Surveillance guidelines for disease elimination: A case study of canine rabies

Abstract

Surveillance is a critical component of disease control programmes but is often poorly resourced, particularly in developing countries lacking good infrastructure and especially for zoonoses which require combined veterinary and medical capacity and collaboration. Here we examine how successful control, and ultimately disease elimination, depends on effective surveillance. We estimated that detection probabilities of <0.1 are broadly typical of rabies surveillance in endemic countries and areas without a history of rabies. Using outbreak simulation techniques we investigated how the probability of detection affects outbreak spread, and outcomes of response strategies such as time to control an outbreak, probability of elimination, and the certainty of declaring freedom from disease. Assuming realistically poor surveillance (probability of detection <0.1), we show that proactive mass dog vaccination is much more effective at controlling rabies and no more costly than campaigns that vaccinate in response to case detection. Control through proactive vaccination followed by 2 years of continuous monitoring and vaccination should be sufficient to guarantee elimination from an isolated area not subject to repeat introductions. We recommend that rabies control programmes ought to be able to maintain surveillance levels that detect at least 5% (and ideally 10%) of all cases to improve their prospects of eliminating rabies, and this can be achieved through greater intersectoral collaboration. Our approach illustrates how surveillance is critical for the control and elimination of diseases such as canine rabies and can provide minimum surveillance requirements and technical guidance for elimination programmes under a broad-range of circumstances.

Determinants of Vaccination Coverage and Consequences for Rabies Control in Bali, Indonesia

“…Therefore, in the aftermath of a vaccination campaign, coverage can rapidly decline. Furthermore, even relatively small gaps in vaccination coverage can facilitate the persistence of infection (4, 5). Understanding the obstacles to maintain high vaccination coverage between campaigns is therefore critical to ensure the elimination of rabies from Bali.…”

Cost Description and Comparative Cost Efficiency of Post-Exposure Prophylaxis and Canine Mass Vaccination against Rabies in N’Djamena, Chad

“…Animal rabies surveillance in our study was based on passive reporting of suspected cases. A study in Tanzania suggests that a passive surveillance system is only able to detect 1% of actual rabies cases (33), and Townsend et al estimate that only a detection success of 10% can prove the absence of animal rabies within the time period of 2 years (34). In our study reporting was boosted by a sensitization campaign, and we also hypothesize that the urban context with high human density leads to a higher detection rate.…”

A Bayesian approach for inferring the dynamics of partially observed endemic infectious diseases from space-time-genetic data

“…As the herpestidassociated genetic variant of rabies virus is rare in KZN, the five cases which could not be sequenced were most likely . Such high detection rates are exceptional for rabies [34] and need further confirmation by contact tracing. However, surveillance effort (measured as the number of samples submitted per month) was fairly constant over the study period while incidence concurrently declined, suggesting that the ongoing intensive control programme is effectively driving rabies towards elimination, which could account for the low total number of cases inferred from this analysis.…”