Human rabies in Côte d'Ivoire 2014-2016: Results following reinforcements to rabies surveillance

Abstract

In Côte d’Ivoire, rabies is endemic and remains largely uncontrolled. The numbers of human exposures and rabies cases are unknown and are probably much higher than reported. Data on human rabies cases are collected by the National Institute of Public Health (NIPH) Anti-rabies Center in Abidjan through a network of 28 NIPH local units, which cover the population of the entire country. During 2014, the NIPH initiated a program to reinforce the human rabies surveillance system in those 28 NIPH local units, with specific goals of improving the infrastructure, training, communication, and government involvement. Here, we report the progress and findings during 2014–2016. The reinforced system recorded 50 cases of human rabies (15–18 cases/year; annual incidence = 0.06−0.08 per 100,000) and more than 30,000 animal exposures (annual incidence = 41.8−48.0 per 100,000). Almost one-half of the human rabies cases were in children ≤15 years old. All were fatal and dog bites were the most common route by which rabies virus was transmitted. In the 32 cases where samples of sufficient quality for analysis were available, rabies was confirmed by reverse transcription-polymerase chain reaction RT-PCR. Post-exposure prophylaxis with rabies vaccine was administered to all animal exposure victims presenting at the NIPH local units, although only about 57% completed the full immunization schedule. All available reports were provided by the NIPH local units, indicating effective communication between them and the NIPH Anti-rabies Center. These findings indicate that the reinforcements resulted in highly specific detection of human rabies, provided detailed epidemiological data about these cases, and improved estimates of animal exposure numbers. These represent substantial advances, but further improvements to the surveillance system are needed to increase disease awareness and capture cases that are currently missed by the system. In the future, better communication between local health centers and the NIPH units, surveillance at the local health center level, and increased veterinarian engagement will help provide a more complete picture of the rabies burden in Côte d’Ivoire.

Improving systematic rabies surveillance in Cameroon: A pilot initiative and results for 2014-2016

“…As found in other countries with endemic canine rabies [ 2 , 5 , 30 , 31 ], exposures were frequent in children, with over 40% in persons ≤ 15 years of age, and mostly involved dogs. The delay between animal exposure and medical consultation was short, which suggests good public awareness of the risk of rabies in the West region.…”

Epidemiological Characteristic of Animal Bite and Direct Economic Burden of Rabies Vaccination in the Southern of Iran

“…According to the report by the Center of Disease Control and Prevention in 2018, the overall incidence rate of animal bites had reached 216 per 100,000 population. Naghibi et al (2014) also reported this incidence rate by 203.4 per 100,000 population in Mazandaran Province, Iran, during 2007-2012. Besides, (Kassiri et al 2014a obtained an incidence rate of 282 per 100,000 individuals in the city of Ahvaz, Iran.…”

“…Rabies is known as one of the most dangerous viral zoonotic diseases that can infect all mammals (Tiembré et al, 2018). Despite being preventable and given the existence of safe and effective vaccines, rabies has still remained a major health problem in numerous countries across the world (Kasem et al, 2019;Banyard et al, 2018).…”

Bolstering human rabies surveillance in Africa is crucial to eliminating canine-mediated rabies

“…Strengthening existing surveillance systems is an implementable action in Africa. In two accompanying reports, we describe efforts to strengthen regional surveillance programs in Cameroon and Ivory Coast, together with the results of over two years of surveillance [ 32 ][ 33 ]. The programs focused on engaging HCPs and veterinary authorities and improving their training in rabies surveillance, animal bite management, human rabies case diagnosis and management, as well as sampling techniques and sample management.…”

“…This is nearly nine-fold more than the 57 exposures reported for the entire West Region in 2013 [ 34 ]. In Ivory Coast, 31,492 animal exposures and 50 suspected human cases were reported, and 32 of the 39 samples submitted for testing were laboratory confirmed [ 32 ]. By comparison, 26 cases of human rabies for the entire country were reported to the Ivory Coast national health ministry between 2001 and 2009, only four of which were sampled and then confirmed by postmortem laboratory analysis [ 35 ].…”