WSAVA Nov 2021 Proceedings - Flipbook - Page 49
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RABIES AND MHEALTH: YOUR ROLE IN RABIES
SURVEILLANCE
T. Scott1, A. Coetzer2, L. Nel2
Luxembourg/Luxembourg, 2Pretoria/South Africa
1
Qualifications:
Dr. Terence Peter Scott
PhD Microbiology (Virology; Rabies)
terence.scott@rabiesalliance.org
Rabies is a disease that is fatal, yet entirely preventable. Despite the
ability and knowledge to control and eliminate the disease through the
availability of effective vaccines for both human and animals, the disease
continues to kill tens of thousands of individuals every year. Only recently
has rabies been recognized by the World Health Organization as a Neglected Tropical Disease (NTD) and is also the only vaccine-preventable
NTD. Thus, the case for the elimination of rabies should be strong, as
elimination is possible and has been demonstrated in both the developed
and developing world. Therefore, it begs the questions as to why rabies
has not been prioritized by governments and stakeholders for elimination.
The perpetuation of neglect for rabies can be traced back to various
factors, including a lack of advocacy and political will to drive rabies
elimination efforts. However, the lack of awareness is not based on
apathy towards a fatal, yet preventable zoonotic disease, but can rather be
attributed to the lack of evidence towards the seriousness and burden that
the disease presents to both human and animal health. With unreliable
or limited burden data, the true disease situation remains unclear, and
the seriousness of the disease is not conveyed to the relevant stakeholders. Due to the lack of data, the case cannot effectively be made
to stakeholders who control the access to the funding and resources
needed for the elimination of the disease. Finally, because of the lack of
funding and resources, programmatic implementation (including effective
data collection and analysis) remains poor. This perpetuates the cycle
of neglect, ensuring that NTDs like rabies remain under-prioritized and
under-resourced 1,2.
As improved programmatic implementation is challenging without
additional resources and funding, coupled with the fact that resourcing
programs is typically based on results and impact, the most feasible
means to break this perpetuating cycle of neglect is through improved
data collection, analysis, and reporting. While data collection is undertaken in many countries and in many programs, it is often the case that
the analysis and use of the data remains lacking. This can be attributed
to various challenges or limitations within the program, including a lack
of skilled personnel capable of analyzing the data, limited capacity of the
personnel or department responsible for data analysis (considering that
these departments are typically responsible for the analysis of multiple
health datasets), and poor/inconsistent data collection. In addition, in
those instances where the data is captured and analyzed, the time taken
to complete this process and share the results with the relevant authorities is often too lengthy for stakeholders to make any informed decisions, thus hindering the potential for any outbreak response or reactive
measures to control and eliminate rabies. Therefore, there is a need for
improved mechanisms for data collection, analysis, and timely reporting
that ensures that decision-makers have the most up-to-date data available
in an easily understandable and usable format that allows them to effectively react to the programmatic needs for rabies elimination.
Considering the zoonotic nature of rabies and the need for a concerted
One Health approach to achieve rabies elimination, the importance of
collecting and sharing data with stakeholders outside of a specific sector
is essential. While many countries have surveillance systems that collect
rabies data (to varying degrees of complexity and completeness) within
both the human health and animal health sectors, it is often the case
that this data is not shared. As a result, the information relating to the
burden of the disease and progress made towards elimination can be
incongruent or inconsistent, especially when analyzing data reported to
international agencies such as the OIE and WHO3. Therefore, for rabies,
there is a clear need for coordinated One Health surveillance systems that
use robust data capture methods, real-time analysis, and have easy and
reliable means to share or report data. These surveillance systems should
not only include data collection from governmental efforts but should
also include data from the non-governmental partners who may contribute towards rabies elimination efforts, including civil society and private
practice veterinarians.
In response to this need, the Global Alliance for Rabies Control (GARC)
developed the Rabies Epidemiological Bulletin (REB) in 20164. The REB
is a health information system that coordinates and integrates data
from both the human and animal health sectors into a single system for
accurate, timely, and meaningful rabies surveillance. It is based on the
DHIS2 (District Health Information System 2) platform, an open-source
program that is widely used in developing countries globally. The REB is
an overarching rabies surveillance system that is comprised of multiple
tools for high-resolution data collection and automatic analysis. These
individual tools within the system are specialized for particular tasks and
surveillance needs but all contribute to data collection and analysis in the
system as a whole. The creation of multiple specialized tools ensures that
data collection remains simple and rapid, removing the need for the user
in the field to filter or sort through multiple datasets.
The REB presently comprises of 6 individual tools. Importantly, these
tools work synchronously, ensuring that the data collected using one
tool contributes to the data analysis from another tool. Furthermore, the
tools also increase in complexity, and can be implemented based on the
available capacity within the country or project site. Therefore, in areas at
early stages of rabies elimination interventions, or those with extremely
limited resources and capacity, the foundational surveillance tools can
be implemented, such as tracking mass dog vaccinations. Once capacity
builds and more resources become available, more complex surveillance
methodologies can be implemented through their supporting tool, such
as the more resource-intensive Integrated Bite Case Management. Most
critically, the data collected using the foundational tools is the same data
used in the more complex programs, resulting in a graduated approach to
a compatible and comprehensive rabies surveillance system.
One of the foundational, yet most important, tools available on the REB
is the Rabies Vaccination Tracker (RVT)5,6. This tool facilitates data
collection through a mobile phone application, ensuring that every dog
vaccinated against rabies is tracked and the pertinent data collected.
Importantly, the tool has been developed so that data collection is rapid
and simple, resulting in the user (the vaccinator) being able to collect the
data during the vaccination process. Data collection takes no more than
5-7 seconds per animal, thus not hindering the vaccinator’s capacity to
vaccinate more animals. The critical impact of this vaccination tracker
app ensures that vaccination coverage can be determined and missed areas - or those where vaccination coverage is insufficient - can be identified
and targeted. Because data analysis is near real-time, analyses can be
undertaken hourly or daily, ensuring that mass dog vaccination campaigns
remain targeted and efficient.
The capture, analysis and sharing of dog vaccination data is important
for all partners involved in rabies control and elimination. Government
veterinarians and those working in mass dog vaccination campaigns in
dog-rabies endemic countries clearly benefit from the use of this tool
as they typically focus on free-roaming dogs that are often ownerless.
On the other hand, private veterinarians typically contribute towards
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