Sunny E. Townsend

Designing programs for eliminating canine rabies from islands: Bali, Indonesia as a case study.

Background Canine rabies is one of the most important and feared zoonotic diseases in the world. In some regions rabies elimination is being successfully coordinated, whereas in others rabies is endemic and continues to spread to uninfected areas. As epidemics emerge, both accepted and contentious control methods are used, as questions remain over the most effective strategy to eliminate rabies. The Indonesian island of Bali was rabies-free until 2008 when an epidemic in domestic dogs began, resulting in the deaths of over 100 people. Here we analyze data from the epidemic and compare the effectiveness of control methods at eliminating rabies. Methodology/Principal Findings Using data from Bali, we estimated the basic reproductive number, R 0, of rabies in dogs, to be ∼1·2, almost identical to that obtained in ten–fold less dense dog populations and suggesting rabies will not be effectively controlled by reducing dog density. We then developed a model to compare options for mass dog vaccination. Comprehensive high coverage was the single most important factor for achieving elimination, with omission of even small areas (<0.5% of the dog population) jeopardizing success. Parameterizing the model with data from the 2010 and 2011 vaccination campaigns, we show that a comprehensive high coverage campaign in 2012 would likely result in elimination, saving ∼550 human lives and ∼

Response to a rabies epidemic, Bali, Indonesia, 2008-2011.

15 million in prophylaxis costs over the next ten years. Conclusions/Significance The elimination of rabies from Bali will not be achieved through achievable reductions in dog density. To ensure elimination, concerted high coverage, repeated, mass dog vaccination campaigns are necessary and the cooperation of all regions of the island is critical. Momentum is building towards development of a strategy for the global elimination of canine rabies, and this study offers valuable new insights about the dynamics and control of this disease, with immediate practical relevance.

Surveillance guidelines for disease elimination: a case study of canine rabies.

Emergency vaccinations and culling failed to contain an outbreak of rabies in Bali, Indonesia, during 2008–2009. Subsequent island-wide mass vaccination (reaching 70% coverage, >200,000 dogs) led to substantial declines in rabies incidence and spread. However, the incidence of dog bites remains high, and repeat campaigns are necessary to eliminate rabies in Bali.

A Bayesian approach for inferring the dynamics of partially observed endemic infectious diseases from space-time-genetic data

Surveillance is a critical component of disease control programmes but is often poorly resourced, particularly in developing countries lacking good infrastructure and especially for zoonoses which require combined veterinary and medical capacity and collaboration. Here we examine how successful control, and ultimately disease elimination, depends on effective surveillance. We estimated that detection probabilities of <0.1 are broadly typical of rabies surveillance in endemic countries and areas without a history of rabies. Using outbreak simulation techniques we investigated how the probability of detection affects outbreak spread, and outcomes of response strategies such as time to control an outbreak, probability of elimination, and the certainty of declaring freedom from disease. Assuming realistically poor surveillance (probability of detection <0.1), we show that proactive mass dog vaccination is much more effective at controlling rabies and no more costly than campaigns that vaccinate in response to case detection. Control through proactive vaccination followed by 2 years of continuous monitoring and vaccination should be sufficient to guarantee elimination from an isolated area not subject to repeat introductions. We recommend that rabies control programmes ought to be able to maintain surveillance levels that detect at least 5% (and ideally 10%) of all cases to improve their prospects of eliminating rabies, and this can be achieved through greater intersectoral collaboration. Our approach illustrates how surveillance is critical for the control and elimination of diseases such as canine rabies and can provide minimum surveillance requirements and technical guidance for elimination programmes under a broad-range of circumstances.

Rabies control and elimination: a test case for One Health

We describe a statistical framework for reconstructing the sequence of transmission events between observed cases of an endemic infectious disease using genetic, temporal and spatial information. Previous approaches to reconstructing transmission trees have assumed all infections in the study area originated from a single introduction and that a large fraction of cases were observed. There are as yet no approaches appropriate for endemic situations in which a disease is already well established in a host population and in which there may be multiple origins of infection, or that can enumerate unobserved infections missing from the sample. Our proposed framework addresses these shortcomings, enabling reconstruction of partially observed transmission trees and estimating the number of cases missing from the sample. Analyses of simulated datasets show the method to be accurate in identifying direct transmissions, while introductions and transmissions via one or more unsampled intermediate cases could be identified at high to moderate levels of case detection. When applied to partial genome sequences of rabies virus sampled from an endemic region of South Africa, our method reveals several distinct transmission cycles with little contact between them, and direct transmission over long distances suggesting significant anthropogenic influence in the movement of infected dogs.

Dog Rabies and its Control

One Health approaches have already been shown to be successful in controlling rabies in different parts of the world. In this article, the latest in Veterinary Records series promoting One Health, Sarah Cleaveland and her colleagues at the University of Glasgow discuss why integrated strategies are needed to enhance the cost effectiveness of measures to control and eliminate rabies, particularly in low-income countries

The Changing Landscape of Rabies Epidemiology and Control

Domestic dogs are the major reservoir of rabies virus across much of its range, and are responsible for the majority of human exposures. The control of the disease in domestic dogs thus has important implications for public health, particularly in Africa and Asia where canine rabies is endemic. Dog rabies control measures have the ultimate objective of decreasing the burden of human rabies, and of eventual elimination in endemic areas. Mass vaccination is the mainstay of successful dog rabies control. This chapter covers some of the key theoretical concepts of the epidemiology of dog rabies, and highlights the principles of control of the disease through mass vaccination. Practical aspects for the successful implementation of mass dog vaccination campaigns, including issues of sustainability, are also discussed.

Mobile phones as surveillance tools: Implementing and evaluating a large-scale intersectoral surveillance system for rabies in Tanzania

Over the past 20 years, major progress has been made in our understanding of critical aspects of rabies epidemiology and control. This paper presents results of recent research, highlighting methodological advances that have been applied to burden of disease studies, rabies epidemiological modelling and rabies surveillance. These results contribute new insights and understanding with regard to the epidemiology of rabies and help to counteract misperceptions that currently hamper rabies control efforts in Africa. The conclusion of these analyses is that the elimination of canine rabies in Africa is feasible, even in wildlife-rich areas, through mass vaccination of domestic dogs and without the need for indiscriminate culling to reduce dog population density. Furthermore, the research provides valuable practical insights that support the operational planning and design of dog vaccination campaigns and rabies surveillance measures.

Can parasites drive population cycles in mountain hares

Katie Hampson and colleagues describe their experience of developing and deploying a large-scale rabies surveillance system based on mobile phones in southern Tanzania.

Heterogeneity in the spread and control of infectious disease: consequences for the elimination of canine rabies.

Understanding the drivers of population fluctuations is a central goal of ecology. Although well-established theory suggests that parasites can drive cyclic population fluctuations in their hosts, field evidence is lacking. Theory predicts that a parasite that loosely aggregates in the host population and has stronger impact on host fecundity than survival should induce cycling. The helminth Trichostrongylus retortaeformis in the UKs only native lagomorph, the mountain hare, has exactly these properties, and the hares exhibit strong population fluctuations. Here we use a host–parasite model parametrized using the available empirical data to test this superficial concordance between theory and observation. In fact, through an innovative combination of sensitivity and stability analyses, we show that hare population cycles do not seem to be driven by the parasite. Potential limitations in our parametrization and model formulation, together with the possible secondary roles for parasites in determining hare demography, are discussed. Improving our knowledge of leveret biology and the quantification of harvesting emerge as future research priorities. With the growing concern over the present management of mountain hares for disease control in Scotland, understanding their population drivers is an important prerequisite for the effective management of this species.