Towards the elimination of dog-mediated rabies: development and application of an evidence-based management tool

Rysava, K. et al. (2020) Towards the elimination of dog-mediated rabies: development and application of an evidence-based management tool. BMC Infectious Diseases, 20, 778. (doi: 10.1186/s12879-020-05457-x) (PMID:33081712) (PMCID:PMC7574347)

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Abstract

Abstract: Background: International organizations advocate for the elimination of dog-mediated rabies, but there is only limited guidance on interpreting surveillance data for managing elimination programmes. With the regional programme in Latin America approaching elimination of dog-mediated rabies, we aimed to develop a tool to evaluate the programme’s performance and generate locally-tailored rabies control programme management guidance to overcome remaining obstacles. Methods: We developed and validated a robust algorithm to classify progress towards rabies elimination within sub-national administrative units, which we applied to surveillance data from Brazil and Mexico. The method combines criteria that are easy to understand, including logistic regression analysis of case detection time series, assessment of rabies virus variants, and of incursion risk. Subjecting the algorithm to robustness testing, we further employed simulated data sub-sampled at differing levels of case detection to assess the algorithm’s performance and sensitivity to surveillance quality. Results: Our tool demonstrated clear epidemiological transitions in Mexico and Brazil: most states progressed rapidly towards elimination, but a few regressed due to incursions and control lapses. In 2015, dog-mediated rabies continued to circulate in the poorest states, with foci remaining in only 1 of 32 states in Mexico, and 2 of 27 in Brazil, posing incursion risks to the wider region. The classification tool was robust in determining epidemiological status irrespective of most levels of surveillance quality. In endemic settings, surveillance would need to detect less than 2.5% of all circulating cases to result in misclassification, whereas in settings where incursions become the main source of cases the threshold detection level for correct classification should not be less than 5%. Conclusion: Our tool provides guidance on how to progress effectively towards elimination targets and tailor strategies to local epidemiological situations, while revealing insights into rabies dynamics. Post-campaign assessments of dog vaccination coverage in endemic states, and enhanced surveillance to verify and maintain freedom in states threatened by incursions were identified as priorities to catalyze progress towards elimination. Our finding suggests genomic surveillance should become increasingly valuable during the endgame for discriminating circulating variants and pinpointing sources of incursions.

Item Type:Articles
Keywords:Canine rabies, decision support tool, freedom from disease, interruption of transmission, management recommendations, mass dog vaccination, scientific guidance, surveillance.
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Haydon, Professor Daniel and Hampson, Professor Katie and Mancy, Dr Rebecca and Johnson, Dr Paul and Rysava, Ms Kristyna
Authors: Rysava, K., Mancero, T., Caldas, E., de Carvalho, M. F., Castro, A. P. B., Gutiérrez, V., Haydon, D. T., Johnson, P. C. D., Mancy, R., Montebello, L. R., Rocha, S. M., Gonzalez Roldan, J. F., Vigilato, M. A. N., Vilas, V. D. R., and Hampson, K.
College/School:College of Medical Veterinary and Life Sciences > Institute of Biodiversity Animal Health and Comparative Medicine
College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > MRC/CSO SPHSU
Journal Name:BMC Infectious Diseases
Publisher:BioMed Central
ISSN:1471-2334
ISSN (Online):1471-2334
Copyright Holders:Copyright © 2020 The Authors
First Published:First published in BMC Infectious Diseases 20: 778
Publisher Policy:Reproduced under a Creative Commons License

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
165644Hierarchical epidemiology: the spread and persistence of infectious diseases in complex landscapesKatie HampsonWellcome Trust (WELLCOTR)095787/Z/11/ZInstitute of Biodiversity, Animal Health and Comparative Medicine
301620The Science of Rabies EliminationKatie HampsonWellcome Trust (WELLCOTR)207569/Z/17/ZInstitute of Biodiversity, Animal Health and Comparative Medicine