One health for neglected tropical diseases

The forthcoming World Health Organization road map for neglected tropical diseases (NTDs) 2021–2030 recognises the complexity surrounding control and elimination of these 20 diseases of poverty. It emphasises the need for a paradigm shift from disease-specific interventions to holistic cross-cutting approaches coordinating with adjacent disciplines. The One Health approach exemplifies this shift, extending beyond a conventional model of zoonotic disease control to consider the interactions of human and animal health systems within their shared environment and the wider social and economic context. This approach can also promote sustainability and resilience within these systems. To achieve the global ambition on NTD elimination and control, political will, along with contextualised innovative scientific strategies, is required.http://trstmh.oxfordjournals.orghj2021Veterinary Tropical Disease

Every Dog Has Its Data:Evaluation of a Technology-Aided Canine Rabies Vaccination Campaign to Implement a Microplanning Approach

Background: Robust dog vaccination coverage is the primary way to eliminate canine rabies. Haiti conducts annual canine mass vaccination campaigns, but still has the most human deaths in the Latin American and Caribbean region. We conducted an evaluation of dog vaccination methods in Haiti to determine if more intensive, data-driven vaccination methods, using smartphones for data reporting and geo-communication, could increase vaccination coverage to a level capable of disrupting rabies virus transmission.Methods: Two cities were designated into “Traditional” and “Technology-aided” vaccination areas. Traditional areas utilized historical methods of vaccination staff management, whereas Technology-aided areas used smartphone-supported spatial coordination and management of vaccination teams. Smartphones enabled real time two-way geo-communication between campaign managers and vaccinators. Campaign managers provided geographic instruction to vaccinators by assigning mapped daily vaccination boundaries displayed on phone handsets, whilst vaccinators uploaded spatial data of dogs vaccinated for review by the campaign manager to inform assignment of subsequent vaccination zones. The methods were evaluated for vaccination effort, coverage, and cost.Results: A total of 11,420 dogs were vaccinated during the 14-day campaign. The technology-aided approach achieved 80% estimated vaccination coverage as compared to 44% in traditional areas. Daily vaccination rate was higher in Traditional areas (41.7 vaccinations per team-day) compared to in technology-aided areas (26.8) but resulted in significantly lower vaccination coverages. The cost per dog vaccinated increased exponentially with the associated vaccination coverage, with a cost of $1.86 to achieve 25$2.51 for 50% coverage, and $3.19 for 70% coverage.Conclusions: Traditional vaccination methods failed to achieve sufficiently high vaccination coverages needed to interrupt sustained rabies virus transmission, whilst the technology-aided approach increased coverage above this critical threshold. Over successive campaigns, this difference is likely to represent the success or failure of the intervention in eliminating the rabies virus. Technology-aided vaccination should be considered in resource limited settings where rabies has not been controlled by Traditional vaccination methods. The use of technology to direct health care workers based on near-real-time spatial data from the field has myriad potential applications in other vaccination and public health initiatives

Appraisal of antivenom production in public laboratories in Latin America during the first semester of 2020: The impact of COVID-19.

VIEWPOINT

Estimating the global burden of endemic canine rabies

Background: Rabies is a notoriously underreported and neglected disease of lowincome countries. This study aims to estimate the public health and economic burden of rabies circulating in domestic dog populations, globally and on a country-by-country basis, allowing an objective assessment of how much this preventable disease costs endemic countries.<p></p> Methodology/Principal Findings: We established relationships between rabies mortality and rabies prevention and control measures, which we incorporated into a model framework. We used data derived from extensive literature searches and questionnaires on disease incidence, control interventions and preventative measures within this framework to estimate the disease burden. The burden of rabies impacts on public health sector budgets, local communities and livestock economies, with the highest risk of rabies in the poorest regions of the world. This study estimates that globally canine rabies causes approximately 59,000 (95% Confidence Intervals: 25- 159,000) human deaths, over 3.7 million (95% CIs: 1.6-10.4 million) disability-adjusted life years (DALYs) and 8.6 billion USD (95% CIs: 2.9-21.5 billion) economic losses annually. The largest component of the economic burden is due to premature death (55%), followed by direct costs of post-exposure prophylaxis (PEP, 20%) and lost income whilst seeking PEP (15.5%), with only limited costs to the veterinary sector due to dog vaccination (1.5%), and additional costs to communities from livestock losses (6%).<p></p> Conclusions/Significance: This study demonstrates that investment in dog vaccination, the single most effective way of reducing the disease burden, has been inadequate and that the availability and affordability of PEP needs improving. Collaborative investments by medical and veterinary sectors could dramatically reduce the current large, and unnecessary, burden of rabies on affected communities. Improved surveillance is needed to reduce uncertainty in burden estimates and to monitor the impacts of control efforts.<p></p&gt

Defining new pathways to manage the ongoing emergence of bat rabies in Latin America

Rabies transmitted by common vampire bats (Desmodus rotundus) has been known since the early 1900s but continues to expand geographically and in the range of species and environments affected. In this review, we present current knowledge of the epidemiology and management of rabies in D. rotundus and argue that it can be reasonably considered an emerging public health threat. We identify knowledge gaps related to the landscape determinants of the bat reservoir, reduction in bites on humans and livestock, and social barriers to prevention. We discuss how new technologies including autonomously-spreading vaccines and reproductive suppressants targeting bats might manage both rabies and undesirable growth of D. rotundus populations. Finally, we highlight widespread under-reporting of human and animal mortality and the scarcity of studies that quantify the efficacy of control measures such as bat culling. Collaborations between researchers and managers will be crucial to implement the next generation of rabies management in Latin America

Towards the elimination of dog-mediated rabies: development and application of an evidence-based management tool

Abstract: Background: International organizations advocate for the elimination of dog-mediated rabies, but there is only limited guidance on interpreting surveillance data for managing elimination programmes. With the regional programme in Latin America approaching elimination of dog-mediated rabies, we aimed to develop a tool to evaluate the programme’s performance and generate locally-tailored rabies control programme management guidance to overcome remaining obstacles. Methods: We developed and validated a robust algorithm to classify progress towards rabies elimination within sub-national administrative units, which we applied to surveillance data from Brazil and Mexico. The method combines criteria that are easy to understand, including logistic regression analysis of case detection time series, assessment of rabies virus variants, and of incursion risk. Subjecting the algorithm to robustness testing, we further employed simulated data sub-sampled at differing levels of case detection to assess the algorithm’s performance and sensitivity to surveillance quality. Results: Our tool demonstrated clear epidemiological transitions in Mexico and Brazil: most states progressed rapidly towards elimination, but a few regressed due to incursions and control lapses. In 2015, dog-mediated rabies continued to circulate in the poorest states, with foci remaining in only 1 of 32 states in Mexico, and 2 of 27 in Brazil, posing incursion risks to the wider region. The classification tool was robust in determining epidemiological status irrespective of most levels of surveillance quality. In endemic settings, surveillance would need to detect less than 2.5% of all circulating cases to result in misclassification, whereas in settings where incursions become the main source of cases the threshold detection level for correct classification should not be less than 5%. Conclusion: Our tool provides guidance on how to progress effectively towards elimination targets and tailor strategies to local epidemiological situations, while revealing insights into rabies dynamics. Post-campaign assessments of dog vaccination coverage in endemic states, and enhanced surveillance to verify and maintain freedom in states threatened by incursions were identified as priorities to catalyze progress towards elimination. Our finding suggests genomic surveillance should become increasingly valuable during the endgame for discriminating circulating variants and pinpointing sources of incursions

Estimating the global burden of endemic canine rabies

Rabies is a fatal viral disease largely transmitted to humans from bites by infected animals —predominantly from domestic dogs. The disease is entirely preventable through prompt administration of post-exposure prophylaxis (PEP) to bite victims and can be controlled through mass vaccination of domestic dogs. Yet, rabies is still very prevalent in developing countries, affecting populations with limited access to health care. The disease is also grossly underreported in these areas because most victims die at home. This leads to insufficient prioritization of rabies prevention in public health agendas. To address this lack of information on the impacts of rabies, in this study, we compiled available data to provide a robust estimate of the health and economic implications of dog rabies globally. The most important impacts included: loss of human lives (approximately 59,000 annually) and productivity due to premature death from rabies, and costs of obtaining PEP once an exposure has occurred. The greatest risk of developing rabies fell upon the poorest regions of the world, where domestic dog vaccination is not widely implemented and access to PEP is most limited. A greater focus on mass dog vaccination could eliminate the disease at source, reducing the need for costly PEP and preventing the large and unnecessary burden of mortality on at-risk communities.S1 Text. Supporting bibliography.S1 Table. Estimates by country of rabies deaths, exposures, PEP use, prevented deaths, dog vaccination coverage, probability that a dog is rabid (RP), of bite victims receiving PEP (PP), DALYs, costs and 95% confidence intervals of estimates. Clusters to which countries are assigned are shown and inputs used for estimating parameters including the human development index and whetehr a country s rabies-free or endemic (RISK). Estimates of years of life lost (YLL) and DALYs (due to rabies and to adverse events from the use of nerve tissue vaccines) are shown under different assumptions (estimates under the assumption of no time discounting or age-weighting should be directly comparable to the 2010 Global Burden of Disease study).S1 Fig. Division of costs associated with rabies, prevention and control across sectors by cluster. Inset shows proportional expenditure in different clusters. Full details of countries by cluster are given in S1 Table. Asia 4 comprises: Philippines, Sri Lanka, Thailand (High PEP use); Asia 3 comprises Bhutan, Nepal, Bangladesh, Pakistan (Himalayan region); Asia 2 comprises Cambodia, Myanmar, Laos, Vietnam and Democratic People’s Republic of Korea; SADC comprises countries in the Southern African Development Community, Eurasia comprises Afghanistan, Kazakhstan, Kyrgyzstan, Mongolia, the Russian Federation, Turkmenistan, Tajikistan, and Uzbekistan.S1 Dataset. Model code and input data files including references, rationale and detail of Delphi process. The code folder contains seven R scripts: burden_model.R runs the model using data compiled in burden_1.R, after estimating parameters using: FitCovInc.R, FitPP.R, and creating Fig 2 (RabiesBurdenFig2.R). The script burden_results.R summarizes findings using the output of burden_model.R and burden_sensitivity.R runs the sensitivity analyses. The data folder contains 12 csv files called by the R code for the analyses, and one excel file (Vet. xlsx) with additional details about the data sources in vcountry2.csv and vcluster2.csv and with Delphi process estimates for dog vaccination coverage. Data sources are detailed in the relevant data sources and the details of the sources of data used in the analysis are in the supporting bibliography, S1 text.This study was funded by the UBS Optimus Foundation (http://www.ubs.com/optimusfoundation) and the Wellcome Trust (095787/Z/11/Z).http://www.plosntds.orgam201

Distribuição espacial da leishmaniose visceral canina e humana no município de Birigui-SP

A leishmaniose visceral americana (LVA) ou calazar é uma antropozoonose causada pelo protozoário Leishmania (L.) chagasi, transmitida através do repasto sanguíneo de flebotomíneos. O cão é o principal reservatório e fonte de infecção para o ser humano e outros cães. Os objetivos deste trabalho foram: determinar a distribuição espacial da leishmaniose visceral canina (LVC) e da LVA no Município de Birigui (SP) no período de 1998 a 2003, localizar, espacialmente, os casos de LVC e LVA; e avaliar a relação espacial da ocorrência da LVC com a LVA. Foi realizada uma busca por dados epidemiológicos dos cães e seres humanos junto à Secretaria Municipal de Saúde. Os dados sobre a ocorrência da LVA e LVC foram distribuídos espacialmente no mapa do município, subdivido em 16 setores, seguindo o critério do Programa Nacional de Combate à Dengue. Foi utilizado o teste de correlação de Pearson para a associação das variáveis. Com relação aos resultados, verificou-se 1.384 cães positivos para pesquisa de anticorpos anti-Leishmania e 13 seres humanos com LVA. Dos cães com LVC, 51,8% eram machos, 65,5% sem raça definida, 67,3% de porte médio e 29,6% tinha idade entre 7 e 12 meses. O tempo médio de espera do diagnóstico laboratorial da Leishmaniose Visceral Canina foi de 49,7 dias e a taxa de ocorrênciade LVC no município foi de 2,97%, com presença da enfermidade em 15 dos 16 setores. Dos seres humanos com LVA, 76,9% eram do gênero masculino e a idade variou de 1 a 76 anos. A incidência no período estudado foi de 13,8/100.000 hab. e taxa de letalidade de 30,8%. Observou-se que em dez setores do município ocorreram casos de LVA. Houve correlação positiva (r=0,963) entre os casos de Leishmaniose Visceral Canina e Leishmaniose Visceral Americana e baixa correlação (r=0,033) entre a taxa de ocorrência de LVC e o coeficiente... .American Visceral Leishmaniasis (AVL) or Kalazar, is one antropozoonosis caused by the protozoan Leishmania (L.) chagasi, it is transmitted by the bites of phlebotomous mosquitoes. The dog is the main reservoir to humans and other dogs. The objectives of this work was: to determine the canine visceral leishmaniasis (CVL) and AVL spatial distribution in the City of Birigui, São Paulo State, Brazil, during 1998 thru 2003; to locate, spacially, the CVL and AVL cases; and to evaluate the spatial relation between CVL and AVL occurrence. An epidemiological data search was carried through for the dogs and human in the City Department of Health. The AVL and CVL occurrence data was spacially distributed in the city map, subdivide in 16 sectors, following the Dengue National Combat Program criteria. The Pearsonþs correlation test was used for the variable association. About the results, was verified 1,384 positive dogs for anti-Leishmania antibodies tests, and 13 human with AVL. The dogs with CVL, 51.8% were male, 65.5% without defined race, 67.3% of medium size and 29.6% had age between 7 and 12 months. The average of time to wait the laboratorial diagnosis on CVL was of 49,7 days and the CVL occurrence rate 2,97%, with disease presence in 15 of the 16 sectors. About the human with AVL, 76.9% they were male and the age varied of 1 thru 76 years. The incidence rate in the period was 13,8/100.000 hab. And the lethality was 30,8%. It was observed that in ten sectors of the city had occurred AVL cases. It had positive correlation (r=0,963) between the CVL cases and AVL, and low correlation (r=0,033) between the CVL occurrence and the AVL incidence. It was concluded that the AVL and CVL cases are spacially distributed in all city. The same model, applied in this study, can be used by other cities that has occurrence of AVL and CVL, to assist in the strategies for the control of this important zoonosis

One Health for neglected tropical diseases

The forthcoming World Health Organization road map for neglected tropical diseases (NTDs) 2021–2030 recognises the complexity surrounding control and elimination of these 20 diseases of poverty. It emphasises the need for a paradigm shift from disease-specific interventions to holistic cross-cutting approaches coordinating with adjacent disciplines. The One Health approach exemplifies this shift, extending beyond a conventional model of zoonotic disease control to consider the interactions of human and animal health systems within their shared environment and the wider social and economic context. This approach can also promote sustainability and resilience within these systems. To achieve the global ambition on NTD elimination and control, political will, along with contextualised innovative scientific strategies, is required.http://trstmh.oxfordjournals.orghj2021Veterinary Tropical Disease