Implementing cost effective tools to improve rabies surveillance

The Global Alliance for Rabies Control (GARC) are coming up with cost-effective tools for the surveillance of rabies in dogs and people, and to meet the 2030 target to eliminate the disease.   

Rabies is a fatal zoonotic disease, which mostly spreads from dogs to people through dog bites. Over 95% of human deaths happen in Asia and Africa, mostly in poor communities who live in rural areas (WHO 2021).

But the disease is entirely preventable by vaccinating at-risk dog populations. Successful interventions have shown that vaccinating at least 70% of at-risk dogs in an area can put countries on the road to eliminating the disease (WOAH 2015). However, resource-constrained countries struggle to vaccinate the required number of dogs because of gaps in the animal health system..

To overcome these gaps, GARC has created tools and resources to improve surveillance of the disease. Better surveillance means countries with high rabies burdens can focus on vaccinating dogs in hotspot areas where rabies is known to occur, rather across the whole country.

This targeted approach is reliant on quality surveillance data and knowledge of how an outbreak has occurred. This data equips governments to make data driven decisions in their response to the disease.  Such an approach was used successfully in the eradication of rinderpest, and in the control of foot and mouth disease as well as malaria.

Developing cost-effective and simple tools

As an example, in 2016 GARC developed a free web-based data platform, called the Rabies Epidemiological Bulletin (REB). Tools were then developed to address rabies surveillance needs across all sectors. This approach has helped the system to be implemented in the most challenging settings where capacity and animal health systems remain limited or weak, building capacity and capturing essential data.

In many places, disease surveillance data is collated at the local level using paper forms, hampering rapid data collection, analysis and sharing, and inhibiting an appropriate response.

The REB and its ‘building block’ tools aims to combat inconsistent rabies data capture and analysis in animals and people in endemic countries by being the ideal tool that collects, and automatically collates, analyses and disseminates rabies data within the ministry or organisation where it is being used. Currently, more than 20 countries use at least one of the REB tools regularly.

Importantly, all the individual tools work seamlessly with one another. For instance, the Rabies Vaccination Tracker (RVT) and Rabies Case Surveillance (RCS) tools can be used for rabies outbreak response. The RCS allows the pinpointing of lab-diagnosed and suspect rabies cases at community level. The end-user inputs the specifics diagnostic outcome and sample number for each lab-diagnosed specimen. Each case is then plotted in real-time on a map using GPS coordinates or an interactive map. This means rabies hotspots and high-risk areas can be identified, and vaccination campaigns implemented.

The RVT tool tracks mass vaccination data. Those working on vaccination drives can enter data for each animal they vaccinate, including species, age, sex and GPS coordinates. System calculations are available to determine the vaccination coverage, based on an estimated dog population. Furthermore, the RCS and the RVT tools can be overlaid to create one map showing rabies vaccination data in relation to rabies-positive cases.

The tools in action

In Unguja, Zanzibar, clinical rabies cases declined after mass vaccination campaigns implemented by government and civil society organisations. The government embarked on declaring the island rabies-free, which would make them the first region in Africa to be declared free through dog vaccination. However, the island lacked diagnostic capacity, meaning that suspect rabies samples could not be put through routine lab diagnosis and therefore the success of the mass vaccination campaign could not be substantiated.

GARC helped to establish a lab-based rabies surveillance system on the island. They trained animal health technicians on sample collection, and local diagnosticians on the implementation of the direct rapid immunohistochemical test (dRIT). With this in place, the REB was introduced for improved data collection, analysis and strategic response. Rabies cases in animals and people could now be detected across the island, with each case captured on the RCS component of the REB.

The RCS helped to identify hotspots and ensured that vaccinations were then directed to high-risk areas. Just 13 people vaccinated 6000 dogs and almost 500 cats in a year. Vaccination data was captured and tracked using the RVT tool. Positive cases decreased by 71% (28 cases to 8) between August 2017 and December 2018, and the likelihood of detecting a positive rabies sample decreased at the end of the strategic vaccination campaign. In 2020, only 4 animal rabies cases and zero human rabies cases were detected, highlighting the continued impact of strategic vaccination through surveillance.

This case study shows the value of strategic dog vaccination in resource-limited settings, and the value understanding how the components of animal health systems fit together. Vaccination works in tandem with surveillance, especially in areas where human resources and financial resources are low. This approach, including the continued development and use of cost-effective and simple-to-use technology, must continue to meet the goal to eliminate dog-mediated human rabies by 2030.

For more information contact the GARC team at: support@rabiesalliance.org

Case study adapted from Coetzer A, Scott TP, Noor KO, Gwenhure LF, Nel LH. A Novel Integrated and Labile eHealth System for Monitoring Dog Rabies Vaccination Campaigns. Vaccines (Basel). 2019 Sep 9;7(3):108.

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