Date Published: November 24, 2015
Publisher: Public Library of Science
Author(s): Ryan M Wallace, Hannah Reses, Richard Franka, Pierre Dilius, Natael Fenelon, Lillian Orciari, Melissa Etheart, Apollon Destine, Kelly Crowdis, Jesse D Blanton, Calvin Francisco, Fleurinord Ludder, Victor Del Rio Vilas, Joseph Haim, Max Millien, Claudia Munoz-Zanzi. http://doi.org/10.1371/journal.pntd.0004245
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.
Partial Text: Rabies is the deadliest of all zoonotic diseases, responsible for more than 59,000 human deaths, annually [1, 2]. It is also the most lethal infectious disease, with a case fatality rate of nearly 100% even with advanced medical intervention . Although all mammals are susceptible to rabies virus infection, only certain reservoir species are capable of maintaining enzootic circulation through conspecific transmission. Reservoir species for the rabies virus include bats in the Western Hemisphere and at least 15 terrestrial mammals worldwide. While all reservoir species can transmit rabies to people, none are more significant than the domesticated dog, which is responsible for nearly all human rabies deaths .
The Haiti Animal Rabies Surveillance Program (HARSP) was initially conceived in 2011 under the leadership of the Ministère de l’Agriculture, des Ressources Naturelles et du Développement Rural (MARNDR), in collaboration with the Ministère de la Santé Publique et de la Population (MSPP), Christian Veterinary Mission (CVM) and the United States Centers for Disease Control and Prevention (CDC). The HARSP was enacted in three stages from 2011–2013, detailed below. Historical records for animal rabies at the national level were available from September 2009 through December 2012 from MARNDR records.
During the two-year period in which HARSP operated, 70 confirmed rabid animals, 36 probable, 178 suspect, and 494 non-cases were reported (Table 1). The HARSP registered 738 passive and 40 active surveillance investigations (Fig 2). Of these 778 investigations, 143 animals (18.0%) were tested for rabies and 70 (9.0%) were confirmed positive; 66 through passive surveillance and 4 through active surveillance. Of confirmed rabid animals, 62 were dogs, 4 were cats, and 4 were goats. Probable rabid animals included 33 dogs, 2 goats, and 1 pig. Overall, passive and active surveillance streams contributed 106 confirmed and probable animals (13.6% of all animals reported to HARSP for assessment).