Rabies epidemiology, prevention and control in Nigeria: Scoping progress towards elimination

Abstract

Background Human rabies remains a significant public health problem in Africa with outbreaks reported in most countries. In Nigeria–the most populous country in Africa–rabies causes a significant public health burden partly due to perennial obstacles to implementing a national prevention and control program. Methods We conducted a scoping review using standard Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify and select published articles from Nigeria during 1978–2020 reporting on rabies virus infections (human, canine, livestock, and wildlife), canine bites, knowledge, attitudes and practices (KAP) surveys on rabies and canine ecology studies. We extracted information on study location, year and additional details of each study such as rabies prevalence, general characteristics of offending dogs, dog vaccination status and health-seeking behaviours. Findings Between 1978 and 2020, 90 published articles met our inclusion criteria. The prevalence of rabies virus antigen detection varied between 3% and 28%, with more studies in the north. Most bites were unprovoked from dog bite studies (36.4%-97%), by dogs with low vaccination rates (12–38%). A more significant proportion of biting dogs were owned (31–90%). Laboratory confirmation for biting was available for only a small proportion of studies (6%; n = 2/32). Of the dogs surveyed during ecology studies, indigenous dogs accounted for the majority (62–98%), used mostly for security purposes (52–98%), with the vaccination rate between 15% and 38% in most states. Studies conducted in areas distant from rabies diagnostic facilities accounted for more human rabies cases and fewer dog rabies cases. Conclusion Significant improvements are necessary to achieve the elimination of human rabies mediated via dogs by 2030.

Spatiotemporal heterogeneity and determinants of canine rabies evidence at Local Government Area Level in Nigeria: Implications for rabies prevention and control

“…Histological staining of Negri bodies is neither as sensitive nor as specific as DFAT and dRIT [ 28 ]. False-positive samples might have been processed, or only submissions from confirmed cases were processed [ [1] , [2] , [3] , [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] ]. Moreover, the Sellers staining method can be laborious, as evident in the number of samples processed before the introduction of DFAT, especially during 2004.…”

“…To evaluate factors associated with potential geographical biases in the NVRI canine rabies surveillance data, we supplemented official NVRI data with rabies data from systematically searched, peer-reviewed research articles on dog and human rabies involving dogs from Nigeria and published between 1990 and 2020. The detailed research protocol and the results of this systematic review were described previously [ 7 ]. In brief, we systematically reviewed published articles on rabies from Nigeria using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to search (PubMed, Web of Science, Scopus, Google scholar) and identify published articles on canine rabies across Nigeria.…”

“…The Stepwise Approach towards Rabies Elimination (SARE) was designed to allow rabies endemic countries to objectively measure their strengths and weaknesses, using available canine rabies evidence with scores between 0 and 5. Zero for canine rabies endemic countries and five signifying freedom from canine rabies [ [5] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] ]. Several countries within the Pan-African Rabies Control Network (PARACON), such as Sierra Leone, Angola, Burkina Faso, Niger, Guinea-Bissau have a score of zero.…”

“…Efficient monitoring of rabies programs depends upon gathering accurate information on disease occurrence and regular evaluation of the representativeness of surveillance efforts for cost-effective interventions. Since the first reported human case from Nigeria in 1912, rabies has remained a significant public health problem [ 7 ]. However, in many endemic countries, the lack of reliable canine rabies evidence to evaluate the performance of the existing control program poses a significant obstacle to understanding the disease burden for targeted interventions.…”

“…The current SARE score for Nigeria is 1.5, implying a lack of reliable evidence is hampering the development of a national rabies control program [ 5 ]. This figure is likely to vary across the country, and a recent scoping review unveiled substantial obstacles in developing cost-effective risk-based interventions [ 7 ].…”