Toward Elimination of Dog-Mediated Human Rabies: Experiences from Implementing a Large-scale Demonstration Project in Southern Tanzania.

Emmanuel Mpolya ,Joel Changalucha,Lwitiko Sikana,Geofrey Mchau,Alphoncina Nanai,Maganga Sambo,Tiziana Lembo,Selemani Makungu,Chanasa Ngeleja,Katie Hampson,Rudovick Kazwala,Sarah Cleaveland,Zacharia Mtema,Kennedy Lushasi,Bernadette Abela-Ridder,Rebecca Mancy,Kristyna Rysava,Gurdeep Jaswant,Matthew Maziku,Eberhard Mbunda ,F X Meslin ,Sunny E Townsend

doi:10.3389/fvets.2017.00021

Abstract

A Rabies Elimination Demonstration Project was implemented in Tanzania from 2010 through to 2015, bringing together government ministries from the health and veterinary sectors, the World Health Organization, and national and international research institutions. Detailed data on mass dog vaccination campaigns, bite exposures, use of post-exposure prophylaxis (PEP), and human rabies deaths were collected throughout the project duration and project areas. Despite no previous experience in dog vaccination within the project areas, district veterinary officers were able to implement district-wide vaccination campaigns that, for most part, progressively increased the numbers of dogs vaccinated with each phase of the project. Bite exposures declined, particularly in the southernmost districts with the smallest dog populations, and health workers successfully transitioned from primarily intramuscular administration of PEP to intradermal administration, resulting in major cost savings. However, even with improved PEP provision, vaccine shortages still occurred in some districts. In laboratory diagnosis, there were several logistical challenges in sample handling and submission but compared to the situation before the project started, there was a moderate increase in the number of laboratory samples submitted and tested for rabies in the project areas with a decrease in the proportion of rabies-positive samples over time. The project had a major impact on public health policy and practice with the formation of a One Health Coordination Unit at the Prime Minister’s Office and development of the Tanzania National Rabies Control Strategy, which lays a roadmap for elimination of rabies in Tanzania by 2030 by following the Stepwise Approach towards Rabies Elimination (SARE). Overall, the project generated many important lessons relevant to rabies prevention and control in particular and disease surveillance in general. Lessons include the need for (1) a specific unit in the government for managing disease surveillance; (2) application of innovative data collection and management approaches such as the use of mobile phones; (3) close cooperation and effective communication among all key sectors and stakeholders; and (4) flexible and adaptive programs that can incorporate new information to improve their delivery, and overcome challenges of logistics and procurement.

Highlights

Rabies is one of the oldest known zoonosis, which is defined as an acute progressive encephalitis that almost inevitably results in death without timely intervention [1]
When the project was officially launched in Tanzania in 2010, mass dog vaccination campaigns were planned and delivered only in urban centers in Dar es Salaam and Morogoro as well as Ulanga and Kilombero districts where vaccination campaigns were ongoing in collaboration with the Ifakara Health Institute (Figures 2 and 3)
Operations were rapidly scaled up with mass vaccinations conducted across the rural areas of the project area in 2011

Summary

Introduction

Rabies is one of the oldest known zoonosis, which is defined as an acute progressive encephalitis that almost inevitably results in death without timely intervention [1]. With a growing recognition of the need for One Health approaches to tackle zoonotic diseases [3], it has been recognized that a paradigm shift is required to tackle human rabies in low- and middle-income countries (LMICs), by focusing on immunization of the primary reservoir hosts, the domestic dogs. In terms of the disease burden, rabies is responsible for an estimated 59,000 human deaths globally, about 96.0% of which occur in Africa and Asia [4]. The escalation of dog rabies across much of Asia and Africa is mainly due to the low priority given to control of the disease. This low priority is in turn due to a lack of awareness of the true scale and magnitude of the disease burden as well as misperceptions as to the feasibility, cost-effectiveness, and public health benefits of dog rabies control [5, 6]

Methods

Results

Conclusion