Development of a Non-Meat-Based, Mass Producible and Effective Bait for Oral Vaccination of Dogs against Rabies in Goa State, India

Introduction: To achieve the global goal of canine-mediated human rabies elimination by 2030 there is an urgent need to scale-up mass dog vaccination activities in regions with large dog populations that are difficult to access; a common situation in much of India. Oral rabies vaccination may enable the vaccination of free-roaming dogs that are inaccessible to parenteral vaccination, and is considered a promising complementary measure to parenteral mass dog vaccination campaigns. WHO and OIE have published detailed minimum requirements for rabies vaccines and baits to be used for this purpose, requiring that baits must not only be well-accepted by the target population but must also efficiently release the vaccine in the oral cavity. For oral rabies vaccination approaches to be successful, it is necessary to develop baits which have a high uptake by the target population, are culturally accepted and amenable to mass production. The aim of this study was to compare the interest and uptake rates of meat-based and an egg-based prototype bait constructs by free roaming dogs in Goa, India. Methods: Three teams randomly distributed two prototype baits; an egg-flavoured bait and a commercial meat dog food (gravy) flavoured bait. The outcomes of consumption were recorded and compared between baits and dog variables. Results: A total of 209 egg-bait and 195 gravy-bait distributions were recorded and analysed. No difference (p = 0.99) was found in the percentage of dogs interested in the baits when offered. However, significantly more dogs consumed the egg-bait than the gravy-bait; 77.5% versus 68.7% (p = 0.04). The release of the blue-dyed water inside the sachet in the oral cavity of the animals was significant higher in the dogs consuming an egg-bait compared to the gravy-bait (73.4% versus 56.7%, p = 0.001). Conclusions: The egg-based bait had a high uptake amongst free roaming dogs and also enabled efficient release of the vaccine in the oral cavity, whilst also avoiding culturally relevant materials of bovine or porcine meat products.

Download Full-text

Review of Oral Rabies Vaccination of Dogs and Its Application in India

Viruses ◽

10.3390/v14010155 ◽

2022 ◽

Vol 14 (1) ◽

pp. 155

Author(s):

Gowri Yale ◽

Marwin Lopes ◽

Shrikrishna Isloor ◽

Jennifer R. Head ◽

Stella Mazeri ◽

...

Keyword(s):

Human Rabies ◽

Global Public Health ◽

Stray Dog ◽

Indian State ◽

The Usa ◽

Public Health Institutions ◽

Health Institutions ◽

Vaccination Campaigns ◽

Rabies Vaccination ◽

High Output

Oral rabies vaccines (ORVs) have been in use to successfully control rabies in wildlife since 1978 across Europe and the USA. This review focuses on the potential and need for the use of ORVs in free-roaming dogs to control dog-transmitted rabies in India. Iterative work to improve ORVs over the past four decades has resulted in vaccines that have high safety profiles whilst generating a consistent protective immune response to the rabies virus. The available evidence for safety and efficacy of modern ORVs in dogs and the broad and outspoken support from prominent global public health institutions for their use provides confidence to national authorities considering their use in rabies-endemic regions. India is estimated to have the largest rabies burden of any country and, whilst considerable progress has been made to increase access to human rabies prophylaxis, examples of high-output mass dog vaccination campaigns to eliminate the virus at the source remain limited. Efficiently accessing a large proportion of the dog population through parenteral methods is a considerable challenge due to the large, evasive stray dog population in many settings. Existing parenteral approaches require large skilled dog-catching teams to reach these dogs, which present financial, operational and logistical limitations to achieve 70% dog vaccination coverage in urban settings in a short duration. ORV presents the potential to accelerate the development of approaches to eliminate rabies across large areas of the South Asia region. Here we review the use of ORVs in wildlife and dogs, with specific consideration of the India setting. We also present the results of a risk analysis for a hypothetical campaign using ORV for the vaccination of dogs in an Indian state.

Download Full-text

Cost-effectiveness of the national dog rabies prevention and control program in Mexico, 1990–2015

PLoS Neglected Tropical Diseases ◽

10.1371/journal.pntd.0009130 ◽

2021 ◽

Vol 15 (3) ◽

pp. e0009130

Author(s):

Jesús Felipe González-Roldán ◽

Eduardo A. Undurraga ◽

Martin I. Meltzer ◽

Charisma Atkins ◽

Fernando Vargas-Pino ◽

...

Keyword(s):

Cost Effectiveness ◽

World Health Organization ◽

Public Health Problem ◽

World Health ◽

Human Rabies ◽

National Program ◽

Rabies Control ◽

Health Organization ◽

Vaccination Campaigns ◽

Rabies Vaccination

Background Rabies is a viral zoonosis that imposes a substantial disease and economic burden in many developing countries. Dogs are the primary source of rabies transmission; eliminating dog rabies reduces the risk of exposure in humans significantly. Through mass annual dog rabies vaccination campaigns, the national program of rabies control in Mexico progressively reduced rabies cases in dogs and humans since 1990. In 2019, the World Health Organization validated Mexico for eliminating rabies as a public health problem. Using a governmental perspective, we retrospectively assessed the economic costs, effectiveness, and cost-effectiveness of the national program of rabies control in Mexico, 1990–2015. Methodology Combining various data sources, including administrative records, national statistics, and scientific literature, we retrospectively compared the current scenario of annual dog vaccination campaigns and post-exposure prophylaxis (PEP) with a counterfactual scenario without an annual dog vaccination campaign but including PEP. The counterfactual scenario was estimated using a mathematical model of dog rabies transmission (RabiesEcon). We performed a thorough sensitivity analysis of the main results. Principal findings Results suggest that in 1990 through 2015, the national dog rabies vaccination program in Mexico prevented about 13,000 human rabies deaths, at an incremental cost (MXN 2015) of $4,700 million (USD 300 million). We estimated an average cost of $360,000 (USD 23,000) per human rabies death averted, $6,500 (USD 410) per additional year-of-life, and $3,000 (USD 190) per dog rabies death averted. Results were robust to several counterfactual scenarios, including high and low rabies transmission scenarios and various assumptions about potential costs without mass dog rabies vaccination campaigns. Conclusions Annual dog rabies vaccination campaigns have eliminated the transmission of dog-to-dog rabies and dog-mediated human rabies deaths in Mexico. According to World Health Organization standards, our results show that the national program of rabies control in Mexico has been highly cost-effective.

Download Full-text

Bite Injuries among Vaccination Staff Participating in a Mass Canine Rabies Vaccination Campaign, Haiti 2016–2017

American Journal of Tropical Medicine and Hygiene ◽

10.4269/ajtmh.21-0241 ◽

2021 ◽

Author(s):

Rudy T. Kirkhope ◽

Andrew D. Gibson ◽

Pierre Dilius Augustin ◽

Kelly Crowdis ◽

Natael Fénelon ◽

...

Keyword(s):

Medical Care ◽

Large Scale ◽

Vaccination Campaign ◽

Human Rabies ◽

Control Group ◽

Survey Analysis ◽

Dog Bite ◽

Increased Risk ◽

Vaccination Campaigns ◽

Rabies Vaccination

Elimination of dog-transmitted human rabies worldwide will require large-scale dog vaccination campaigns. However, this places participating vaccinators at increased risk. Data from the 2016–2017 Haitian mass rabies vaccination campaign was analyzed to determine dog bite incidence among vaccinators. A survey was then developed for completion by all identifiable bitten vaccinators covering demographics; experience and training; bite episode details; attitudes toward dogs and rabies; and medical care. A parallel group of unbitten vaccinators was also surveyed. Dog bite incidence was 0.03% (43/127,000) of all dogs vaccinated. The capture, vaccinate, and release method of vaccination carried a significantly higher risk of dog bite (0.35%, 6/1,739 vaccinations) than other methods (P < 0.001). Twenty-seven bitten vaccinators, and 54 control vaccinators were included in the survey analysis. No differences were found between groups in demographics, experience, or training. However, bitten vaccinators were significantly more likely than the control group to have experienced a dog bite before the study period (P < 0.001). This may be associated with a lesser appreciation of dogs, and/or a poorer ability to interpret dog behavioral signals within this group. Although 98% of the control group indicated they would seek medical care for a dog bite, only 35% of bitten vaccinators sought such care. On a yearly basis, for the Haitian campaign, a full series of postexposure rabies vaccinations for all bite victims would prove more cost-effective than preexposure vaccination of all vaccinators. These findings may prove useful for the planning and safety of future mass dog vaccination campaigns.

Download Full-text

Rabies Vaccination of 6-Week-Old Puppies Born to Immunized Mothers: A Randomized Controlled Trial in a High-Mortality Population of Owned, Free-Roaming Dogs

Tropical Medicine and Infectious Disease ◽

10.3390/tropicalmed5010045 ◽

2020 ◽

Vol 5 (1) ◽

pp. 45 ◽

Cited By ~ 1

Author(s):

Sintayehu Arega ◽

Anne Conan ◽

Claude T. Sabeta ◽

Jan E. Crafford ◽

Jeanette Wentzel ◽

...

Keyword(s):

High Mortality ◽

Controlled Trial ◽

Geometric Mean ◽

Human Rabies ◽

Average Effect ◽

Randomized Controlled ◽

Causes Of Mortality ◽

Vaccination Campaigns ◽

Current Guidelines ◽

Rabies Vaccination

To achieve global elimination of human rabies from dogs by 2030, evidence-based strategies for effective dog vaccination are needed. Current guidelines recommend inclusion of dogs younger than 3 months in mass rabies vaccination campaigns, although available vaccines are only recommended for use by manufacturers in older dogs, ostensibly due to concerns over interference of maternally-acquired immunity with immune response to the vaccine. Adverse effects of vaccination in this age group of dogs have also not been adequately assessed under field conditions. In a single-site, owner-blinded, randomized, placebo-controlled trial in puppies born to mothers vaccinated within the previous 18 months in a high-mortality population of owned, free-roaming dogs in South Africa, we assessed immunogenicity and effect on survival to all causes of mortality of a single dose of rabies vaccine administered at 6 weeks of age. We found that puppies did not have appreciable levels of maternally-derived antibodies at 6 weeks of age (geometric mean titer 0.065 IU/mL, 95% CI 0.061–0.069; n = 346), and that 88% (95% CI 80.7–93.3) of puppies vaccinated at 6 weeks had titers ≥0.5 IU/mL 21 days later (n = 117). Although the average effect of vaccination on survival was not statistically significant (hazard ratio [HR] 1.35, 95% CI 0.83–2.18), this effect was modified by sex (p = 0.02), with the HR in females 3.09 (95% CI 1.24–7.69) and the HR in males 0.79 (95% CI 0.41–1.53). We speculate that this effect is related to the observed survival advantage that females had over males in the unvaccinated group (HR 0.27; 95% CI 0.11–0.70), with vaccination eroding this advantage through as-yet-unknown mechanisms.

Download Full-text

Trends and Clinico-Epidemiological Features of Human Rabies Cases in Bangladesh, 2006–2018

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.1072 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s416-s416

Author(s):

Sumon Ghosh ◽

Md. Sohel Rana ◽

Sukanta Chowdhury

Keyword(s):

Effective Means ◽

Scale Up ◽

Traditional Healers ◽

Human Rabies ◽

Epidemiological Analysis ◽

Increasing Trend ◽

The Mean ◽

Death Cases ◽

Death Data

Background: Vaccinating dogs against rabies is an effective means of reducing human rabies. Methods: We analyzed 1,327 clinically diagnosed human rabies deaths and mass dog vaccination (MDV) data during 2006–2018 to quantify the impacts of MDV on human rabies incidence in Bangladesh and a subset of rabies death data (n = 422) for clinico-epidemiological analysis. Results: We found a positive and increasing trend of dog population vaccination (P = .01 and τ = 0.71) and a negative and declining trend (P < .001 and τ = −0.88) of human rabies cases (correlation coefficient, −0.82). Among 422 human rabies death cases, most victims (78%) sought treatment from traditional healers, and 12% received postexposure prophylaxis (PEP). The mean incubation period of rabies cases with exposure sites on the head and neck (35 days) was shorter than the upper limb (mean, 64 days; P = .02) and lower limb (mean, 89 days; P < .01). MDV is effective for reducing human rabies cases in Bangladesh. Conclusions: Creating awareness among the animal bite victims to stop relying on traditional healers rather seeking PEP, addressing the role of traditional healers through an awareness education program in respect to the treatment of dog bites, ensuring availability of PEP, and continuing to scale up MDV can help prevent human rabies deaths.Funding: NoneDisclosures: None

Download Full-text

Evaluation of dog population in an urban area of Southeastern Brazil

Revista de Saúde Pública ◽

10.1590/s0034-89101997000300013 ◽

1997 ◽

Vol 31 (3) ◽

pp. 308-309 ◽

Cited By ~ 10

Author(s):

Cáris M. Nunes ◽

Dejanira de A. Martines ◽

Stélios Fikaris ◽

Luzia H. Queiróz

Keyword(s):

Population Size ◽

Urban Area ◽

Human Population ◽

Total Population ◽

Southeastern Brazil ◽

Control Programs ◽

Paulo State ◽

Vaccination Campaigns ◽

Rabies Vaccination ◽

Size And Structure

Planning control programs, for diseases such as rabies requires information on the size and structure of the dog and cat population. In order to evaluate the dog population of the urban area of Araçatuba city, S. Paulo State, Brazil, a survey was conducted using a questionnaire to interview members of households. Eighty-eight districts were visited (37,778 houses) and the interview was possible at 77.93% of these. Human population size evaluated was 113,157 inhabitants. Houses that owned animals represented 55.2%, 26,926 of the animals concerned were dogs and 5,755 were cats. Of the dogs, 56.64% were 1-4 year olds and males represented 56.2% of the total population. Dog: person ratio was estimated at 2.8 dogs to every 10 persons, almost 3 times the ratio hitherto estimated and used in the planning of rabies vaccination campaigns.

Download Full-text

Feasibility of oral rabies vaccination campaigns of young foxes (Vulpes vulpes) against rabies in summer

European Journal of Wildlife Research ◽

10.1007/s10344-008-0198-3 ◽

2008 ◽

Vol 54 (4) ◽

pp. 763-766 ◽

Cited By ~ 8

Author(s):

Ad Vos ◽

Thomas Selhorst ◽

Ronald Schröder ◽

Jaap Mulder

Keyword(s):

Vulpes Vulpes ◽

Vaccination Campaigns ◽

Rabies Vaccination

Download Full-text

Estimation of the Active Social Network of Street Children in Shiraz (A City of Iran)

international journal high risk behaviors & addiction ◽

10.5812/ijhrba.94467 ◽

2020 ◽

Vol 9 (2) ◽

Author(s):

Nasrin Motazedian ◽

Mehrab Sayadi ◽

Somaye Oboodi ◽

Hassan Joulaei

Keyword(s):

Social Network ◽

Direct Method ◽

Street Children ◽

Scale Up ◽

Sampling Technique ◽

Target Population ◽

Network Size ◽

Hidden Population ◽

Face To Face ◽

Social Network Size

: Street children are a hard-to-reach population. Since the direct method is not feasible and has some limitations, we utilized the network scale-up (NSU) as an indirect method. This study was conducted in Shiraz municipalities. Our target population was Iranian boys between 10 to 18 years of age during the years 2014 to 2016. Three trained psychologists conducted face to face interviews with 86 street children (boys) on the streets, through the convenience sampling technique. The social network size of street boys in Shiraz was estimated at 17 persons (ranging from zero to 92 people, mean = 17 ± 17, median = 13). Overall, the network size of the hidden population might be smaller than the general population, due to the stigmatized nature of their behavior and place of work.

Download Full-text

Scaling up population health interventions from decision to sustainability – a window of opportunity? A qualitative view from policy-makers

Health Research Policy and Systems ◽

10.1186/s12961-020-00636-3 ◽

2020 ◽

Vol 18 (1) ◽

Author(s):

Karen Lee ◽

Femke van Nassau ◽

Anne Grunseit ◽

Kathleen Conte ◽

Andrew Milat ◽

...

Keyword(s):

Case Studies ◽

Good Governance ◽

Scale Up ◽

Target Population ◽

Scaling Up ◽

Structured Interview ◽

Health Interventions ◽

Decision Makers ◽

Framework Analysis ◽

Policy Makers

Abstract Background While known efficacious preventive health interventions exist, the current capacity to scale up these interventions is limited. In recent years, much attention has focussed on developing frameworks and methods for scale-up yet, in practice, the pathway for scale-up is seldom linear and may be highly dependent on contextual circumstances. Few studies have examined the process of scaling up from decision to implementation nor examined the sustainability of scaled-up interventions. This study explores decision-makers’ perceptions from real-world scaled-up case studies to examine how scale-up decisions were made and describe enablers of successful scale-up and sustainability. Methods This qualitative study included 29 interviews conducted with purposively sampled key Australian policy-makers, practitioners and researchers experienced in scale-up. Semi-structured interview questions obtained information regarding case studies of scaled-up interventions. The Framework Analysis method was used as the primary method of analysis of the interview data to inductively generate common and divergent themes within qualitative data across cases. Results A total of 31 case studies of public health interventions were described by interview respondents based on their experiences. According to the interviewees’ perceptions, decisions to scale up commonly occurred either opportunistically, when funding became available, or when a deliberate decision was made and funding allocated. The latter scenario was more common when the intervention aligned with specific political or strategic goals. Decisions to scale up were driven by a variety of key actors such as politicians, senior policy-makers and practitioners in the health system. Drivers of a successful scale-up process included good governance, clear leadership, and adequate resourcing and expertise. Establishing accountability structures and appropriate engagement mechanisms to encourage the uptake of interventions were also key enablers. Sustainability was influenced by evidence of impact as well as good acceptability among the general or target population. Conclusions Much like Kingdon’s Multiple Streams Theory of ‘policy windows’, there is a conceptually similar ‘window for scale-up’, driven by a complex interplay of factors such as political need, strategic context, funding and key actors. Researchers and policy-makers need to consider scalability from the outset and prepare for when the window for scale-up opens. Decision-makers need to provide longer term funding for scale-up to facilitate longer term sustainability and build on the resources already invested for the scale-up process.

Download Full-text

Modified Directly Observed Therapy for Antiretroviral Therapy: A Primer from the Field

Public Health Reports ◽

10.1177/003335490712200408 ◽

2007 ◽

Vol 122 (4) ◽

pp. 472-481 ◽

Cited By ~ 21

Author(s):

Kathy Goggin ◽

Robin J. Liston ◽

Jennifer Adelson Mitty

Keyword(s):

Antiretroviral Therapy ◽

Program Implementation ◽

Staff Training ◽

Target Population ◽

Directly Observed Therapy ◽

Federally Funded ◽

Target Populations ◽

Sufficient Detail ◽

Minimum Requirements ◽

Efficacy Studies

Modified directly observed therapy (mDOT), in which a portion of total doses of a medication regime is ingested under supervision, has demonstrated efficacy as an intervention to assist patients in maintaining adherence to complicated antiretroviral therapy (ART). Although findings are favorable, existing efficacy studies fail to provide sufficient detail to guide others who wish to implement mDOT interventions. The aim of this article is to provide a primer for practitioners and researchers who wish to implement mDOT interventions. Drawing on the experience of 10 federally funded research projects, we provide guidance on critical questions for program implementation, including: who should be targeted, length/duration/content/location/tapering of sessions, staffing, incentives, and approaches to data collection. In addition, guidance on staff training and minimum requirements for mDOT interventions is offered along with real-world examples of mDOT interventions. mDOT is feasible and easily adapted to many settings and target populations. Interventions should match the specific needs of the target population and setting and be flexible in terms of design and delivery. mDOT should be considered among the spectrum of adherence interventions.

Download Full-text