T3 ONE HEALTH MALAWI Research Papers Rabies

T3 ONE HEALTH MALAWI Research Papers Rabies

Rabies

2012

• TITLE - World Rabies Day: evidence of rise in paediatric rabies cases in Malawi
• AUTHOR - Sarita Depani, Macpherson Mallewa, Neil Kennedy, Elizabeth Molyneux
• JOURNAL - The Lancet
• ABSTRACT - Sept 28 marks World Rabies Day, launched in 2007 to increase public health awareness and reduce the incidence of this fatal but preventable disease. 5 years on, our experience in Malawi suggests that rabies incidence is rising and control measures are inadequate. We have seen ten cases of rabies in children at the Queen Elizabeth Central Hospital in Blantyre, Malawi, over a 9-month period (June, 2011, to February, 2012). This is the largest number of paediatric rabies cases described from a single institution in Africa and a three-fold increase in the number of cases reported between 2002 and 2005 at the same hospital.
  All the patients had clear evidence of rabies encephalitis and all died. In the eight patients for whom history of exposure was obtained, all were secondary to a dog bite. A third of the patients did not report the exposure to their guardian; another third sought medical attention but there was unavailable or inadequate vaccine; one patient was denied treatment because they did not have a vet's certificate.
  
• ISSUE - 9848
• VOLUME - 380
• DOI - 10.1016/s0140-6736(12)61668-7

2016

• TITLE - The Vaccination of 35,000 Dogs in 20 Working Days Using Combined Static Point and Door-to-Door Methods in Blantyre, Malawi
• AUTHOR - Andrew D Gibson, Ian G Handel, Kate Shervell, Tarryn Roux, Dagmar Mayer, Stanford Muyila, Golden B Maruwo, Edwin M. S Nkhulungo, Rachel A Foster, Patrick Chikungwa, Bernard Chimera, Barend M.deC Bronsvoort, Richard J Mellanby, Luke Gamble
• JOURNAL - PLoS Neglected Tropical Diseases
• ABSTRACT - An estimated 60,000 people die of rabies annually. The vast majority of cases of human rabies develop following a bite from an infected dog. Rabies can be controlled in both human and canine populations through widespread vaccination of dogs. Rabies is particularly problematic in Malawi, costing the country an estimated 13 million USD and 484 human deaths annually, with an increasing paediatric incidence in Blantyre City. Consequently, the aim of this study was to vaccinate a minimum of 75% of all the dogs within Blantyre city during a one month period. Blantyre‚Äôs 25 administrative wards were divided into 204 working zones. For initial planning, a mean human:dog ratio from the literature enabled estimation of dog population size and dog surveys were then performed in 29 working zones in order to assess dog distribution by land type. Vaccination was conducted at static point stations at weekends, at a total of 44 sites, with each operating for an average of 1.3 days. On Monday to Wednesday, door-to-door vaccination sessions were undertaken in the areas surrounding the preceding static point stations. 23,442 dogs were vaccinated at static point stations and 11,774 dogs were vaccinated during door-to-door vaccinations. At the end of the 20 day vaccination programme, an assessment of vaccination coverage through door-to-door surveys found that of 10,919 dogs observed, 8,661 were vaccinated resulting in a vaccination coverage of 79.3% (95%CI 78.6‚Äì80.1%). The estimated human:dog ratio for Blantyre city was 18.1:1. Mobile technology facilitated the collection of data as well as efficient direction and coordination of vaccination teams in near real time. This study demonstrates the feasibility of vaccinating large numbers of dogs at a high vaccination coverage, over a short time period in a large African city.
• ISSUE - 7
• VOLUME - 10
• DOI - 10.1371/journal.pntd.0004824

2018

• TITLE - The problem of stray dogs
• AUTHOR - Luke Gamble, A.D. Gibson, K. Shervell, F. Lohr, I. Otter, R.J. Mellanby
• JOURNAL - Revue Scientifique et Technique
• ABSTRACT - The effective management of stray dogs is critically important in any rabies vaccination programme. In many rabies-endemic countries, stray dogs represent a significant proportion of both the free-roaming and total dog populations, and to ensure that rabies elimination programmes are successful, it is essential that this portion of the dog population (stray dogs) is vaccinated at high coverage. However, there are a number of challenges to managing and delivering rabies vaccinations to stray dogs. This paper will review the most pertinent issues relating to the problem of stray dogs and rabies elimination, focusing on the challenges relating to the estimation of population size, vaccination administration and vaccine coverage assessment in stray dog populations. The authors will highlight how these challenges can be overcome, notably by reviewing the census techniques that have been employed to assess stray dog populations, which then facilitate the planning and design of vaccination programmes. In addition, they discuss the range of vaccination strategies that are available and that have been used to vaccinate stray dogs and review how vaccination coverage can be assessed in this population. Finally, the benefits of population management in stray dogs
  through neutering programmes are reviewed. In short, this paper highlights the importance of ensuring that stray dogs, as well as owned dogs, are included in vaccination programmes and emphasises that many of the challenges related to
  protecting stray dogs from rabies can be overcome.
  

2019

• TITLE - Sociodemographic factors which predict low private rabies vaccination coverage in dogs in Blantyre, Malawi
• AUTHOR - Stella Mazeri, Andrew D Gibson, Barend Mark de Clare Bronsvoort, Ian G Handel, Fred Lohr, Jordana Burdon Bailey, Dagmar Mayer, Luke Gamble, Richard J Mellanby
• JOURNAL - Veterinary Record
• ABSTRACT - Although rabies kills approximately 60,000 people globally every year, vaccination of over 70 per cent of the canine population has been shown to eliminate the disease in both dogs and human beings. In some rabies endemic countries, owners are able to vaccinate their dogs through private veterinary clinics. However, uptake of dog vaccinations through private veterinary clinics is often low in many rabies endemic countries. In this study, the authors examined the sociodemographic factors which predicted low private rabies vaccination coverage in Blantyre, Malawi. Data on 23,205 dogs were recorded during a door-to-door rabies vaccination programme in 2016. A multivariable logistic regression model was built to identify factors associated with private rabies vaccination. Negative predictors of private vaccination included increasing poverty levels, higher housing densities, male dogs, pregnant or lactating dogs, and puppies and dogs allowed to roam. In contrast, neutered and healthy dogs had greater odds of being privately vaccinated. The present study demonstrated that low private rabies vaccination coverage can be accurately predicted by sociodemographic factors. This information may help inform public health interventions which deliver mass vaccination programmes in rabies endemic countries.
• ISSUE - 9
• VOLUME - 184
• DOI - 10.1136/vr.105000

2017

• TITLE - Rationale and support for a One Health program for canine vaccination as the most cost-effective means of controlling zoonotic rabies in endemic settings
• AUTHOR - Robert P. Lavan, Alasdair I. MacG. King, David J. Sutton, Kaan Tunceli
• JOURNAL - Vaccine
• ABSTRACT - Although dog vaccination has been demonstrated to reduce and eliminate rabies in humans, during meetings there are often calls for further pilot studies. The assembled data proves that a widespread approach is now required. While zoonotic rabies has a minimal presence in developed nations, it is endemic throughout most of Asia and Africa, where it is considered to be a neglected tropical disease. In these areas, rabies causes an estimated annual mortality of at least 55,000 human deaths. Worldwide rabid dogs are the source of the vast majority of human rabies exposures. The World Health Organization (WHO), the Food and Agriculture Organization (FAO) of the United Nations and the World Organization for Animal Health (OIE) advocate a collaborative One Health approach involving human public health and veterinary agencies, with mass canine vaccination programs in endemic areas being the mainstay of strategies to eliminate dog-mediated human rabies. While post-exposure prophylaxis (PEP) is effective in preventing deaths in people exposed to rabies, it is comparatively expensive and has little impact on the canine reservoir that is the primary source of zoonotic rabies. Indiscriminate culling of the dog population is expensive and there is little evidence that it is effective in controlling rabies in non-island locations. Mass canine vaccination programs using a One Health framework that achieves a minimum 70% vaccination coverage during annual campaigns have proven to be cost-effective in controlling zoonotic rabies in endemic, resource-poor regions. Case studies, such as in Tanzania and Bhutan, illustrate how an approach based on mass canine rabies vaccination has effectively reduced both canine and human rabies to minimal levels. The multiple benefits of mass canine rabies vaccination in these cases included eliminating rabies in the domestic dog reservoirs, eliminating human rabies cases, and decreasing the rabies economic burden by reducing expenditures on PEP.
• ISSUE - 13
• VOLUME - 35
• DOI - 10.1016/j.vaccine.2017.02.014

2020

• TITLE - Implementation of a mass canine rabies vaccination campaign in both rural and urban regions in southern Malawi
• AUTHOR - Carlos Sanchez-Soriano, Andrew D. Gibson, Luke Gamble, Jordana L. Burdon Bailey, Dagmar Mayer, Frederic Lohr, Patrick Chikungwa, Julius Chulu, Ian G. Handel, Barend M. deC. Bronsvoort, Richard J. Mellanby, Stella Mazeri
• JOURNAL - PLOS Neglected Tropical Diseases
• ABSTRACT - Rabies is a devastating zoonotic disease causing nearly 60,000 deaths globally each year. The disease causes Malawi an economic loss of 13 million USD and kills almost 500 people annually. Domestic dogs are the main reservoir for rabies and vaccinating over 70% of the dog population is the most efficient method to reduce its incidence in both humans and canines. However, achieving such coverages is often difficult and depend on many geospatial factors. Rural and pastoral regions are considered difficult to vaccinate efficiently due to low dog densities, and reports of campaigns spanning large areas containing vastly different communities are lacking. This study describes a mass canine vaccination campaign covering rural and urban regions in southern Malawi. The campaign achieved an average vaccination coverage of 83.4% across 3 districts, and vaccinated over 89,000 dogs through a combined static point and door-to-door effort. A dog population of 107,574 dogs was estimated (dog:human ratio of 1:23). The canine population was found to be almost completely owned (99.2%) and mostly kept for security purposes (82.7%). The dogs were mainly adults, males, and not neutered. Regression analysis identified education level and proportion of young dogs as the only factors influencing (positively and negatively, respectively) whether vaccination coverage over 70% was achieved in a region, independently of variables such as population density or poverty. A second regression analysis was performed predicting absolute vaccination coverage. While education level and the proportion of confined dogs were associated with positive vaccination coverage, higher proportions of young animals and female dogs were associated with a decrease in coverage. This study confirms the feasibility of homogeneously vaccinating over 70% of the dogs in a large area including rural and urban communities. These findings can inform the logistics of future campaigns and might be used as a template to facilitate high-number, high-coverage vaccination campaigns to other regions in sub-Saharan Africa.
• ISSUE - 1
• VOLUME - 14
• DOI - 10.1371/journal.pntd.0008004

2020

• TITLE - Factors associated with mobile phone ownership and potential use for rabies vaccination campaigns in southern Malawi
• AUTHOR - Orla Marron, Gareth Thomas, Jordana L. Burdon Bailey, Dagmar Mayer, Paul O. Grossman, Frederic Lohr, Andy D. Gibson, Luke Gamble, Patrick Chikungwa, Julius Chulu, Ian G. Handel, Barend M. de C Bronsvoort, Richard J. Mellanby, Stella Mazeri
• JOURNAL - Infectious Diseases of Poverty
• ABSTRACT - Rabies is a fatal but preventable viral disease, which causes an estimated 59 000 human deaths globally every year. The vast majority of human rabies cases are attributable to bites from infected domestic dogs and consequently control of rabies in the dog population through mass vaccination campaigns is considered the most effective method of eliminating the disease. Achieving the WHO target of 70% vaccination coverage has proven challenging in low-resource settings such as Sub Saharan Africa, and lack of public awareness about rabies vaccination campaigns is a major barrier to their success. In this study we surveyed communities in three districts in Southern Malawi to assess the extent of and socio-economic factors associated with mobile phone ownership and explore the attitudes of communities towards the use of short message service (SMS) to inform them of upcoming rabies vaccination clinics. This study was carried out between 1 October‚Äì3 December 2018 during the post-vaccination assessment of the annual dog rabies campaign in Blantyre, Zomba and Chiradzulu districts, Malawi. 1882 questionnaires were administered to households in 90 vaccination zones. The surveys gathered data on mobile phone ownership and use, and barriers to mobile phone access. A multivariable regression model was used to understand factors related to mobile phone ownership. Most survey respondents owned or had use of a mobile phone, however there was evidence of an inequality of access, with higher education level, living in Blantyre district and being male positively associated with mobile phone ownership. The principal barrier to mobile phone ownership was the cost of the phone itself. Basic feature phones were most common and few owned smartphones. SMS was commonly used and the main reason for not using SMS was illiteracy. Attitudes to receiving SMS reminders about future rabies vaccination campaigns were positive. The study showed a majority of those surveyed have the use of a mobile phone and most mobile phone owners indicated they would like to receive SMS messages about future rabies vaccination campaigns. This study provides insight into the feasibility of distributing information about rabies vaccination campaigns using mobile phones in Malawi.
• ISSUE - 1
• VOLUME - 9
• DOI - 10.1186/s40249-020-00677-4

2012

• TITLE - Case report: Evidence of rise in rabies cases in southern Malawi--better preventative measures are urgently required
• AUTHOR - S J Depani, N Kennedy, M Mallewa, E M Molyneux
• JOURNAL - Malawi medical journal : the journal of Medical Association of Malawi
• ABSTRACT - We describe five children who died of clinical rabies in a three month period (September to November 2011) in the Queen Elizabeth Central Hospital. From previous experience and hospital records, this number of cases is higher than expected. We are concerned that difficulty in accessing post-exposure prophylaxis (PEP) rabies vaccine may be partly responsible for this rise. We advocate: (a) prompt course of active immunisation for all patients with significant exposure to proven or suspected rabid animals. (b) the use of an intradermal immunisation regime that requires a smaller quantity of the vaccine than the intramuscular regime and gives a better antibody response. (c) improved dog rabies control measures.
• ISSUE - 3
• VOLUME - 24

2018

• TITLE- Canine rabies vaccination reduces child rabies cases in Malawi
• AUTHOR - Barbara Zimmer, Luke Gamble, Dagmar Mayer, Rachel Foster, Josephine Langton
• JOURNAL - The Lancet
• ABSTRACT - In 2012, the largest ever case series of rabies from a single site in Africa was published by The Lancet. On World Rabies Day 2018 (Sept 28, 2018), we can report a pronounced fall in the number of cases presenting to that site, following a successful mass canine vaccination programme implemented by the non-governmental organisation, Mission Rabies. Rabies is an endemic disease in Malawi. Substantial numbers of children die each year as a consequence. Many more are bitten by potentially infected dogs and require post-exposure prophylaxis (PEP). However, rabies is a preventable disease against which effective vaccines for animals and humans exist. Evidence shows that if vaccination coverage can reach 70% of the canine population, human incidence will fall. The paediatric department at Queen Elizabeth Central Hospital in Blantyre, Malawi, has monitored the number of rabies cases in the past decade, revealing a peak over a 9-month period in 2012 (from June, 2011, to February, 2012), when ten paediatric rabies cases were reported. This prevalence represented a three-times increase in the number of cases reported between 2002 and 2005 at the same hospital. Between May, 2012, and May, 2015, there were 12 paediatric rabies cases.
  In May, 2015, a comprehensive canine rabies vaccination campaign was started in Blantyre, Malawi by Mission Rabies. In Blantyre, they achieved total vaccination coverage in the canine population of 79·3% in 2015, 78·3% in 2016, and 72·3% in 2017.
  Since these canine rabies vaccination campaigns, only two paediatric patients with rabies have been admitted to Queen Elizabeth Central Hospital (figure), representing a substantial and clinically meaningful decrease in cases of paediatric rabies. Neither of these individuals lived in areas where the vaccination campaign occurred.
  

2016

• TITLE - Battling rabies in Malawi
• AUTHOR - Andy Gibson
• JOURNAL - Companion Animal
• ABSTRACT - Mission Rabies, tackling rabies in Malawi by mass-vaccination of dogs in large cities, has shown that door-to-door visits reach more puppies than static clinics and can produce good vaccination rates.
• ISSUE - 9
• VOLUME - 21
• DOI - 10.12968/coan.2016.21.9.538

2019

• TITLE - Assessment of the impact on paediatric rabies at Queen Elizabeth Central Hospital, Blantyre, Malawi, following a mass canine rabies vaccination programme
• AUTHOR - B.L. Zimmer, L. Gamble, R. Foster, N. Kennedy, D. Mayer, J. Burdon Bailey, J. Lemon, J. Langton
• JOURNAL - International Journal of Infectious Diseases
• ABSTRACT - In total 14 paediatric rabies cases were found during the study period. More males than females were affected (males: 10 (71%); females: 4 (29%)). The average age was seven years (range 3–11). The average length of stay in hospital was three days until death (range 1–7). Geographical locations of dog bites since data collection (May 2012) included Limbe, Lundu, Bangwe, Chileka, Mulanje, Muwalo, Nkhataumbera, Thyolo, Zomba, Mpemba and Mangochi region (four were unknown). Since May 2015 only two patients were admitted to QECH, but none of them came from Blantyre city nor district. This study underlines the importance of eliminating human rabies through canine rabies vaccination. Further funding of these campaigns will prevent unnecessary child deaths.
  
• VOLUME - 79
• DOI - 10.1016/j.ijid.2018.11.165

2021

• TITLE - Using data-driven approaches to improve delivery of animal health care interventions for public health
• AUTHOR - Stella Mazeri, Jordana L. Burdon Bailey, Dagmar Mayer, Patrick Chikungwa, Julius Chulu, Paul Orion Grossman, Frederic Lohr, Andrew D. Gibson, Ian G. Handel, Barend M. deC. Bronsvoort, Luke Gamble, Richard J. Mellanby
• JOURNAL - Proceedings of the National Academy of Sciences
• ABSTRACT - Rabies kills ‚60,000 people per year. Annual vaccination of at least 70% of dogs has been shown to eliminate rabies in both human and canine populations. However, delivery of large-scale mass dog vaccination campaigns remains a challenge in many rabies-endemic countries. In sub-Saharan Africa, where the vast majority of dogs are owned, mass vaccination campaigns have typically depended on a combination of static point (SP) and door-to-door (D2D) approaches since SP-only campaigns often fail to achieve 70% vaccination coverage. However, D2D approaches are expensive, labor-intensive, and logistically challenging, raising the need to develop approaches that increase attendance at SPs. Here, we report a real-time, data-driven approach to improve efficiency of an urban dog vaccination campaign. Historically, we vaccinated ‚àº35,000 dogs in Blantyre city, Malawi, every year over a 20-d period each year using combined fixed SP (FSP) and D2D approaches. To enhance cost effectiveness, we used our historical vaccination dataset to define the barriers to FSP attendance. Guided by these insights, we redesigned our vaccination campaign by increasing the number of FSPs and eliminating the expensive and labor-intensive D2D component. Combined with roaming SPs, whose locations were defined through the real-time analysis of vaccination coverage data, this approach resulted in the vaccination of near-identical numbers of dogs in only 11 d. This approach has the potential to act as a template for successful and sustainable future urban SP-only dog vaccination campaigns.
• ISSUE - 5
• VOLUME - 118
• DOI - 10.1073/pnas.2003722118

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