Establishment of a Canine Rabies Burden in Haiti through the Implementation of a Novel Surveillance Program

Abstract

The Republic of Haiti is one of only several countries in the Western Hemisphere in which canine rabies is still endemic. Estimation methods have predicted that 130 human deaths occur per year, yet existing surveillance mechanisms have detected few of these rabies cases. Likewise, canine rabies surveillance capacity has had only limited capacity, detecting only two rabid dogs per year, on average. In 2013, Haiti initiated a community-based animal rabies surveillance program comprised of two components: active community bite investigation and passive animal rabies investigation. From January 2013 –December 2014, 778 rabies suspect animals were reported for investigation. Rabies was laboratory-confirmed in 70 animals (9%) and an additional 36 cases were identified based on clinical diagnosis (5%), representing an 18-fold increase in reporting of rabid animals compared to the three years before the program was implemented. Dogs were the most frequent rabid animal (90%). Testing and observation ruled out rabies in 61% of animals investigated. A total of 639 bite victims were reported to the program and an additional 364 bite victims who had not sought medical care were identified during the course of investigations. Only 31% of people with likely rabies exposures had initiated rabies post-exposure prophylaxis prior to the investigation. Rabies is a neglected disease in-part due to a lack of surveillance and understanding about the burden. The surveillance methods employed by this program established a much higher burden of canine rabies in Haiti than previously recognized. The active, community-based bite investigations identified numerous additional rabies exposures and bite victims were referred for appropriate medical care, averting potential human rabies deaths. The use of community-based rabies surveillance programs such as HARSP should be considered in canine rabies endemic countries.

Knowledge, attitudes and practices regarding rabies risk in community members and healthcare professionals: Pétionville, Haiti, 2013

“…Bite incidence data for persons aged <18 years was not collected; however, the trend observed here is consistent with WHO published literature which equates a higher bite risk in younger age groups [14]. One in three bites occurred on the street; these exposures likely represent a higher rabies risk due to higher rates of rabies transmission in free-roaming dogs [9, 15]. …”

Difficulties in estimating the human burden of canine rabies

“…On a larger scale, once rabies is targeted for control, surveillance will improve, because stakeholders have a reason to show the impacts of their efforts. This will typically mean that rabies incidence (based on passive surveillance data) will increase at the start of a control programme (as surveillance effort increases, Wallace et al, 2015) and then in the longer term will decline as control measures have an impact, which can then be quantified from the improved surveillance data. It is clear from Fig.…”

“…There are however, still some gaps from countries struggling with limited health infrastructure and capacity. A case in point is Haiti, thought to account for over 90% of the current human cases of rabies transmitted by dogs in Latin America (Hampson et al, 2015), but no human rabies cases were reported from there in 2013/4, and subsequent active surveillance there has further demonstrated how current systems under report rabies (Wallace et al, 2015). However, even for the countries reporting regularly, the level of detection of human deaths will depend on the surveillance capacity within the country.…”

Eliminating Dog-Mediated Rabies in Sikkim, India: A 10-Year Pathway to Success for the SARAH Program

“…An effective surveillance system with tracing back of suspect animals is needed to confirm this hypothesis (37, 38). Increasing human wildlife conflict in Sikkim (6) may increase the risk of rabies transmission.…”

“…Effort is being directed at establishing low cost enhanced active rabies surveillance (37). The Rapid Test (BioNote) is used in the field when available.…”