Control and elimination strategies
Global freedom from the threat of dog-mediated rabies is feasible within our lifetime. With the tools, vaccine and evidence available, an integrated investment strategy and intersectoral approach is needed to make this vision a reality.
This strategy would combine the expertise of FAO, OIE and WHO as well as other major stakeholders including the Global Alliance for Rabies Control (GARC), with the aim of gaining support from countries and funding agencies worldwide to act through existing international health mechanisms including rabies vaccine banks, reporting systems, control tools (such as The Rabies Blueprint, Rabies Stakeholder Consultations, and the Stepwise Approach towards Rabies Elimination), regional frameworks and resources, and collaboration between animal and human health sectors.
Past rabies elimination strategies included the reduction of population density through culling, based on the rationale that rabies transmission is density-dependent with disease density increasing proportional to host density. However studies have shown that culling is an ineffective means of elimination and mass vaccination is most efficacious to reduce disease incidence in all species. The Bangladesh canine rabies elimination program focuses primarily on dog bite management and mass dog vaccination to reduce the incidence of human deaths. Since 2011, dog vaccines have been administered in 58 of the 64 districts, combined with local capacity building and knowledge transfer, resulting in a 50% decrease in human rabies deaths, demonstrating the effectiveness of mass vaccination.
Coordinated actions for eliminating human rabies in the Americas began in 1983, with technical cooperation from PAHO on regional programmes and the operation of epidemiologic surveillance system (Siepi). Achievements have been due largely to strong cooperation between the health and the agricultural sectors, as well as with regional and international organisations, public and private agencies and nongovernmental organisations. Since the introduction of the programme, the number of human rabies cases has dropped 95% and decline in dogs, 98%.
Elimination of dog-mediates rabies is feasible given political will, adequate resources and diligent programme management. The progress of elimination strategies must be continuously controlled and evaluated at regional and national levels, in order to monitor subsequent effectiveness and ensure optimisation of the use of financial and human resources. Successful follow-up and evaluation requires data, rendering the need for rabies to be a disease of obligatory notification.
Proof of concept for elimination: success stories in KwaZulu-Natal (South Africa), the Visayas (the Philippines) and Tanzania.
Projects supported by the Bill & Melinda Gates Foundation and coordinated by WHO