“Rabies Control Tackled Locally and Advanced Globally ...
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The Alliance is a registered charity in the UK and a 501(c)(3) organization in the US www.rabiesalliance.org 1 RITA 2016................................................ 1-2 Illocos Norte Project Awarded.................... 3 2015 GARC Annual Report........................ 3 WRD MSD Animal Health Awards.............. 4 SARE Workshop in Ethiopia....................... 5 WRD in Philippines .................................... 6 Journalism Students in Philippines ............ 7 Human Rabies Survivors ............................ 7 Rapid Diagnostic Tests for Rabies ............. 8 WRD in Pakistan ........................................ 9 Thermostability of Rabies Vaccine.......10-11 Recent Research ......................................11 Upcoming Conferences ........................... 12 NOVEMBER 2016 ISSUE 50 Where Do We Go From Here? The GARC newsleer generally concentrates on rabies news, but this month the implicaons of the US elecons are at the forefront of many people’s minds. Love him or loathe him, Trump’s success represents an overthrow of the establishment and a period of uncertainty. How will his ascent to the presidency affect the world order? And— of course—what impact will this have on support for internaonal aid and global rabies prevenon efforts? The whole non-profit sector is wondering what will happen next but, as Nonprofit Quarterly points out, “It is hard to see what parts of the rhetoric of the campaign will be brought forth, but we do have some control over how we will carry on.” The answer to the queson “where do we go from here?” is onwards and upwards. As a community commied to rabies prevenon, we need to deepen our resolve, strengthen our links with like-minded organisaons, and connue to push our advocacy efforts to make sure policy makers understand the importance and value of rabies prevenon. And with that in mind, in this issue we report on new developments in rabies control, including: an update to the Stepwise Approach to Rabies Eliminaon; a summary of the Rabies In The Americas conference in Brazil; promising research assessing the thermo-stability of an exisng rabies vaccine; the winners of the World Rabies Day MSD Awards, and much more. In the next issue we’ll give you a full report on the 10th World Rabies Day but today we can tell you that a fantasc 302 events were registered in 55 different countries, with increases in the number of events registered in 5 of the 7 regions. If you took part in an event, please do share your photos and experiences on the event’s unique page on our website or on Facebook and Twier. As always, we love to hear from you. If you have comments, suggesons or would like to submit an arcle for the newsleer, please get in touch. “Rabies Control Tackled Locally and Advanced Globally” Explored at 27th RITA Meeting The annual Rabies in the Americas (RITA) conference was held on October 23-28th in Belem, Brazil in the heart (and the heat!) of the Amazon region, coinciding with the 80th anniversary of the Instuto Evandro Chagas, Brazil’s public health surveillance agency. First started 27 years ago in Atlanta, GA, this meeng connues to bring together veterinarians, public health officials, academics and students to present and discuss the latest research on rabies and how to control and prevent its spread in domesc animals and wildlife in the Americas. The warm hospitality of the Brazilian people was evident throughout the meeng, especially during the evening recepons, the gala dinner and the fundraising aucon where tradional Brazilian musical fesvies and dancing were the highlights. Connued on page 2...
Transcript of “Rabies Control Tackled Locally and Advanced Globally ...
The Alliance is a registered charity in the UK and a 501(c)(3) organization in the US www.rabiesalliance.org 1
RITA 2016................................................1-2Illocos Norte Project Awarded .................... 32015 GARC Annual Report ........................ 3WRD MSD Animal Health Awards.............. 4SARE Workshop in Ethiopia....................... 5WRD in Philippines .................................... 6Journalism Students in Philippines ............ 7Human Rabies Survivors ............................ 7Rapid Diagnostic Tests for Rabies ............. 8WRD in Pakistan ........................................ 9Thermostability of Rabies Vaccine .......10-11Recent Research ......................................11Upcoming Conferences ........................... 12
NOVEMBER 2016 ISSUE 50
Where Do We Go From Here? TheGARCnewslettergenerallyconcentratesonrabiesnews,butthismonththeimplicationsoftheUSelectionsareattheforefrontofmanypeople’sminds.Lovehimorloathehim,Trump’ssuccessrepresentsanoverthrowoftheestablishmentandaperiodofuncertainty.Howwillhisascenttothepresidencyaffecttheworldorder?And—ofcourse—whatimpactwillthishaveonsupportforinternationalaidandglobalrabiespreventionefforts? Thewholenon-profit sector iswonderingwhatwillhappennextbut,asNonprofitQuarterlypointsout, “It ishardtoseewhatpartsoftherhetoricofthecampaignwillbebroughtforth,butwedohavesomecontroloverhowwewillcarryon.”
Theanswertothequestion“wheredowegofromhere?”isonwardsandupwards.Asacommunitycommittedto rabiesprevention,weneed todeepenour resolve, strengthenour linkswith like-mindedorganisations,andcontinuetopushouradvocacyeffortstomakesurepolicymakersunderstandtheimportanceandvalueofrabiesprevention. Andwiththatinmind,inthisissuewereportonnewdevelopmentsinrabiescontrol,including:anupdatetotheStepwiseApproachtoRabiesElimination;asummaryoftheRabiesInTheAmericasconferenceinBrazil;promisingresearchassessingthethermo-stabilityofanexistingrabiesvaccine;thewinnersoftheWorldRabiesDayMSDAwards,andmuchmore. In thenext issuewe’llgiveyoua full reportonthe10thWorldRabiesDaybuttodaywecantellyouthatafantastic302eventswereregisteredin55differentcountries,withincreasesinthenumberofeventsregisteredin5ofthe7regions.Ifyoutookpartinanevent,pleasedoshareyourphotosandexperiencesontheevent’suniquepageonourwebsiteoronFacebookandTwitter. Asalways,welovetohearfromyou.Ifyouhavecomments,suggestionsorwouldliketosubmitanarticleforthenewsletter,pleasegetintouch.
“Rabies Control Tackled Locally and Advanced Globally” Explored at 27th RITA Meeting
TheannualRabiesintheAmericas(RITA)conferencewasheldonOctober23-28thinBelem,Brazilintheheart(andtheheat!)oftheAmazonregion,coincidingwiththe80thanniversaryoftheInstitutoEvandroChagas,Brazil’spublichealthsurveillanceagency.Firststarted27yearsagoinAtlanta,GA,thismeetingcontinuestobringtogetherveterinarians,publichealthofficials,academicsandstudentstopresentanddiscussthelatestresearchonrabiesandhowtocontrolandpreventitsspreadindomesticanimalsandwildlifeintheAmericas.ThewarmhospitalityoftheBrazilianpeoplewasevidentthroughoutthemeeting,especiallyduring theevening receptions, thegaladinnerand the fundraisingauctionwheretraditionalBrazilianmusicalfestivitiesanddancingwerethehighlights.
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The Alliance is a registered charity in the UK and a 501(c)(3) organization in the US www.rabiesalliance.org 2
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AlongwiththePresidentofRITA,Dr.IvaneteKotaitoftheVencofarmaLaboratoryofBrazil,participants at the opening ceremoniesincludedseniorrepresentativesfrommanyofthe Brazilian public health organizations andgovernment departments. Inclusion of andcollaboration between multiple governmentandregionalpublichealthorganizationsacrossall health sectors (veterinary and human) isessentialforachievingrabieseliminationintheregion, and gathering these senior ministersat the event indicated a strong commitmentregionallytorabiescontrolefforts. Each year, RITA draws accomplishedrabies researchers from around theworld toparticipate, but this meeting also providesmany opportunities for young scientists topresenttheirwork.WinneroftheannualGeorgeBaerLatinAmericanInvestigatorAward,JulioBenavidesspokeonthe“SpatialExpansionsandTravellingWavesofRabiesinVampireBatsinPeru”anddescribedhowhisresearchispredictingpatternsofspreadofbatrabiesintoWesternPeruanddiscussedtheopportunitieshehashadtotestcontrolstrategies. Otherresearchpresentationsexploredissuessuchasthecontrolofrabiesarisingfrombatbites,treatingthoseexposedtothevirus,theimmuneresponseinhumans,aswellastheevaluationofcontrolandsurveillanceefforts.Amongstmanyimportantnewfindings,someofthosesharedwere:
• UsingabitecasemanagementprogramsignificantlyimprovedhumanhealthoutcomesafterpotentialexposuresinHaiti.
• Alowercostanti-RABVmonoclonalantibodycocktailhasbeentestedthatcouldbeusedasareplacementforRIGduringPEP.
• Developmentofsensitivesurveillancemethods focusedontargetedapproachessuchasactivecase-findingshouldbemoreeffectivethanrandomsamplingduringthefinalstagesofelimination.
• Therecentre-emergenceofcaninerabiescasesinSouthernPeruhasraisedconcernsamongstthemedicalandpublichealthcommunities.
Themeetingwas cappedbya thought-provokingwebinarwhichwasbroadcast tohundredsof viewersnotattending themeeting inperson.Presentationswere focusedon: the roleof serology in assessingananimal’svaccinestatusafterapotentialrabiesexposure;theuseofaninexpensivemicroscopefrompaperfordRITdiagnosis;usingasmartphoneapptoassessvaccinationcoverageindogs;thevalueoforalrabiesvaccine(ORV)fordogsandtakingstockofalltheresourcesneededtoachievethegoalofglobaleliminationby2030.Thelastsessionexploredimmunizinghigh-riskindigenouspopulationswithPrEPpriortoexposures;thedevelopmentofpotentialanti-viralmedicationsforrabies;andtheincreasingsuccessratesofintensive-caretreatmentforrabiespatients. Theconferenceproceedingsendedwithapresentationonthe2017RITAtobeheld inCalgaryCanada.TheUniversityofCalgaryFacultyofVeterinaryMedicinewillbehost,alongwithitspartners,AlbertaAgricultureandForestrydept.,theCanadianFoodInspection,andCanadianPublicHealthAgencies. As theAmericas region comescloserand closer to reaching completeeliminationof canine rabies, there isincreasingneedtoshareandtransfertheknowledgeandlessonslearnedalongthewaytoothercountriesinAfricaandAsiawhocontinuetostrugglewithahighburdenofhumancases.Bycontinuingtosetanexampleofsuccessfulinternationalcollaborationamongstrabiesexperts,theRITAmeetingcanhelptoinformrabiescontroleffortsnotjustintheAmericasregion,butaroundtheworld.Contributed by Laura Baker, who represented GARC with Louise Taylor at the meeting
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The Alliance is a registered charity in the UK and a 501(c)(3) organization in the US www.rabiesalliance.org 3
APRIL 2015 • Issue 42NOVEMBER 2016 • Issue 50
GARC’s Ilocos Norte Project Receives National AwardGARC’sCommunitiesAgainstRabiesExposure(CARE)project
siteinIlocosNortereceivedanawardforbeingoneoftheBestLocalGovernmentUnitRabiesProgramImplementers inthePhilippinesduringthenationalcelebrationoftheWorldRabiesDayonSeptember28th inQuezonCity.GARC’sCommunityEducationOfficer,EuniceCharisMendozaandFieldVeterinarian,DianneLicuanreceivedtheawardonbehalfofDr.LoidaValenzuela,theProvincialVeterinarianofIlocosNorte,whowasnotabletoattendtheevent.
AlsoreceivingawardswereDrManuelCarlosofMarikinaCityandDrStellaLapiztheProvincialVeterinarianofBoholProvince–bothareaswhereGARChascollaboratedonrabiescontrolprojectswiththelocalgovernment.
TheNationalWRDcelebrationalsosawthelaunchingoftherabiesmascot,SuperBantay(GuardDog)andthedeclarationofthreemoreareasasrabies-free:theMunicipalityofRomblonandMunicipalityofSanJoseinRomblonProvince; and Pan De Acuzar and Botog Islands in theMunicipality ofConcepcion,IloiloProvince. It gives GARC great pleasure to receive this award, to join in therecognitionofallthosewhohavecontributedtotherabiescontroleffortsacross the Philippines, and to recognize howmuch closer these effortshaveleadustowardsarabiesfreePhilippines. TheeventalsogaveGARCtheopportunitytoformallypresent10,000copies of a GARC rabies prevention storybook to the National RabiesPrevention and Control Committee, to the Department of Interior andLocalGovernment,andProvincial,City,MunicipalVeterinariansLeagueofthePhilippines.Thebookfocusesonhowchildrenshouldproperlytakecare of their pets, the importance of telling their parents when bittenbyadogorotheranimalsandalsodiscussesanimalbitepreventionandmanagement.
The storybooks, kindly reproduced by Merial, will be distributed tothedaycarecentersandelementary schools in theGARCCAREProjectsitesandtootherhighriskrabiesareas inthecountry.AnanimationofthestorybookhasalsobeenairedontheKnowledgeChannelacrossthePhilippines.Contributed by Sarah Jayme, country representative for the Philippines, GARC
2015 GARC Annual Report – a Very Productive YearWe’repleasedtoshareour2015AnnualReport,whichprovidesanopportunitytoreflecton themajorachievements in rabiespreventionandcontrol thathappenedover theyear,including:• Theglobalrabiesmeetingandagreementontheeliminationofdeathsby2030• Thepublicationof a revisedestimateof theglobalburdenof rabies - anannual
burdenof59,000deathsandUSD8.6billion• The launchof the EndRabiesNowmulti-partner campaign, calling for an end to
humandeathsfromdog-transmittedrabiesby2030• TheinauguralmeetingofthePan-AfricanRabiesControlNetwork,withrepresentatives
from33Africancountries
Wehavealsocreatedashortvideototakeyouthroughthe2015highlights–availablehere.Youcandownloadthefullannualreportonourwebsitehere.
The Alliance is a registered charity in the UK and a 501(c)(3) organization in the US www.rabiesalliance.org 4
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Congratulations to the Recipients of the World Rabies Day MSD Animal Health Awards
GARCishonouredtorecogniseoutstandingcontributionstorabiespreventionwiththefirstWorldRabiesDayMSDAnimalHealthAwards.EveryawardeereceivedUSD1,200(orequivalentinkind),acertificateandanawardplaque.Theawardwinnersarelistedhere:
Theideabehindtheawardswastodrawmoreattentionto thepositiveworkbeingdone tobringuscloser to thegoal of eliminating human deaths by canine rabies in2030.Toaccomplishthis,GARCteamedupwithveterinarypharmaceutical manufacturer MSD Animal Health tolaunch these awards for the 10thWorld RabiesDay. TheeightawardwinnerswerechosenbyapanelofjudgesfromtheCDC,FAO,OIE,WHO,MSDandGARC,alongwithvotingbyMSDemployees. It is hoped that by highlighting the work of thesewinnersandnominees,moreemphasis canbeplacedonthesustainedprogressthathappensdailyincommunitiesaroundtheworld.Additionally,knowingtherearededicatedindividualswhocontinuetoaccomplishsomuchisasourceofinspirationforusall,andwehopethatyou’llsendinmoregreatnominationsfornextyear’sawards.Viewmoreinformationaboutthewinnersandtheshortlistednomineesandthegreatworkthey’redoing,here.
Submitted by Deepa Balaram and Laura Baker, GARC
Organisation Category Awardees
Visakha Society for Protection And Care of Animals (Asia) advocates for and implements humanealternatives to culling street dogs in the state ofAndhraPradesh.
Liberia Animal Welfare & Conservation Society (LAWCS,Sub-SaharanAfrica)provideseducationandoutreachsupportforrabiesawarenessanddogbiteprevention in Liberian schools and communities,while also running no-cost, dog-rabies vaccinationcampaigns.
Kurdistan Organization for Animal Rights Protection(KOARP,MiddleEast,NorthAfrica,CentralAsia&Europe)focusesitsworkonrabiespreventionandanimalwelfarethroughvolunteer-runveterinaryservices for stray animals, while also working toreformstray-dog-controllaws.
Zach Jones Memorial Fund (ZJMF, Americas) waslaunchedtopromoterabiesawarenessandresearchafter Connie and Larry Jones lost their only child,Zach,at16yearsofagetorabiesafterabatbitein2006.
Individual Category Awardees
Dr. Thinlay Bhutia (Asia), leader of the Sikkim Anti-Rabies andAnimalHealth Program (SARAH) in India,has worked to end local dog culling and implementstray-dogandrabies-controleffortsthathavereducedthestreetdogpopulationsandreducetheincidenceofrabies.
Dr Agnes Korir(Sub-Saharan Africa) founded theSharon LiveOnFoundation following thedeath fromrabiesofherseven-yearolddaughterandhassuppliedover270,000vaccinationstodogsinKenya.
Professor Kastriot Korro(Middle East, North Africa,CentralAsia&Europe) represents theNational FocalPointforwildlifediseasesforAlbania,andcontinuestosustaincommunityawarenessagainstrabiesinpeopleanddomesticandwildanimals,effortshehasengagedinsince1996.
Dr. Sergio Recuenco-Cabrera(Americas)isanadvocatefor controlling vampire bat-associated rabies in theAmazonwhileworkingwithin theCDC,Rabies in theAmericas and subsidiary meetings, Pan AmericanHealthOrganization, the PeruvianMinistry of Health(MOH)andNationalInstitutesofHealth(NIH).
The Alliance is a registered charity in the UK and a 501(c)(3) organization in the US www.rabiesalliance.org 5
APRIL 2015 • Issue 42NOVEMBER 2016 • Issue 50
Helping Countries to Help Themselves: the Updated SARE Tool
As thefightagainst rabies continues toevolveandadapt, somust thetoolsthatareusedtowinthatfight. Withtheglobaldrivetowardscanine-mediatedhumanrabieseliminationby2030onthetonguesofeverybodyintherabiesfieldthesedays,thereisalotofattentionfocusedonthisachievablegoal.Yet,manycountriesfaceachallengingtaskaheadofthembecausemostrabies-endemiccountriesinAfricaandAsiaarestillintheearlystagesofthisfight.Asmanypublications,presentations and speeches before this have highlighted, the globalcommunityismakingeveryefforttohelpthesecountriestoinitiateeffectiveandsustainablecontrolprogrammes,whilstalsoencouragingmoreadvancedcountriestoshowcasetheireffortsandsharetheirexperiencesastheyreachtheireliminationtargets. Theever-presentdilemmaofthecycleofneglecthashinderedanysubstantialprogresshistorically;however,withthesupportfromtheglobalcommunityandthetoolsthathavebeendevelopedinmorerecentyears,itisnowpossibletobreakthiscycle.OnesuchtoolinidentifyingthemeanstobreakthecycleofneglectistheStepwiseApproachtowardsRabiesElimination(SARE)toolthathasbeenincorporatedintotheBlueprintforRabiesControl(http://rabiesblueprint.org). The SARE tool enables countries to perform self-assessments of their ownuniquerabiessituationandcreatesascorebasedonspecificachievementsthateachcountryhascompleted.Thus,ascorefromstage0–5isprovidedataglance,givinganimmediateoverviewoftheprogressthecountryhasmadetowardsbeingfreefromcaninerabies.Withamorein-depthanalysisoftheoutputs,thetoolhighlightstheexactactivitiesthathavebeencompletedaswellasthosethatarepending.Byusingthesependingactivitiesasguidelinesforthenextstepsneededtoachieveelimination,countriesareabletoeasilyandeffectivelyidentifyareasofconcernortargetareasforfurtherattention. TheSAREtoolisnowmorethan2-yearsold,andalthoughsomeminorrevisionshavebeenmade,someofthequestionswereeitherunclearorvague,expectinguserstohaveanin-depthknowledgeoftheSAREconceptandanunderstandingoftheprocessesthathavebeendeveloped.Inlightofthis,GARCincollaborationwiththeFAOandotherpartnershasworkedtirelesslyoverthepastmonthstoreviseandimproveupontheSAREtool.
Revisions and updates to the tool:- Clarified instructions to users- Locked access until instructions are read- Revision of activities in each stage- Improved and revised SARE diagram- Automatic scoring of stage- Direct links to Blueprint for Rabies Control- Addition of activities to clarify progression- Progression on activities revised- Improved Dog-population management (DPM) criteria- Improved Information, Education and Communication (IEC) criteria- Improved language and clarity on questions
Thenewestversionof theSARE toolhasalreadybeenpre-tested in thePhilippinesandsubsequentlybeta-testedataPhilippinessub-nationalmeeting.Furthermore,therevisedtoolwaslaunchedattheGARC-WAPjointrabieseliminationplanningworkshopthatwasheldinSouthAfricafrom25-26October2016.Delegatesfoundthatusingandinterpretingthetoolwasfareasierthanbefore,withthemajorityofdelegatesbeingabletocompletetheassessmentwithlittlehelporclarificationfromthefacilitators. Althoughthetoolhasbeensubstantiallyimproved,therewillalwaysbewaystobetterthetoolforuseinvarioussituations.Becauseofthis,adedicatedteamofexpertsfromaroundtheworldcontinuetoworkontheSAREtooltoensurethatitprovideseasy-to-use,accurateandmuchneededguidancetorabies-endemiccountriestohelpthemreach theirgloballyacceptedgoalof canine-mediatedhuman rabieseliminationby theyear2030.MoreinformationabouttheSAREcanbefoundhere and the updated SARE tool will be incorporated into the blueprint shortly.Submitted by Terence Scott and Andre Coetzer, GARC and members of the Pan-African Rabies Control Network (PARACON) Steering Committee
The Alliance is a registered charity in the UK and a 501(c)(3) organization in the US www.rabiesalliance.org 6
APRIL 2015 • Issue 42NOVEMBER 2016 • Issue 50
World Rabies Day 2016 Celebration in the Philippines: Towards Rabies-free by 2020
Septemberisalwaysanaction-packedmonthfortheGARCteaminthePhilippines,who—togetherwithourpartners—markthismonthfortheannualnationwidecelebrationofWorldRabiesDay(WRD)onSeptember28.ThePhilippinesisamongthesevenSoutheastAsiancountrieswherecaninerabiesisstillhighlyendemic,andsotheWorldRabiesDaycelebrationpresentsanopportunitytoeducateandinvolveFilipinosinthesharedgoaltoultimatelyeliminaterabiesinthecountrybytheyear2020.
From the national government down to the villages, thenumberofpeoplewhoparticipateinthecelebrationkeepsgrowingeachyear.For2016,morethan80eventorganizersparticipatedintheWRDcelebrationwithover90eventsregisteredontheGARCwebsite,asubstantial increase from66events in2014and76 in2015. These events include routine free mass dog vaccinations,spay and neuter services, and community/school lectures, butsome partners organized pet-and-owner fun runs, school-basedcompetitions, dog shows, radio and television interviews, andrabiessummits. Atthenationallevel,theDeclarationofRabies-freeZoneshasalwaysbeenahighlightoftheWRDcelebration.Since2008,38areashavealreadybeendeclaredrabies-freethroughthisjointendeavoroftheDepartmentofHealthandDepartmentofAgriculture.Thirty-eightlocalgovernmentunitswerealsorecognizedastheBestRabiesProgram Implementers including IlocosNorte,which isoneof the
CAREprojectsitesinthePhilippines.NationalpartneragenciessuchastheDepartmentofEducation(DepEd)andDepartment of Interior and Local Government released national memorandums encouraging schools and localgovernmentsnationwidetoconducttheirownWRDactivities. GARC also teamed up with the Philippine InformationAgency(PIA),DepEd,andtheArmedForcesofthePhilippinesVeterinary Dispensary (AFPVD) to boost the promotionof WRD through multi-media platforms. PIA facilitatedtelevisioninterviewsandatextorSMSblastthatwassentto approximately 8,800 subscribers across the country,whileDepEdpostedkeymessagesonrabiesontheirofficialFacebookpage.AfirstthisyearwasaWRDvideoadvertisedon theelectronic billboard along amajor freewayaroundManilaincoordinationwiththeAFPVD. Theteamalsosupportedlocalgovernmentpartnersbyprovidingbannertarpaulinstothosewhoregisteredtheirevents.Justrecently,wepresentedWRDupdatesduringtheAnimalHealthandWelfareForumattendedbyaroundahundredlocalgovernmentveterinariansandprofessorsfromveterinaryschools.AnumberofpeopleapproachedusattheeventandthankedusforthebannersandIECmaterialswesent.HearingtheirstoriesfirsthandabouthowwecontributedtotheirWRDcelebrationtrulywasthehighlightofourday. OurprojectpartnersinSorsogonandIlocosNortewereequallybusywithWRDevents.Morethan800studentsfrompre-schooltothehighschoollevelalongwitharound200teachersandparentsparticipatedinaseriesofinformationandeducationactivitiesheldinbothareas.TheseincludetheStarHolidayEncampmentincoordinationwiththeGirlScoutsofthePhilippinesinSorsogonandtheChildren’sFestival,OneHealthQuizBee,andtheFolk/ModernMediaCompetitioninIlocosNorte.Similartothenationalgovernmentaward,theprovinceofIlocosNortealsorecognizedtheindividuallocalgovernmentsandgroupswhoexcelledinimplementingtherabiespreventionandcontrolprogramintheirrespectivelocalities. Wewouldliketoextendahugethankyoutoourlocalpartnersfortheseevents,fortheircommitment,andfortheiractiveinvolvement.Withtheincreasedawarenessandknowledgeofrabies,weexpectthatmorepeoplewillgetinvolvedintheWRDactivitiesinthecomingyears.Contributed by Dane Medina, communications officer for GARC’s Philippines office
An educational program on rabies awareness and bite prevention at Yakap Daycare Center, led by the AFPVD in Camp Aguinaldo, Quezon City. Whilst the children learned through play, their parents watched a rabies awareness video and were encouraged to bring their pets for vaccination.
Over 150 Grade 1 to 6 students representing the 26 school districts of Ilocos Norte competed in a One Health Provincial Quiz Bee answering questions on Rabies, Dengue, and Helminthiasis.
The Alliance is a registered charity in the UK and a 501(c)(3) organization in the US www.rabiesalliance.org 7
APRIL 2015 • Issue 42NOVEMBER 2016 • Issue 50
Journalism Students Experience Rabies Control in Action Forthelastfewmonths,theGARCPhilippinesteamhasbeenworkingwithagroupofdevelopmentcommunicationsstudentsfromtheUniversityofthePhilippinesLosBaños.ThestudentswereinvitedtodocumenttheCommunitiesAgainstRabiesExposure(CARE)projectsinIlocosNorteandSorsogon. The students accompanied the barangay healthworkers and vaccinationteamstoremotevillagestovaccinatedogs.Heretheyobservedrabiescontrolinpracticeandinterviewedtraditionalhealers(Tandoks),teachers,childrenandcommunitymembersabouttheirexperiencesofrabiesandtherabiescontrolprogrammes. Theopportunityallowedthestudentstolearnthetechnicalitiesandpracticesof journalism,andconsider theethicsof interviewing. ItalsoprovidedthemwithanexperienceofthecultureinthesemoreremoteareasofthePhilippinesandadeeperunderstandingof theneed for rabiescontroland theprojectsthemselves. Summinguphervisit ina testimonial,ArianaAlcalasaid:“Thisfieldworkwillbeoneofthemostmemorableformebecauseitletmeseehowcollectiveactionof communitymembers canmake a big difference…Moreover, theirsuccessstoriesgavemehopethatifIlocosNortecanbearabies-freeregion,ourcommunitycanalsobe.” Thestudentsarecurrentlyfinalisingtheirarticlesandvideodocumentaries,so look out for more stories coming out of this collaboration in the nextnewsletter.Submitted by Louise Taylor, GARC Scientific Director
Ma’am Marilou Ofiana, a master teacher and a district science curriculum coordinator, willingly shared stories on how her students participate in rabies-based lessons and how they applied the lessons outside their classroom.
The journalism students enjoy a photo opportunity with children at a day care center in Laoag City, Ilocos Norte.
Could More People Survive Rabies? A recentarticlebyManietal.discussesanewtrendinIndia:withinthelast6years,therehavebeensixsurvivorsof clinical rabies contracted from dogs. The authors attribute this upward trend in survival to increased access toconventionalcriticalcarefacilitiesandmoredoctorstryingtosaverabiespatients.ManyoftheIndiansurvivorshavebeenleftwithsevereneurologicalcomplications,butthesepatientssurvivednonetheless,asituationundocumentedinIndiabefore2010.
EversinceJeannaGiese,a15yearoldgirlbittenbyabatwastreatedforand survived clinicalrabies inMilwaukee in2004,therehasbeenheightened interestindeveloping areliablecureforrabies.Theearlyoptimismovertheso-calledMilwaukeeprotocolhasnotbeenfollowedbyahighsuccessrate,anddespitealterationstotheprotocolduring48furtherattemptstotreatrabieswithit,just7additionalsurvivorsareknown.Theprotocolishighlycontroversial,inpartbecausemostofthesurvivorsarenotfullydocumented.However,datafromthesurvivorsalongwiththosewhosurvivelongerbeforedyingcanprovidedataaboutclinicalrabiesthatcanbelearnedfromtodevelopbettertherapies.Reviewspublishedinlate2015and lastmonthlistatotalof19documentedsurvivorsfrom1970onwards,notingthatmanyhadpartialordelayedpre-orpost-exposurevaccinationagainstrabiespriortosymptomsdeveloping.Thosewithbat-associatedrabiesandthosewithrobustearlyimmunereactionsmayalsohavebettersurvivalprospects. Finally,a recent reportdescribesapatientwithahistoryofabite fromadog infectedwith rabieswhorecentlysurvivedafteronlyrelativelysimplehospitaltreatmentinahospitalinGhana.Thiscaseisoneofpresumptiverabies,aslaboratorydiagnosiswasnotavailableinthissetting,butthesymptoms,includinghydrophobiaandphotophobia,werehighlycharacteristicofrabies. In resource poor settings, where rabies is woefully underreported, diagnoses of rabies are rarely confirmedin laboratories,andpeopleclinicallydiagnosedwith rabiesaregenerally senthometodie, is itpossible thatmore,undocumentedsurvivorsexist? Thesecasesareextremelyrareanddonotaffectthegeneralconclusionthatrabies isanalmostuniversally fataldisease.However,asaccesstowell-equippedmedicalfacilitiesimprovesacrossAfricanandAsiaandtheexpertiseofmedicalpersonnelintreatingrabiesimproves,weshouldexpectmorerabiessurvivorswithbetteroutcomes.Studyingthese patientswill allow us to learn from them, and thus improve our understanding ofwhat interventions couldpotentiallyleadtosuccessfulrecoveryfromclinicalrabies. Written by Louise Taylor, Scientific Director, GARC
The Alliance is a registered charity in the UK and a 501(c)(3) organization in the US www.rabiesalliance.org 8
APRIL 2015 • Issue 42NOVEMBER 2016 • Issue 50
Rapid Diagnostic Tests Show Great Promise, but also Unacceptable Inconsistency
Rabiesdiagnosticsteststhatarecheapandeasytousecouldhugelybenefitrabiescontrolefforts,providingconfirmationofanimalcasestohelpsavelivesandrefinecontrolstrategiestobetterprotectcommunities.Thegoldstandardtest,thefluorescentantibodytest(FAT)requireslaboratoryequipment,trainedstaff,andtemperature-sensitive reagents, limiting their application. In contrast, recently developed rapid immunodiagnostic tests forrabiesdiagnosispromisetestingoutsidethelaboratory,requirevirtuallynoequipmentandminimaltraining,andproducearesultinminutes.Suchtestsareavailableonthemarketnow,butdotheywork?Tworecentlypublishedpapersdemonstrateboththepromiseandthecurrentinadequaciesofthesetests.
Astudy,publishedinPLOSNeglectedTropicalDiseasesthismonth,evaluatedtheAnigenRapidRabiesTest®with48 samples in a field laboratory (inN’Djamena, Chad) and 73 samplesinaninternationalreferencelaboratory(InstitutePasteur,Paris,France).Inthereference laboratory inFrance,thetestproducedaspecificityof93.3%andsensitivityof95.3%comparedtothegolstandardFATtest.Inthefieldlaboratory,therapidtestyieldedahigherreliabilitythantheFATtest(thoughheretheFATdidnotfollowthegoldstandardmethodologyexactly) particularly on fresh and decomposed samples. The studyconcluded that the test performed excellently in termof both ease ofuseandthereliabilityoftheresults.Importantly,theseauthorsomittedadilutionstepfromthemanufacturer’sprotocol. However,asecondstudy,publishedinthesamejournalinJunetestedsixcommerciallyavailablerapidrabiestests(includingtheAnigenRapidRabies Test®) in a controlled laboratory setting.Over 80 (naturally andlab-infected)animalbrainsamplesweretestedattheFriedrich-Loeffler-InstituteinGermany,aWHOCollaboratingCentreforRabiesSurveillanceandResearchand20naturally-infectedanimalbrainsamplesweretestedat the OIE Rabies Reference Laboratory, in Onderstepoort VeterinaryInstitute,SouthAfrica.EachbrainsamplewastestedbyeachrapidtestkitandalsobythegoldstandardFAT. Thesecondstudyconcludedthatthetestsdidnotgivereproduciblyaccurate results. While all six tests showed good specificity (i.e., theydid not come upwith “false positives”), but none demonstrated goodsensitivityacrossthedifferentsamplesets.Overall,morethanhalfofallpositive samples (i.e., thosewith positive FAT andPCR results) yielded“falsenegative”LFDresults.SomeLFDtestsdidbetterthanothers,andinsomecasesspecificbatchesofthesametestdidbetterthanothers,but
overalltheresultsweredisappointing. TheseauthorssuggestthatcommerciallyavailablerabiesLFDscannotberecommendedforroutinediagnosisandsurveillanceat thistime. However,acknowledging thegreatpotential for these tests, theyalsostate thatthestudy“isnotmeant todiscredit theuseofLFDs for rabiesdiagnosisbut rather toencourageproducers tosubstantiallyimproveandassurethequalityoftheirproducts”. BothstudiesdemonstratedtheabilitytorecovervirusRNAfromtheteststripsforgeneticanalysisbyPCR,whichmeansthatthetestscouldbeusedasavehicletoshipviralRNAtoreferencelaboratoriesforfurtherlaboratoryconfirmationofthediagnosisandforgeneticallycharacterisingtheviruses,whichcouldbeextremelyvaluabletoepidemiologicalinvestigations. Theauthorsofthefirststudysuggestthattheiromissionofthedilutionstepcouldhavecontributedtotheirmoreconsistentresults,butclearlymoreassessmentofthesetests’reliabilityandrefinementoftheirinstructionsforusewillbeneededbeforetheycanfulfiltheirpotential.FurthervalidationiscurrentlyongoinginpilotfieldstudiesinChad,MaliandIvoryCoastandisexpectedtoprovidealargedatasetoverthenexttwoyears.Written by Louise Taylor, based on Lechenne et al. (2016) “Validation of a Rapid Rabies Diagnostic Tool for Field Surveillance in Developing Countries” and Eggerbauer et al. (2016) “Evaluation of Six Commercially Available Rapid Immunochromatographic Tests for the Diagnosis of Rabies in Brain Material” both published in PLOSNTDs.
Rabid rabies diagnostic tests. The control (C) line shows the test is valid, and the test (T) line a positive rabies result. Image from Lechenne et al. (2016) in PLOS NTDs.
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APRIL 2015 • Issue 42NOVEMBER 2016 • Issue 50
“Your Child Will Be Dead Before the End of the Day” Karachi in Pakistan is a mega city of nearly 20 millionpeople.Ithassprawlinghomessurroundedbyhighwallsandfragrantflowerhedges.Chauffeur-drivencars take ladies toelegantshoppingmallsandteapartiesandbringhometheirchildrenfromeliteschools.Itisnotuncommontoseearmedguardsescortthemwhileonroad. Andthenthereareshantytowns,surroundedbymoundsofgarbage;dilapidatedbuseslurchoverpotholedroads.Men,hurryingtowardsmosquestocatchtheearlymorningprayer,stoptobuyfruitsandvegetablespiledonricketypushcarts.Packsofmangydogs roam the streets, scrounging for foodoutofgarbagedumps.Agroupofboysisplayingfootball.Oneofthemplayfullyaimsastoneatabitchguardingherlitterofpuppies.Shegrowls,hestonesher.Sheisangryandapproacheshimmenacingly.Otherboysjoininthestonepeltingtillthemotherlungesattheboy,nipshiscalfanddrawsblood. EmergencyDepartmentsinKarachi’sthreemajorhospitalsreportover100dogbitesaday,butmostvictimsstayhomeandliterallyrubsaltintothewound.“Betterthis,thangetfourteeninjectionsintotheabdomen.Neverletwatertouchadogbitewound,”quipsthegrandmother.Othersmayfindittedioustoreachahospitalwherethedoctorwouldonlycleantheinjurywithantisepticsolutionandapplyabandage;thereisnoconceptofinfiltratingimmunoglobulin.Ifthereisvaccine,thedoctormayinjectitintothearmorintothethigh.Furtheradvicemaybegiven,dependinguponthedoctor’sknowledgeandaptitudeandpractice;oftenbotharepathetic.
The IndusHospital (TIH)wasestablished in 2007 toprovidefreebutqualityhealthcareinvariousdisciplinesofmedicine.Weopenedadog-bite-managementcenter,equipped itwitha wound wash area complete with disinfectants, eRIG andvaccine.We have trained, and continue to train, nurses anddoctors through video and slide presentations on hands-ontraining for post-exposure prophylaxis (PEP). TIH has earneda reputation for proper care and was awarded the statusof Training Center for the entire province of Sindh (pop. 35million).Doctorsandparamedicsarrivefromdifferentpartsofthecityandprovincetoacquiretrainingandreturntopracticeintheirparentinstitution.AtleastfiveotherPEPcentersinthecityare functioningsatisfactorilyandhavetakenthe loadoffexistingcenters.
Unfortunately,wecontinuetoseevictimsofrabiesencephalitisfrommedicalcenterswhosephysicianshavenotreceivedpropertraining,orlackvaccinesorRIG.Ihavewatchedhelplessly,timeandagain,theagonyofparents,imploringmetosavetheirchildwhoisgaspingandchokingbeforetheireyes.Thatsamechild,whowasplayingfootball,justafewweeksback,willbedeadbeforetheendoftheday. EversinceGARCinitiatedWRD,IndusHospital,supportedbyothersocietieshaslaunchedablitzofawarenessandinstructioncampaigns.ForWRD2016,wereachedouttotensofthousandsofindividuals,throughamassivedriveviatelevision,radio,newspapersandmagazines,visitstoschools,boardgames,billboards,walksandstreetannouncements through amegaphone, and freely distributed flyers, posters and teaching aids to health careworkers.Throughunrelentingadvocacy,NIHPakistanhasfinallydiscontinuedtheproductionoftheodioussheepbrainvaccineandisnowimportingalowcostVerocellvaccine. Sadly, the local government has still notwoken up to the tragic situation. It is the poor and the homelessstreetchildren,sidewalkvendorsandsuchlessermortalsthatfallvictimtothisincurabledisease.Periodicdog-killingcampaignswillnevercontainstraydogpopulation.Onlyconcertedeffortsofcivilsociety,physicians,citygovernmentandveterinarians,approachedinascientificmannerwillreducethescourgeofrabies.Contributed by Dr. Naseem Salahuddin, Head of the Dept. of Medicine and Infectious Disease, The Indus Hospital, Karachi
Dr Salahuddin being interviewed for WRD 2016
Raising awareness about rabies amongst school children
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APRIL 2015 • Issue 42NOVEMBER 2016 • Issue 50
Thermotolerant Vaccines: A Game Changer?
The Serengeti Health Initiative (SHI)—cofounded byWashington State University and Lincoln Park Zoo(Chicago)—has,since2003,beencontrollingrabiesthroughtheimplementationofannualmassdograbiesvaccinationcampaignsinremotevillagesinnorthernTanzania.Theeffectivenessofcampaignssuchasthese,andtheepidemiologicalfeaturesthatmakeeliminationfeasible(e.g.,effectivevaccinesareavailable;domesticdogs,notwildlife,arethereservoirofinfection;and rabies has a relatively low R0 (thenumberofsecondaryinfectionsproducedfromaprimarycase))haveledtheWorldHealthOrganization(WHO),togetherwiththeFood&AgriculturalOrganization(FAO)and the World Organization for AnimalHealth(OIE),torecognizecanine-mediatedhuman rabies as a global health priorityand to unite in a tripartite commitmenttoitsglobaleliminationby2030.Whetherthis commitment is met with successwill, in part, be determined by vaccinedeliveryprogramsbeingabletoovercomethe logistical problems associated withrampingupfromthesmalltotheregionalscale. One constraint that poses a particularproblem is the difficulty of achievingvaccination coverage of 70% of the dogpopulationconsistentlyacrossthevastandremoterural landscapesthatcharacterizemuchofsub-SaharanAfrica and Asia. With the elimination of rabies critically dependent on contiguous vaccination coverage,evensmallpocketsoflowcoverage(e.g.,involving<0.5%ofthedogpopulation)willcausesignificantdelay.Consequently,ifthelarge,coalescent,disease-freezonesnecessaryforregionaleliminationaretobecreated,itwillbeessentialtoovercomethisconstraint. Onefactorhamperingthedeliveryofsufficientquantitiesofrabiesvaccinestohard-to-reachareasisthelackofelectricalpowerneededtomaintainthecold-chain.Asaresultthetransportandstorageofvaccinesinremotelocationsiscompromised.Consequentlyentirecommunitiesare,atbest,dependentondonor-fundedteam-ledvaccinationcampaignsor,atworst,receivenorabiescontrolatall.Moreover,inthosecommunitiesthatarefortunateenoughtobetargeted,theinabilitytostorevaccinesintheselocationsmeansthatanynewdogsthatenterthepopulationsuchaspuppiesmustremainunvaccinateduntilthenextcampaigneventpassesthrough.Whenthisimmigrationofunvaccinateddogsiscoupledwithahighmortalityrate(lifeexpectancyofdogsinrabiesendemiccountries<3years),theresultistheproportionofimmunizeddogsdecreasingsteadilyfollowingeachcampaign.IfcoveragefallsbelowacriticalthresholdthenR0willbecomegreaterthan1,and,ifvirusentersthepopulation,rabieswillbesustained. Apotential solution to thisproblemofhowvaccinescanbedelivered toandstored in remoteareas isthermotolerance–theabilityofavaccinetoretainitspotencyfollowingstorageattemperaturesinexcessofthecold-chain(4°C).Indeed,thermotolerancehasbeencitedasacriticalaspectofthesuccessfulcampaignstoeliminatebothrinderpestandsmallpoxbecauseitempoweredlocalcommunitiestocoordinateanddelivertheir own campaigns using vaccines safely stored for extended periods outside of the cold-chain, greatlyincreasingthereachofbothcampaigns.Ifrabiesvaccinescanalsobeshowntobethermotolerant,thiscouldhaveanequallytransformativeeffectontheglobaleliminationofcanine-mediatedrabies.
Legend:A boxplot showing the range of (2log) day-28 titres produced by vaccine stored at elevated temperatures for zero (cold-chain), three or six months (red diamond = 2log titre mean; G1 – 7 = treatment groups 1 – 7).
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APRIL 2015 • Issue 42NOVEMBER 2016 • Issue 50
The Alliance is a registered charity in the UK and a 501(c)(3) organization in the US www.rabiesalliance.org 11
RECENT RESEARCH- November 2016
Genetic Epidemiology
Host-pathogenevolutionarysignaturesrevealdynamicsandfutureinvasionsofvampirebat rabies.Host and virus genetic information is used tounderstandthe geographic spread of vampire bat rabies virus (VBRV) in Peru. Virus canspreadbetweenapparently isolatedhostpopulationsviadispersingmalebatsPredictionsofviralspreadthroughnorthernPeruthatwerevalidatedbylivestockrabiesmortalitydata,andpredictionsmadeforthattheviruscouldreachthePacificcoastby2020.
ElucidatingthephylodynamicsofendemicrabiesvirusineasternAfricausingwhole-genomesequencing.Thefirstwhole-genomephylogeneticanalysisofrabiesvirusinEastAfrica,revealedlong-distancedispersalwithinTanzania,whichcouldbeattributedtohuman-mediatedmovement,andmultiplepersistent,co-circulatinglineageswithinsingledistricts,despiteon-goingmassdogvaccinationcampaigns.ThedataindicatethatsuccessfulrabiescontrolinTanzaniacouldbeestablishedatanationallevel,butsomecoordinationwithneighbouringcountriesmayberequiredtolimittransboundarymovements.
PhylogeneticanalysisofrabiesvirusisolatedfromcanidsinNorthandNortheastBrazil.Molecularcharacterizationof 102 rabies virus isolates fromdogs andCerdocyon thous fromvarious states inNorth andNortheastBrazilbetween2006and2012wascompleted.Twodistinctgeneticlineages,oneassociatedwithcanidsandonewithbats,werefoundandwithinthecanidcluster,twodistinctsublineagescirculateamongdogsandCerdocyonthous,withinterspecificinfectionobservedamongthecanidviruses.
Human Rabies and Biologicals
Ineffectivenessofrabiesvaccinationaloneforpost-exposureprotectionagainstrabiesinfectioninanimalmodels.Variousanimalswerechallengedwithwild-typerabiesvirus,followedbyvaccinationwitheitherrabiesvaccinescommercially availableorexperimentalPIKA rabies vaccines.100%ofanimals given traditional rabies vaccinesplusRIGsurvived,80%ofanimalssurvivedwithRIGalone,butanimalsreceivingtraditionalrabiesvaccinesaloneshowed extremely low survival rates, not significantly different from unvaccinated controls. The experimentalvaccinealoneprotected40-80%ofanimals.
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Tothisend,in2015–16,acollaborativeprojectbetweenWSUandMSDAnimalHealthbeganinvestigatingwhetherthecommonly-usedcaninerabiesvaccineNobivac®Rabieshadthermotolerantproperties.Thefirstphaseofthistrial,whichinvestigatedtheeffectthatvariouslevelsofnoncold-chainstoragehadonthepotencyofthevaccine,indicatedthatthisvaccineretaineditsefficacyfollowingstorageat25°Cforsixmonthsand30°Cforthreemonths.Theseresultsareextremelyexcitingastheyprovidethefirstevidencethatthisvaccinecanbesafelyusedfollowingextendedstorageinconditionswelloutsideofthecold-chain.Further,theresultssuggestthatmorecost-effectivedeliverystrategies,potentially involvingcommunitiesmanagingand implementingtheirowncampaigns,canbedeveloped. Ifsuccessful thesedevelopmentscouldtransformhowmassdograbiesvaccinationisdeliveredtohard-to-reachcommunitieswhererabiesremainsstubbornlyendemic.Giventhetripartiteagreementforglobaleliminationofrabies,thesedevelopmentswillbeparticularlytimely. Submitted by Felix Lankester, Clinical Assistant Professor, Paul G. Allen School for Global Animal Health, Washington State University. The study "Thermotolerance of an inactivated rabies vaccine for dogs" has just been published in Vaccine.
...Thermotolerant Vaccines continued from page 10.
APRIL 2015 • Issue 42NOVEMBER 2016 • Issue 50
...Recent Research continued from page 11.
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The editors of the GARC newsletter are Louise Taylor and Laura Baker, contact them through [email protected] is by Pete Else. For further information on the Alliance’s work see www.rabiesalliance.org.
Two decades of pharmacovigilance and clinical experiencewith highly purified rabies immunoglobulin F(ab’)2fragments.AnoverviewofclinicalexperiencewithahighlypurifiedpreparationofF(ab’)2fragmentsfromequinerabiesimmunoglobulin(FavirabTM)inrabiesPEPandreportedadverseeventsconcludesitissafeandeffective.ThegeneralsafetyprofileofF(ab’)2pERIGisdiscussed,asaretheoccurrenceofrareanaphylacticreactionsandsuspectedinterventionfailure.
HumanRabies:A2016Update.Anewreviewofhumanrabiesinfectionsandtreatmentoptionsconcludesthatthe Milwaukee protocol is ineffective and that novel therapeutic approaches may depend on a betterunderstandingofbasicmechanismsunderlyingthedisease.
Animal Vaccines
Thermotoleranceofaninactivatedrabiesvaccinefordogs.ThisstudyprovidesthefirstrobustdatathattheantibodyresponseofdogsvaccinatedwithNobivac®Rabiesvaccinestoredforseveralmonthsathightemperatures(upto30°C)isnotinferiortothatofdogsvaccinatedwithvaccinestoredunderrecommendedcold-chainconditions(2-8°C).Seefullarticleformore.
Diagnostics
ValidationofaRapidRabiesDiagnosticToolforFieldSurveillanceinDevelopingCountries.Arapidimmunodiagnostictest(RIDT)wascomparedtothestandardFATwithgeneticdetectionofviralRNA.TheRIDTperformedexcellentlyandresultswerereliablebutchangestothestandardprotocolaresuggested,andfurthervalidationisneeded.(Seeseparatearticleinthisnewsletter.)
Rabiesvaccineresponsemeasurementisassaydependent.Enzyme-linkedimmunosorbentassay(ELISA)andserumneutralisationtestsonserumtodetermineprotectiveantibodylevelswerecomparedacrossatimeseries.Similarvaccineequivalencyconclusionsweremadeusingeithermethod,howevervaccination-regimenequivalencyvariedbytestmethodused.Protectiveantibodycut-offlevelsshouldbedeterminedforeachtestindependently.
Control Strategies
TheSAREtoolforrabiescontrol:CurrentexperienceinEthiopia.TheStepwiseApproachtowardsRabiesElimination(SARE)toolprovidesastandardmechanismforcountriestoassesstheirrabiessituationandmeasureprogressineliminatingthedisease.Ethiopiaundertookaself-assessmentusingtheSAREtoolwhichidentifiedanumberofcriticalgapsandstrengthsinthecurrentrabiescontrolefforts,andenabledkeycriteriatobeprioritized,therebyacceleratingtheNationalStrategy.
Amixedmethodsapproachtoassessanimalvaccinationprogrammes:thecaseofrabiescontrolinBamako,Mali.A mixed method approach, combining quantitative and qualitative tools across different sectoral issues, wasdevelopedtoevaluateeffectivenessof the intervention.Thefinaleffectiveness levelswere33%and28%,withvaccinationcoveragesof27%and20%,andalackofinformationaboutthecampaignwasidentifiedasacriticalfactor.Qualitativedataprovideanexplanatoryframeworkfordeeperinsightintoimprovingtheinterventiondesignwhileinvolvingallstakeholders.
Upcoming ConferencesThe OneHealthEcoHealth2016conferencewillbringtogethertheglobalOneHealthandEcoHealthcommunitiesinMelbourne,Australia,fromDecember4thto7th.
