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ISDS 2016 Conference Abstracts

Management tool to guide rabies elimination 
programmes
Kristyna Rysava*2, 1, Tamara Mancero3, Eduardo Caldas4, Mary Carvalho6, 
Veronica Gutierrez5, Daniel Haydon2, Paul Johnson2, Rebecca Mancy2, 
Jesus F. Gonzalez Roldan5, Victor D. Vilas6 and Katie Hampson2
1University of Warwick, School of Life Sciences, Coventry, United Kingdom; 2University of Glasgow, Institute of Biodiversity, 
Animal Health & Comparative Medicine, Glasgow, United Kingdom; 3Pan American Health Organization (Mexico), Mexico City, 
Mexico; 4Unidade Técnica de Vigilância de Zoonoses, Brasilia, Brazil; 5CENAPRECE, Mexico City, Mexico; 6Pan American Health 
Organization (Brazil), Rio de Janeiro, Brazil

Objective
To provide surveillance tools to support policymakers and 

practitioners to identify epidemiological situations and inform the 
progressive implementation of rabies elimination programmes.

Introduction
Global targets for elimination of human rabies mediated by dogs 

have been set for 2030. In the Americas countries are progressing 
towards interruption of transmission and declaration of rabies 
freedom1. Guidance for managing elimination programmes to 
ensure continued progress during the endgame is critical, yet often 
limited and lacking in specific recommendations. Characteristic 
spatiotemporal incidence patterns are indicative of progress, and 
through their identification, tailored guidance can be provided.

Methods
Using SIRVERA, a surveillance database for rabies in the 

Americas2, we developed a classification framework for identification 
of epidemiological situations at subnational level. Each situation 
exhibits a characteristic pattern identified via a set of objective criteria 
including trends in case detection, assessment of virus variants, case 
locations and measures of incursion risk.

We refined our framework through application to Mexico in 
consultation with stakeholders. To understand factors predicting 
incursions we analysed state-level data on vaccination campaigns, 
populations and socioeconomic indicators employing multivariate 
regression models.

Results
We were able to classify all states in Mexico and provide 

correspondingly tailored guidance. Control efforts have resulted 
in progress towards elimination; however rabies still circulates 
endemically in one state Chiapas, putting its neighbours at risk of 
re-emergence.

Epidemiological and socioeconomic factors associated with 
incursions were primarily geographic proximity to endemic and high-
prevalence states, and inconsistent vaccination campaigns associated 
with a low human development index.

Conclusions
Our management tool can support rabies programme managers 

at subnational levels to identify their epidemiological situation, 
develop tailored plans to meet targets, and sustainably maintain 
rabies freedom, as demonstrated for Mexico. Effective surveillance 
is critical for disease elimination. Control options differ depending 
on whether disease circulates intermittently through reintroductions 
or persists focally, but with poor detection these situations might 
be indistinguishable. Our analysis enables identification of at-risk 
areas and methods to reduce risk. Investment in remaining endemic 
areas, through improved implementation and monitoring of mass dog 
vaccinations, is expected to provide the most cost-effective approach 
to elimination whilst preventing re-emergence elsewhere.

Decision-tree framework.

Rabies incursions in Mexico, 2005-2015. Blue circles indicate incursion 
locations, and resulting outbreak sizes, with darker shading for more recent 
incursions. Red shading indicates the duration of endemic circulation over the 
ten-year period.

Keywords
Rabies elimination; Incursion detection; Policy guidelines; 
Programme management

Acknowledgments
This research was supported by the Wellcome Trust. Data were provided 
by the PAHO and regional government and stakeholders in Mexico.

References
1. OIE. Global elimination of dog-mediated human rabies−The time is

now! Report of the Rabies Global Conference. Geneva, Switzerland, 
2015.

2. Vigilato MAN, Clavijo A, Knobl T, Silva HMT, Cosivi O, Schneider
MC, Leanes LF, Belotto AJ, Espinal MA. Progress towards eliminating 
canine rabies: policies and perspectives from Latin America and the 
Caribbean. Phil Trans R Soc B, 2013; 368.

*Kristyna Rysava
E-mail: istyrysava@gmail.com

Online Journal of Public Health Informatics * ISSN 1947-2579 * http://ojphi.org * 9(1):e87, 2017