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

BMC Infectious Diseases

Veronica Gutiérrez¹  Silene M. Rocha¹  Jesús F. Gonzalez Roldan¹  Lúcia R. Montebello¹  André P. B. Castro¹  Mary Freire de Carvalho²  Tamara Mancero²  Marco Antonio Natal Vigilato²  Victor Del Rio Vilas²  Paul C. D. Johnson³  Daniel T. Haydon³  Rebecca Mancy³  Katie Hampson³  Kristyna Rysava⁴  Eduardo Caldas⁵ 

[1] Ministry of Health;Pan American Health Organization (PAHO);University of Glasgow, Institute of Biodiversity, Animal Health and Comparative Medicine;University of Warwick, School of Life Sciences;Virology, Central Laboratory, State Center for Health Surveillance, State Department of Health;

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

DOI  :  10.1186/s12879-020-05457-x

来源: DOAJ

【 摘 要 】

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.

【 授权许可】

Unknown