Epidemiological models of rabies in domestic dogs: dynamics and control

Abstract

Epidemiological models are frequently used to estimate basic parameters, evaluate

alternative control strategies, and set levels for control measures such as vaccination,
culling, or quarantine. However, inferences drawn from these models are sensitive to the
assumptions upon which they are based. While many simple models provide qualitative
insights into disease dynamics and control, they may not fully capture the mechanisms
driving transmission dynamics and, therefore, may not be reasonable approximations of
reality. This thesis examines how the predictions made by simple models are influenced
by assumptions regarding the dispersion of the transition periods, alternative infection
states, and transmission heterogeneity resulting from population structuring. More
realistic models of rabies transmission dynamics among domestic dogs in Serengeti
District (Tanzania) are developed and applied to the problem of assessing vaccination
efficacy, and designing pulsed vaccination campaigns. Several themes emerge from the
discussion of the models. First, the characteristics of outbreaks can be strongly influenced
by the dispersion of the incubation and infectious period distributions, which has
important implications for parameter estimation, such as the estimation of the basic
reproductive number, R0. Similarly, alternative infection states, such as long incubation
times, can substantially alter outbreak characteristics. Second, we find that simple SEIR
models fail to accurately capture important aspects of rabies disease outbreaks among
domestic dog populations in northern Tanzania, and therefore may be a poor basis for
assigning control targets in this system. More complex models that included the role of
human intervention in limiting outbreak severity, or that included population structure,
were able to reproduce the observed outbreak size distribution. We argue that there is
greater support for the structured population model, and discuss the implications of the
three models on the evaluation of vaccination efficacy. Third, at a more regional scale, we
build metapopulation models of rabies transmission among domestic dog sub-
populations. We use a Bayesian framework to evaluate competing hypotheses about
mechanisms driving transmission, and sources of reinfection external to the dog
population. The distance between sub-populations, and the size of the sub-populations
receiving and transmitting infection are identified as important components of
transmission dynamics. We also find evidence for a relatively high rate of re-infection of
these populations from neighbouring inhabited districts, or from other species distributed
throughout the study area, rather than from adjacent wildlife protected areas. We use the
highest ranked models to quantify the efficacy of vaccination campaigns that took place
between 2002-2007. This work demonstrates how a coarse, proximate sentinel of rabies
infection is useful for making inferences about spatial disease dynamics and the efficacy
of control measures. Finally, we use these metapopulation models to evaluate alternative
strategies of pulse vaccination in order to maximize the reduction in the occurrence of
rabies. The strategies vary in both the way in which vaccine doses are allocated to sub-
populations, and in the trade-off between the frequency and intensity of vaccination
pulses. The most effective allocation strategy was based on a measure of the importance
of sub-populations to disease dynamics, and it had 30-50% higher efficacy than the other
strategies investigated. This work demonstrates the strong potential for the role of
metapopulation models in optimizing disease control strategies.

Keywor Epidemiology, rabies, Beyer, H. L. (2010.). Epidemiological models of

rabies in domestic dogs : Dynamics and control.
ds: dynamics, metapopulation Thesis (Ph.D.) -- University of Glasgow, 2010.
The Epidemiology of Rabies in Thailand.
Abstract

This study was designed to investigate the epidemiology of rabies in Thailand and to evaluate the
rabies control programme. The study involved retrospective analysis of seven years data (1993 to
1999), concerning rabies incidence and control activity. Five datasets from four different
organisations responsible for rabies control in Thailand were collected between March and June,
2000. Control activity data were found to be incomplete due mainly to problems associated with
the data collection form and with methods of data storage and retrieval in provincial offices.
Recommendations are made in this thesis to modify the data collection form and data storage
methods to improve data collection and the usefulness of information collected in the future. The
annual cumulative incidence of rabies in both animals and humans has declined considerably
between 1993 to 1999 as a result of the control programme implemented under the Rabies Act
B.E. 2535 (1992). Rabies in humans is more common in males than females and is more
common in young children (less than 10 years of age) than any other age group. Dogs were the
most commonly submitted animal for rabies diagnosis as part of the surveillance programme,
accounting for 87% of the total of 40,649 submissions. Cows were more likely to return a positive
rabies diagnosis than any other animal (57% of a total of 409 animals submitted) while dogs
returned more cases than any other animal species (43% of a total of 35,338 animals submitted).
Detailed investigations were confined to dogs. Rabies was more common in non-owned dogs,
non-vaccinated dogs, dogs showing signs consistent with furious rabies, and dogs with a history
of having attacked or bitten either other animals or both animals and people. ii The spatio-
temporal pattern of rabies in both dogs and people, showed changes in the distribution of rabies
cases during the seven year period of the study. Mixed effect Poisson regression models
incorporating spatial and non-spatial random effect terms were used to investigate risk factors
associated with rabies. Factors associated with increasing risk of rabies in people at the province
level included: increasing dog density, increasing incidence of rabies in dogs, and reduction in
human population density. In the 1999 dataset, there was evidence of spatial clustering of rabies
risk. In addition a cluster of provinces showed an elevation in rabies risk that was unexplained by
the explanatory variables included in the model. The reason for this cluster of elevated risk
remains to be elucidated. Factors associated with an increasing risk of rabies in dogs at the
province level included increasing dog population density and increasing proportion of dogs
vaccinated against rabies. Relative risk estimates were close to one suggesting the strength of
the association for both terms was weak. Increased dog vaccination against rabies is likely to
occur in provinces with a higher risk of both animal and human rabies.

Panichabhongse, P. (2001). The Epidemiology of Rabies in Thailand.

https://www.massey.ac.nz/massey/fms/Colleges/College%20of
%20Sciences/Epicenter/docs/PraneePanichabhongseMVS.pdf?
D82675CCD4EE3A67E6535B14E28520E1
Studies on the Epidemiology and Control of Rabies in Bhutan

Rabies, a fatal and neglected zoonotic disease, is reported mainly from the southern parts of
Bhutan bordering India, but sporadic occurrences have been reported in other, previously free
areas. Domestic dogs play a principal role in the transmission of rabies and no wildlife rabies
cases have been reported so far in Bhutan. Although rabies has been endemic and causes
substantial financial losses, no detailed studies have been conducted to understand the
epidemiology of rabies in Bhutan. The overall objective of this research was to better understand
the epidemiology of animal and human rabies and estimate the cost of various rabies intervention
measures in humans and animals. This was the first epidemiologic research on rabies ever
conducted in Bhutan. Rabies surveillance data (1996 to 2009) and field surveys were used for
this epidemiologic research. The spatial and temporal distribution of animal rabies cases was
examined by using a Geographic Information System and time series analysis approaches. The
study showed that 59 of the 205 sub-districts in Bhutan reported animal rabies from 1996 to 2009
with increased incidences in the four districts in southern parts of Bhutan. Significant (P<0.05)
clusters of cases were observed in south central and south west Bhutan. More cases were
reported in cattle (n=447) and domestic dogs (n=317) and a significant cross correlation between
the number of reported cases in dogs and other domestic animals was demonstrated, wherein the
report of cases in dogs predicted cases in other domestic animals. Rabies cases were reported
throughout the year with more reports during spring and summer months, likely to be associated
with the breeding season of dogs. The annual patterns of cases were relatively stable until 2005,
but increased in 2006 and 2008. This increased incidence was associated with re-emergence of
rabies in eastern and south west Bhutan between 2005 and 2008, areas that had been previously
free from rabies. This major rabies outbreak in eastern Bhutan resulted in one human and 256
domestic animal deaths while the outbreak in south west Bhutan resulted in 97 animal deaths;
both outbreaks caused serious financial losses to society. During these outbreaks, large numbers
of people (~2000) were directly or indirectly exposed to either suspected rabid animals or animal
products derived from rabid animals and were given post-exposure prophylaxis. The outbreak in
eastern Bhutan was believed to have been due to an iv incursion from across the border while
local spread from the endemic areas or an incursion was hypothesized in the south-west Bhutan
outbreak. The high densities and movements of stray dogs with inadequate control measures
were responsible for the rapid spread and persistence of the infection for about two years (from
May 2005 to November 2007) in eastern Bhutan. In contrast, the outbreak in south west Bhutan
during 2008 was controlled within six months by culling of stray dogs, mass dog vaccination, and
impounding of dogs. Anthropogenic factors − including human population characteristics and its
movement, road network accessibility, and high dog density − played a major role in the spread of
disease during both of these outbreaks. The assessment of risk factors for the occurrence of
rabies at the sub-district level identified the socio-demographic and anthropogenic factors
significantly associated with reporting of rabies in domestic animals in Bhutan. Sharing a common
border with India was found to be the most important individual predictor of the overall distribution
of rabies occurrence in Bhutan (odds ratio 10.43; 95% CI: 4.42–24.64; P<0.001). Of the 59 sub-
districts that reported rabies in Bhutan, 43 (73%) shared a border with India. The trans-border
movement or translocation of stray dogs and an inadequate control program may be responsible
for the maintenance of rabies endemicity and transmission among the stray dog population in
these border areas. Molecular and phylogenetic analyses further demonstrated that Bhutanese
rabies virus isolates were found to be closely related to Indian rabies virus strain and belong to
Arcticlike-1 viruses which are widely circulating in the Indian sub-continent. This study suggests
that the rabies viruses spreading in southern parts of Bhutan have originated from a common
ancestor. However, more sampling is needed from Bhutan-India border areas to understand the
transmission dynamic of rabies virus in the region. In humans, rabies cases were found to be
sporadic, mainly reported in the canine rabies endemic areas of southern Bhutan. A total of 15
human rabies deaths was reported between January 2006 and July 2011 (with 5 deaths reported
in 2011 alone), equivalent to a cumulative incidence of 2.14 per 100000 population (annual
incidence of 0.28 per 100000 people). Although the number of human rabies deaths was
sporadic, there were increased number of dog bite incidents and post-exposure prophylaxis
(PEP) administration to the patients. In order to understand the use and distribution of rabies v
PEP in humans, PEP data for the period from 2005 to 2008 were retrieved from the hospital
medical database and analysed. The study showed that PEP was provided to the patients free of
charge by the medical hospitals in Bhutan, and followed the 5-dose Essen intramuscular regimen.
A significant (P<0.001) difference in gender and age groups receiving PEP was observed: males
received more PEP than females across all age groups. Children − particularly 5–9 years of age −
received more PEP than other age groups, indicating children and males are more at risk of
rabies exposure in Bhutan. PEP was provided throughout the year with a higher number of doses
administered during the winter and spring months, and was given to both animal bite and non-bite
exposures. The study also identified a lack of patient compliance to complete the course of PEP:
some 40% (n = 3360) of the patients received an incomplete course of vaccine (less than the
required course of 5-doses). However, the results suggest that patients with animal bite injury
were less likely to receive an incomplete vaccine course than non-bite recipients. Secondly,
patients presented to hospitals in rabies endemic or outbreak areas were less likely to receive an
incomplete course than in rabies free interior Bhutan, thus reducing the chances of vaccination
failures. The study also showed that the PEP was provided to patients that have low or no risk of
rabies exposure. Therefore, a thorough assessment of each individual case based on the WHO
guidelines would reduce unnecessary use of PEP, and therefore costs in Bhutan. The main
reason for providing PEP was found to be due to dog bites. To better understand the dog bites
incidents in humans, a hospital-based survey was conducted at the three hospitals in Western
and Southern Bhutan (Thimphu, Phuentsholing and Gelephu) for a period of nine months. The
study revealed that dog bites in human are common in the survey areas and showed significant
(P<0.001) gender and age differences in bite incidents. Males were more at risk of dog bites than
females, and the children aged 5–9 years were bitten more than other age groups, which
substantiate our earlier findings of more use of PEP in males and children. The majority of victims
were bitten by stray dogs, and the most common anatomical bite sites were on the legs. Using
data on the anatomical location of dog bites in humans and a probability of dying from rabies, a
decision tree model was constructed to estimate human deaths from rabies in two rabies endemic
areas of southern Bhutan. Based on the official reported cases of vi rabies in two hospital areas
(Gelephu and Phuentsholing) in southern Bhutan, the average number of human rabies death
was 1.5 (95% CI: 0.75–3.00) per year, equivalent to an annual incidence of 3.14 (95% CI: 1.57–
6.29) per 100,000 population. The decision tree model predicted 2.23 (95% CI: 1.20−3.59) human
deaths from rabies per year, equivalent to an annual incidence of 4.67 (95% CI: 2.53–7.53)
deaths per 100,000 populations. This indicated that no major underreporting of human rabies
deaths has occurred, unlike in other rabies endemic countries, although some underreporting of
dog bites is possible. In the absence of post-exposure prophylaxis, the model predicted 19.24
(95% CI: 13.69– 25.14) deaths per year, equivalent to an annual incidence of 40.31 (95% CI:
28.70–52.68) per 100,000 population, suggesting post-exposure prophylaxis is important to
prevent human rabies deaths. Since both dog bite incidents and the use of PEP were high in
Bhutan, a cross-sectional study was conducted at Gelephu (south central Bhutan), an area
endemic for rabies, to understand people’s level of knowledge and awareness about rabies. The
study showed that a majority of the interviewed respondents had heard of rabies, and had a
positive attitude towards the prevention and control of rabies. About 84 to 92% of the respondents
also mentioned that they would report to the hospital for treatment if bitten by dogs and other
animals, indicating good health seeking behaviours of the people. The respondents also had a
positive attitude towards prevention and control of rabies in dogs by vaccination. However, these
findings also indicated the existence of some knowledge gaps (knowledge about rabies and its
transmission and importance of wound washing) which could be filled by creating awareness
education programmes on: the danger of rabies and mode of transmission to humans and
importance washing animal bite wound and visiting a hospital for post-exposure prophylaxis.
Since rabies causes substantial financial losses to society, understanding the cost-benefit or cost-
effectiveness of the intervention programme is important. Quantification of the financial cost of
rabies intervention in Bhutan suggested that the average direct medical cost of human PEP
(using rabies vaccine only) was approximately Bhutanese Ngultrum (Nu) 1615 (US$ 35.65) per 5-
dose Essen regimen per patient. The cost would increase to Nu. 2497 (US$ 55.13) and Nu.
19633 (US$ 433.41) per patient, if one dose of either equine rabies immunoglobulin (ERIG) or
human rabies immunoglobulin (HRIG) was administered, respectively. The societal cost (public
plus private cost) per patient was vii estimated to be Nu. 2019 (US$ 45), Nu. 2901 (US$ 64), and
Nu. 20037 (US$ 442) using vaccine alone, vaccine with ERIG and vaccine with HRIG,
respectively. The average cost per dog vaccination was estimated to be Nu. 75 (US$ 1.66) and
the cost per dog sterilization was estimated to be Nu. 288 (US$ 6.52). The total direct medical
cost due to rabies (including surveillance and livestock loss cost, PEP in human and dog
vaccination and sterilization) between 2001 and 2008 was estimated to be Nu. 48.54 million (US$
1.07 million). The analysis also showed that mass dog vaccination would be more costeffective
than intensified post-exposure prophylaxis in human alone. The above findings suggest that an
area bordering India in the south were at higher risk of reporting rabies than the interior of Bhutan.
More resources for rabies control programs and surveillance should be targeted and focussed in
the highly endemic ‘hot spot’ areas of southern Bhutan. Mass vaccination of dogs in the border
areas in the south would create an immune buffer (cordon sanitaire) and prevent incursion of
rabies into interior Bhutan. A One-Health approach for rabies control in Bhutan should be
implemented towards elimination of rabies through creation of effective partnership focussing on
coordinating research, operational activities and pooling of resources between public health and
veterinary services. Elimination of rabies through mass dog vaccination would reduce the
recurrent cost of intensified PEP in humans and will produce economic savings in the long run by
preventing human and livestock deaths and by discontinuing the intensified use of PEP in
humans and rabies control programmes. Public awareness education is necessary and should
include: the risk of rabies exposure; importance of preventing dog bites and wound washing and
visiting health centres following dog bites and exposure to suspected rabid animals.
Epidemiological surveillance of rabies should be improved by the laboratory confirmation of all
suspected cases, including human, and the data so generated should be shared between the
public health and veterinary sectors and also relevant international organizations. International
collaboration is necessary for technical and financial support for sustaining rabies control in
Bhutan

Tenzin. (2012, March 21). Studies on the Epidemiology and Control of Rabies in Bhutan.
https://ses.library.usyd.edu.au/bitstream/2123/10489/4/tenzin_thesis.pdf
RABIES SERO-SURVEY IN VACCINATED DOMESTIC DOGS AND KNOWLEDGE
ASSESSMENT OF RABIES AMONG DOG OWNERS, OHANGWENA REGION, NAMIBIA

ABSTRACT

Rabies kills over 55,000 people worldwide annually of which about 97% die resulting from the bite(s)
of rabid dogs. Despite the free annual vaccination of dogs in Namibia and Ohangwena region in
particular, rabies is still on the increase in both animals and humans. We conducted this study to
establish the level of protection against rabies in the vaccinated domestic dogs through antibody
testing. Furthermore, the study assessed the level of people’s knowledge on rabies. A descriptive
cross-sectional study design was used. A random sample of 170 sera was collected from the dogs after
one year from the previous vaccination. We tested sera at the Central Veterinary Laboratory using the
BioPro Rabies ELISA test kit and defined rabies protective antibody titre as titres ≥0.5IU/mL. Data
were collected using a structured questionnaire and analysed using Epi info 7 and Microsoft excel.
Among the 170 dogs, 136 (80%) acquired protective antibody titres (95% CI: 73.2%- 85.7%). The
majority of samples came from dogs younger than 3 years 90(53%). However, dogs older than 3 years
maintained rabies protective antibodies better than the younger dogs (87% versus 74%), Chi2= 4.2,
df=1, P=0.04. About 88% of dogs that received repeated vaccinations (boosters) over the years
maintained protective antibodies compared to only 74% of dogs that received a single vaccination a
year ago without a booster (P= 0.03). Eighty (80%) of the vaccinated dogs maintained protective
rabies antibodies. High level of protective antibodies was observed more in older dogs and dogs that
received booster vaccinations over the last three years. We recommend rabies vaccination to be
conducted twice per year and forceful vaccination be instituted for iv stray dogs and dogs that are
difficult to handle during the campaigns. Cooperation among relevant stakeholders should be
instituted to ensure effective rabies control.

Key words: rabies, dogs, protective, antibodies, vaccination

HIKUFE, E. (2016, April). RABIES SERO-SURVEY IN VACCINATED DOMESTIC

DOGS AND KNOWLEDGE ASSESSMENT OF RABIES AMONG DOG OWNERS,
OHANGWENA REGION, NAMIBIA.
Overview, Prevention, and Treatment of Rabies

Abstract
Rabies is a uniformly fatal viral encephalitis that causes 30,000 to 70,000 deaths
worldwide each year. Prevention is the primary approach to the disease. In the United
States, 25,000 to 40,000 people are treated annually for exposure to rabid or potentially
rabid animals at a per-patient cost exceeding 1000 dollars. Rabies is transmitted usually
by saliva from infected animal bites. However, recent findings that rabies can be
transmitted from bats to humans by relatively casual contact has resulted in dramatic
changes in guidelines from the Centers for Disease Control and Prevention for
postexposure prophylaxis. We review the 5 clinical stages of rabies, current methods of
diagnosis, and prevention in animal reservoirs and in humans. We also discuss the use of
rabies immune globulin and active and passive vaccinations for preexposure prophylaxis
and postexposure treatment of rabies. Human exposure to rabies will always be a
possibility, but methods to prevent the disease both before and after exposure to the virus
are safe and readily available.

Hankins, D. G., MD, & Rosekrans, J. A., MD. (2004, June). Overview, Prevention, and
Treatment of Rabies. Mayo Clinic Proceedings 79(5):671-6.
Review of Rabies Epidemiology and Control in South, South East and East Asia: Past, Present
and Prospects for Elimination

Abstract

Rabies is a serious public health problem in Asia. It causes substantial animal welfare, economic and
human health impacts, with ~39,000 human deaths each year. Domestic dogs are the main reservoir
and source of rabies in Asia. Common constraints for the control of rabies in the countries of Asia
include inadequate resources; lack of political commitment to control programs; lack of consensus on
strategy; weak intersectoral coordination and inadequate management structure; insensitive
surveillance systems; limited accessibility to modern rabies vaccine and supply problems; lack of
public awareness and public cooperation; and the existence of myths and religious issues. In this
review, we summarise the epidemiology of rabies in both human and animals in each South and South
East Asian country, the past and current approaches to control, and the prospect for rabies elimination.
We conclude that defining the cost of rabies to society and communicating this to decisionmakers
might be the key to achieving such an advance

Keywords: Rabies, Human and animals, Epidemiology, control programs, south Asia, South East Asia

Tenzin, & Ward, M. P. (2012, July 14). REVIEW OF RABIES EPIDEMIOLOGY AND
CONTROL IN SOUTH, SOUTH EAST AND EAST ASIA: PAST, PRESENT AND
PROSPECTS FOR ELIMINATION. Zoonosis and Public Health (in Press). doi:doi:
10.1111/j.1863-2378.2012.01489.x
 Compendium of Animal Rabies Prevention and Control, 2016

Rabies is a fatal viral zoonosis and serious public health problem.1 All mammals are believed to
be susceptible to the disease, and for the purposes of this document, use of the term animal refers to
mammals. The disease is an acute, progressive encephalitis caused by viruses in the genus Lyssavirus.
2 Rabies virus is the most important lyssavirus globally. In the United States, multiple rabies virus
variants are maintained in wild mammalian reservoir populations such as raccoons, skunks, foxes, and
bats. Although the United States has been declared free from transmission of canine rabies virus
variants, there is always a risk of reintroduction of these variants.3–7 The rabies virus is usually
transmitted from animal to animal through bites. The incubation period is highly variable. In domestic
animals, it is generally 3 to 12 weeks, but can range from several days to months, rarely exceeding 6
months.8 Rabies is communicable during the period of salivary shedding of rabies virus. Experimental
and historic evidence documents that dogs, cats, and ferrets shed the virus for a few days prior to the
onset of clinical signs and during illness. Clinical signs of rabies are variable and include in appetence,
dysphagia, cranial nerve deficits, abnormal behavior, ataxia, paralysis, altered vocalization, and
seizures. Progression to death is rapid. There are currently no known effective rabies antiviral drugs.
The recommendations in this compendium serve as a basis for animal rabies prevention and control
programs throughout the United States and facilitate standardization of procedures among
jurisdictions, thereby contributing to an effective national rabies control program. The compendium is
reviewed and revised as necessary, with the most current version replacing all previous versions.
These recommendations do not supersede state and local laws or requirements. Principles of rabies
prevention and control are detailed in Part I, and recommendations for parenteral vaccination
procedures are presented in Part II. All animal rabies vaccines licensed by the USDA and marketed in
the United States are listed and described in Appendix 1, and contact information for manufacturers of
these vaccines is provided in Appendix 2. Modifications of note in this updated version of the
compendium, compared with the previous version,9 include clarification of language, explicit
encouragement of an interdisciplinary approach to rabies control, a recommendation to collect and
report at the national level additional data elements on rabid domestic animals, changes to the
recommended management of dogs and cats exposed to rabies that are either unvaccinated or overdue
for booster vaccination, reduction of the recommended 6-month quarantine period for certain species,
and updates to the list of marketed animal rabies vaccines.
Brown, C. M., Slavinski, S., Ettestad, P., Sidwa, T. J., & E. Sorhage, F. E. (2016,
March 1). Compendium of Animal Rabies Prevention and Control, 2016. Public
Veterinary Medicine: Public Health. Retrieved from
http://nasphv.org/Documents/NASPHVRabiesCompendium.pdf
 A dog ecology study in an urban and a sem1-rural area
of Zambia
ABSTRACT
DE BALOGH, K.K.I.M., WANDELER, A.l. & MESLIN, F.-X. 1993. A dog ecology
study in an urban and
a semi-rural area of Zambia. Onderstepoort Journal of Veterinary Research, 60:437-443
Characteristics of dog populations and their accessibilityfor rabies vaccination were
compared in an urban and a semi-rural area in Zambia. A total of 1190 households were
interviewed. In the urban study area (Mutendere, a low income suburb of Lusaka) only 11
% of the households kept dogs with a dog:human ratio of 1:45. In the semi-rural area
(Palabana) dogs were kept by 42% of households with a dog:human ratio of 1:6,7. In
conjuction with the study of the dog populations in these two areas, immunization of dogs
against rabies was provided by door-to-door visits in both study areas and also through
central point vaccination in the urban area. The attitude of the public towards free rabies
vaccinations was positive, althoughsome misconceptions regarding indications and
modalities of treatment following exposure to suspect dogs
were found.Approximately 50% of the dog removals were as a result of disease and the
demand for dogs was higher than the supply. Although only information on the owned
segment of the dog population was obtained during the study, the proportion of ownerless
dogs appeared to be very low. Generally, there is a need for better co-ordination between
the different services involved in rabies control in Zambia to enhance the sustainability of
vaccination programmes and improve the treatment of persons bitten by dogs.

DE BALOGH, K.K.I.M., WANDELER, A.l. & MESLIN, F.-X. 1993. A dog ecology
study in an urban and
a semi-rural area of Zambia. Onderstepoort Journal of Veterinary Research, 60:437-
443
Abstract

Wenwu Yin and co-workers conducted a systematic review on challenges and needs to
eliminate rabies in China (Yin et al., 2013 in this journal). Their analysis shows that there
is considerable overrepresentation of laboratory and basic epidemiology research. On the
other hand, information on effective control activities and policies are nearly absent.
Currently we know enough to control and eliminate dog rabies effectively. Continuing
basic research while not engaging in the control of rabies appears almost cynical. Why is
it not attractive to do research on effective control and elimination? Let us move now
from the biological understanding to the science of rabies elimination.

Keywords
Rabies ,Dog China Control Elimination

Zinsstag, J. (2013, October 2). Towards a science of rabies elimination. Infectious

Diseases of Poverty. doi:10.1186/2049-9957-2-22
ASEAN RABIES ELIMINATION STRATEGY

Abstract

The ASEAN Rabies Elimination Strategy (ARES) has been developed to provide a strategic
framework for the reduction and ultimate eradication of rabies in ASEAN Member States. The
strategy describes an integrated ‘One Health’ approach that brings together the necessary socio-
cultural, technical, organizational and political pillars to address this challenge. Rabies is a neglected
zoonotic disease. However, the tools are available and it is the neglected zoonotic disease most
amenable to control. Accordingly, rabies is the first zoonosis on the list of neglected diseases targeted
for regional and eventually global eradication. The 2008 ASEAN Call for Action towards the
Elimination of Rabies in the ASEAN Member States and the Plus Three Countries (China, Japan and
Korea) by 2020 demonstrated the key importance attached to rabies control at a political level. The
ARES is designed to complement the existing sub-regional frameworks developed to control and
eliminate human rabies, such as those developed by the ASEAN Expert Group on Communicable
Diseases (AEGCD) in 2010 and by the WHO South-East Asia Regional Office (SEARO) in 2012.
ASEAN endorsement of the ARES and commitment will be sought through the ASEAN Sectoral
Working Group for Livestock (ASWGL), ASEAN Expert Group on Communicable Diseases
(AEGCD), Senior Officials Meeting on Health Development (SOMHD) and AMAF processes. Once
the strategy is endorsed, implementation will be the responsibility of National Governments. The
World Organisation for Animal Health (OIE), the United Nations Food and Agriculture Organization
(FAO), the World Health Organization (WHO) will oversee developments and provide advice. Success
will be dependent on effectiveness of interdisciplinary and inter-sectoral collaboration. A wide range
of organizations, such as medical services, the community, scientists, academics, policy makers and
non-government organizations (NGOs) will need to be kept engaged to ensure the successful
implementation of the ARES at the Member State level. Political support will be essential as will the
provision of adequate resources. The ARES is consistent with contemporary One Health approaches
and the management of zoonoses in general. The populations of rabies endemic and non-endemic
countries will benefit from the concerted efforts outlined in the Strategy.

ASEAN RABIES ELIMINATION STRATEGY. (n.d.). Retrieved October 15, 2016.

 DEVELOPING A STEPWISE APPROACH FOR RABIES PREVENTION AND
CONTROL

Abstract

More than 50 000 people die from rabies worldwide every year. Most of the victims
live in developing countries in Africa and Asia, and are exposed to the rabies virus
through dog bites. Every case of rabies prevented is a life saved, so there is an urgent
need to implement rabies prevention diligently and globally. In November 2012, the Food
and Agriculture Organization of the United Nations (FAO) and the Global Alliance for
Rabies Control (GARC) convened 21 experts in canine rabies surveillance and prevention
at FAO headquarters in Rome, Italy, to develop a new tool to aid health programme
planners and managers. Participants included rabies experts from two rabies-endemic
countries (Kenya and China), academic institutions, GARC, the World Health
Organization (WHO), the World Organisation for Animal Health (OIE) and FAO.
Building on successes and lessons learned in the use of the FAO-developed progressive
control pathway for Foot-and-Mouth disease, the workshop participants developed the
first model for a stepwise approach to rabies prevention and control. The approach
comprises six stages, ranging from Stage 0, where no information on rabies is available in
a suspected rabies-endemic area, to Stage 5, where valid and timely epidemiological
surveillance data confirm the elimination of rabies in humans and canines. The stepwise
approach is intended for adoption and adaptation by national rabies control and
elimination programmes as a tool for managing rabies surveillance, control and
prevention.

Proceedings of the FAO/GARC Workshop, November 2012, Rome, Italy. FAO Animal
Production and Health Proceedings, No. 18. Rome, Italy
WHO Expert Consultation on Rabies re-evaluates the burden and methods of
treatment
The second report of a WHO Expert Consultation on Rabies calls for strong, effective
and inter-sectoral collaboration to progress the elimination of rabies at all levels.
Human rabies transmitted by dogs accounts for more than 95% of the estimated
number of rabies deaths globally.

According to the report (WHO Technical Report Series, No. 982 [pdf 3.7Mb]) about
60000 people, mostly children, die from human dog-mediated rabies every year mostly
in Africa and Asia. This poses a significant health and economic burden and incurs the
annual use of 70 million doses of human rabies vaccines in an estimated 20 million
people, mostly in developing countries.

“The societal cost of rabies worldwide is a lot more, maybe in excess of US$ 6 billion
per year” said Dr Bernadette Abela-Ridder, Team Leader, Neglected Zoonotic
Diseases, WHO Department of Control of Neglected Tropical Diseases. “It includes an
estimated US$ 1.6 billion spent on post-exposure prophylaxis.”

Statistics show that the majority of human rabies deaths occur in poor, rural
communities without dog bite management centres with access to PEP and rabies
biologicals.

The TRS recommends that efforts to advocate for prevention of human rabies should
be sustained through elimination of the disease in dogs and in promoting wider use of
intradermal PEP, which reduces the volume and cost of cell-cultured vaccine by an
estimated 60–80%. Effective measures to prevent the disease are available in its major
animal host – the dog – but are often not implemented.

At present, under-reporting remains a main obstacle to assessing the incidence of the

disease. Under-reporting also prevents mobilization of resources and undermines
implementation of control and prevention measures, such as dog vaccination.

The WHO Technical Report Series (TRS No. 982) presents progress made in tools and
current strategies forrabies with a focus on human dog-mediated rabies, which include:

1 new recommendations for pre- and post-exposure prophylaxis and management of

rabid patients;
2 design and implementation of comprehensive dog and wildlife rabies control
programmes;
3 the health and economic burden of the disease;
4 classification of rabies and other lyssaviruses;
5 laboratory diagnosis of rabies in humans and animals;
Other novel approaches relating to applied research on the health economics of dog
vaccination for human rabies prevention, and the sustainability and cost-effectiveness
of such programmes in various cultural, ecological and economic settings are also
examined. Consideration is given to the potential for integrating dog rabies control
with other dog-borne zoonoses such as echinococcosis and Leishmaniases.
National rabies control programmes would need to involve at a minimum the animal
and public health sectors but also others such as the education sector, local
government, police and civil society, animal welfare and conservation associations.

Elimination of rabies is technically feasible through dog immunization campaigns that

achieve 70% coverage combined with humane dog population management, effective
surveillance and coordinating disease control efforts across national and regional
borders.

Key to attaining the elimination goal will be building awareness and securing political
commitment to implement and disseminate available tools.
Joint statement of FAO,OIE and WHO on World Rabies Day 2013
http://www.fao.org/news/story/en/item/198087/icode/

Immunization, Vaccines and Biologicals

Rabies
Rabies is a zoonotic viral disease which infects domestic and wild animals. It is
transmitted to other animals and humans through close contact with saliva from
infected animals (i.e. bites, scratches, licks on broken skin and mucous membranes).
Once symptoms of the disease develop, rabies is fatal to both animals and humans.

Approximately 60 000 people die from rabies each year. The vast majority of these
deaths occur in Asia and Africa. Children are at particular risk.

Two types of vaccines to protect against rabies in humans exist - nerve tissue and cell
culture vaccines. WHO recommends replacement of nerve tissue vaccines with the
more efficacious, safer vaccines developed through cell culture as soon as possible.
Cell culture vaccines which are more affordable and require less vaccine have been
developed in recent years.

Intradermal immunization using cell-culture-based rabies vaccines is an acceptable

alternative to standard intramuscular administration. Intradermal vaccination has been
shown to be as safe and immunogenic as intramuscular vaccination, yet requires less
vaccine, for both pre- and post-exposure prophylaxis, leading to lower direct costs.
This alternative should thus be considered in settings constrained by cost and/or supply
issues.

Pre-exposure prophylaxis is recommended for anyone at continual, frequent or

increased risk of exposure to rabies virus, either by nature of their residence or
occupation.

Periodic booster injections are recommended as an extra precaution only for people
whose occupation puts them at continual or frequent risk of exposure. If available,
antibody monitoring of personnel at risk is preferred to the administration of routine
boosters.
Recommendations for post-exposure depend on the type of contact with the suspected
rabid animal. For category I exposure (touching or feeding animals, licks on intact
skin), no prophylaxis is required; for category II (nibbling of uncovered skin, minor
scratches or abrasions without bleeding), immediate vaccination; and for category III
(single or multiple transdermal bites or scratches, contamination of mucous membrane
with saliva from licks, licks on broken skin, exposures to bats), immediate vaccination
and administration of rabies immunoglobulin are recommended.
WHO Immunization, Vaccines and Biologicals – Rabies
http://www.who.int/immunization/diseases/rabies/en/
Controlling rabies

Dogs: the main carrier of rabies

More than 95% of human cases of rabies are due to bites from infected dogs. Controlling
and eradicating rabies therefore means combatting it at its animal source.
The solution: dog vaccination
Mass vaccination of dogs is the method of choice, because it is the only real way to
interrupt the disease’s infectious cycle between animals and humans.
Rabies control programmes
Some countries have already managed to eradicate the disease by applying strict
prophylactic measures. But it remains endemic in other countries, mainly affecting wild
host species.
In countries where rabies is endemic, measures are in place to control and reduce the risk
of infection in vulnerable populations (wildlife, stray and domestic animals) and create a
barrier between the animal source and humans.
To achieve this, there need to be mass dog vaccination campaignscombined with public
information campaigns and the improvement of access to human medical care (anti-rabies
vaccines and sera).
The effective control of stray dog populations and responsible behaviour by dog owners
OIE Standards on rabies
The OIE develops and publishes regularly updated, scientific standards regarding:
1 the prevention and control of rabies;
2 stray dog population control;

3 the international movement of dogs and cats originating from rabies infected
countries;
4 diagnostic methods and the production of vaccines of a veterinary standard.
These standards have been adopted through consensus by all 180 OIE Member Countries.
The OIE has been striving to combat rabies for decades
Aside from its normative work, the OIE has two objectives:
5 Ensuring transparency regarding knowledge of the disease at the animal level,
through an obligation for the OIE’s 180 Member Countries to declare cases and the
gathering of scientific data from its worldwide network of reference laboratories.
6 Also, encouraging governments and international donors to invest in rabies control
programmes, and particularly in the vaccination of dogs.
Veterinarians and the national Veterinary Services of OIE Member Countries have a
major role to play in implementing these strategies at the national and regional level.
Their involvement is a vital element in coordinating operations between public health
services, local authorities including town councils, law enforcement agencies, and NGOs
working in some of the poorest countries.
The OIE supports the vaccination campaigns of its Member Countries
Support for developing countries is essential. With the financial support of the European
Union, Australia, Germany and France, the OIE World Animal Health and Welfare Fund
has already enabled various steps to be taken, such as the creation of an anti-rabies dog
vaccine bank to be used by some of Asia’s and, since 2014, of Africa’s poorest countries.
To date (Aug. 2016), 12.5 million anti-rabies vaccines have been disseminated by the
OIE. Of these, 4 million have been directly delivered by the OIE to fifteen countries to
aid their national vaccination programmes. An additional 3.5 million doses have been
ordered by countries or international organisations, bringing the total number of rabies
vaccines requested to over 16 million.
In addition, in the framework of the Tripartite Alliance (WHO, OIE, FAO) on rabies
control, the World Health Organization (WHO) has decided to place its procurement
orders for canine vaccines through the OIE Rabies Vaccine Bank. As of August 2016, 11
million doses of rabies vaccines were purchased by WHO through the OIE Rabies
Vaccine Bank for delivery to the Philippines, South Africa and Tanzania.
This model guarantees the availability of high-quality vaccines complying with OIE
intergovernmental Standards as well as their rapid delivery on the ground and a price
obtained after a global competition between potential providers.
OIE Rabies Portal http://www.oie.int/en/animal-health-in-the-world/rabies-portal/
Mass Dog Vaccination Could Eliminate Rabies Globally

1 Rettner, R. (n.d.). Mass Dog Vaccination Could Eliminate Rabies Globally.

Retrieved October 15, 2016, from http://www.livescience.com/48016-rabies-elimination-
dogs.html

It is possible to eliminate cases of the deadly rabies virus in people worldwide through
mass vaccinations of dogs, some researchers argue.
Rabies cases are extremely rare in developed countries — in the United States, there was
just one rabies case in 2013, and the patient acquired the disease while in Guatemala,
according to researchers from Washington State University. Effective rabies vaccines
ﾧ have been available for years, but the virus still kills more than 69,000 people yearly
worldwide, most of them children in Africa and Asia.
The rabies vaccine can be given to people after a possible exposure to the virus, and is
extremely effective in preventing the disease from taking hold. But once a person begins
to show symptoms of rabies — which can include delirium, abnormal behavior,
hallucinations and partial paralysis — the disease is almost always fatal.
"The irony is that rabies is 100 percent preventable. People shouldn't be dying at all," said
Dr. Guy Palmer, a veterinary infectious disease expert at Washington State University's
Allen School for Global Animal Health. [5 Viruses That Are Scarier Than Ebola ﾧ]
In an article published today (Sept. 25) in the journal Science, Palmer and his colleagues
argue that eliminating rabies cases is possible if doctors, veterinarians and public health
professionals work together to establish mass vaccination programs for dogs.

Although rabies can infect many different animals, studies show that domestic dogs ﾧ,
rather than wildlife, are the main source of rabies infections in people, the researchers
said.
In his article, Palmer pointed to a 2009 study that found that vaccinating 70 percent of
dogs in villages in the East African country of Tanzania was enough to break the chain of
rabies transmission from dogs to people, and eventually eliminate the disease in those
areas.
Since a mass dog vaccination program began in Tanzania in 2003, the number of deaths
from rabies droped from 50 a year to almost zero, the researchers said.
Studies also show that vaccinating 70 percent of dogs in an area is cost-effective, and less
expensive over the long term than providing vaccinations to bite victims, the researchers
said.
In many countries, progress toward eliminating rabies is "hampered by lack of political
commitment and financing," the researchers wrote. Support from international human and
animal health organizations could play an important role in scaling up pilot dog
vaccination programs to the national level, they said.
"Caine rabies elimination meets all the criteria for a global health priority: It is
epidemiologically and logistically feasible, cost effective, and socially equitable," they
wrote.

The vision of Louis Pasteur ﾧ, who invented the first rabies vaccination in 1885 and
wanted to rid the world of the disease, "is within our reach," the researchers said.
ASEAN Rabies Elimination Strategy: Ending Rabies Together by 2020

16 September 2015
It is estimated that 608 million people are potentially at risk of rabies in Southeast Asia
with seven out of ten ASEAN (Association of Southeast Asia Nations) Member States
(AMS) endemically infected with rabies. Cambodia, Indonesia, Lao PDR, Myanmar, the
Philippines, Thailand and Vietnam are all rabies endemic, with dogs remaining the most
important maintenance host and 96% of documented human cases due to contact with
infected dogs.
Three countries, namely Singapore, Brunei and Malaysia, are historically free of rabies.
However, just this August, rabies was reported in a dog in the northern part of Malaysia
which is close to Thailand and Myanmar. The last rabies case reported in a domestic
animal by Malaysia was in 1999. This incident further highlights the transboundary
nature of rabies as a disease and the need for a regional approach for disease elimination.
The ASEAN Rabies Elimination Strategy (ARES) provides a strategic framework for the
reduction and elimination of rabies in the AMS. It anchors on the “One Health “approach
through the use of STOP pillars which are defined as S-Socio cultural; T-Technical; O-
Organizational and One Health Framework; P-Policy and Legislative.
The Socio cultural pillar focuses on the need to understand the motivations of different
stakeholders involved in rabies elimination and developing appropriate messages for
communities to protect human health, animal health and animal welfare. The Technical
pillar highlights the importance of competent human and veterinary services to be able to
control rabies in dogs as well as public health interventions to treat humans bitten by a
possibly rabid animal. Coordination between veterinary and human health services are
the key in the Organizational and One Health pillar, such as in Integrated Bite Case
Management wherein both sectors are involved whenever rabies in a dog or a human is
reported. The Policy and Legislative pillar emphasizes on the importance of national
legislation on rabies as well as provision for human and financial resources.
The ARES was jointly endorsed by the 36th ASEAN Ministerial Meeting on Agriculture
and Forestry and the 12 ASEAN Health Ministers Meeting respectively held in
September 2014. Viet Nam as the lead country for rabies control, through its Ministers of
Agriculture and Rural Development and Health, have further expressed confidence that
through ARES, cooperation and collaboration between and among Member States and
other stakeholders will be strengthened.
Other partners involved in the development and implementation of the strategy include
the Food and Agriculture Organization of the United Nations, World Organisation for
Animal Health (OIE), World Health Organization, World Animal Protection, and Global
Alliance for Rabies Control.
The ARES was designed to complement the existing sub-regional frameworks developed
to control and eliminate human rabies, such as those developed by the ASEAN Expert
Group on Communicable Diseases (AEGCD) in 2010 and by the WHO South-East Asia
Regional Office (SEARO) in 2012. The call to action ‘Towards the Elimination of Rabies
in the ASEAN Member States and the Plus Three Countries’ in 2008 was the catalyst for
the regional elimination of rabies in ASEAN.
Through an AEGCD-ASWGL joint consultative workshop on 30-31st March 2015 in
Chiang Mai, Thailand, the ARES Action Plan was developed to identify and prioritize the
regional activities to be able to develop and ARES Operational Plan and mobilize
technical and financial support from relevant stakeholders/partners to effectively
implement ARES.
As part of the ASEAN World Rabies Day celebration in 2015, copies of the final version
of ARES will be distributed to all ASEAN member states.
Contributed by Sarah Jayme, GARC’s country representative in Philippines, with
excerpts from the ASEAN news story, the ASEAN Rabies Elimination Strategy and
Malaysia’s outbreak notification to OIE.

2
3
4
5
A review of facial injuries due to dog bites
ABSTRACT

Bite injuries to the head and neck region can result in facial disfigurement with distressing physical
and psychological consequences. This article reviewed the causes and management of facial bite
wounds due to dog bites. A PUBMED search of the National Library of Medicine from 1995 to
December 2005 was conducted. Keywords used in the search were ‘facial wound’, ‘bite wound’,
‘dog bite’. The results showed that the risk factors for dog attacks include: school-aged children,
male, households with dogs, male dogs and certain breeds (german shepherds, bull terriers, blue/red
heelers, dobermans and rottwellers). Early management of such complex injuries usually
guarantees satisfactory outcome. Most of the cases involve a known dog (friends, neighbors) and
family pet. Although animal bites are not the most accounted children injuries, deaths may a result
of these attacks. Antibiotic therapy is indicated for infected bite wounds and fresh wounds
considered at risk for infection, such as extremely large wounds, large hematoma, and cat bites, that
appear be more infected than dog bites. Tetanus immunization status and the risk of rabies infection
should be routinely addressed in bite wound management. Prevention strategies should be
considered for preventing dog bites. Key words: Facial wound, bite wound, dog bite

Abuabara A. A review of facial injuries due to dog bites. Med Oral Patol Oral Cir Bucal
2006;11:E348-50
A One Health Framework for the Evaluation of Rabies Control Programmes: A Case Study
from Colombo City, Sri Lanka

Abstract

Background: One Health addresses complex challenges to promote the health of all species and the
environment by integrating relevant sciences at systems level. Its application to zoonotic diseases is
recommended, but few coherent frameworks exist that combine approaches from multiple
disciplines. Rabies requires an interdisciplinary approach for effective and efficient management.

Methodology/Principal Findings: A framework is proposed to assess the value of rabies

interventions holistically. The economic assessment compares additional monetary and non-
monetary costs and benefits of an intervention taking into account epidemiological, animal welfare,
societal impact and cost data. It is complemented by an ethical assessment. The framework is
applied to Colombo City, Sri Lanka, where modified dog rabies intervention measures were
implemented in 2007. The two options included for analysis were the control measures in place
until 2006 (‘‘baseline scenario’’) and the new comprehensive intervention measures
(‘‘intervention’’) for a four-year duration. Differences in control cost; monetary human health costs
after exposure; Disability-Adjusted Life Years (DALYs) lost due to human rabies deaths and the
psychological burden following a bite; negative impact on animal welfare; epidemiological
indicators; social acceptance of dogs; and ethical considerations were estimated using a mixed
method approach including primary and secondary data. Over the four years analysed, the
intervention cost US $1.03 million more than the baseline scenario in 2011 prices (adjusted for
inflation) and caused a reduction in dog rabies cases; 738 DALYs averted; an increase in
acceptability among non-dog owners; a perception of positive changes in society including a
decrease in the number of roaming dogs; and a net reduction in the impact on animal welfare from
intermediate-high to low-intermediate.

Conclusions: The findings illustrate the multiple outcomes relevant to stakeholders and allow
greater understanding of the value of the implemented rabies control measures, thereby providing a
solid foundation for informed decision-making and sustainable control.

:Ha¨sler B, Hiby E, Gilbert W, Obeyesekere N, Bennani H, et al. (2014) A One Health Framework
for the Evaluation of Rabies Control Programmes: A Case Study from Colombo City, Sri Lanka.
PLoS Negl Trop Dis 8(10): e3270. doi:10.1371/journal.pntd.0003270
A Step Forward in Molecular Diagnostics of Lyssaviruses – Results of a Ring Trial among
European Laboratories

Abstract Rabies is a lethal and notifiable zoonotic disease for which diagnostics have to meet the
highest standards. In recent years, an evolution was especially seen in molecular diagnostics with a
wide variety of different detection methods published. Therefore, a first international ring trial
specifically designed on the use of reverse transcription polymerase chain reaction (RT-PCR) for
detection of lyssavirus genomic RNA was organized. The trial focussed on assessment and
comparison of the performance of conventional and real-time assays. In total, 16 European
laboratories participated. All participants were asked to investigate a panel of defined lyssavirus
RNAs, consisting of Rabies virus (RABV) and European bat lyssavirus 1 and 2 (EBLV-1 and -2)
RNA samples, with systems available in their laboratory. The ring trial allowed the important
conclusion that conventional RT-PCR assays were really robust assays tested with a high
concordance between different laboratories and assays. The real-time RT-PCR system by Wakeley
et al. (2005) in combination with an intercalating dye, and the combined version by Hoffmann and
co-workers (2010) showed good sensitivity for the detection of all RABV samples included in this
test panel. Furthermore, all used EBLV-specific assays, real-time RT-PCRs as well as conventional
RT-PCR systems, were shown to be suitable for a reliable detection of EBLVs. It has to be
mentioned that differences were seen in the performance between both the individual RT-PCR
systems and the laboratories. Laboratories which used more than one molecular assay for testing
the sample panel always concluded a correct sample result. Due to the markedly high genetic
diversity of lyssaviruses, the application of different assays in diagnostics is needed to achieve a
maximum of diagnostic accuracy. To improve the knowledge about the diagnostic performance
proficiency testing at an international level is recommended before using lyssavirus molecular
diagnostics e.g. for confirmatory testing.

: Fischer M, Wernike K, Freuling CM, Mu¨ller T, Aylan O, et al. (2013) A Step Forward in
Molecular Diagnostics of Lyssaviruses – Results of a Ring Trial among European Laboratories.
PLoS ONE 8(3): e58372. doi:10.1371/journal.pone.0058372