Novel Community-Based Rabies Surveillance (CBRS) In Urban Lilongwe City, Malawi

Abstract

AbstractIntroductionRabies is a neglected tropical disease that is endemic to Malawi, killing almost 500 people every year. Domestic dogs are implicated as the main reservoir for rabies. However, there is limited capacity to detect canine rabies in the country, particularly in urban areas where there are high dog densities. The Lilongwe Society for the Protection and Care of Animals designed and implemented a canine community-based rabies surveillance (CBRS) in Lilongwe city between January and June 2020.ObjectivesThis study assessed the effectiveness of the CBRS program in canine rabies detection compared to the traditional passive routine surveillance data of the years between 2015 and 2019. Furthermore, the study determined rabies Post-Exposure Prophylaxis (PEP) issuance trends in emergent cases.MethodsSuspected rabies cases were recorded and followed. The dogs that were found alive were quarantined for 10 days for observation. Brain samples were collected post-mortem for direct-fluorescent antibody testing for antigen detection.ResultsThere were 610 suspected cases, and only 217 (39.2%) were followable. Out of these, 150 (62.8%) were followed. A total of 9 dogs (6%) tested positive, and there were 11 (7.3%) probable cases. This represents a 4.97-fold increase in rabies cases detected compared to the pre-surveillance period, with a resultant of 3.33 cases/month from 0.67 cases/month. The program also helped to initiate PEP treatment in exposed people. There were 141 bite victims and 136 (96.5%) reported for PEP. Out of these, 89 (65.4%) were from healthy bites and 33 (24.4%) from suspect cases indicating a 63.97% to 88.24% rate of irrelevant PEP issuance.ConclusionThe CBRS program established relevance in increasing canine rabies detection and subsequent prevention of related human infections. It also established a high rate of PEP issuance following healthy bites. Therefore, we recommend enhanced multi-sectoral collaborative efforts aimed at increasing rabies detection and optimizing PEP usage.One Health Impact StatementThis novel implementation research features a One Health approach, bringing together various stakeholders from the public and private sectors, as well as the community, in the effort to eradicate rabies. This collaboration provides synergy towards accelerating the identification of rabid animals in the community and effectively guides people to take the necessary precautions including prompt Post-Exposure Prophylaxis in cases of exposure, ultimately promoting health at the human-animal interface.