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Page 1: Setting a Clear Pathway Towards Global Rabies Elimination...needs going forward. This data is vital to assessing and directing customized national rabies elimination plans, and from

The Alliance is a registered charity in the UK and a 501(c)(3) organization in the US www.rabiesalliance.org 1

Editorial: Pathway to Global Rabies Elimination ....1

The 1st ARACON Meeting ......................................2

GARC Statement on Dog Culling ...........................3

Bolstering Rabies Control in Guinea ......................4

World Rabies Day 2018 Theme .............................5

Wildlife and Rabies .................................................5

WHO Updated Rabies Guidance ...........................6

Prestigious Award for Rabies Research.................7Recent Research ....................................................8

Upcoming Conferences ..........................................9

APRIL 2018 ISSUE 57

Setting a Clear Pathway Towards Global Rabies Elimination

Over the last few years, this newsletter has charted an important progression--the strengthening andstreamliningofGARC’sworktosupportcountriesintheirrabieseliminationefforts. Buildingontheevidenceofpilotprojectsthatdemonstratedthefeasibilityofrabieselimination,wehavedevelopedthepracticaltoolsandthenecessarynetworksforsupportingsuccessfulrabiescontrolefforts.

The strengthening of regional networks, first inAfricawith the establishment of PARACON, just took asignificantstepwiththelaunchinglastmonthofARACONinAsia. Andnowasimilarnetworkwillbemirroredin theMiddleEast andEasternEuropewith the formationof theMERACONnetwork this comingmonth.TheseplatformsallowGARCandourpartnersto strengthen coordination and introduce national rabies focal points from many countries into rabies control planning and evaluation tools, providing the supportnecessaryforsuccessthroughworkshopsandtrainingcourses. Participants can try these tools outwith their owndata, assess their program’sneeds and create theirownworkplanstomovetheirprogramforward.Themeetingsalsoallowforanothervaluableprocess:theprovisionoffeedbackonhowthesetoolscanbeimproved,fillingtheremaininggapsthatholdcountriesback. The Rabies Epibulletin, designed to support and improve rabies data reporting, is another tool beingpromotedat regionalmeetings.Databrought to themeetings frombothhealthandveterinary services isaddedintocountry-focussedEpibulletindashboards,whichcanthenbetailoredtosuitacountry’sindividualneedsgoingforward.Thisdataisvitaltoassessinganddirectingcustomizednationalrabieseliminationplans,andfromthere,progresstowardsregionalandglobalgoals.Onceacountry’srabiescontrolneedsandprioritieshavebeenestablished,scare resources can be better utilised and expert help can be sought for in-country capacity building in areas where it is lacking. Theexpertise ofmany international organizations is already being channelled into training courses and othercapacitybuildingexercisesinendemiccountriesthatcanadaptedtomeetacountry’sneeds. GARC’s advocacy work has also transformed over the years. The World Rabies Day campaign and thereassessmentoftheburdenofcaninerabiesformedasolidfoundation,butmuchhasbeenbuiltsincethen.GARC alongside the WHO, OIE and FAOhasnowbuiltthecaseforglobalelimination and setatargetdateof2030foranendtohumandeathsfromcaninerabies. GARCnowmanagestheEndRabiesNowcampaigntohelppromoteawarenessoftheglobalaspirations, and United Against Rabies is now focused on developing a business plan to achieve this goal. The plan will be launched before the end of May. Theglobaleliminationbusinessplanwillbeusedtoattractmuchneededresourcesforcapacitybuildingtoallowcountriestoreachthetargetsset.Apowerfulpackageofsupportcombiningwell-designeddataandassessment tools, rabies vaccinebanks, global awareness campaigns and expert support through regionalrabiesnetworksandin-countryworkshopsnowexists.Incombination,thesemechanismsprovideaclearpaththatcountriescanfollowtokeepusontracktoreachtheglobalgoal. Louise Taylor, GARC

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Protecting 4 Billion People Against Rabies Through Strengthened Regional Collaboration: The 1st ARACON Meeting

InAsia,morethan4billionpeoplecontinuetobeatriskofrabies.Oftheestimated59,000humanrabiesdeathseveryyear,themajority(59.6%)occurinAsia.AsanexpansionofGARC’sregionalrabiesnetworks,the1stAsianRabiesControlNetwork(ARACON)MeetingwasheldinBangkok,ThailandfromMarch13th-14th2018. Theglobal rabiesconference inGeneva inDecember2015set thegoalofeliminatingcanine-mediatedhumanrabiesby2030throughtheGlobalFrameworkfortheEliminationofDog-MediatedHumanRabies.Fivepillarswereidentifiedtoachieverabieselimination:S-Socio-cultural;T-Technical;O-Organizational;P-Political;andR-Resources(STOP-R).Twoofthekeyaspectshighlightedweretheimportanceofstrengtheningtheintersectoralcollaborationthrough theOneHealth approach (O-Organization) and creating avenues for participatory approach to exchangelessonslearntandexperiencesthroughregionalcollaboration(P-Political).

In2015,thePan-AfricanRabiesControlNetwork(PARACON)wasformedwithGARCasthesecretariattounifyallexistingnetworksandharmonizetherabiescontrolandeliminationeffortsofallcountriesinsub-SaharanAfrica.ThePARACONmeetingshavebecomeawayforcountryrepresentativesfromthemedicalandanimalhealthsectortogainhands-onexperienceinstrategicplanning,implementationandevaluationofnationalrabiesprogramsusingtoolsdevelopedbyGARCincollaborationwithother internationalorganizations(FAO,USCDC,WHO).ThesetoolsincludetheStepwiseApproachtowardsRabiesElimination(SARE);theRabiesEpidemiologicalBulletin(REB);andtheGARCEducationPlatform(GEP).ThemeetingsalsointroducedtheGlobalDogRabiesEliminationPathway(GDREP)developedbyUSCDCtoguidehigh-levelpolicymakersindeterminingthefundsandresourcestoplanandconductmassdogvaccinations.Todate,38countrieshavejoinedthePARACON. NowaregionalnetworkhasbeenestablishedforAsia.OrganizedbyGARC incollaborationwiththeUSCDC,atotalof45participantsattendedthefirstmeeting.Participantsincluded27countrydelegatesfrom13Asiancountriesaswellasrepresentativesfrominternationalorganizations(FAO,OIE,WHO,USCDC),animalwelfareorganizations(HumaneSocietyInternational,FourPaws,BluePawTrust),andseveralpharmaceuticalcompanies. SimilartoPARACON,themeetingwasdesignedtobeinformal,interactivethrough“learningbydoing”whereindelegates were given time to explore the different existing rabies elimination tools. The 1st ARACON meetingenabledthefirstSAREassessmentsformanyAsiancountriesandbecameavenuetolaunchthePracticalWorkplancomponentoftheSAREtool.ThisadditionalcomponentbuildsthependingactivitiesfromtheSAREassessmentintoacountryspecificworkplancompletewithaGANTTchart,objectives,outcomes,deliverables,andnumberofyearstocompletion. Otherhighlightsofthemeetingwerethesharingoflessonslearntfromdifferentcountries(Thailand,Philippines,Indonesia,SriLanka,andMalaysia)intheimplementationofnationalrabiesprogramsaswellasapresentationfrom

Country delegates develop rabies control workplans. Photo: GARC

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...ARACON continued from page 2.

Vietnamonhowacountryalignsitsrabiesprogrambasedonaregionalstrategy,theASEANRabiesEliminationStrategy(ARES).FAO,OIE,WHO,providedexamplesonhowtheysupportrabieseliminationefforts intheAsianregion.AnoverviewwasalsogivenregardingtheUnitedAgainstRabies(UAR)initiativewhichisaglobalpartnershipbetweenFAO,OIE,WHOandGARCtoengagecountriesandotherstakeholdersfromthenational,regionalandinternationalleveltogeneratehighimpactglobalresponse. Themeetingendedwithanopenforumbetweenthecountrydelegatesandrepresentativesfromtheinternationalorganizations.Oneofthekeypointsduringthediscussionwastheemphasisonregionalcooperationandcollaborativeapproachwhicharecrucialduetothetransboundarynatureof rabies.Therabies incursion inPenang(2015)andSarawak(2017)experiencedbyMalaysia,whichusedtobearabiesfreecountry,isacaseinpointofthischallengeandhighlightstheimportanceofregionalcoordinationforstrengthenedearlywarningandrapidresponsebetweencountries.Contributed by Sarah Jayme, Asian Regional Coordinator for GARC. The meeting was made possible through the support of UBS Optimus Foundation, Four Paws, IDT Biologika, MSD Animal Health, and Sanofi Pasteur.

Asian country delegates and representatives of supporting organizations. Photo:GARC

GARC Statement on Dog Culling for Rabies Control Storiesappearwithalarmingregularityintheinternationalmediaaboutauthoritiescarryingoutmassstraydogcullinginresponsetorabiescases.Attractingfewerheadlinesisthehighfrequencyofroutinecullingcarriedoutmonthaftermonth,andyearafteryearaimingtocurbrabiesinstraydogpopulations.Inarecentarticle,WorldAnimalProtectionsuggestedthatperhaps10milliondogsareculledacrosstheglobeinthenameofrabiescontroleveryyear. Thereisnodoubtthatstraydogspresentmanyproblemstopublicsafetyandenvironmentalhealth,anditisnosurprisethattherearefrequentcallsforauthoritiestodosomethingabouttheproblem.Oftenrabiesgetscaughtupinthemoregeneraldebatearoundfreeroamingdogsanddogoverpopulation,andarabiesoutbreakcanbethetippingpointatwhichauthoritiesdecidetorespond. Superficially,itmayseemthatreducingthedogpopulationwouldhelplimitthespreadofrabies,butthedesireforauthoritiestobeseentobedoingsomethinghidesamoreworryingtruth.Indiscriminatedogcullingissimplynotaneffectivewayofcontrollingrabies,andworse,itunderminesthedevelopmentofalongertermsolutionthatwouldwork.Additionally,theuseofcullingcanfrequentlyresultinabacklashfromthecommunity,especiallyifinhumanemethodsareused. Tosupportthosefightingforeffectiverabiescontrolintheircommunities,GARChaspreparedastatementforthe EndRabiesNowcampaignontheuseofdogcullinginrabiescontrol.Thisstatementsetsoutthereasonswhyindiscriminatemasscullingdoesn’twork,itdescribesthedamagethatcullingcandotofuturecontrolefforts,anditsuggestsmoreeffectivealternativesinresponsetoarabiesoutbreakcentredoncaninevaccination.Thesealternatives,aspartofalongertermstrategy,willseecommunitieseliminatethethreatofrabiesfordogsandpeoplealike. YoucanfindthestatementontheEndRabiesNowwebsitehere.Contributed by Louise Taylor, Scientific Director of GARC.

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Diagnosing the Problem and Planning for the Future:Bolstering Rabies Control in Guinea InthewesternreachesoftheAfricancontinentliesGuinea,acountrythatmadeheadlinesgloballyduringtheEbolaoutbreakthatendedinearly2016.However,recentmoreexcitingandpositivedevelopmentsinpublichealthhaveemergedfromthescapitalcityofConakry,whererabiescontroleffortshavebeenbuoyedthroughintensivetrainingsandworkshops. ThroughacollaborationbetweentheUNFAO,USAIDandGARC,anintensiverabiesdiagnostictrainingcoursewas hosted at the Central Veterinary Laboratory inConakry,Guineafrom22-24March2018bytheGuineaFAOoffice.Sixlaboratorypersonnelweretrainedintheuse of the DRIT (Direct Rapid ImmunohistochemicalTest), aneasy, cost-effectiveassay for thediagnosisofsuspect rabies samples. The rabies diagnostic trainingwasanimportantfoundationalstepinimprovingrabiessurveillanceinthecountry,providingastrongplatformfor Guineans to advocate for support and raisingawarenessaboutrabies. Later in March, a national workshop was held todemonstratethevarioustoolsdevelopedtoassistcountriesinthecreationandimplementationofaneffectiveandstrategicnationalrabieseliminationstrategy.TheworkshopwasorganisedandhostedbyacollaborationbetweentheUNFAO,USAID,GARCandtheUSCDC. The Stepwise Approach towards Rabies Elimination (SARE) was undertaken in an intensive workshop thatincludedamultitudeofstakeholdersandpartnersfromvariousministries(includingMinistryofHealth,MinistryofAnimalHusbandryandtheMinistryofEnvironmentalAffairs),internationalorganisations(WHO,OIE,FAO,CDC,GARC,USAID,InstitutPasteur)andtheprivatesector,amongothers.ThisworkshoptrulyencompassedtheOneHealthspiritandresultedinacomprehensiveself-assessmentofthecurrentsituationinthecountry.

Following the SARE analysis, the Global Dog RabiesElimination Pathway (GDREP) tool was demonstratedby the US CDC as a tool to facilitate budgeting for arabiescontrolstrategy,includingthehumanresourcesrequired to achieve adequate animal vaccinationcoverage. With this powerful information at hand, astrongerandmoreaccurateestimateof theneedsofthe country could be assessed and advocated for atthe national level to drive any future rabies controlcampaigns.Although both the SARE and the GDREP providedetailsofwhat is requiredtodevelopand implementaneffectivenationalrabiescontrolstrategy,aconcretemeansastohowtheseactivitiescanbeachievedwasstill lacking. A newly developed tool--the Practical

WorkplantowardsAchievingRabiesElimination(PWARE)—wasdevelopedbyGARCtoconvertinformationfromtheSAREintoactionableitems,highlightingpendingactivitiesandthendevelopingaconcreteanddetailedworkplanonexactlyhowthosependingactivitiescanbeaccomplished.Aftermanyhoursoffruitfuldiscussionsbetweenthevariouspartners,Guineadevelopedanactionableworkplanandfurtherprioritisedseveralactivitiestobeachievedinthecomingmonths. TheworkshopclosedwithpositiveremarksfromthevariousinternationalorganisationsandtheencouragementofGuineatoimplementandundertakethoseactivitiesthatwereprioritisedbythePWAREtooltodrivetheireffortsofrabieseliminationclosertothegoalofbeingfreefromdog-mediatedhumanrabiesbytheyear2030.Submitted by Terence Scott, GARC and member of the Pan-African Rabies Control Network (PARACON) Steering Committee

Terence Scott (GARC) leads the workshop in the development of a nationalWorkplan for rabies using the SARE-PWARE tool. Photo: GARC

DRIT training graduates with their certificates outside of the Central Veterinary Laboratory in Conakry. Photo: GARC

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Share your message this World Rabies Day!

Asmostofyoualreadyknow,WorldRabiesDayisagreatannualopportunitytoincreaseawarenessbyholdinganevent,gettingthemediainterestedinyourworkandconnectingwiththewiderrabiespreventioncommunity. TheWorldRabiesDay2018themeisRabies:Share the message. Save a life.Thishighlightsthe importanceofeducationandawarenesstopreventrabies.Youcanusethisatmanylevelstosharedifferentmessages,fromthepolicy-levelmessagetogovernmentstocommit tothe2030deadline, tocommunity-levelmessagesaboutvaccinatingdogsandtreatingbitewounds,anddogbitepreventioneducationforschoolchildren. Please register your event at https://rabiesalliance.org/world-rabies-day/register. You can also downloadbannerswiththisyear’sthemeathttps://rabiesalliance.org/world-rabies-day/event-resources/logos. Keep an eye out formore resources and activities asWorld Rabies Day approaches.We’ll be sharing newcustomisableposterssoon,andthe2018WorldRabiesDayAwardswillbelaunchedinJunewithmorecategoriestorecogniseevenmorerabieschampionsinthecommunity. WelookforwardtolearningmoreaboutyourWorldRabiesDayactivities–[email protected] by Deepa Balaram, on behalf of the WRD team

Vaccinating Dogs Protects from Wildlife Threats Severalrecentstoriesinthenewsillustratehowwildlifecansignificantlyimpactrabiesecologyinaparticularregion.Wildanimalslivingnearhumansofteninteractwithlocaldogpopulationsandcanmodulatethethreatofrabies—sometimesinunexpectedways—buttheinfluenceofwildlifeonrabiestransmissiontodomesticanimalsandpeoplecanbediminishedbyafullyvaccinateddomesticdogpopulation. Wildlifecanbringrabiesintoacommunityandinfectnon-vaccinatedpets,whicharethenabletotransmitthediseasetohumans.Tomaintainabarrierbetweenwildlife-transmittedrabiesandhumans,effectivevaccinationofdomesticandstraydogsinareasborderingwildernesshabitatsmustbeestablished. Droppingbaitstovaccinatewildlifeagainstrabiesisanotherstrategyforkeepingrabiesincidencelowinwildlifepopulations.Israelusuallyseesabout13-30rabiescasesayear,mostlyinwildlife,butnewsreportshaveshownthatcaseshavebeenincreasingoverthepastyear,with17casesinthefirst3weeksof2018,and74casesin2017,upfromjust29casesin2016.TheoutbreakisattributedtowildjackalscrossingoverfromJordan—wherethegovernmentdoesnottreatthediseaseindomesticorwildanimals—thatbringthediseaseintoIsrael’snorthernvalleys,heighteningtheprospectofasevereoutbreak.Jackalsnormallydon’tinteractwithhumans,butifinfected,theybecomelessinhibitedandcanmoreeasilytransmitthediseasetofarmanimalsorpets. Israelusuallycontrolsrabiesbyscatteringediblevaccineintheborderregions,butadiplomaticcrisislastyearbetweenIsraelandJordanpreventedlastyear’swildlifevaccinedistributionprogramfromoperatingintheregion.Over3000 jackals live in theoutbreakarea,and reports indicate that the IsraeliNatureandParksAuthority isnow trying to control rabies in the jackal populationby culling and scattering vaccinepelletsmoredensely inproblemareas. TheAgricultureMinistrywants toensure that thediseasedoesn’t crossover to catsanddogsandis inoculatingferalcatsandprovidingrabiesboostershotsfreeofcharge,withthehopesthatkeepingthe

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domestic animal population protected against rabies willhelppreventtheoutbreakfromspreading. Sometimes critically endangered wildlife fall victimtorabies. Recently,anentirefamilyofwilddogs living inZimbabwe’sHwangeNationalParkwaseradicatedbyrabies,infectedbywithotherwildpredatorsinthepark.Wilddogsaregenerallynotvaccinated,andwithoutprotectionfromthedisease,entirepackshavesuccumbedtorabies,greatlyconcerningenvironmentalistsandconservationists.ASierraClubarticlerevealedhowvaccinating localdomesticdogsaroundtheparkhashelpedpreventthetransferofrabiestoandfromwildAfricanpainteddogs,withthehopesofguarding this endangered species from extinction. Theringofvaccinationaroundtheparkkeepsthediseasefromspreadingtoandfromdomesticdogsandsusceptiblewildanimals.

While unvaccinatedwild animal reservoirs can spreadrabies,wildpredatorscanalsodecreasethepopulationdensityofareservoirspeciesandreducediseaseincidence.AnewstudypublishedinFrontiersinEcologyandtheEnvironmentreportedhowleopardsinSanjayGhandiNationalParknearMumbai,Indiahuntstraydogsnearthepark’sborderastheirprimarysourceoffood.About40leopardshavebeencorrelatedwithalowerincidenceofrabiescomparedtosurroundingareasofthecity.Itisestimatedthat1500dogsarekilledannuallybytheleopards,reducingthedogdensitybyafactoroftencomparedtotherestofthecity—andtherebyreducingtheincidenceofrabies.Itwasestimatedthatthecullingperformedbythepark’sleopardsprevented1000possiblebitesfromdogsand90potentialrabiescases.Submitted by Laura Baker, GARC. From the Sierra Club, “As Rabies Scourges Painted Dogs, a Race to Vaccinate Domestic Breeds”; From the Times of Israel, Animal rabies incidents quadruple, raising fears of outbreak among humans; From the Haaretz, “Israel on the Brink of a Rabies Epidemic, Thousands of Coyotes Killed”; From National Geographic, “How City-Dwelling Leopards Improve Human Health”

Leopards living in Sanjay Gandhi National Park in Mumbai India have been attributed with decreasing rabies incidence by hunting stray dogs living nearby. Photo: Maheshshinde (http://en.wikipedia.org/wiki/File:P1010426.JPG) [Public domain], via Wikimedia Commons

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WHO announces updated guidance on rabies WHOisdelightedtoannouncethepublicationoftwonewguidancedocuments,eachtheproductofmonthsofexpertreview. Sincethelaunchoftheglobalframeworktoeliminatehumanrabiestransmittedbydogsby2030in2015,WHOhasworkedwiththeFoodandAgricultureOrganizationoftheUnitedNations,theWorldOrganisationforAnimalHealth,theGlobalAllianceforRabiesControlandotherstakeholdersandpartnerstoprepareaglobalstrategicplan.This includesa country-centricapproach to support,empowerandcatalysenationalentitiestocontrolandeliminaterabies.

In this context, WHO convened its network of collaborating centres on rabies,specializedinstitutions,membersoftheWHOExpertAdvisoryPanelonRabies,rabiesexpertsandpartnerstoreviewstrategicandtechnicalguidanceonrabiestosupportimplementationofcountryandregionalprogrammes. The new WHO Expert Consultation on Rabies: WHO TRS N°1012 report provides

updatedguidancebasedonevidenceandprogrammaticexperienceonthemultiplefacetsofrabiesprevention,controlandelimination.Keyupdatesinclude:(i)surveillancestrategies,includingcross-sectorallinkingofsystemsandsuitablediagnostics;(ii)thelatestrecommendationsonhumanandanimalimmunization;(iii)palliativecareinlowresourcesettings;(iv)riskassessmenttoguidemanagementofbitevictims;and(v)aproposedprocessforvalidationandverificationofcountriesreachingzerohumandeathsfromrabies. The meeting supported the recommendations endorsed by theWHO Strategic Advisory Group of ExpertsonImmunizationinOctober2017toimproveaccesstoaffordablerabiesbiologicals,especiallyforunderservedpopulations,andincreaseprogrammaticfeasibilityinlinewiththeobjectivesofuniversalhealthcoverage.

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ThecollaborativemechanismsrequiredtopreventrabiesareamodelforcollaborationonOneHealthateverylevelandamongmultiplestakeholdersandarearecipeforsuccess. Rabies is a vaccine-preventable disease. Theprovisionofsupporttocountrieswillendthepainandsufferingduetorabiesthatburdenspeople,especiallychildren. Investing in rabies control and eliminationstrengthens health systems, improves equity andaccess tohealth care and contributes to sustainabledevelopment.Investmentinrabieseliminationisnotonlyforeliminationofthisfatalbutpreventablediseasebutalsoforbuildingcapacityintheworld’smostneglectedregions.

Thisreport,requestedbycountries,provideshands-onguidancetodriveprogresstowardsrabieselimination. The new WHO position paper on Rabies Vaccine, was published April is part of WHO’s series of regularlyupdatedpositionpapersonvaccinesandcombinationsofvaccinesagainstdiseases thathavean internationalpublichealthimpact.TheysummarizeessentialbackgroundinformationondiseasesandvaccinesandconcludewiththecurrentWHOpositionontheuseofvaccinesworldwide.

ThepapersarereviewedbyexternalexpertsandWHOstaff,andreviewedandendorsedbytheWHOStrategicAdvisoryGroupofExperts(SAGE)onimmunization.TheGRADEmethodologyisusedtosystematicallyassessthequalityoftheavailableevidence.TheSAGEdecision-makingprocessisreflectedintheevidence-to-recommendationtables. Thepositionpapersareintendedforusemainlybynationalpublichealthofficials.Theymayalsobeofinterestto international fundingagencies,vaccineadvisorygroups,vaccinemanufacturers,themedicalcommunity,thescientificmediaandthegeneralpublic.

Thispositionpaperreplacesthe2010WHOpositiononrabiesvaccines.Itpresentsnewevidenceinthefieldofrabiesandtheuseofrabiesvaccines,focusingonprogrammaticfeasibility,simplificationofvaccinationschedulesand improved cost-effectiveness. The recommendations concern the 2 main immunization strategies, namelyvaccination forpost-exposureprophylaxisandvaccination forpre-exposureprophylaxis. In thecontextofpost-exposureprophylaxis,recommendationsarealsoprovidedontheuseofrabiesimmunoglobulins. RecommendationsontheuseofrabiesvaccineswerediscussedbySAGEinOctober2017;evidencepresentedatthemeetingcanbeaccessedhere.Contributed by Bernadette Abela-Ridder and Lea Knopf of the WHO Department of Control of Neglected Tropical Diseases

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Prestigious Award for Rabies Research

Professor SarahCleavelandOBE FRSwas awarded the2018 LeeuwenhoekMedalandLecturebytheUK’sRoyalSocietyforherpioneeringworktowardstheeliminationofrabiesthroughouttheworld.Theawardwasnamedafterthefatherofmicrobiology,DutchmicroscopistAntonievanLeeuwenhoek.

Beforereceivingheraward,Prof.CleavelanddeliveredapubliclectureattheRoyalSocietyinLondononApril17thentitled“Canwemakerabieshistory?Realisingthevalueofresearchfortheglobaleliminationofrabies”. Prof. Cleaveland contributes to global rabies elimination efforts through the Global Alliance for Rabies Control, Partners for Rabies Prevention and other international expert groups.

Contributed by Kim Doyle of GARC. You can read more about and watch a recording of the lecture here.Prof. Sarah Cleaveland (right) with Dr Julie Gallagher after the award lecture. Photo: GARC

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Recent ResearchAdvocacy / Policy

Estimating the burden of rabies in Ethiopia by tracing dog bite victims. 655 animal bite cases weretracedtotheircommunitiesandfurthervictimsidentified.Annualsuspectedrabiddogexposureswere

estimatedperevaluatedurban,ruralhighlandandrurallowlanddistrictat,respectively,135,101and86bites,whichled,respectively,toabout1,4and3deathsper100,000population.AveragecostspercompletedPETwere23,31and40USD,whichwassignificantlyhigherinruraldistricts.Extrapolationofthedistrictresultstothenationallevelindicatedanannualestimateofapproximately3,000humandeathsresultinginabout194,000DALYsperyearand97,000exposedpersonsrequiringonaverage2millionUSDtreatmentcostsperyearcountrywide.RabiesintheAmericas:1998-2014.Thispaperpresentslongitudinaldatafor21LACcountriesondogvaccination,PEPandrabiessurveillance.Dogandhumanrabieshavedecreasedsignificantly,butdifferencesinhumananddograbiesincidenceratesanddogvaccinationrateswereshownbetweenlow,middleandhigh-incomecountries.Atthepeak,over50milliondogswerevaccinatedannuallyinnationalcampaignsinthecountriesrepresented.Onaverage,over2milliondosesofhumanvaccinewereappliedannually.Inthemostrecentsurvey,only37%ofcountriesreportedthattheyhadsufficientfinancialresourcestomeettheprogramobjectives.ThedatashowasufficientandsustainedeffortoftheLACcountriesintheareaofdogvaccinationandprovideunderstandingofthebaselineeffortrequiredtoreducedog-mediatedrabiesincidence.

Diagnosis and SurveillanceEvaluation of Monoclonal Antibody-Based Direct, Rapid Immunohistochemical Test for Rabies Diagnosis. The dRITtesthasaworldwidepromisingapplication,particularlyindevelopingcountries.However,nocommercialconjugatedantibodyisavailabletomeetthelaboratorydemand.Wedescribeheretheproductionofamonoclonalantibody(MAb)againstrabiesvirus(RABV)NproteinanditsuseasabiotinylatedconjugateinadRIT.ResultsshowedthatthedRIThad100%specificity(95%CI0.93-1.00)and96.49%sensitivity(95%CI0.88-1.00)ascomparedwiththegoldstandardFAT.Itthereforeprovidesasimple,economicalalternativetoFAT.ApplicationandComparativeEvaluationof FAT, dRIT andRT-PCRTests for theDetectionofRabiesVirusAntigenorNucleicAcid inBrain SamplesofAnimals SuspectedofRabies in India.DFA,dRIT andRT-PCRdiagnostic testswerecomparedon257brain samples, includingdecomposed samples. The results confirm100%corroborationbetweenDFAanddRIT,buttresstheapplicabilityofdRITinthesimpleandrapiddiagnosisofrabiesinanimals,andreaffirmthesuitabilityofRT-PCRforsamplesunfitfortestingeitherbyDFAordRIT.Rabies surveillance in theUnited States during 2016.During 2016, 50 states andPuertoRico reported4,910 rabidanimalstotheCDCofwhich4,487(91.4%)involvedwildlife.Relativecontributionsbythemajoranimalgroupswereas follows:1,646 (33.5%)bats,1,403 (28.6%) raccoons,1,031 (21.0%) skunks,313 (6.4%) foxes,257 (5.2%)cats,70(1.4%)cattle,and58(1.2%)dogs.Therewasa4.6%decreaseinthenumberofsamplessubmittedfortestingin2016,comparedwith2015.Nohumanrabiesdeathswerereportedin2016.Laboratorytestingofanimalssuspectedtoberabidremainsacriticalpublichealthfunctionandcontinuestobeacost-effectivemethodtodirectlyinfluencehumanrabiespostexposureprophylaxisrecommendationsPotentialConfoundingofDiagnosisofRabies inPatientswithRecentReceiptof Intravenous ImmuneGlobulin.ThisreportdescribessixpatientswhoweretestedforrabiesbyCDCandwhometCSTEcriteriaforconfirmedhumanrabiesandfourpatientswhowerefoundtohaveserumRLNAsdespitehavingnotbeenvaccinatedforrabies.Noneofthese10patientsreceivedarabiesdiagnosis;rather,theywereconsideredtohavebeenpassivelyimmunizedagainstrabiesthroughrecentreceiptofintravenousimmuneglobulin(IVIG).

PEPManagementofdogbitesbyfrontlineserviceprovidersinprimaryhealthcarefacilitiesintheGreaterAccraRegionofGhana,2014-2015.57.8%of232frontlineserviceproviderswerecorrectinthattherabiesvirusisthecausativeagentofrabies,39.2%attributedittoadogbite,2.6%didnotknowthecause,andonepersonattributedittotheherpesvirus.Only15.5%knewtheincubationperiodindogsandtheperiodrequiredtoobserveforsignsofarabiesinfection.42.2%ofthedidnotknowhowtoadministerRIG.Ofthefacilitiesvisited,76%didnothavetherabiesvaccinesand44%didnotknowwheretogetrabiesvaccinesfrom.Mostoftheserviceproviders(87.9%;204/232)hadneverreportedeitheradogbiteorasuspectedcaseofrabies.RabiesVaccineHesitancyandDeathsAmongPregnantandBreastfeedingWomen-Vietnam,2015-2016. During

Page 9: Setting a Clear Pathway Towards Global Rabies Elimination...needs going forward. This data is vital to assessing and directing customized national rabies elimination plans, and from

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APRIL 2015 • Issue 42APRIL 2018 • Issue 57

...Recent Research continued from page 8.

The editors of the GARC newsletter are Louise Taylor and Laura Baker. You can contact them through [email protected] is by Pete Else. For further information on the Alliance’s work see www.rabiesalliance.org.

2015-2016, among 169 cases reported in Vietnam, two probable cases of rabies were reported in breastfeedingmothersandfourinpregnantwomen,allofwhomhadbeenbittenbydogs.Allsixpatientsdied.Threeofthefourpregnantwomenhad cesarean deliveries. In each case, families reported the patient’s fear of risk to the fetus orbreastfedchildastheprimarybarriertoreceivingPEP.

EducationArabieslessonimprovesrabiesknowledgeamongstprimaryschoolchildreninZomba,Malawi.Knowledgeandattitudestowardsrabieswereassessedbyaquestionnairebeforeaprimaryschoollesson,immediatelyafterthelessonand9weekslatertoassesstheimpactthelessonhadonschoolchildren’sknowledgeandattitudes,andalsoinchildrenwhowereexposedtoamassdogvaccinationprogrammebutdidnotreceivethelesson.Knowledgeofrabiesandhowtobesafearounddogsincreasedfollowingthelesson,andknowledgeremainedhigherthanbaseline9weeksafterthelesson.Knowledgewasgreateramongstschoolchildrenwhohadreceivedthelessoncomparedtothosewhohadnotindicatingthatthelessonitselfwascriticalinimprovingknowledge.

Mass Dog Vaccination Impactofcommunity-deliveredSMSalertsondog-ownerparticipationduringamassrabiesvaccinationcampaign,Haiti2017.Toimproveawarenessamongdogowners,600,000textmessagesweresenttophonesintwoHaitiancommunestoreminddogownerstoattenddogvaccinationcampaigns.Apost-campaignhouseholdsurveywasconductedtoassessdogowner’sperceptionofthetextmessagesandtheimpact.91.9%oftext-receivingdogownersindicatedthetextwashelpful. Incentralpointcampaignareas, therewas73.1%attendanceamongthosewhoreceivedthetextvs36.4%amongthosewhodidnot.Inareasincorporatingdoor-to-doorvaccinationovermultipledaystherewasnosignificantimpactofreceivingatext.QualitativeEvaluationoftheFive-Year‘RedCollar’CampaigntoEndInhumaneCullingofDogsasaMethodofRabiesControl.Toendtheinhumanecullingofdogsinresponsetorabies,WorldAnimalProtectionlaunched‘RedCollar’;afive-yearcampaign(2011-2016)thatworkedwithgovernmentstopromotetheimplementationofmassdogvaccinationfor rabies control.Wepresent the findings froma qualitative evaluationof ‘Red Collar’, conducted both regionallyand with national focus on Bangladesh, China, Indonesia, the Philippines and Zanzibar, Tanzania, based on semi-structuredinterviewsandwrittencontributionsfromstakeholders.Thecampaignsuccessfullygeneratedmomentumforimplementationofmassdogvaccinationbytargetedgovernmentsandlessonslearnedwereestablished.

Epidemiology in WildlifeThe spread and evolution of rabies virus: conquering new frontiers. Robust surveillance efforts combined withdiagnosticsanddiseasemodellingarenowprovidinginsightsintotheepidemiologyandevolutionofrabiesvirus.Theimmunestatusofthehost,thenatureofexposureandstraindifferencesallclearlyinfluenceinfectionandtransmissiondynamics.This reviewfocussesonrabies inwildlife,synthesizecurrentknowledge in therapidlyadvancingfieldsofrabiesvirusepidemiologyandevolution,andadvocateformultidisciplinaryapproachestoadvanceourunderstandingofthisdisease.

Upcoming MeetingsNECTM7.The7thNorthernEuropeanConferenceonTravelMedicine,inStockholm,Swedenfrom2-4thMay2018.

5th International One Health Congress.The5thInternationalOneHealthCongress,withtheoverarchingtheme‘OneHealthinUnderservedCommunities’willbeheldinSaskatoon,Canada,22-25thJune2018.

6th ACC&D Symposium.6thInternationalSymposiumonNon-SurgicalFertilityControlforDogsandCats,tobeheldinBoston,MA,UnitedStatesfrom22-24thJuly2018.

NNN Summit 2018.TheNeglectedTropicalDiseaseNGONetwork(NNN)2018summit,willbehostedbytheEthiopianFederalMinistryofHealthandNGOpartners,24-26September2018inAddisAbaba,Ethiopia.

XXIX RITA Conference.TheXXIXRabiesintheAmericas(RITA)ConferencewillbeheldOctober28–November2,inBuenosAires,Argentina.Moredetailswillbeavailablesoonatwww.ritaconference.org.


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