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Eliminating rabies: Africa closer than ever?

Eliminating rabies: Africa closer than ever?

Domestic dogs are the most common reservoir of rabies virus, with more than 99 percent of human deaths caused by dog-mediated rabies Roselyne Sachiti Features, Health and Society Editor On Friday August 2, Bulawayo City Council placed a public notice warning of the increase in the number of people being bitten by stray dogs in the country’s second largest city. In the notice, the local authority advised residents and dog owners that in terms of Bulawayo (Dog Licensing and Control) by-laws), no person was allowed to keep in the council area more than two dogs on any property measuring less than 2 000 square metres or more than four dogs in any property. The city also said no person should allow his dog(s) to roam outside his premises without restraint, adding that dogs would only be kept where the property is securely fenced/walled and gated, adding hedges were not permissible. Most importantly, the city said all dogs within council area would be vaccinated against rabies and licensed. “The Department of Veterinary (Field) Services will be undertaking a vaccination exercise for all dogs in the city during the month of August 2019. Dog owners are advised to utilise this opportunity and vaccinate their dogs. “Please be advised that the City of Bulawayo, Zimbabwe Republic Police, Department of Veterinary Field Services and Society for the Prevention of Cruelty to Animals (SPCA) is enforcing a TIE UP ORDER as from September 1, 2019 to November 30, 2019. All stray dogs found during this period will be shot . . . ” said the city’s town clerk Christopher Dube in the public notice. What the City of Bulawayo is doing is commendable, given the burden of rabies on the African continent. Rabies cause thousands of human deaths annually. According to the World Health Organisation (WHO), rabies is a zoonotic disease (a disease that is transmitted from animals to humans), caused by the rabies virus, of the Lyssavirus genus, within the family Rhabdoviridae. Domestic dogs are the most common reservoir of the virus, with more than 99 percent of human deaths caused by dog-mediated rabies. WHO further says the virus is transmitted in the saliva of rabid animals and generally enters the body via infiltration of virus-laden saliva from a rabid animal into a wound (e.g. scratches), or by direct exposure of mucosal surfaces to saliva from an infected animal (e.g. bites). Today, the African continent more than ever, is taking the problem of canine rabies seriously, with several researches currently underway. Research consortium African Science Partnership for Intervention Research Excellence (Afrique One –ASPIRE) currently has several ongoing rabies researches focusing on different issues across the continent. ASPIRE, is a Pan-African research consortium for capacity building in “One Health”, collaborating with 21 institutions from 14 African and European countries. At the 2019 DELTAS Africa Scientific Conference in Dakar Senegal, a young researchers under the Afrique One-ASPIRE shared achievements in the areas of rabies. The fellows’ delegation delivered eight oral presentations and presented six posters, all focusing on the elimination of zoonoses in Africa through One Health approach implementation. Preliminary results on zoonoses elimination pathways in Africa also released by the consortium at the conference show that there is still need for greater understanding of the social, economic and political factors that affect motivation, awareness and responses towards rabies interventions; operational research to improve delivery of and participation in rabies intervention strategies and research to support the elimination process. This time, young researches promise to provide a “loud bark with a bite” and lasting solutions to rabies elimination. One of the fellows Ahmed Lugelo has been conducting research which seeks to find out how indigenous knowledge systems can be used for the storage of rabies vaccines in rural areas, which do not have access to electricity. Titled “Community engagement in the development of temperature-controlled device for storage of rabies vaccine in rural areas,” the objectives of his research are to develop and evaluate the effectiveness of locally-developed temperature-controlled storage device for keeping rabies vaccine cool under field conditions. “Based on the recent findings that Nobivac Canine Rabies vaccine can remain potent over six and three months when stored at fixed temperature of 250C and 300C respectively, here we used local community-based knowledge to design and develop an affordable and practical tool which is heat-resistant and power-free for storage of vaccines for extended periods in settings where power and refrigeration are limited,” his preliminary findings note. Five prototypes, Zeepot cements and, Coolbox sand, Coolbox sawdust and Coolgardie were developed using locally available materials such as woods, plastic, clay and cement, and field evaluated for two months in terms of stabilising temperatures. The five prototypes were placed inside trial house and each was equipped with digital temperature data logger for recording daily temperatures. Two litres of water were added to each prototype daily. The most resistant prototype was then identified and its impact in retaining the potency of vaccine compared with gold standard refrigerators. The research found out that Coolgardie Indoor had the lowest mean temperature of all the prototypes 18.20C. However, the zeepot clay consistently maintained internal temperature between 18 and 200C even when ambient temperature reached 37 degrees Celsius. The zeepot clay showed that it maintained potency of Nobivac Rabies vaccine for up to two months. In conclusion, Lugelo said the deployment of this novel tool, especially in hard -to-reach communities would increase access to vaccine and improve coverage. Another fellow, Prisca Ndour, has been conducting research on “Integrated regional approaches and use of new tools for rabies elimination in Africa.” Her objectives are to design development and field validation of a practical surveillance system and low-cost tools for both, rapid and point-of-care diagnosis and an innovative vaccine storage system. Ndour said the shortage of trained personnel and inadequate communication system which prevented accurate and timely detection and response presented major challenges for the elimination of rabies. “In Chad, Cote d Ivoire and Mali, trials with the Agien test (Rapid Immunodiagnostic test) and the Drit (Direct Rapid Immunohistochemical Test) for rabies point-of-care diagnostic have been demonstrated accurate and reliable when compared with the FAT (Fluorescent Antibody Test) on fresh tissue.” She added that the research in the validation of rapid tests and their application at the field level present real hope for developing countries which usually have only one laboratory for the diagnosis of rabies. “In Tanzania, a novel device using locally available materials and more importantly, which do not require a power supply have been demonstrated to maintain the vaccine at similar potency as the classic cooling system. “The result is critical as it will enable the vaccine to be accessed even in very remote areas with no power supply and thus improve vaccination coverage,” she said. Ndour added that in Tanzania, a surveillance system integrating human health and veterinary health sectors in the management of bite cases was being piloted. This, she explained, will improve collaboration between the health and veterinary sector and potentially improve delivery of post-exposure prophylaxis to bite victims in a cost effective way. In Chad, Jean M Nodjimbadem has been evaluating the use of a toll-free phone number in the surveillance and prevention of rabies cases. The objective of his research is to use two toll-free phone numbers that have been set up to report animal bite cases. “The purpose of these numbers is to facilitate access to care in cases were humans have been bitten by animals suspected of rabies. “The activity was part in the provinces of Logone Occidental, Ouaddai and the outskirts of N’Djamena, Chad. “This study aimed to manage and monitor animal bite cases in three provinces in Chad using telephone communication.” Telephone data recording began after a rabies awareness campaign from September 29, 2016 to March 28, 2018. Of the 354 recorded calls, 243 (69 percent) have been issued by men and 34 percent of those are between 45 and 54 years old. More calls were received from heads of households of bite victims (55 percent) than from human health (31 percent) or animal health (12 percent) professionals. With regards to the locality, Logone Occidental totalled 203 (57 percent) of the calls recorded. “Most of these calls came from rural areas (185 i.e 52 percent) than urban (147 i.e 42 percent). Calls primarily reported cases of animal bites (82 percent). In 97 percent of cases, the bite-inflicting animal was a dog. After a bite, the animal has been reported to have either been killed or disposed of (26 percent). In 46 percent of the cases, the description of the behaviour of the animal suggested rabies. The difficulty in accessing a health centre (52 percent) was frequently reported.” Through the toll-free number, 108 (31 percent) human health workers and 44 (12 percent) veterinary professionals collaborated to prevent rabies, which is an added value. “In N’Djamena, 186 bite victims have found access to Post-Exposure Prophylaxis, thanks to the hotline,” he noted. Nodjimbadem concluded that free calls improve the reporting rates of suspected rabies cases and access to care for the victims. “It is a very useful tool for the surveillance of rabies in Chad,” he said. In Cote d Ivoire, Nestor N’dri’ has been conducting a study aimed at identifying the social factors responsible for the low rabies vaccination coverage of the canine population in Bouake, the country’s second largest city. “Overall, rabies vaccination coverage in the district of Bouake is only 7 percent. “While in the city itself 30 percent of dogs are vaccinated, this drops down only to 3 percent of all dogs in rural areas.” The study found out that most dog owners in Bouake were unaware of rabies as a human disease and they associate it with scabies. “They perceive rabies as a disease affecting dogs only. In rural areas, where dogs are kept mainly for hunting, vaccination is perceived as an inhibitor of the dog’s abilities to hunt. “These knowledge gaps and community practices constitute, among other factors, obstacles to the wide use of canine rabies vaccination.” The research concluded that to improve coverage of dogs in Bouake and its rural areas, awareness campaigns were needed that take all perceptions into consideration. Director of the Afrique One-ASPIRE consortium, Professor Bassirou Bonfoh, said the various researches on rabies provide last mile strategy for elimination as tools and methods are available. “We need to provide non-drug vaccine interventions. We have vaccines, but communication between sectors is lacking. We need to understand and provide mechanisms for effective communication for adding value in the context of lack of resources,” he told The Herald. With such researches aimed at pushing out rabies in Africa, there is hope that elimination is a step away. There is thus need for more financing at the local level through national health budgets by African governments. Moreover, according to WHO, rabies is a 100 percent vaccine-preventable disease and countries embarking on rabies elimination programmes have successfully experienced marked reductions, often progressing to the elimination of rabies. roselyne.sachiti@zimpapers.co.zw roselyne.sachiti33@gmail.com Twitter @RoselyneSachiti

Eliminating rabies: Africa closer than ever?

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