Abstract
This study compares data on animal rabies cases from the Chadian national rabies laboratory, hosted at the Insitut de Recherche en Elevage pour le Developpement (IRED), with bite case reporting from health facilities. The data collection accompanied a mass dog vaccination intervention over two years in N’Djaména, Chad. This allowed for a comparison of the dynamics of the incidence of animal rabies cases, human bite exposure incidence and post-exposure prophylaxis (PEP) demand during a dog rabies elimination attempt. Following the mass vaccination, the monthly animal rabies incidence dropped from 1.1/10,000 dogs, as observed prior to the campaign in 2012, to 0.061/10,000 dogs in 2014. However, the PEP demand was found to be largely unaffected. The suspicion of the rabies exposure as reported by health personnel in most cases did not reflect the status of the biting animal but rather the severity of the bite wound, resulting in inappropriate PEP recommendations. In addition, the levels of reporting dead or killed animals to the rabies laboratory was found to be very low. These results reveal a profound lack of communication between health facilities and veterinary structures and the absence of an integrated bite case management (IBCM) approach. Improved communication between human health and veterinary workers is imperative to prevent human rabies deaths through the appropriate use of PEP and to further translate success in animal rabies control into cost savings for the public health sector through a lower PEP demand. Improved training of health and veterinary personnel and the sensitisation of the public are needed to achieve good IBCM practice, to increase the rate of diagnostic testing, to provide adequate and timely PEP, and to reduce the wastage of scarce vaccine resources.
Highlights
Within a One Health framework, rabies is likely the best documented example for the added value of closer collaboration of human and veterinary medicine for the control of zoonotic diseases [1]
Because only a fraction of all bite cases are inflicted by a rabid animal [7,8] and because many countries face a shortage of the human vaccine for post-exposure prophylaxis (PEP), an integrated bite case management (IBCM) approach is required to guide treatment recommendations in order to save the highest percentage of human lives in the short term
To investigate why successful rabies control in the animal sector did not translate to beneficial effects in the human health sector through a lower demand for PEP, we investigated the available epidemiological follow-up data at the laboratory and health facility level
Summary
Within a One Health framework, rabies is likely the best documented example for the added value of closer collaboration of human and veterinary medicine for the control of zoonotic diseases [1]. In order to achieve the challenging goal of zero human deaths from dog-mediated rabies by 2030, as postulated by the World Health Organization (WHO) and partners [6], access to and the adequate use of PEP must be implemented. Vaccination of dogs is the only control measure that will lead to the elimination of rabies in domestic animals and result in a reduction of the exposure risk in humans by more than 90% [3]. Rabies control can lead to even higher PEP demand in the face of decreasing the exposure risk, which can be explained by heightened rabies awareness in the community [14,15,16]. The data collection was performed during an epidemiological follow up study on the dynamics of the dog rabies incidence, the human dog-bite incidence and the PEP demand during a rabies elimination program in N’Djaména, Chad
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