Epidemiological dynamics of rabies in Tanzania

Full Title Epidemiological dynamics of rabies in Tanzania, impacts on local  communities, and implications for health and veterinary services.  Short Title Rabies Project  Project Leader Sambo Maganga  Description Rabies is a fatal viral disease transmitted to humans by animal bites, most usually domestic dogs. Although under control in the developed world, this disease continues to kill more than 50,000 people each year throughout Africa and Asia. Human rabies deaths are almost entirely preventable through delivery of prompt post-exposure prophylaxis (PEP) to bite victims following a bit. However, in many areas of sub-Saharan Africa, shortages of PEP are frequent and bite-victims have to travel long distances to obtain expensive treatment incurring delays and increasing the risk of developing this fatal disease. Rabies can be eliminated by sustained mass vaccination of domestic dogs, which are the reservoir for the disease in these regions. Local programs in Tanzania have shown domestic dog vaccination campaigns to be cost-effective and efficacious in reducing rabies incidence and human exposures, and a large scale regional elimination programme is due to rolled out across the southeast third of Tanzania in 2009. In this study we propose to use active surveillance to monitor the incidence of rabies in response to control efforts, to evaluate the true burden of the disease and to provide recommendations for rovision of post-exposure vaccines using cost-effectiveness analyses in a variety of socio-economic settings. The purpose of this study is to pilot an integrated public health and veterinary surveillance system for rabies in Ulanga and Kilombero districts, south eastern Tanzania, where a sizable outbreak is ongoing. We aim to apply novel surveillance techniques that have been developed in northwest Tanzania to determine the severity and extent of the current epidemic and to gain a better understanding of the process of transmission that leads to repeated epidemics and long-term persistence of domestic dog rabies. Development of an operational surveillance system will be essential for monitoring the effectiveness of control efforts based on dog vaccination, and will serve as a valuable platform from which to scale-up surveillance activities to a regional or national level.  The surveillance system will also serve as an applied research tool for investigating strategic spatially targeted control activities, for identifying areas most at risk and for the early detection of rabies incursions. By providing inter-disciplinary training for local medical and veterinary professionals in rabies surveillance techniques we hope to stimulate effective partnerships between human health and animal health services contributing towards sustainable solutions for zoonotic disease control. Ultimately this research will promote a more complete understanding of infection dynamics and will lead to the development of better strategies to combat rabies. Specifically we propose: 1. To quantify the spatial and temporal dynamics in rabies incidence (human exposures, human deaths and animal cases) in the Kilombero Valley (Ulanga and Kilombero Districts), Southern Tanzania and to compare these with patterns in Serengeti and Ngorongoro districts, Northern Tanzania to raise capacity in rabies control and epidemiology by training district and ward-level public health and veterinary staff in rabies diagnostic, surveillance and control methods to evaluate the impact of control efforts, as well as geographic features and demographic attributes of domestic dog populations on the magnitude of outbreaks and rates of spread in order to provide recommendations for more targeted control. 2. To quantify the economic burden of rabies in different socioeconomic and epidemiological settings in Tanzania. 3. To identify the major factors that prevent access to adequate PEP for rabies-exposed bite victims and therefore to formulate evidence-based policy recommendations for improving access to PEP.  Collaborators Katie Hampson                   University of Glasgow  Source of funding UBS Optimus Foundation  Start Date 2010                                     End Date     2012

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