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

BMC Infectious Diseases

André P. B. Castro¹  Silene M. Rocha¹  Lúcia R. Montebello¹  Jesús F. Gonzalez Roldan²  Veronica Gutiérrez²  Marco Antonio Natal Vigilato³  Mary Freire de Carvalho³  Tamara Mancero³  Victor Del Rio Vilas⁴  Katie Hampson⁵  Daniel T. Haydon⁵  Paul C. D. Johnson⁵  Rebecca Mancy⁵  Kristyna Rysava⁶  Eduardo Caldas⁷ 

[1] Ministry of Health, Brasília, Distrito Federal, Brazil;Ministry of Health, Mexico, Distrito Federal, Mexico;Pan American Health Organization (PAHO), Duque de Caxias, Rio de Janeiro, Brazil;Pan American Health Organization (PAHO), Duque de Caxias, Rio de Janeiro, Brazil;University of Surrey, School of Veterinary Medicine, VSM Building, Guildford, UK;University of Glasgow, Institute of Biodiversity, Animal Health and Comparative Medicine, Graham Kerr building, MVLS, G12 8QQ, Glasgow, UK;University of Warwick, School of Life Sciences, Gibbet Hill Road, Coventry, UK;University of Glasgow, Institute of Biodiversity, Animal Health and Comparative Medicine, Graham Kerr building, MVLS, G12 8QQ, Glasgow, UK;Virology, Central Laboratory, State Center for Health Surveillance, State Department of Health, São Paulo, Rio Grande do Sul, Brazil;

关键词: Canine rabies;    Decision support tool;    Freedom from disease;    Interruption of transmission;    Management recommendations;    Mass dog vaccination;    Scientific guidance;    Surveillance;   

DOI  :  10.1186/s12879-020-05457-x

来源: Springer

【 摘 要 】

BackgroundInternational 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.MethodsWe 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.ResultsOur 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%.ConclusionOur 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.

【 授权许可】

CC BY