Establishment of a Canine Rabies Burden in Haiti through the Implementation of a Novel Surveillance Program

The Republic of Haiti is one of only several countries in the Western Hemisphere in which canine rabies is still endemic. Estimation methods have predicted that 130 human deaths occur per year, yet existing surveillance mechanisms have detected few of these rabies cases. Likewise, canine rabies surveillance capacity has had only limited capacity, detecting only two rabid dogs per year, on average. In 2013, Haiti initiated a community-based animal rabies surveillance program comprised of two components: active community bite investigation and passive animal rabies investigation. From January 2013 –December 2014, 778 rabies suspect animals were reported for investigation. Rabies was laboratory-confirmed in 70 animals (9%) and an additional 36 cases were identified based on clinical diagnosis (5%), representing an 18-fold increase in reporting of rabid animals compared to the three years before the program was implemented. Dogs were the most frequent rabid animal (90%). Testing and observation ruled out rabies in 61% of animals investigated. A total of 639 bite victims were reported to the program and an additional 364 bite victims who had not sought medical care were identified during the course of investigations. Only 31% of people with likely rabies exposures had initiated rabies post-exposure prophylaxis prior to the investigation. Rabies is a neglected disease in-part due to a lack of surveillance and understanding about the burden. The surveillance methods employed by this program established a much higher burden of canine rabies in Haiti than previously recognized. The active, community-based bite investigations identified numerous additional rabies exposures and bite victims were referred for appropriate medical care, averting potential human rabies deaths. The use of community-based rabies surveillance programs such as HARSP should be considered in canine rabies endemic countries.     

Elimination of rabies from red foxes in eastern Ontario

The province of Ontario (Canada) reported more laboratory confirmed rabid animals than any other state or province in Canada or the USA from 1958-91, with the exception of 1960-62. More than 95% of those cases occurred in the southern 10% of Ontario (approximately 100,000 km2), the region with the highest human population density and greatest agricultural activity. Rabies posed an expensive threat to human health and significant costs to the agricultural economy. The rabies variant originated in arctic foxes: the main vector in southern Ontario was the red fox (Vulpes vulpes), with lesser involvement of the striped skunk (Mephitis mephitis). The Ontario Ministry of Natural Resources began a 5 yr experiment in 1989 to eliminate terrestrial rabies from a approximately 30,000 km2 study area in the eastern end of southern Ontario. Baits containing oral rabies vaccine were dropped annually in the study area at a density of 20 baits/km2 from 1989-95. That continued 2 yr beyond the original 5 yr plan. The experiment was successful in eliminating the arctic fox variant of rabies from the whole area. In the 1980's, an average of 235 rabid foxes per year were reported in the study area. None have been reported since 1993. Cases of fox rabies in other species also disappeared. In 1995, the last bovine and companion animal cases were reported and in 1996 the last rabid skunk occurred. Only bat variants of rabies were present until 1999, when the raccoon variant entered from New York (USA). The success of this experiment led to an expansion of the program to all of southern Ontario in 1994. Persistence of terrestrial rabies, and ease of elimination, appeared to vary geographically, and probably over time. Ecological factors which enhance or reduce the long term survival of rabies in wild foxes are poorly understood.     

The epidemiology of rodent and lagomorph rabies in Maryland, 1981 to 1986

Records from the Maryland Public Health Department were screened for confirmed rodent and lagomorph rabies between 1981 and 1986. Questionnaires were designed for collection of information about events that led to the exposure of human and/or domestic animals to rabid rodent or lagomorphs. These species comprised 1.2% of all the reported rabies in the state. Woodchucks (Marmota monax) constituted 80.0% of all the reported rodent/lagomorph rabies cases in Maryland. The majority showed aggressive behavior (55.0%). Woodchucks exposed 15 persons (75.0% of all the exposures by rodents/lagomorphs). Domestic animal and human rabies exposure due to rodents and lagomorphs represents a small but significant number of the total exposure to rabid animals.     

Environmental and human demographic features associated with epizootic raccoon rabies in Maryland, Pennsylvania, and Virginia

We assessed land use and demographic data as predictors discriminating between counties experiencing large or small first epizootics of rabies among raccoons (Procyon lotor). Monthly county reports of raccoons testing positive for rabies were obtained from rabies surveillance databases from Maryland, Pennsylvania, and Virginia (USA). Environmental and demographic data for the three states were obtained from public sources. On the basis of total reports of raccoon rabies during the first defined epizootic period, the 203 counties were dichotomized at the 75th percentile as having a large epizootic (> or = 24 rabid raccoons in the first epizootic) (51 counties) or a small epizootic or no epizootic (152 counties). A high percentage of agricultural land use [OR = 9.1, 95% CI (3.6-23.1)], high water coverage in combination with low human population density [OR = 8.8, 95% CI (2.9-27.0)], and low water coverage with high human population density [OR = 11.7, 95% CI (4.0-34.1)] were positively associated with large rabies epizootics. Counties with more than 15% of mixed forest were less likely to experience large epizootics than were counties with < or = 15% of mixed forest [OR = 0.3, 95% CI (0.1, 0.9)]. A combination of land use and human population density measures provided the best model for determining epizootic size and may be important predictors of epizootic behavior and risk of exposure to this reservoir species.     

Knowledge,Attitudes and Practices (KAP) about Rabies Prevention and Control: A Community Survey in Tanzania

Background

Despite being entirely preventable, canine rabies still kills 55,000 people/year in developing countries. Information about local beliefs and practices can identify knowledge gaps that may affect prevention practices and lead to unnecessary deaths.

Methodology/Principal Findings

We investigated knowledge, attitudes and practices related to rabies and its prevention and control amongst a cross-section of households (n = 5,141) in urban and rural areas of central, southern and northern Tanzania. Over 17% of respondents owned domestic dogs (average of 2.3 dogs/household),>95% had heard about rabies, and>80% knew that rabies is transmitted through dog bites. People who (1) had greater education, (2) originated from areas with a history of rabies interventions, (3) had experienced exposure by a suspect rabid animal, (4) were male and (5) owned dogs were more likely to have greater knowledge about the disease. Around 80% of respondents would seek hospital treatment after a suspect bite, but only 5% were aware of the need for prompt wound cleansing after a bite. Although>65% of respondents knew of dog vaccination as a means to control rabies, only 51% vaccinated their dogs. Determinants of dog vaccination included (1) being a male-headed household, (2) presence of children, (3) low economic status, (4) residing in urban areas, (5) owning livestock, (6) originating from areas with rabies interventions and (7) having purchased a dog. The majority of dog-owning respondents were willing to contribute no more than US$0.31 towards veterinary services.

Conclusions/Significance

We identified important knowledge gaps related to, and factors influencing the prevention and control of rabies in Tanzania. Increasing knowledge regarding wound washing, seeking post-exposure prophylaxis and the need to vaccinate dogs are likely to result in more effective prevention of rabies; however, greater engagement of the veterinary and medical sectors is also needed to ensure the availability of preventative services.     

Rabies and canine distemper in an arctic fox population in Alaska

Two oil field workers were attacked by a rabid arctic fox (Alopex lagopus) in the Prudhoe Bay oil field (Alaska, USA) prompting officials to reduce the local fox population. Ninety-nine foxes were killed during winter 1994. We tested foxes for prevalence of rabies and canine distemper. Exposure to rabies was detected in five of 99 foxes. Of the five, only one fox had rabies virus in neural tissue as determined by the direct fluorescent antibody test. The other four foxes had been exposed to rabies, but had apparently produced antibodies and did not have an active infection. No evidence of canine distemper was detected as determined by the absence of distemper antibodies in serum and distemper virus in neural tissue.     

Isolation and characterization of novel human monoclonal antibodies possessing neutralizing ability against rabies virus

Rabies is a fatal viral encephalitis which is transmitted by exposure to the bite of rabid animals. Human and equine rabies immunoglobulins are indispensable pharmacological agents for severe bite exposure, as is vaccine. However, several disadvantages, including limited supply, adverse reactions, and high cost, hamper their wide application in developing countries. In the present study, two novel huMabs which neutralize rabies virus were established from vaccinated hyperimmune volunteers using the Epstein‐Barr virus transformation method. One MAb (No. 254), which was subclass IgG3, effectively neutralized fixed rabies viruses of CVS, ERA, HEP‐Flury, and Nishigahara strains and recognized a well‐conserved epitope located in antigenic site II of the rabies virus glycoprotein. No. 254 possessed 68 ng/ml of FRNT₅₀ activity against CVS, 3.7 × 10^?7 M of the Kd value, and the enhancing effect of complement‐dependent virolysis. In addition, No. 254 showed effective neutralization potency in vivo in the mouse challenge test. The other MAb, 4D4, was subclass IgM and showed neutralizing activity against CVS and Nishigahara strains. 4D4 recognized a novel antigenic site which is associated with the neurovirulence of rabies, a glycoprotein located between antigenic site I and VI. Both human MAbs against rabies are expected to be utilized as a tool for future post‐exposure prophylaxis.     

Costs of Rabies Control: An Economic Calculation Method Applied to Flores Island

Background

Rabies is a zoonotic disease that, in most human cases, is fatal once clinical signs appear. The disease transmits to humans through an animal bite. Dogs are the main vector of rabies in humans on Flores Island, Indonesia, resulting in about 19 human deaths each year. Currently, rabies control measures on Flores Island include mass vaccination and culling of dogs, laboratory diagnostics of suspected rabid dogs, putting imported dogs in quarantine, and pre- and post-exposure treatment (PET) of humans. The objective of this study was to estimate the costs of the applied rabies control measures on Flores Island.

Methodology/principal findings

A deterministic economic model was developed to calculate the costs of the rabies control measures and their individual cost components from 2000 to 2011. The inputs for the economic model were obtained from (i) relevant literature, (ii) available data on Flores Island, and (iii) experts such as responsible policy makers and veterinarians involved in rabies control measures in the past. As a result, the total costs of rabies control measures were estimated to be US$1.12 million (range: US$0.60–1.47 million) per year. The costs of culling roaming dogs were the highest portion, about 39 percent of the total costs, followed by PET (35 percent), mass vaccination (24 percent), pre-exposure treatment (1.4 percent), and others (1.3 percent) (dog-bite investigation, diagnostic of suspected rabid dogs, trace-back investigation of human contact with rabid dogs, and quarantine of imported dogs).

Conclusions/significance

This study demonstrates that rabies has a large economic impact on the government and dog owners. Control of rabies by culling dogs is relatively costly for the dog owners in comparison with other measures. Providing PET for humans is an effective way to prevent rabies, but is costly for government and does not provide a permanent solution to rabies in the future.     

Roles of traditional medicine and traditional healers for rabies prevention and potential impacts on post-exposure prophylaxis: A literature review

IntroductionGlobally, traditional medicine is widely used to treat a variety of injuries and illnesses, including dog bites, and exposures that are risky for rabies. However, efficacy of most traditional remedies used for rabies prevention or treatment has not been demonstrated in controlled trials or proven in community-based surveys.MethodsSix databases were searched including the terms rabies, traditional treatment, traditional remedy, traditional therapy, traditional medicine, and medicinal treatment to review traditional remedies used in the prevention and treatment of rabies. In addition, published literature of rabies transmission dynamics was used to estimate statistical likelihood of dog bite victims developing rabies to provide clarity as to why traditional healers have a high apparent success rate when preventing death from rabies in victims bitten by suspected rabid dogs.ResultsLiterature review yielded 50 articles, including three controlled experiments, that described use of traditional remedies for rabies prevention and treatment. Traditional remedies for rabies ranged from plant- or animal-based products to spiritual rituals; however, only a few controlled mice trials were conducted, and none of these trials demonstrated efficacy in preventing or treating rabies. Risk of dying from rabies after a bite from a dog with unknown rabies status is low, 1.90% (0.05%-29.60%). Therefore, traditional healers had a 98.10% (70.40%-99.95%) apparent success rate in preventing death from suspected rabid dog bites despite inefficaciousness of herbal remedies.ConclusionThere was no universal plant species or route of administration that was consistently used for rabies prevention or treatment across countries. No traditional remedy was efficacious in the prevention or treatment of rabies in randomized controlled experiments. Understanding the cultural context under which traditional remedies are used may facilitate collaboration of traditional healers with the modern medical system to ensure timely and appropriate use of proven therapies for prevention and clinical management of rabies.     

Rabies in skunks from Mexico.

An enzootic focus of rabies in skunks in Mexico is described. Fifty three wild animals including two badgers (Taxidea taxus), 32 bats (various species), one bobcat (Lynx rufus), two coatis (Nasua narica) three foxes (Urocyon cineroargenteus), one raccoon (Procyon lotor) and 12 skunks (see below) were tested for rabies by direct immunofluorescence assay from 1991 to 1997 in the central part of San Luis Potosi State, Mexico. Rabies occurrence was 21% of all tested mammals, with 19% in skunks and only 2% in other wild species (one bobcat). Skunks represented 23% of all mammals tested and had a rabies prevalence of 83%. Only 10 individuals were identified: three hog-nosed skunks (Conepatus leuconotus) and seven spotted skunks (Spilogale putorius). All were involved in human attacks; the spotted skunk attacks were inside bedrooms while people were sleeping, and the hog-nosed skunk attacks occurred outdoors. Skunk cases of rabies represented 40% of all rabies cases in 1997, and 100% of cases registered for wild animals in San Luis Potosi state. This situation constitutes an important public health problem and requires further epidemiological research to make the human population aware of the problem and to establish measures to limit further human attacks by rabid skunks.     

Ecology of wildlife rabies in Europe

• 1 The number of wildlife rabies cases has increased in Europe in recent years. We review the epizootiology of wildlife rabies in Europe, paying special attention to recent changes to the situation of two important vector species: the red fox and the raccoon dog. Red fox Vulpes vulpes has been the main vector of rabies since 1945, but the number and proportion of raccoon dog Nyctereutes procyonoides cases has rapidly increased during the past few years, particularly in north‐eastern Europe.
• 2 The transmission rate (average number of susceptible animals infected by each rabid animal) is critical for rabies spread and is partly determined by population density. Both raccoon dogs and foxes live in pairs. Foxes also live in family groups. Pairs and groups share their territories. Home range size usually correlates negatively with population density. Fox home ranges are 50–1500 ha, those of raccoon dogs 150–700 ha. The threshold value for rabies spread among foxes is estimated to be 0.63 individuals/km². Although fox density in eastern and northern Europe may be lower than this, the pooled density of foxes and raccoon dogs exceeds the threshold density.
• 3 Animal movements, especially dispersal of young, pose a risk for rabies spread. Although the likelihood of an epizootic is highest where fox and raccoon dog densities are highest, rabies may spread fastest where population densities are lower, because dispersal distances tend to correlate negatively with population density.
• 4 Oral vaccinations have been more effective in rabies control than culling foxes. Where two vector species exist, vaccination should be conducted twice a year, because most raccoon dogs disperse in autumn but some foxes do not disperse before mid‐ or late winter.
• 5 New rabies models, based on two vector species and their interaction, and which take into account the hibernation period of raccoon dogs, are needed for north‐eastern Europe.

     

Epidemiology of raccoon rabies in Virginia, 1984 to 1989.

Geographical and temporal trends in reports of rabid raccoons (Procyon lotor) in Virginia were summarized for 1984 to 1989; 3,256 raccoons were submitted for rabies testing, of which 1,053 (32.3%) had rabies. Both the absolute number of rabid raccoons and the percent of rabid raccoons (number rabid divided by number submitted) were examined for seasonal and yearly trends. Geographically, the epidemic moved eastward and southward in the state. The seasonal trend showed bimodal peaks in late winter and early fall and a seasonal low in summer. The percent of rabies positive raccoons peaked 1 mo earlier than the absolute number of rabies positive raccoons. The peak in the number of rabies positive raccoons occurred in 1987, while the percent of rabies positive raccoons peaked in 1986. These trends were used to recommend timing and placement of oral vaccine as one strategy to control raccoon rabies in wildlife.     

Targeted surveillance of raccoon rabies in Québec,Canada

Data from wildlife disease surveillance programs are used to inform implementation of disease control (e.g., vaccination, population reduction) in space and time. We developed an approach to increase detection of raccoon rabies in raccoons (Procyon lotor) and skunks (Mephitis mephitis) of Québec, Canada, and we examined the implications of using this approach for targeted surveillance. First we modeled the probability of a rabid animal relative to environmental characteristics of sampling locations. Rabid animals were more likely to be found in low-lying flat landscapes that had higher proportions of corn-forest edge habitat and hay agriculture, and that were within 20 km of one or more known rabies cases. From the model, we created 2 complementary risk maps to identify areas where rabid animals were most likely to be sampled. One map accounted for habitat and known rabies case locations, and can be used to define an infection zone from which surveillance can be targeted along the periphery to determine if disease is continuing to spread. The other map only accounted for habitat and can be used to locate areas most likely to contain rabid animals when the disease is present. In a further analysis we compared the 2 most successful methods for detecting raccoon rabies in Québec, given the disease was present. Government trapping operations (active surveillance) detected more cases in the short-term, but citizen notification (passive and enhanced) was more effective after 12 trapping days from which the initial rabies case was found. Our approach can benefit wildlife and public health agencies wanting to assess the disease status of regions by targeting surveillance to habitats most likely to contain infected animals and by defining the duration over which sampling methods are effective. © 2011 The Wildlife Society.     

Behavior, movements, and demographics of rabid raccoons in Ontario, Canada: management implications

During 1999-2003, 127 cases of raccoon variant rabies were reported in raccoons (Procyon lotor) and striped skunks (Mephitis mephitis) in Ontario, Canada. Raccoons accounted for 98% (125/127) of the reported cases with behaviors/conditions including aggression, fighting with dogs, ataxia, vocalizations, appearance of being sick, and the presence of porcupine (Erethizon dorsatum) quills. Seventy-eight percent of the rabid raccoons were adults. Juveniles were underrepresented (22%) compared with the adult/juvenile ratios found in nonrabid Ontario raccoon populations. Of the known aged raccoons, 83% were < or = 3 yr of age, and 22% of the rabid adult female raccoons had evidence of having had a litter during the year in which they were found to be rabid. The majority of rabid raccoons were reported during the fall, winter, and spring, suggesting a relationship between raccoon behavioral activities such as denning and breeding and the timing of rabies outbreaks. Multiple cases of raccoon rabies occurred at several barns, suggesting that those structures serve as focal points of rabies transmission as a result of denning activities. Movements of five rabid raccoons (range 1,564-4,143 m) were not different from movements of nonrabid raccoons in Ontario. Sixty-six percent of the rabid animals were submitted by government staff, stressing the importance of those agencies in rabies control and surveillance operations. Increased knowledge of the behaviors of rabid raccoons should assist in the development of management strategies for rabies.     

Emergency rabies control in a community of two high-density hosts

ABSTRACT: BACKGROUND: Rabies is a fatal viral disease that potentially can affect all mammals. Terrestrial rabies is not present in the United Kingdom and has been eliminated from Western Europe. Nevertheless the possibility remains that rabies could be introduced to England, where it would find two potentially suitable hosts, red foxes and badgers. With the aim to analyse the spread and emergency control of rabies in this two species host community, a simulation model was constructed. Different control strategies involving anti-rabies vaccination and population culling were developed, considering control application rates, spatial extent and timing. These strategies were evaluated for efficacy and feasibility to control rabies in hypothetical rural areas in the South of England immediately after a disease outbreak. RESULTS: The model confirmed that both fox and badger populations, separately, were competent hosts for the spread of rabies. Realistic vaccination levels were not sufficient to control rabies in high-density badger populations. The combined species community was a very strong rabies host. However, disease spread within species appeared to be more important than cross-species infection. Thus, the drivers of epidemiology depend on the potential of separate host species to sustain the disease. To control a rabies outbreak in the two species, both species had to be targeted. Realistic and robust control strategies involved vaccination of foxes and badgers, but also required badger culling. Although fox and badger populations in the UK are exceptionally dense, an outbreak of rabies can be controlled with a higher than 90% chance, if control response is quick and follows a strict regime. This requires surveillance and forceful and repeated control campaigns. In contrast, an uncontrolled rabies outbreak in the South of England would quickly develop into a strong epizootic involving tens of thousands of rabid foxes and badgers. CONCLUSIONS: If populations of both host species are sufficiently large, epizootics are driven by within-species transmission, while cross-species-infection appears to be of minor importance. Thus, the disease control strategy has to target both host populations.     

Bat rabies in South Carolina, 1970-90.

This retrospective study examines the geographic and temporal distribution of bat species submitted for rabies testing in South Carolina (USA) from 1970 to 1990. Histories of human or animal exposures to rabid and nonrabid bats submitted during this time period were compared. Two hundred and thirty-one bats were found to be rabid from the 2,657 bats submitted over this 20 yr period. The two species most frequently submitted for testing were Lasiurus borealis with 785 specimens (30% of the total) and Nycticeius humeralis with 607 specimens (22% of the total). Lasiurus borealis also had the highest prevalence of rabies (18%) while N. humeralis had the lowest prevalence (3%). Fifty-one percent (1,259) of the bats received for testing were submitted from June through August. The majority (54%) of rabid bats were received from August through October.