One Health Surveillance for Rabies: A Case Study of Integrated Bite Case Management in Albay Province, Philippines

Abstract

Canine rabies is a significant public health concern and economic burden in the Philippines. Animal Bite Treatment Centers (ABTCs) that provide post-exposure prophylaxis (PEP) to bite patients have been established across the country, but the incidence of bite patient presentations has grown unsustainably, whilst rabies transmission in domestic dogs has not been controlled. Moreover, weak surveillance leads to low case detection and late outbreak responses. Here we investigated the potential for Integrated Bite Case Management (IBCM) to improve rabies detection in Albay province. Using information obtained from animal bite histories combined with phone follow-ups and field investigations, we demonstrated that IBCM resulted in a fourfold increase in case detection over 13 months of study compared to the prior period. Bite patient incidence across Albay was very high (>600/100,000 persons/year) with PEP administered mostly indiscriminately. Clinic attendance reflected availability of PEP and proximity to ABTCs rather than rabies incidence (<3% of patient presentations were from “probable” or confirmed rabies exposures) and is therefore not a suitable indicator of rabies burden. Further analysis of the IBCM data suggests that rabies transmission is mostly localized with focal cases from the previous month and current cases in neighbouring villages being most predictive of future rabies occurrence. We conclude that investigations of suspicious biting incidents identified through IBCM have potential to foster intersectoral relationships, and collaborative investments between public health and veterinary services, enabling the One Health ethos to be applied in a more sustainable and equitable way. Triage of patients and investigations of suspect dogs offer an effective tool for improved PEP provisioning and reduction of unnecessary expenditure, whilst targeted field investigations should lead to increased and earlier detection of rabid dogs. Given the enduring risk of re-introductions from neighbouring populations, enhanced surveillance is critical to achieving and maintaining rabies freedom.

An assessment of the operationality and factors influencing the effectiveness of rabies surveillance in Gombe State, Nigeria

“…For instance, One Health surveillance has been previously implemented in Kyrgyzstan where joint surveillance in livestock and humans formed the basis for the development of intersectoral and cost-effective control [61]. A similar joint surveillance approach has also been reported in Mongolia, the Philippines, and Tanzania [61][62][63].…”

“…The Integrated Bite Case Management (IBCM), known to have increased rabies case detection in the Philippines, Tanzania and Chad [ 47 , 62 , 63 ], is a One Health approach for rabies mitigation that links both the veterinary and health sectors to assess the risk of rabies among dog bite victims and the implicated biting animal to ensure optimal treatment. The risk assessment of the IBCM is dependent upon the patients’ ability to present themselves to a health facility following a bite incidence [ 62 ].…”

Nationally and locally-initiated One Health approach in controlling rabies in West Kalimantan, Indonesia

“…The programs implemented in Sanggau District, Pontianak City, and Ketapang District optimized cross-sectoral surveillance. The lack of integrated surveillance was the primary constraint in understanding rabies dynamics locally and effectively controlling the disease [ 14 ].…”

“…Implementing cross-sectoral integrated surveillance can substantially improve case detection so that information on detected cases can impact the use of proper PEP [ 14 ]. Sufficiency and availability of PEP are the only prevention of rabies in humans after the bite of a rabies-carrier animal [ 12 ].…”

“When a dog bites someone”: Community and service provider dynamics influencing access to integrated bite case management in Chad

“…Investigation of the rabies suspicion status of a biting animal through an animal health professional can help to assess a patient's exposure risk and thus ensure adequate use of human rabies vaccine that is currently in short supply ( 9 , 10 ). This risk assessment and advanced surveillance based on a One Health (OH) approach is called integrated bite case management (IBCM) ( 11 ) and has been proven to be effective in various settings including Haiti ( 12 ), Tanzania ( 13 ) and the Philippines ( 14 ). To describe effectiveness of IBCM the elements of access to health care described in the framework proposed by Obrist et al ( 15 ) can be applied on community, human health and veterinary health levels, respectively.…”