Setting a Clear Pathway Towards Global Rabies Elimination...needs going forward. This data is vital...
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The Alliance is a registered charity in the UK and a 501(c)(3) organization in the US www.rabiesalliance.org 1 Editorial: Pathway to Global Rabies Elimination ....1 The 1st ARACON Meeting......................................2 GARC Statement on Dog Culling ...........................3 Bolstering Rabies Control in Guinea ......................4 World Rabies Day 2018 Theme .............................5 Wildlife and Rabies .................................................5 WHO Updated Rabies Guidance ...........................6 Prestigious Award for Rabies Research.................7 Recent Research ....................................................8 Upcoming Conferences ..........................................9 APRIL 2018 ISSUE 57 Setting a Clear Pathway Towards Global Rabies Elimination Over the last few years, this newsleer has charted an important progression--the strengthening and streamlining of GARC’s work to support countries in their rabies eliminaon efforts. Building on the evidence of pilot projects that demonstrated the feasibility of rabies eliminaon, we have developed the praccal tools and the necessary networks for supporng successful rabies control efforts. The strengthening of regional networks, first in Africa with the establishment of PARACON, just took a significant step with the launching last month of ARACON in Asia. And now a similar network will be mirrored in the Middle East and Eastern Europe with the formation of the MERACON network this coming month. These platforms allow GARC and our partners to strengthen coordination and introduce national rabies focal points from many countries into rabies control planning and evaluation tools, providing the support necessary for success through workshops and training courses. Parcipants can try these tools out with their own data, assess their program’s needs and create their own work plans to move their program forward. The meengs also allow for another valuable process: the provision of feedback on how these tools can be improved, filling the remaining gaps that hold countries back. The Rabies Epibulletin, designed to support and improve rabies data reporting, is another tool being promoted at regional meengs. Data brought to the meengs from both health and veterinary services is added into country-focussed Epibullen dashboards, which can then be tailored to suit a country’s individual needs going forward. This data is vital to assessing and direcng customized naonal rabies eliminaon plans, and from there, progress towards regional and global goals. Once a country’s rabies control needs and priorities have been established, scare resources can be better utilised and expert help can be sought for in-country capacity building in areas where it is lacking. The expertise of many international organizations is already being channelled into training courses and other capacity building exercises in endemic countries that can adapted to meet a country’s needs. GARC’s advocacy work has also transformed over the years. The World Rabies Day campaign and the reassessment of the burden of canine rabies formed a solid foundation, but much has been built since then. GARC alongside the WHO, OIE and FAO has now built the case for global elimination and set a target date of 2030 for an end to human deaths from canine rabies. GARC now manages the End Rabies Now campaign to help promote awareness of the global aspirations, and United Against Rabies is now focused on developing a business plan to achieve this goal. The plan will be launched before the end of May. The global eliminaon business plan will be used to aract much needed resources for capacity building to allow countries to reach the targets set. A powerful package of support combining well-designed data and assessment tools, rabies vaccine banks, global awareness campaigns and expert support through regional rabies networks and in-country workshops now exists. In combinaon, these mechanisms provide a clear path that countries can follow to keep us on track to reach the global goal. Louise Taylor, GARC
Transcript of Setting a Clear Pathway Towards Global Rabies Elimination...needs going forward. This data is vital...
The Alliance is a registered charity in the UK and a 501(c)(3) organization in the US www.rabiesalliance.org 1
Editorial: Pathway to Global Rabies Elimination ....1
The 1st ARACON Meeting ......................................2
GARC Statement on Dog Culling ...........................3
Bolstering Rabies Control in Guinea ......................4
World Rabies Day 2018 Theme .............................5
Wildlife and Rabies .................................................5
WHO Updated Rabies Guidance ...........................6
Prestigious Award for Rabies Research.................7Recent Research ....................................................8
Upcoming Conferences ..........................................9
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Setting a Clear Pathway Towards Global Rabies Elimination
Over the last few years, this newsletter has charted an important progression--the strengthening andstreamliningofGARC’sworktosupportcountriesintheirrabieseliminationefforts. Buildingontheevidenceofpilotprojectsthatdemonstratedthefeasibilityofrabieselimination,wehavedevelopedthepracticaltoolsandthenecessarynetworksforsupportingsuccessfulrabiescontrolefforts.
The strengthening of regional networks, first inAfricawith the establishment of PARACON, just took asignificantstepwiththelaunchinglastmonthofARACONinAsia. Andnowasimilarnetworkwillbemirroredin theMiddleEast andEasternEuropewith the formationof theMERACONnetwork this comingmonth.TheseplatformsallowGARCandourpartnersto strengthen coordination and introduce national rabies focal points from many countries into rabies control planning and evaluation tools, providing the supportnecessaryforsuccessthroughworkshopsandtrainingcourses. Participants can try these tools outwith their owndata, assess their program’sneeds and create theirownworkplanstomovetheirprogramforward.Themeetingsalsoallowforanothervaluableprocess:theprovisionoffeedbackonhowthesetoolscanbeimproved,fillingtheremaininggapsthatholdcountriesback. The Rabies Epibulletin, designed to support and improve rabies data reporting, is another tool beingpromotedat regionalmeetings.Databrought to themeetings frombothhealthandveterinary services isaddedintocountry-focussedEpibulletindashboards,whichcanthenbetailoredtosuitacountry’sindividualneedsgoingforward.Thisdataisvitaltoassessinganddirectingcustomizednationalrabieseliminationplans,andfromthere,progresstowardsregionalandglobalgoals.Onceacountry’srabiescontrolneedsandprioritieshavebeenestablished,scare resources can be better utilised and expert help can be sought for in-country capacity building in areas where it is lacking. Theexpertise ofmany international organizations is already being channelled into training courses and othercapacitybuildingexercisesinendemiccountriesthatcanadaptedtomeetacountry’sneeds. GARC’s advocacy work has also transformed over the years. The World Rabies Day campaign and thereassessmentoftheburdenofcaninerabiesformedasolidfoundation,butmuchhasbeenbuiltsincethen.GARC alongside the WHO, OIE and FAOhasnowbuiltthecaseforglobalelimination and setatargetdateof2030foranendtohumandeathsfromcaninerabies. GARCnowmanagestheEndRabiesNowcampaigntohelppromoteawarenessoftheglobalaspirations, and United Against Rabies is now focused on developing a business plan to achieve this goal. The plan will be launched before the end of May. Theglobaleliminationbusinessplanwillbeusedtoattractmuchneededresourcesforcapacitybuildingtoallowcountriestoreachthetargetsset.Apowerfulpackageofsupportcombiningwell-designeddataandassessment tools, rabies vaccinebanks, global awareness campaigns and expert support through regionalrabiesnetworksandin-countryworkshopsnowexists.Incombination,thesemechanismsprovideaclearpaththatcountriescanfollowtokeepusontracktoreachtheglobalgoal. Louise Taylor, GARC
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Protecting 4 Billion People Against Rabies Through Strengthened Regional Collaboration: The 1st ARACON Meeting
InAsia,morethan4billionpeoplecontinuetobeatriskofrabies.Oftheestimated59,000humanrabiesdeathseveryyear,themajority(59.6%)occurinAsia.AsanexpansionofGARC’sregionalrabiesnetworks,the1stAsianRabiesControlNetwork(ARACON)MeetingwasheldinBangkok,ThailandfromMarch13th-14th2018. Theglobal rabiesconference inGeneva inDecember2015set thegoalofeliminatingcanine-mediatedhumanrabiesby2030throughtheGlobalFrameworkfortheEliminationofDog-MediatedHumanRabies.Fivepillarswereidentifiedtoachieverabieselimination:S-Socio-cultural;T-Technical;O-Organizational;P-Political;andR-Resources(STOP-R).Twoofthekeyaspectshighlightedweretheimportanceofstrengtheningtheintersectoralcollaborationthrough theOneHealth approach (O-Organization) and creating avenues for participatory approach to exchangelessonslearntandexperiencesthroughregionalcollaboration(P-Political).
In2015,thePan-AfricanRabiesControlNetwork(PARACON)wasformedwithGARCasthesecretariattounifyallexistingnetworksandharmonizetherabiescontrolandeliminationeffortsofallcountriesinsub-SaharanAfrica.ThePARACONmeetingshavebecomeawayforcountryrepresentativesfromthemedicalandanimalhealthsectortogainhands-onexperienceinstrategicplanning,implementationandevaluationofnationalrabiesprogramsusingtoolsdevelopedbyGARCincollaborationwithother internationalorganizations(FAO,USCDC,WHO).ThesetoolsincludetheStepwiseApproachtowardsRabiesElimination(SARE);theRabiesEpidemiologicalBulletin(REB);andtheGARCEducationPlatform(GEP).ThemeetingsalsointroducedtheGlobalDogRabiesEliminationPathway(GDREP)developedbyUSCDCtoguidehigh-levelpolicymakersindeterminingthefundsandresourcestoplanandconductmassdogvaccinations.Todate,38countrieshavejoinedthePARACON. NowaregionalnetworkhasbeenestablishedforAsia.OrganizedbyGARC incollaborationwiththeUSCDC,atotalof45participantsattendedthefirstmeeting.Participantsincluded27countrydelegatesfrom13Asiancountriesaswellasrepresentativesfrominternationalorganizations(FAO,OIE,WHO,USCDC),animalwelfareorganizations(HumaneSocietyInternational,FourPaws,BluePawTrust),andseveralpharmaceuticalcompanies. SimilartoPARACON,themeetingwasdesignedtobeinformal,interactivethrough“learningbydoing”whereindelegates were given time to explore the different existing rabies elimination tools. The 1st ARACON meetingenabledthefirstSAREassessmentsformanyAsiancountriesandbecameavenuetolaunchthePracticalWorkplancomponentoftheSAREtool.ThisadditionalcomponentbuildsthependingactivitiesfromtheSAREassessmentintoacountryspecificworkplancompletewithaGANTTchart,objectives,outcomes,deliverables,andnumberofyearstocompletion. Otherhighlightsofthemeetingwerethesharingoflessonslearntfromdifferentcountries(Thailand,Philippines,Indonesia,SriLanka,andMalaysia)intheimplementationofnationalrabiesprogramsaswellasapresentationfrom
Country delegates develop rabies control workplans. Photo: GARC
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...ARACON continued from page 2.
Vietnamonhowacountryalignsitsrabiesprogrambasedonaregionalstrategy,theASEANRabiesEliminationStrategy(ARES).FAO,OIE,WHO,providedexamplesonhowtheysupportrabieseliminationefforts intheAsianregion.AnoverviewwasalsogivenregardingtheUnitedAgainstRabies(UAR)initiativewhichisaglobalpartnershipbetweenFAO,OIE,WHOandGARCtoengagecountriesandotherstakeholdersfromthenational,regionalandinternationalleveltogeneratehighimpactglobalresponse. Themeetingendedwithanopenforumbetweenthecountrydelegatesandrepresentativesfromtheinternationalorganizations.Oneofthekeypointsduringthediscussionwastheemphasisonregionalcooperationandcollaborativeapproachwhicharecrucialduetothetransboundarynatureof rabies.Therabies incursion inPenang(2015)andSarawak(2017)experiencedbyMalaysia,whichusedtobearabiesfreecountry,isacaseinpointofthischallengeandhighlightstheimportanceofregionalcoordinationforstrengthenedearlywarningandrapidresponsebetweencountries.Contributed by Sarah Jayme, Asian Regional Coordinator for GARC. The meeting was made possible through the support of UBS Optimus Foundation, Four Paws, IDT Biologika, MSD Animal Health, and Sanofi Pasteur.
Asian country delegates and representatives of supporting organizations. Photo:GARC
GARC Statement on Dog Culling for Rabies Control Storiesappearwithalarmingregularityintheinternationalmediaaboutauthoritiescarryingoutmassstraydogcullinginresponsetorabiescases.Attractingfewerheadlinesisthehighfrequencyofroutinecullingcarriedoutmonthaftermonth,andyearafteryearaimingtocurbrabiesinstraydogpopulations.Inarecentarticle,WorldAnimalProtectionsuggestedthatperhaps10milliondogsareculledacrosstheglobeinthenameofrabiescontroleveryyear. Thereisnodoubtthatstraydogspresentmanyproblemstopublicsafetyandenvironmentalhealth,anditisnosurprisethattherearefrequentcallsforauthoritiestodosomethingabouttheproblem.Oftenrabiesgetscaughtupinthemoregeneraldebatearoundfreeroamingdogsanddogoverpopulation,andarabiesoutbreakcanbethetippingpointatwhichauthoritiesdecidetorespond. Superficially,itmayseemthatreducingthedogpopulationwouldhelplimitthespreadofrabies,butthedesireforauthoritiestobeseentobedoingsomethinghidesamoreworryingtruth.Indiscriminatedogcullingissimplynotaneffectivewayofcontrollingrabies,andworse,itunderminesthedevelopmentofalongertermsolutionthatwouldwork.Additionally,theuseofcullingcanfrequentlyresultinabacklashfromthecommunity,especiallyifinhumanemethodsareused. Tosupportthosefightingforeffectiverabiescontrolintheircommunities,GARChaspreparedastatementforthe EndRabiesNowcampaignontheuseofdogcullinginrabiescontrol.Thisstatementsetsoutthereasonswhyindiscriminatemasscullingdoesn’twork,itdescribesthedamagethatcullingcandotofuturecontrolefforts,anditsuggestsmoreeffectivealternativesinresponsetoarabiesoutbreakcentredoncaninevaccination.Thesealternatives,aspartofalongertermstrategy,willseecommunitieseliminatethethreatofrabiesfordogsandpeoplealike. YoucanfindthestatementontheEndRabiesNowwebsitehere.Contributed by Louise Taylor, Scientific Director of GARC.
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Diagnosing the Problem and Planning for the Future:Bolstering Rabies Control in Guinea InthewesternreachesoftheAfricancontinentliesGuinea,acountrythatmadeheadlinesgloballyduringtheEbolaoutbreakthatendedinearly2016.However,recentmoreexcitingandpositivedevelopmentsinpublichealthhaveemergedfromthescapitalcityofConakry,whererabiescontroleffortshavebeenbuoyedthroughintensivetrainingsandworkshops. ThroughacollaborationbetweentheUNFAO,USAIDandGARC,anintensiverabiesdiagnostictrainingcoursewas hosted at the Central Veterinary Laboratory inConakry,Guineafrom22-24March2018bytheGuineaFAOoffice.Sixlaboratorypersonnelweretrainedintheuse of the DRIT (Direct Rapid ImmunohistochemicalTest), aneasy, cost-effectiveassay for thediagnosisofsuspect rabies samples. The rabies diagnostic trainingwasanimportantfoundationalstepinimprovingrabiessurveillanceinthecountry,providingastrongplatformfor Guineans to advocate for support and raisingawarenessaboutrabies. Later in March, a national workshop was held todemonstratethevarioustoolsdevelopedtoassistcountriesinthecreationandimplementationofaneffectiveandstrategicnationalrabieseliminationstrategy.TheworkshopwasorganisedandhostedbyacollaborationbetweentheUNFAO,USAID,GARCandtheUSCDC. The Stepwise Approach towards Rabies Elimination (SARE) was undertaken in an intensive workshop thatincludedamultitudeofstakeholdersandpartnersfromvariousministries(includingMinistryofHealth,MinistryofAnimalHusbandryandtheMinistryofEnvironmentalAffairs),internationalorganisations(WHO,OIE,FAO,CDC,GARC,USAID,InstitutPasteur)andtheprivatesector,amongothers.ThisworkshoptrulyencompassedtheOneHealthspiritandresultedinacomprehensiveself-assessmentofthecurrentsituationinthecountry.
Following the SARE analysis, the Global Dog RabiesElimination Pathway (GDREP) tool was demonstratedby the US CDC as a tool to facilitate budgeting for arabiescontrolstrategy,includingthehumanresourcesrequired to achieve adequate animal vaccinationcoverage. With this powerful information at hand, astrongerandmoreaccurateestimateof theneedsofthe country could be assessed and advocated for atthe national level to drive any future rabies controlcampaigns.Although both the SARE and the GDREP providedetailsofwhat is requiredtodevelopand implementaneffectivenationalrabiescontrolstrategy,aconcretemeansastohowtheseactivitiescanbeachievedwasstill lacking. A newly developed tool--the Practical
WorkplantowardsAchievingRabiesElimination(PWARE)—wasdevelopedbyGARCtoconvertinformationfromtheSAREintoactionableitems,highlightingpendingactivitiesandthendevelopingaconcreteanddetailedworkplanonexactlyhowthosependingactivitiescanbeaccomplished.Aftermanyhoursoffruitfuldiscussionsbetweenthevariouspartners,Guineadevelopedanactionableworkplanandfurtherprioritisedseveralactivitiestobeachievedinthecomingmonths. TheworkshopclosedwithpositiveremarksfromthevariousinternationalorganisationsandtheencouragementofGuineatoimplementandundertakethoseactivitiesthatwereprioritisedbythePWAREtooltodrivetheireffortsofrabieseliminationclosertothegoalofbeingfreefromdog-mediatedhumanrabiesbytheyear2030.Submitted by Terence Scott, GARC and member of the Pan-African Rabies Control Network (PARACON) Steering Committee
Terence Scott (GARC) leads the workshop in the development of a nationalWorkplan for rabies using the SARE-PWARE tool. Photo: GARC
DRIT training graduates with their certificates outside of the Central Veterinary Laboratory in Conakry. Photo: GARC
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Share your message this World Rabies Day!
Asmostofyoualreadyknow,WorldRabiesDayisagreatannualopportunitytoincreaseawarenessbyholdinganevent,gettingthemediainterestedinyourworkandconnectingwiththewiderrabiespreventioncommunity. TheWorldRabiesDay2018themeisRabies:Share the message. Save a life.Thishighlightsthe importanceofeducationandawarenesstopreventrabies.Youcanusethisatmanylevelstosharedifferentmessages,fromthepolicy-levelmessagetogovernmentstocommit tothe2030deadline, tocommunity-levelmessagesaboutvaccinatingdogsandtreatingbitewounds,anddogbitepreventioneducationforschoolchildren. Please register your event at https://rabiesalliance.org/world-rabies-day/register. You can also downloadbannerswiththisyear’sthemeathttps://rabiesalliance.org/world-rabies-day/event-resources/logos. Keep an eye out formore resources and activities asWorld Rabies Day approaches.We’ll be sharing newcustomisableposterssoon,andthe2018WorldRabiesDayAwardswillbelaunchedinJunewithmorecategoriestorecogniseevenmorerabieschampionsinthecommunity. WelookforwardtolearningmoreaboutyourWorldRabiesDayactivities–[email protected] by Deepa Balaram, on behalf of the WRD team
Vaccinating Dogs Protects from Wildlife Threats Severalrecentstoriesinthenewsillustratehowwildlifecansignificantlyimpactrabiesecologyinaparticularregion.Wildanimalslivingnearhumansofteninteractwithlocaldogpopulationsandcanmodulatethethreatofrabies—sometimesinunexpectedways—buttheinfluenceofwildlifeonrabiestransmissiontodomesticanimalsandpeoplecanbediminishedbyafullyvaccinateddomesticdogpopulation. Wildlifecanbringrabiesintoacommunityandinfectnon-vaccinatedpets,whicharethenabletotransmitthediseasetohumans.Tomaintainabarrierbetweenwildlife-transmittedrabiesandhumans,effectivevaccinationofdomesticandstraydogsinareasborderingwildernesshabitatsmustbeestablished. Droppingbaitstovaccinatewildlifeagainstrabiesisanotherstrategyforkeepingrabiesincidencelowinwildlifepopulations.Israelusuallyseesabout13-30rabiescasesayear,mostlyinwildlife,butnewsreportshaveshownthatcaseshavebeenincreasingoverthepastyear,with17casesinthefirst3weeksof2018,and74casesin2017,upfromjust29casesin2016.TheoutbreakisattributedtowildjackalscrossingoverfromJordan—wherethegovernmentdoesnottreatthediseaseindomesticorwildanimals—thatbringthediseaseintoIsrael’snorthernvalleys,heighteningtheprospectofasevereoutbreak.Jackalsnormallydon’tinteractwithhumans,butifinfected,theybecomelessinhibitedandcanmoreeasilytransmitthediseasetofarmanimalsorpets. Israelusuallycontrolsrabiesbyscatteringediblevaccineintheborderregions,butadiplomaticcrisislastyearbetweenIsraelandJordanpreventedlastyear’swildlifevaccinedistributionprogramfromoperatingintheregion.Over3000 jackals live in theoutbreakarea,and reports indicate that the IsraeliNatureandParksAuthority isnow trying to control rabies in the jackal populationby culling and scattering vaccinepelletsmoredensely inproblemareas. TheAgricultureMinistrywants toensure that thediseasedoesn’t crossover to catsanddogsandis inoculatingferalcatsandprovidingrabiesboostershotsfreeofcharge,withthehopesthatkeepingthe
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domestic animal population protected against rabies willhelppreventtheoutbreakfromspreading. Sometimes critically endangered wildlife fall victimtorabies. Recently,anentirefamilyofwilddogs living inZimbabwe’sHwangeNationalParkwaseradicatedbyrabies,infectedbywithotherwildpredatorsinthepark.Wilddogsaregenerallynotvaccinated,andwithoutprotectionfromthedisease,entirepackshavesuccumbedtorabies,greatlyconcerningenvironmentalistsandconservationists.ASierraClubarticlerevealedhowvaccinating localdomesticdogsaroundtheparkhashelpedpreventthetransferofrabiestoandfromwildAfricanpainteddogs,withthehopesofguarding this endangered species from extinction. Theringofvaccinationaroundtheparkkeepsthediseasefromspreadingtoandfromdomesticdogsandsusceptiblewildanimals.
While unvaccinatedwild animal reservoirs can spreadrabies,wildpredatorscanalsodecreasethepopulationdensityofareservoirspeciesandreducediseaseincidence.AnewstudypublishedinFrontiersinEcologyandtheEnvironmentreportedhowleopardsinSanjayGhandiNationalParknearMumbai,Indiahuntstraydogsnearthepark’sborderastheirprimarysourceoffood.About40leopardshavebeencorrelatedwithalowerincidenceofrabiescomparedtosurroundingareasofthecity.Itisestimatedthat1500dogsarekilledannuallybytheleopards,reducingthedogdensitybyafactoroftencomparedtotherestofthecity—andtherebyreducingtheincidenceofrabies.Itwasestimatedthatthecullingperformedbythepark’sleopardsprevented1000possiblebitesfromdogsand90potentialrabiescases.Submitted by Laura Baker, GARC. From the Sierra Club, “As Rabies Scourges Painted Dogs, a Race to Vaccinate Domestic Breeds”; From the Times of Israel, Animal rabies incidents quadruple, raising fears of outbreak among humans; From the Haaretz, “Israel on the Brink of a Rabies Epidemic, Thousands of Coyotes Killed”; From National Geographic, “How City-Dwelling Leopards Improve Human Health”
Leopards living in Sanjay Gandhi National Park in Mumbai India have been attributed with decreasing rabies incidence by hunting stray dogs living nearby. Photo: Maheshshinde (http://en.wikipedia.org/wiki/File:P1010426.JPG) [Public domain], via Wikimedia Commons
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WHO announces updated guidance on rabies WHOisdelightedtoannouncethepublicationoftwonewguidancedocuments,eachtheproductofmonthsofexpertreview. Sincethelaunchoftheglobalframeworktoeliminatehumanrabiestransmittedbydogsby2030in2015,WHOhasworkedwiththeFoodandAgricultureOrganizationoftheUnitedNations,theWorldOrganisationforAnimalHealth,theGlobalAllianceforRabiesControlandotherstakeholdersandpartnerstoprepareaglobalstrategicplan.This includesa country-centricapproach to support,empowerandcatalysenationalentitiestocontrolandeliminaterabies.
In this context, WHO convened its network of collaborating centres on rabies,specializedinstitutions,membersoftheWHOExpertAdvisoryPanelonRabies,rabiesexpertsandpartnerstoreviewstrategicandtechnicalguidanceonrabiestosupportimplementationofcountryandregionalprogrammes. The new WHO Expert Consultation on Rabies: WHO TRS N°1012 report provides
updatedguidancebasedonevidenceandprogrammaticexperienceonthemultiplefacetsofrabiesprevention,controlandelimination.Keyupdatesinclude:(i)surveillancestrategies,includingcross-sectorallinkingofsystemsandsuitablediagnostics;(ii)thelatestrecommendationsonhumanandanimalimmunization;(iii)palliativecareinlowresourcesettings;(iv)riskassessmenttoguidemanagementofbitevictims;and(v)aproposedprocessforvalidationandverificationofcountriesreachingzerohumandeathsfromrabies. The meeting supported the recommendations endorsed by theWHO Strategic Advisory Group of ExpertsonImmunizationinOctober2017toimproveaccesstoaffordablerabiesbiologicals,especiallyforunderservedpopulations,andincreaseprogrammaticfeasibilityinlinewiththeobjectivesofuniversalhealthcoverage.
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ThecollaborativemechanismsrequiredtopreventrabiesareamodelforcollaborationonOneHealthateverylevelandamongmultiplestakeholdersandarearecipeforsuccess. Rabies is a vaccine-preventable disease. Theprovisionofsupporttocountrieswillendthepainandsufferingduetorabiesthatburdenspeople,especiallychildren. Investing in rabies control and eliminationstrengthens health systems, improves equity andaccess tohealth care and contributes to sustainabledevelopment.Investmentinrabieseliminationisnotonlyforeliminationofthisfatalbutpreventablediseasebutalsoforbuildingcapacityintheworld’smostneglectedregions.
Thisreport,requestedbycountries,provideshands-onguidancetodriveprogresstowardsrabieselimination. The new WHO position paper on Rabies Vaccine, was published April is part of WHO’s series of regularlyupdatedpositionpapersonvaccinesandcombinationsofvaccinesagainstdiseases thathavean internationalpublichealthimpact.TheysummarizeessentialbackgroundinformationondiseasesandvaccinesandconcludewiththecurrentWHOpositionontheuseofvaccinesworldwide.
ThepapersarereviewedbyexternalexpertsandWHOstaff,andreviewedandendorsedbytheWHOStrategicAdvisoryGroupofExperts(SAGE)onimmunization.TheGRADEmethodologyisusedtosystematicallyassessthequalityoftheavailableevidence.TheSAGEdecision-makingprocessisreflectedintheevidence-to-recommendationtables. Thepositionpapersareintendedforusemainlybynationalpublichealthofficials.Theymayalsobeofinterestto international fundingagencies,vaccineadvisorygroups,vaccinemanufacturers,themedicalcommunity,thescientificmediaandthegeneralpublic.
Thispositionpaperreplacesthe2010WHOpositiononrabiesvaccines.Itpresentsnewevidenceinthefieldofrabiesandtheuseofrabiesvaccines,focusingonprogrammaticfeasibility,simplificationofvaccinationschedulesand improved cost-effectiveness. The recommendations concern the 2 main immunization strategies, namelyvaccination forpost-exposureprophylaxisandvaccination forpre-exposureprophylaxis. In thecontextofpost-exposureprophylaxis,recommendationsarealsoprovidedontheuseofrabiesimmunoglobulins. RecommendationsontheuseofrabiesvaccineswerediscussedbySAGEinOctober2017;evidencepresentedatthemeetingcanbeaccessedhere.Contributed by Bernadette Abela-Ridder and Lea Knopf of the WHO Department of Control of Neglected Tropical Diseases
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Prestigious Award for Rabies Research
Professor SarahCleavelandOBE FRSwas awarded the2018 LeeuwenhoekMedalandLecturebytheUK’sRoyalSocietyforherpioneeringworktowardstheeliminationofrabiesthroughouttheworld.Theawardwasnamedafterthefatherofmicrobiology,DutchmicroscopistAntonievanLeeuwenhoek.
Beforereceivingheraward,Prof.CleavelanddeliveredapubliclectureattheRoyalSocietyinLondononApril17thentitled“Canwemakerabieshistory?Realisingthevalueofresearchfortheglobaleliminationofrabies”. Prof. Cleaveland contributes to global rabies elimination efforts through the Global Alliance for Rabies Control, Partners for Rabies Prevention and other international expert groups.
Contributed by Kim Doyle of GARC. You can read more about and watch a recording of the lecture here.Prof. Sarah Cleaveland (right) with Dr Julie Gallagher after the award lecture. Photo: GARC
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Recent ResearchAdvocacy / Policy
Estimating the burden of rabies in Ethiopia by tracing dog bite victims. 655 animal bite cases weretracedtotheircommunitiesandfurthervictimsidentified.Annualsuspectedrabiddogexposureswere
estimatedperevaluatedurban,ruralhighlandandrurallowlanddistrictat,respectively,135,101and86bites,whichled,respectively,toabout1,4and3deathsper100,000population.AveragecostspercompletedPETwere23,31and40USD,whichwassignificantlyhigherinruraldistricts.Extrapolationofthedistrictresultstothenationallevelindicatedanannualestimateofapproximately3,000humandeathsresultinginabout194,000DALYsperyearand97,000exposedpersonsrequiringonaverage2millionUSDtreatmentcostsperyearcountrywide.RabiesintheAmericas:1998-2014.Thispaperpresentslongitudinaldatafor21LACcountriesondogvaccination,PEPandrabiessurveillance.Dogandhumanrabieshavedecreasedsignificantly,butdifferencesinhumananddograbiesincidenceratesanddogvaccinationrateswereshownbetweenlow,middleandhigh-incomecountries.Atthepeak,over50milliondogswerevaccinatedannuallyinnationalcampaignsinthecountriesrepresented.Onaverage,over2milliondosesofhumanvaccinewereappliedannually.Inthemostrecentsurvey,only37%ofcountriesreportedthattheyhadsufficientfinancialresourcestomeettheprogramobjectives.ThedatashowasufficientandsustainedeffortoftheLACcountriesintheareaofdogvaccinationandprovideunderstandingofthebaselineeffortrequiredtoreducedog-mediatedrabiesincidence.
Diagnosis and SurveillanceEvaluation of Monoclonal Antibody-Based Direct, Rapid Immunohistochemical Test for Rabies Diagnosis. The dRITtesthasaworldwidepromisingapplication,particularlyindevelopingcountries.However,nocommercialconjugatedantibodyisavailabletomeetthelaboratorydemand.Wedescribeheretheproductionofamonoclonalantibody(MAb)againstrabiesvirus(RABV)NproteinanditsuseasabiotinylatedconjugateinadRIT.ResultsshowedthatthedRIThad100%specificity(95%CI0.93-1.00)and96.49%sensitivity(95%CI0.88-1.00)ascomparedwiththegoldstandardFAT.Itthereforeprovidesasimple,economicalalternativetoFAT.ApplicationandComparativeEvaluationof FAT, dRIT andRT-PCRTests for theDetectionofRabiesVirusAntigenorNucleicAcid inBrain SamplesofAnimals SuspectedofRabies in India.DFA,dRIT andRT-PCRdiagnostic testswerecomparedon257brain samples, includingdecomposed samples. The results confirm100%corroborationbetweenDFAanddRIT,buttresstheapplicabilityofdRITinthesimpleandrapiddiagnosisofrabiesinanimals,andreaffirmthesuitabilityofRT-PCRforsamplesunfitfortestingeitherbyDFAordRIT.Rabies surveillance in theUnited States during 2016.During 2016, 50 states andPuertoRico reported4,910 rabidanimalstotheCDCofwhich4,487(91.4%)involvedwildlife.Relativecontributionsbythemajoranimalgroupswereas follows:1,646 (33.5%)bats,1,403 (28.6%) raccoons,1,031 (21.0%) skunks,313 (6.4%) foxes,257 (5.2%)cats,70(1.4%)cattle,and58(1.2%)dogs.Therewasa4.6%decreaseinthenumberofsamplessubmittedfortestingin2016,comparedwith2015.Nohumanrabiesdeathswerereportedin2016.Laboratorytestingofanimalssuspectedtoberabidremainsacriticalpublichealthfunctionandcontinuestobeacost-effectivemethodtodirectlyinfluencehumanrabiespostexposureprophylaxisrecommendationsPotentialConfoundingofDiagnosisofRabies inPatientswithRecentReceiptof Intravenous ImmuneGlobulin.ThisreportdescribessixpatientswhoweretestedforrabiesbyCDCandwhometCSTEcriteriaforconfirmedhumanrabiesandfourpatientswhowerefoundtohaveserumRLNAsdespitehavingnotbeenvaccinatedforrabies.Noneofthese10patientsreceivedarabiesdiagnosis;rather,theywereconsideredtohavebeenpassivelyimmunizedagainstrabiesthroughrecentreceiptofintravenousimmuneglobulin(IVIG).
PEPManagementofdogbitesbyfrontlineserviceprovidersinprimaryhealthcarefacilitiesintheGreaterAccraRegionofGhana,2014-2015.57.8%of232frontlineserviceproviderswerecorrectinthattherabiesvirusisthecausativeagentofrabies,39.2%attributedittoadogbite,2.6%didnotknowthecause,andonepersonattributedittotheherpesvirus.Only15.5%knewtheincubationperiodindogsandtheperiodrequiredtoobserveforsignsofarabiesinfection.42.2%ofthedidnotknowhowtoadministerRIG.Ofthefacilitiesvisited,76%didnothavetherabiesvaccinesand44%didnotknowwheretogetrabiesvaccinesfrom.Mostoftheserviceproviders(87.9%;204/232)hadneverreportedeitheradogbiteorasuspectedcaseofrabies.RabiesVaccineHesitancyandDeathsAmongPregnantandBreastfeedingWomen-Vietnam,2015-2016. During
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APRIL 2015 • Issue 42APRIL 2018 • Issue 57
...Recent Research continued from page 8.
The editors of the GARC newsletter are Louise Taylor and Laura Baker. You can contact them through [email protected] is by Pete Else. For further information on the Alliance’s work see www.rabiesalliance.org.
2015-2016, among 169 cases reported in Vietnam, two probable cases of rabies were reported in breastfeedingmothersandfourinpregnantwomen,allofwhomhadbeenbittenbydogs.Allsixpatientsdied.Threeofthefourpregnantwomenhad cesarean deliveries. In each case, families reported the patient’s fear of risk to the fetus orbreastfedchildastheprimarybarriertoreceivingPEP.
EducationArabieslessonimprovesrabiesknowledgeamongstprimaryschoolchildreninZomba,Malawi.Knowledgeandattitudestowardsrabieswereassessedbyaquestionnairebeforeaprimaryschoollesson,immediatelyafterthelessonand9weekslatertoassesstheimpactthelessonhadonschoolchildren’sknowledgeandattitudes,andalsoinchildrenwhowereexposedtoamassdogvaccinationprogrammebutdidnotreceivethelesson.Knowledgeofrabiesandhowtobesafearounddogsincreasedfollowingthelesson,andknowledgeremainedhigherthanbaseline9weeksafterthelesson.Knowledgewasgreateramongstschoolchildrenwhohadreceivedthelessoncomparedtothosewhohadnotindicatingthatthelessonitselfwascriticalinimprovingknowledge.
Mass Dog Vaccination Impactofcommunity-deliveredSMSalertsondog-ownerparticipationduringamassrabiesvaccinationcampaign,Haiti2017.Toimproveawarenessamongdogowners,600,000textmessagesweresenttophonesintwoHaitiancommunestoreminddogownerstoattenddogvaccinationcampaigns.Apost-campaignhouseholdsurveywasconductedtoassessdogowner’sperceptionofthetextmessagesandtheimpact.91.9%oftext-receivingdogownersindicatedthetextwashelpful. Incentralpointcampaignareas, therewas73.1%attendanceamongthosewhoreceivedthetextvs36.4%amongthosewhodidnot.Inareasincorporatingdoor-to-doorvaccinationovermultipledaystherewasnosignificantimpactofreceivingatext.QualitativeEvaluationoftheFive-Year‘RedCollar’CampaigntoEndInhumaneCullingofDogsasaMethodofRabiesControl.Toendtheinhumanecullingofdogsinresponsetorabies,WorldAnimalProtectionlaunched‘RedCollar’;afive-yearcampaign(2011-2016)thatworkedwithgovernmentstopromotetheimplementationofmassdogvaccinationfor rabies control.Wepresent the findings froma qualitative evaluationof ‘Red Collar’, conducted both regionallyand with national focus on Bangladesh, China, Indonesia, the Philippines and Zanzibar, Tanzania, based on semi-structuredinterviewsandwrittencontributionsfromstakeholders.Thecampaignsuccessfullygeneratedmomentumforimplementationofmassdogvaccinationbytargetedgovernmentsandlessonslearnedwereestablished.
Epidemiology in WildlifeThe spread and evolution of rabies virus: conquering new frontiers. Robust surveillance efforts combined withdiagnosticsanddiseasemodellingarenowprovidinginsightsintotheepidemiologyandevolutionofrabiesvirus.Theimmunestatusofthehost,thenatureofexposureandstraindifferencesallclearlyinfluenceinfectionandtransmissiondynamics.This reviewfocussesonrabies inwildlife,synthesizecurrentknowledge in therapidlyadvancingfieldsofrabiesvirusepidemiologyandevolution,andadvocateformultidisciplinaryapproachestoadvanceourunderstandingofthisdisease.
Upcoming MeetingsNECTM7.The7thNorthernEuropeanConferenceonTravelMedicine,inStockholm,Swedenfrom2-4thMay2018.
5th International One Health Congress.The5thInternationalOneHealthCongress,withtheoverarchingtheme‘OneHealthinUnderservedCommunities’willbeheldinSaskatoon,Canada,22-25thJune2018.
6th ACC&D Symposium.6thInternationalSymposiumonNon-SurgicalFertilityControlforDogsandCats,tobeheldinBoston,MA,UnitedStatesfrom22-24thJuly2018.
NNN Summit 2018.TheNeglectedTropicalDiseaseNGONetwork(NNN)2018summit,willbehostedbytheEthiopianFederalMinistryofHealthandNGOpartners,24-26September2018inAddisAbaba,Ethiopia.
XXIX RITA Conference.TheXXIXRabiesintheAmericas(RITA)ConferencewillbeheldOctober28–November2,inBuenosAires,Argentina.Moredetailswillbeavailablesoonatwww.ritaconference.org.
