Epidemiological Characteristics of Human and Animal Rabies in Azerbaijan

Abstract

The Caucasus is a region of geopolitical importance, in the gateway between Europe and Asia. This geographical location makes the region equally important in the epidemiology and control of transboundary infectious diseases such as rabies. Azerbaijan is the largest country in the Caucasus, and although rabies is notifiable and considered endemic, there is little information on the burden of human and animal rabies. Here, we describe a cross-disciplinary international collaboration aimed at improving rabies control in Azerbaijan. Partial nucleoprotein gene sequences were obtained from animal rabies cases for comparison with those from surrounding areas. Reported human and animal rabies cases between 2000 and 2010 were also reviewed and analysed by region and year. Comparison of rabies virus strains circulating in Azerbaijan demonstrates more than one lineage of rabies virus circulating concurrently in Azerbaijan and illustrates the need for further sample collection and characterization. Officially reported rabies data showed an increase in human and animal rabies cases, and an increase in animal bites requiring provision of post-exposure prophylaxis, since 2006. This is despite apparently consistent levels of dog vaccination and culling of stray dogs.

Difficulties in estimating the human burden of canine rabies

“…The recently developed Rabies Surveillance Blueprint provides specific guidance on national rabies surveillance, based on international recommendations and practical experience, in a user friendly Question and Answer format (Partners for Rabies Prevention, 2014) and international cooperation through projects such as laboratory twinning and training exercises can significantly improve rabies surveillance (Zeynalova et al, 2014; Banyard et al, 2013, Wallace et al, 2015). …”

Complex Epidemiology of a Zoonotic Disease in a Culturally Diverse Region: Phylogeography of Rabies Virus in the Middle East

“…With evidence of recent interbreeding between wolves and shepherd dogs in the Caucasus, and now the evidence for a dog associated strain in a wolf in Syria, there is potential for more complex reservoir dynamics [ 74 ]. Again, continued improvement of systematic surveillance and international reporting will help resolve these questions [ 16 – 18 , 39 ].…”

“…The estimated date of divergence, 200–300 years ago, coincides with a period of increased human movements, increasing human population, and increasing domestic dog population associated with urbanisation in the 18 th century. Current epidemiological evidence also supports this, suggesting dog rabies predominates, at least in Jordan, Lebanon, Iraq and Iran, [ 16 , 17 , 19 , 23 – 27 ] and also remains a concern in some central Asian countries and in the Caucasus region [ 18 , 28 ]. However, the historical reports of disease consistent with rabies in the Middle East pre-date this relatively recent spread of the cosmopolitan lineage, and additional separate rabies lineages appear to be spreading in neighbouring regions which may also be circulating in the Middle East [ 16 , 18 , 29 ].…”

“…Current epidemiological evidence also supports this, suggesting dog rabies predominates, at least in Jordan, Lebanon, Iraq and Iran, [ 16 , 17 , 19 , 23 – 27 ] and also remains a concern in some central Asian countries and in the Caucasus region [ 18 , 28 ]. However, the historical reports of disease consistent with rabies in the Middle East pre-date this relatively recent spread of the cosmopolitan lineage, and additional separate rabies lineages appear to be spreading in neighbouring regions which may also be circulating in the Middle East [ 16 , 18 , 29 ]. Throughout the Indian subcontinent and South East Asia, dogs are considered the principal reservoir of rabies, with a genetically distinct lineage of RABV predominating, indicating prolonged circulation without mixing from other regions [ 30 – 33 ].…”

“…Recent reported annual incidences of human rabies in countries of the Middle East vary from 0.02 to 1.3 per million human population, with annual incidence of post exposure prophylaxis administration varying from 1700 to over 6000 per million [ 16 , 17 ]. These figures are heavily influenced by variation in surveillance and reporting in different countries, yet reflect an on-going burden of rabies in the region [ 16 – 18 ]. Although many countries in the Middle East collate and report human rabies cases, routine surveillance and reporting of animal rabies is less systematic, often relying on local awareness and resources with associated potential biases [ 16 , 17 , 19 ].…”