Meeting the urgent need for rabies education in Haiti

Abstract

The highest rate of human rabies deaths reported in the Americas is in Haiti, and most of these deaths result from rabies virus infections that occur after individuals are bitten by infected dogs and do not receive rabies post-exposure prophylaxis. One barrier to rabies prevention in Haiti is a lack of knowledge about this disease among healthcare professionals and community members. During the past 4 years, The US Centers for Disease Control and Prevention has collaborated with public health officials and partners to develop, test and refine educational materials aimed at filling this need for rabies education. This report summarizes the use of feedback from knowledge, attitudes and practises surveys; key informant interviews; and focus groups to develop culturally appropriate rabies prevention materials for community members, health officials, clinicians, laboratory professionals, veterinary professionals, government officials and national and local district leaders about ways to prevent rabies. These formative research methods were critically important in ensuring that the materials would be culturally appropriate and would stand the greatest likelihood of motivating Haitians to protect themselves from rabies. Centers for Disease Control and Prevention is using lessons learned in Haiti to develop and test materials in other countries with high rates of canine rabies.

A brief history of rabies in Haiti until the adoption of the One Health approach for its epidemiological surveillance and control

“…Observations and research have shown that purely basic vaccination and surveillance interventions can successfully stop transmission [18][19][20] . Passive surveillance programs, in addition to providing valuable information for targeted interventions, can also help stop enzootic transmission at the community level through the rapid elimination of rabid animals and reduction of dog-to-dog contact.…”

“…However, it did not create genuine coordination of the Rabies activities among different public and private institutions to establish a functional partnership model integrating a One Health approach. During this period, there was some improvement in rabies vaccination campaigns, but the epidemiological surveillance of rabies remained slow [18][19][20] . [18] .…”

“…The training included both theoretical courses in the classroom and practical activities in the field. A total of 18 participants made up of veterinary agents (9 weeks para-professional training plus experience), and veterinary technicians (2 or 3 diploma) were selected by the MARNDR to undergo training that enabled them to engage in rabies surveillance work [9,[18][19][20] .…”

Barriers to attendance of canine rabies vaccination campaigns in Haiti, 2017

“…In average, four canine and seven human rabies cases have been reported by Haiti's national surveillance system; however, the burden of rabies still remains underestimate (Hampson et al, 2015;Wallace et al, 2015). The lack of healthcareseeking behaviours among persons bitten by dogs, inadequate access to post-exposure prophylaxis, limited knowledge about this disease among healthcare professionals and community members, and low attendance to vaccination campaigns are some key barriers/factors to rabies elimination and control (Etheart et al, 2017;Osinubi et al, 2018;Wallace et al, 2015Wallace et al, , 2016.…”

“…As reported by Cleaton et al, during a canine vaccination campaign in Haiti, a combination of communication methods of awareness is needed to increase population awareness and consequently improve the vaccination campaign to achieve a >70% coverage (Cleaton et al., 2018). Furthermore, implementing educational measures could also be helpful to reduce other barriers related to poor knowledge regarding rabies risks, increasing control interventions (Castillo‐Neyra et al., 2017; Osinubi et al., 2018). Additionally, a combination of vaccination strategies such as fixed point supplemented by door‐to‐door methodology could increase the attendance to vaccination campaigns (Gibson et al., 2016; Taylor et al., 2017), therefore reducing barriers related to location, and dog owners not accustomed to using leashes.…”