Implementing a One Health Approach to Rabies Surveillance: Lessons From Integrated Bite Case Management

Abstract

As part of the ‘Zero by 30’ strategy to end human deaths from dog-mediated rabies by 2030, international organizations recommend a One Health framework that includes Integrated Bite Case Management (IBCM). However, little is understood about the implementation of IBCM in practice. This study aims to understand how IBCM is conceptualized, exploring how IBCM has been operationalized in different contexts, as well as barriers and facilitators to implementation. Semi-structured interviews were conducted with seventeen practitioners and researchers with international, national, and local expertise across Africa, Asia, and the Americas. Thematic analysis was undertaken using both inductive and deductive approaches. Four main themes were identified: 1) stakeholders’ and practitioners’ conceptualization of IBCM and its role in rabies elimination; 2) variation in how IBCM operates across different contexts; 3) barriers and facilitators of IBCM implementation in relation to risk assessment, PEP provisioning, animal investigation, One Health collaboration, and data reporting; and 4) the impact of the COVID-19 pandemic on IBCM programs. This study highlights the diversity within experts’ conceptualization of IBCM, and its operationalization. The range of perspectives revealed that there are different ways of organizing IBCM within health systems and it is not a one-size-fits-all approach. The issue of sustainability remains the greatest challenge to implementation. Contextual features of each location influenced the delivery and the potential impact of IBCM. Programs spanned from highly endemic settings with limited access to PEP charged to the patient, to low endemicity settings with a large patient load associated with free PEP policies and sensitization. In practice, IBCM was tailored to meet the demands of the local context and level of rabies control. Thus, experts’ experiences did not necessarily translate across contexts, affecting perceptions about the function, motivation for, and implementation of IBCM. To design and implement future and current programs, guidance should be provided for health workers receiving patients on assessing the history and signs of rabies in the biting animal. The study findings provide insights in relation to implementation of IBCM and how it can support programs aiming to reach the Zero by 30 goal.

Integrating contact tracing and whole-genome sequencing to track the elimination of dog-mediated rabies: An observational and genomic study

“…Without enhanced surveillance during the endgame, incursions would be more likely to go undetected until human deaths occur ( Townsend et al, 2013b ). Other less intensive approaches, such as integrated bite case management, may be more feasible if used to first increase case detection, strengthen intersectoral working and build technical competence in One Health working generally ( Swedberg et al, 2022 ). Genomic approaches are also increasingly affordable, and capacity for genomic surveillance is growing, accelerated over the course of the SARS-CoV-2 pandemic.…”

Dog Ecology and Rabies Knowledge, Attitude and Practice (KAP) in the Northern Communal Areas of Namibia

“…This requires closer cooperation between public health and veterinary services. Experience has shown that implementing an IBCM within a One Health framework can significantly improve rabies surveillance and performance and access to post-exposure prophylaxis (PEP) in a region [87][88][89][90][91][92].…”

Rabies post-exposure prophylaxis delivery to ensure treatment efficacy and increase compliance

“…1 above) and the offending animal side (see Fig. 2 above) [13] . Additionally, connecting human exposures to rabies susceptible animals, human rabies cases and animal rabies cases can help draft local endemicity maps, to better determine the level of rabies risk and deliver rabies biologicals in a more informed manner [14] .…”