CAN RABIES BE ERADICATED

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CAN RABIES BE ERADICATED?

C.E. Rupprecht Poxvirus Rabies Branch National
Center for Zoonotic, Vector-borne, Enteric
Diseases
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• RABIES ERADICATION OUTLINE
• Definitions
• Global perspective
• Examples of dog rabies elimination
• Challenges and opportunities

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• TERMINOLOGY
• Eradication
• Elimination
• Prevention
• Control

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The disease Rabies is an acute progressive
encephalitis caused by a lyssavirus
LYLES RUPPRECHT, 2006
Despite repeated attempts to muddy the
epidemiological waters, carriers are unimportant
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• TO BE FREE OF THE DISEASE
• Assumes a minimum infrastructure
• Implies ability for routine surveillance
• Suggests a means to maintain status
• Confounds the objective imagination

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• SURVEILLANCE
• The systematic, on-going, long term collection,
  analysis, interpretation, and dissemination of
  data regarding the specific temporal and spatial
  occurrence of rabies for use in public health and
  veterinary actions.
• Approach infers a sensitive and specific
  laboratory-based methodology applied to basic
  case definition.
• System may be either passive (e.g. public health
  submissions of biting animals) or active (e.g.,
  enhanced studies unrelated to human exposure).

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RABIES SURVEILLANCE MILESTONES

• PRIORITIZATION zoonotic significance
• COOPERATION intersectoral health/agricultural
• STANDARDIZATION methods
• DECENTRALIZATION locality-based efforts
• COORDINATION local - national links

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RABIES SURVEILLANCE MILESTONES

• EDUCATION public outreach
• INTEGRATION NGOs, academic programs, etc.
• MODERNIZATION electronic age, tech transfer
• COLLABORATION borders international partners
• LEGISLATION reportable disease

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MODERN SURVEILLANCE IMPLIES MORE THAN
CASE IDENTIFICATION
Fox (Arctic, Red)
Gray Fox (AZ)
90
Arctic Fox
NC Skunk
Red Fox (Historic)
Skunk (NC USA) CA Skunk Coyote (TX) Gray Fox
(TX)
80
CA Skunk
Raccoon (E USA)
AZ Gray Fox
85
Raccoon
TX Gray Fox
SC Skunk
Skunk (SC-USA)
TX Coyote (Historic)
Nucleotide Sequence Identity of Antigenic Variants
Antigenic genetic typing adds resolution
identifies distinct viral variants.
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Advances in Computer Technology Aid in
Descriptive and Analytical Rabies Epidemiology

• Applications of GIS
• Human, animal, environmental data
• Definition of high risk areas
• Models can predict spread

Suggested rabies spread in Ohio
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Electronic Reporting
Allows Real-time Awareness Promotes Data
Dissemination Enhances Decision Making
Incorporates GIS features Demonstrates
Surveillance Efforts Accesses Direct Web-based
Links to Central Case Database Permits
International Sharing to Promote Multi-National
Efforts
Example of RabID
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• SURVEILLANCE RATIONALE
• Immediate public health actions (e.g.
  prophylaxis, quarantine, etc.)
• Program planning and implementation (e.g.
  domestic animal control, wildlife vaccination,
  etc.)
• Public education (e.g. health communications,
  translocation issues, etc.)
• Research applications (e.g., pathogen discovery,
  diagnostic assays, etc.)

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Field evaluation of diagnostics in the Serengeti
ecological region of Northwestern Tanzania
Lembo et al 2006
Genet
Domestic dog
DRIT
63x
DRIT
100x
DFA test
20x
DFA test
20x
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Global Vision

• Elimination of human rabies transmitted by
  dogs
• (PAHO-WHO)

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Human rabies and canine rabies cases, Latin
America, 1980-2003
Source SIRVERA, PAHO/WHO, 2003
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ORV Progress
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Wildlife Implications Rabies Among Coyotes in
Texas
Year
Rabies Cases
ORV
1995
Rabies case in 2001 and 2004
2000- 2004
ORV zone
No detection of canine rabies virus variant since
2004
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ORV Concepts from Wildlife Have Been Applied To
Free-ranging Dogs in Africa, Asia, Europe, North
America
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• AFRICA
• Greatest area lacking information
• Dog rabies enzootic in most areas
• Limited exceptions are considered free (e.g.,
  Cape Verde, Libya, Mauritius, Reunion, Sao Tome
  and Principe, Seychelles, etc.)

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• ANTARCTICA
• Rabies never reported
• No bats or terrestrial carnivores
• Illegal to introduce non-native fauna

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• ASIA
• Greatest disease burden
• Dog rabies enzootic in most areas
• Limited exceptions are considered free (e.g.,
  Japan, Hong Kong, parts of Indonesia, Malaysia,
  etc.)

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• AUSTRALIA NEW ZEALAND
• Canine rabies never established
• No lyssaviruses reported in New Zealand

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• EUROPE
• Canine rabies eliminated from majority of
  continent
• Wild carnivore rabies eliminated from most of
  western Europe

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• PACIFIC OCEANIA
• Rabies never reported or established in vast
  majority of area
• Rare example of canine rabies introduction
  followed by elimination (e.g., Guam)

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• THE NEW WORLD
• Canada the United States
• Caribbean (with exception of Haiti)
• In Latin America, parts of Central America (e.g.
  Costa Rica, Panama), as well as several countries
  in South America (e.g. Uruguay, Chile).

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HUMAN RABIES PREVENTION

• Human rabies cases are preventable
• -By avoiding exposures.
• -By the application of appropriate wound care,
  tissue culture vaccines, and immune globulins

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CONCLUSIONS
Broadly interpreted, rabies is not a candidate
for eradication now. Future technologies will
provide applications for enhanced
abatement. Global opportunities exist for
renewed engagement in the 21st century. Canine
rabies can be eliminated. Rabies occurrence in
humans is preventable. Wild carnivore rabies may
be controlled.
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• CAN RABIES BE ERADICATED????
• -Yes (a question of balance in perspective)
• - No (if we are honest and live in the now)
• - Maybe (because hope springs eternal)
• - I do not know (as ignorance is bliss, things
  change, and life on earth is unpredictable)

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Acknowledgements

• J. Barrett
• D. Briggs
• F. Cliquet
• T. Fooks
• B. Lumlertdacha
• F. Meslin
• T. Muller
• L. Nel
• C. Schneider
• N. Tordo
• A. Wandeler

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QUESTIONS?

The views expressed are those of the authors and
not necessarily representative of their
institutions.