Abstract

Canine rabies transmission was interrupted in N’Djaména, Chad, following two mass vaccination campaigns. However, after nine months cases resurged with re-establishment of endemic rabies transmission to pre-intervention levels. Previous analyses investigated district level spatial heterogeneity of vaccination coverage, and dog density; and importation, identifying the latter as the primary factor for rabies resurgence. Here we assess the impact of individual level heterogeneity on outbreak probability, effectiveness of vaccination campaigns and likely time to resurgence after a campaign. Geo-located contact sensors recorded the location and contacts of 237 domestic dogs in N’Djaména over a period of 3.5 days. The contact network data showed that urban dogs are socially related to larger communities and constrained by the urban architecture. We developed a network generation algorithm that extrapolates this empirical contact network to networks of large dog populations and applied it to simulate rabies transmission in N’Djaména. The model predictions aligned well with the rabies incidence data. Using the model we demonstrated, that major outbreaks are prevented when at least 70% of dogs are vaccinated. The probability of a minor outbreak also decreased with increasing vaccination coverage, but reached zero only when coverage was near total. Our results suggest that endemic rabies in N’Djaména may be explained by a series of importations with subsequent minor outbreaks. We show that highly connected dogs hold a critical role in transmission and that targeted vaccination of such dogs would lead to more efficient vaccination campaigns.

Highlights

  • The viral disease rabies, transmitted between mammals through bites, is fatal following the onset of symptoms

  • Rabies transmission between dogs and from dogs to humans can be interrupted by mass vaccination of dogs

  • Rabies transmission was interrupted in January 2014 after the second vaccination campaign [3], but there was a resurgence of cases nine months later

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Summary

Introduction

The viral disease rabies, transmitted between mammals through bites, is fatal following the onset of symptoms. Rabies transmission was interrupted in January 2014 after the second vaccination campaign [3], but there was a resurgence of cases nine months later. Subsequent analyses considered reasons for the quick resurgence, including spatial heterogeneity of vaccination coverage, and dog density; underreporting of cases; and importation. Deterministic models can predict the effect of large scale vaccination campaigns and the overall population dynamics, they do not adequately capture effects of stochasticity in low level endemic settings. This becomes important towards the end of an elimination campaign or upon re-establishment after interruption of transmission [7]. Previous models did not include fine scale heterogeneity at the individual level or the network structure of dog to dog contacts

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