Summary
Motivation
Rabies management in Latin America
Management tool
Methods
Algorithm development
Data
Classification criteria
1) ENDEMIC TRANSMISSION: Canine rabies (variants 1 & 2 in Latin America [19]) detected over at least two consecutive months during the previous 2 years, indicating focal transmission. No significant decrease in the frequency of months with case detection over the previous 5 years. 2) DECLINING TRANSMISSION: At least 1 month with detected canine rabies cases in the previous 2 years, but a declining frequency of months with detected cases over the previous 5 years. 3) INTERMITTENT DETECTION: Canine rabies cases detected during the past 2 years but not over consecutive months. No temporal trend in the frequency of months with detected cases during the previous 5 years. 4) ABSENT-VULNERABLE: Either: (i) canine rabies cases not detected in the previous 2 years, but neighbouring an area where rabies is Endemic or Declining and therefore vulnerable to incursions; or (ii) a single month with cases detected during the previous 2 years, but no case detection prior to that month for at least 2 years (i.e. recently experienced an incursion that did not lead to further spread). 5) ABSENT: No cases of canine rabies cases detected during the last 2 years and minimal risk of incursion (i.e. not neighbouring with any Endemic or Declining states). |
Classification | Cases in last 2 years | Trend (model coefficient) over 5 years | Absence (> 2 yrs with no V1 or V2) | Incursion risk |
---|---|---|---|---|
Endemic | Yes, V1 &/ V2, over at least two consecutive months | None/ positive | NA | NA |
Declining | Yes, V1 &/ V2 | Negative | NA | NA |
Intermittent | Yes, but not over two or more consecutive months | None/ positive | NA | NA |
Absent - Vulnerable (i) or (ii) | (i) No (ii) V1 &/V2 in 1 month only | (i & ii) NA | (i) At least last 2 years (ii) > 2 yr absence prior to last detected case(s) | (i & ii) Adjacent to Endemic or Declining area(s) |
Absent | No | NA | NA | Not adjacent to any Endemic or Declining areas |
Case detection
Temporal trends in case detection
Variant identification
Incursion risk
Algorithm testing and validation
Algorithm application
Results
Algorithm development
Algorithm testing and validation
Algorithm application
MEXICO | 2005 | 2010 | 2015 |
---|---|---|---|
Aguascalientes | Absent | Absent | Absent |
Baja California | Absent | Absent | Absent |
Baja California Sur | Absent | Absent | Absent |
Campeche | Absent-Vulnerable | Absent-Vulnerable | Absent |
Coahuila de Zaragoza | Intermittent | Absent | Absent |
Colima | Absent | Absent | Absent |
Chiapas | Endemic | Intermittent | Endemic |
Chihuahua | Absent | Absent-Vulnerable | Absent |
Distrito Federal | Intermittent | Absent-Vulnerable | Absent |
Durango | Absent | Absent | Absent |
Guanajuato | Absent | Absent | Absent |
Guerrero | Absent-Vulnerable | Absent-Vulnerable | Absent |
Hidalgo | Absent-Vulnerable | Declining | Absent |
Jalisco | Absent | Absent | Absent |
Mexico | Endemic | Endemic | Absent |
Michoacan de Ocampo | Absent-Vulnerable | Absent-Vulnerable | Absent |
Morelos | Absent-Vulnerable | Absent-Vulnerable | Absent |
Nayarit | Absent | Absent | Absent |
Nuevo Leon | Absent | Absent | Absent |
Oaxaca | Endemic | Absent-Vulnerable | Absent-Vulnerable |
Puebla | Endemic | Declining | Absent |
Queretaro Arteaga | Absent-Vulnerable | Absent-Vulnerable | Absent |
Quintana Roo | Absent-Vulnerable | Absent-Vulnerable | Absent |
San Luis Potosi | Absent | Absent-Vulnerable | Absent |
Sinaloa | Absent-Vulnerable | Absent | Absent |
Sonora | Absent-Vulnerable | Absent | Absent |
Tabasco | Absent-Vulnerable | Absent | Absent-Vulnerable |
Tamaulipas | Absent | Absent | Absent |
Tlaxcala | Intermittent | Absent-Vulnerable | Absent |
Veracruz de Ignacio de la Llave | Intermittent | Absent-Vulnerable | Absent-Vulnerable |
Yucatan | Endemic | Declining | Intermittent |
Zacatecas | Absent-Vulnerable | Absent | Absent |
BRAZIL | 2005 | 2010 | 2015 |
Acre | Absent | Absent | Absent |
Alagoas | Absent-Vulnerable | Absent-Vulnerable | Absent |
Amapa | Absent-Vulnerable | Absent-Vulnerable | Absent |
Amazonas | Absent-Vulnerable | Absent-Vulnerable | Absent |
Bahia | Endemic | Declining | Absent |
Ceara | Intermittent | Endemic | Absent |
Distrito Federal | Absent | Absent | Absent |
Espirito Santo | Absent | Absent | Absent |
Goias | Absent-Vulnerable | Absent-Vulnerable | Absent-Vulnerable |
Maranhao | Endemic | Declining | Declining |
Mato Grosso | Endemic | Absent-Vulnerable | Absent-Vulnerable |
Mato Grosso do Sul | Absent-Vulnerable | Intermittent | Endemic |
Minas Gerais | Absent-Vulnerable | Absent-Vulnerable | Absent-Vulnerable |
Para | Endemic | Declining | Absent-Vulnerable |
Paraiba | Endemic | Intermittent | Absent |
Parana | Absent-Vulnerable | Absent-Vulnerable | Absent-Vulnerable |
Pernambuco | Endemic | Declining | Absent |
Piaui | Endemic | Declining | Absent-Vulnerable |
Rio de Janeiro | Absent | Absent | Absent |
Rio Grande do Norte | Absent-Vulnerable | Intermittent | Intermittent |
Rio Grande do Sul | Absent | Absent | Absent |
Rondonia | Intermittent | Absent | Absent |
Roraima | Absent | Absent | Absent |
Santa Catarina | Absent | Absent | Absent |
Sao Paulo | Absent | Absent | Absent-Vulnerable |
Sergipe | Intermittent | Absent-Vulnerable | Absent |
Tocantins | Absent-Vulnerable | Absent-Vulnerable | Absent-Vulnerable |
Discussion
Key findings
1) ENDEMIC TRANSMISSION: control measures have not been implemented sufficiently to demonstrably reduce incidence. Mass vaccination campaigns should therefore be implemented within all administrative units, at least annually, using modern cell-culture vaccines of proven efficacy, aiming to reach > 70% of dogs in all communities. Gaps in coverage can allow persistence, even when average coverage is high [21, 26]. Therefore, if ongoing vaccination campaigns are not controlling rabies, their implementation and coverage at local levels should be monitored to identify areas for improvement. 2) DECLINING TRANSMISSION: Control measures are demonstrably effective and current mass dog vaccinations should be sustained. Plans for maintaining rabies freedom should be developed, including emergency response strategies and preparation for enhanced surveillance required to verify freedom from disease [27]. 3) INTERMITTENT DETECTION: Criteria indicate that either: i) transmission is endemic but surveillance is poor; ii) transmission has been interrupted but incursions are frequent; or iii) other circulating variants are causing cases in dogs. Assuming surveillance information is available, updating the classification with removal of wildlife variants could resolve scenario iii, while case locations may allow incursions to be distinguished from local transmission (i.e. scenario ii); otherwise surveillance needs enhancing to distinguish these scenarios. Management recommendations are either for improved high coverage comprehensive vaccination campaigns to interrupt transmission (scenario i); investment in rabies control in source populations and in populations at risk from incursions (scenario ii); maintained dog vaccination to prevent further spread of these spillover variants (scenario iii). 4) ABSENT-VULNERABLE: Control efforts should be maintained while incursion risks remain high. Enhanced surveillance should be implemented for early detection of incursions and a detailed emergency response strategy prepared to ensure rapid response capacity [20]. In light of any incursions this emergency response strategy should be reviewed. All cases should be sequenced to identify variants and sources of incursions. Evidence should be compiled to verify freedom from rabies, including the absence of case detection during 2 years of enhanced surveillance [20]. 5) ABSENT: Although no cases have been detected for extended periods, enhanced surveillance should be maintained and evidence compiled to verify rabies freedom. |