carried out, vaccinating in total 349,513 dogs in 2,066 administrative vaccination units (rural villages or urban wards). Progressively more dogs were vaccinated over the successive campaigns. The campaigns did not reach all vaccination units each year, with only 16–28% of districts achieving 100% campaign completeness (where all units were vaccinated). During 2013–2017 when vaccination coverage was monitored, approximately 20% of vaccination units achieved the recommended 70% coverage, with average coverage around 50%. Campaigns were also not completed at annual intervals, with the longest interval between campaigns being 27 months. Our analysis revealed that districts with higher budgets generally achieved higher completeness, with a twofold difference in district budget increasing the odds of a vaccination unit being reached by a campaign by slightly more than twofold (OR: 2.29; 95% CI: 1.69–3.09). However, higher budgets did not necessarily result in higher coverage within vaccination units that were reached. We recommend national programs regularly monitor and evaluate the performance of their vaccination campaigns, so as to identify factors hindering their effective delivery and to guide remedial action.
Highlights
Each year, canine rabies causes approximately 59,000 human deaths worldwide, mostly in Asia and Africa [1]
While human rabies can be effectively prevented with post-exposure prophylaxis (PEP), the intervention is expensive, with direct expenditure on PEP estimated at 1.70 billion US Dollars (US$) per year and indirect costs estimated at US$1.31 billion [1]
Over five rounds of mass dog vaccinations (MDV), campaigns were conducted in every vaccination unit in only 13–28% of districts, and at the district level, MDV campaigns achieved a mean coverage of 50%, below the World Health Organisation (WHO)-recommended coverage of 70%
Summary
Canine rabies causes approximately 59,000 human deaths worldwide, mostly in Asia and Africa [1]. Human rabies deaths are 100% vaccine-preventable through two complementary interventions: administration of post-exposure prophylaxis (PEP) to people bitten by suspected rabid animals to prevent disease onset; and sustained mass dog vaccinations (MDV) to eliminate transmission within the main source (reservoir) of infection [3]. While human rabies can be effectively prevented with PEP, the intervention is expensive, with direct expenditure on PEP estimated at 1.70 billion US Dollars (US$) per year and indirect costs estimated at US$1.31 billion [1]. Both the disease and the financial burden of rabies falls disproportionately upon people living in rural communities where most rabies occurs. Economic analysis has shown that canine vaccination against rabies is very cost-effective for preventing human rabies and is even cost-saving relative to PEP alone [8]
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