Review of rabies situation and control in the North African region with a focus on Tunisia

Abstract

Rabies is a major zoonosis that affects the central nervous system of warm-blooded mammals. The disease is present worldwide, except for some islands. Africa and Asia record over 95% of the fatal cases of rabies worldwide, and therefore the greatest risk to human life from rabies occurs in these regions. Mass vaccination of dogs is the most appropriate way to control and eliminate the disease at the animal source, in order to interrupt the infectious cycle of the disease from animals to humans. Rabies is endemic in the North African region, and countries should be encouraged to develop programmes for eliminating human rabies through the implementation of sustained campaigns to immunise dogs and by providing post-exposure prophylaxis (PEP) to people who have been exposed to suspected rabid dogs. In Tunisia, the national strategy against rabies was started in 1981 and it has been upgraded since. Following the launch of the annual vaccination programme in 1993, there was a significant improvement in the health status for rabies in Tunisia, with a decrease in the number of cases in animals and humans. Since 2011, an increase in cases of rabies in dogs and humans has been observed, due to lower vaccination coverage, mismanagement of waste and an increase in the stray dog population. The political will at international, regional and national levels is the cornerstone of the strategy to eliminate the disease. In the framework of the regional approach in the Maghreb, additional efforts and political willingness are necessary at the national level to better control and eventually eliminate rabies.

Temporal and spatial distributions of animal and human rabies cases during 2012 and 2018, in Tunisia

“…As described, animal rabies is enzootic in Tunisia (Ripani et al., 2017). Such epidemiological situation of the disease is comparable with that of many other countries in North Africa (Morocco, Algeria, Libya, etc.)…”

“…This decrease coincided with a period of intense destabilization in Tunisia. Instability and insecurity resulting from the manifestations had indirect consequences on the disease surveillance (Ripani et al., 2017). Veterinarians were unable to collect samples and a notable variation in reporting cases was observed.…”

Animal bites and post-exposure prophylaxis in Central-West Tunisia: a 15-year surveillance data

“…Rabies is a neglected zoonotic disease caused by an RNA virus of the genus Lyssavirus of the Rhabdoviridae family [ 1 ] . It is an infectious viral disease that affects the central nervous system of mammals and is fatal once symptoms develop [ 2 ]. Rabies is a disease of antiquity, still existing, and leading to more fatalities than any other zoonotic diseases [ 3 , 4 ].…”

“…Rabies is endemic in North Africa and thus, the development of an elimination program through dog vaccination and PEP provided to people exposed to suspected rabid animal should be encouraged [ 2 ]. In Tunisia, rabies is a notifiable disease with a national surveillance system in place [ 2 ].…”

“…Rabies is endemic in North Africa and thus, the development of an elimination program through dog vaccination and PEP provided to people exposed to suspected rabid animal should be encouraged [ 2 ]. In Tunisia, rabies is a notifiable disease with a national surveillance system in place [ 2 ]. The National Rabies Control Program (NRCP) was implemented in 1982, by a collaboration of the Ministry of Interior, the Ministry of Agriculture and the Ministry of Health.…”