June 01, 2016

CDC Assesses Rabies Control Measures in Ethiopia

A recent article in Morbidity and Mortality Weekly Report describes a pilot program to improve the reporting and management of dog bites in Gondar, Ethiopia.
 
By Laurie Anne Walden, DVM, ELS
Over 2700 people die of rabies each year in Ethiopia, according to the Centers for Disease Control and Prevention (CDC). Rabies, which is endemic in dogs in Ethiopia, also causes livestock losses estimated at over $50 million USD. A recent article in Morbidity and Mortality Weekly Report describes a pilot program to improve the reporting and management of dog bites in Gondar, Ethiopia.
 
The CDC, the Ohio State University, the University of Gondar, and the Ethiopian Public Health Institute collaborated to develop an integrated bite-case management program in the city of Gondar. This program has been shown to increase bite detection rates and reduce the use of unneeded rabies postexposure prophylaxis. “Because [an integrated bite-case management program] represents integration of both human and animal health, it offers an opportunity to prevent human rabies deaths” and reduce the cost of postexposure prophylaxis, write the authors.
 
Dog bites are reportable in Ethiopia, but the human and animal health sectors have not routinely worked together to manage rabies or other zoonotic diseases. In an integrated bite-case management program, bites are reported by human health facilities to animal health workers, whose assessments of the animals guide treatment decisions for human patients. The program has 3 goals:
  • Record dog bites
  • Test dogs suspected of having rabies
  • Reduce human rabies exposure
     
The CDC evaluated the first 9 months of the pilot program (January through September 2015). Several factors hindered its implementation:
  • Shortages of rabies postexposure prophylaxis
  • Inadequate access to canine rabies vaccine
  • Delays in funding
  • Low dog-bite reporting rate because people often sought treatment from traditional healers instead of health professionals
  • Lack of rabies testing because construction of a rabies diagnostic center was delayed
  • Quarantine of suspected rabid animals in owners’ homes because of inadequate quarantine facilities
  • Inadequate cold-chain capacity (ability to maintain refrigeration throughout storage and distribution)
 
Measures that have been taken to improve dog-bite management in Ethiopia include the following:
  • Training more animal health workers, laboratory employees, and supervisors
  • Improving access to postexposure prophylaxis and canine rabies vaccine
  • Developing a rabies surveillance system
  • Identifying a temporary diagnostic laboratory to use while a rabies laboratory is being constructed
  • Building regional animal quarantine facilities
 
Recommendations for further work include increasing community awareness of the bite-case management program (to increase reporting of suspected rabid animals), ensuring that rabies vaccines are handled by facilities with proper cold-chain capacity, and encouraging traditional healers to send dog-bite patients for postexposure prophylaxis.
 
Dr. Laurie Anne Walden received her doctorate in veterinary medicine from North Carolina State University in 1994. After an internship at Auburn University College of Veterinary Medicine, she returned to North Carolina, where she has been in companion animal general practice for over 20 years. Dr. Walden is also a board-certified Editor in the Life Sciences and owner of Walden Medical Writing. 
 

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