Rabies surveillance is the key index for the success of any intervention programme. It involves the collection of essential data to (1) determine the rabies situation at the start of the programme, (2) monitor and evaluate the progress and impact of intervention, (3) manage potential human exposures adequately and (4) calculate the cost-effectiveness of control efforts. If surveillance measures are not in place at the start, they must be implemented quickly and strategically. It is important to stress that efficient reporting of data is as important as its collection, so that timely analyses can be conducted. Such analyses may reveal changes in the rabies situation, such as outbreaks which require immediate intervention.
Rabies in animals can be suspected based on bite history and clinical signs, but laboratory confirmation is the only definitive means of diagnosis. Countries embarking in a rabies control program must have the minimum infrastructure for laboratory-based diagnosis, as described here, using the gold standard direct fluorescent antibody test, at least at the central level (national rabies laboratories). Click here for a list of basic supplies you need to run this test. If alternative validated techniques are used, as described here, confirmation of results should be carried out at central laboratories using the fluorescent antibody test.
Simple sample collection techniques that can be implemented by a range of operators, including veterinary, livestock and extension officers and game wardens can be introduced to facilitate field collection and transport of samples in remote rural locations and in general to improve sample submission rates. Click here for the list of supplies rabies surveillance personnel need in the field. It is essential that transport of specimens to rabies diagnostic facilities is organized in an efficient way to ensure timely and safe delivery.
- Photo courtesy of the Serengeti Carnivore Disease Project
Rabies recognition by communities living in rabies-endemic areas is generally relatively accurate. Information on (unconfirmed) cases of human and animal rabies and animal-bite injuries can therefore be obtained during questionnaire surveys. However, this is generally of most use for rapid assessments rather than determining incidence, unless all reports can be followed up for further investigation. Questionnaire surveys may also be of value in understanding local knowledge, attitudes and behaviors and this information can be used for more targeted communication and education programmes.
- Photo courtesy of the Serengeti Carnivore Disease Project
Animal-bite injury data from hospitals are an easily accessible source of data and can be used as indicators of animal rabies cases in an area and rabies exposures, and to assess the impact of dog vaccination on human rabies exposures.
Hospitals can also provide information on post-exposure prophylaxis doses administered which can be used to evaluate the cost-effectiveness of canine rabies control programs through reduction in public health expenditure on costly human rabies vaccines (resulting from reduction in dog rabies).
It is also vital that accurate records of all expenditures on rabies control efforts are kept so that cost-benefit analyses can be completed at a later date. For the types of data needed to conduct economic and cost-benefit analyses see these examples.
Geo-referenced data on human and animal rabies cases (including clinical, laboratory-confirmed and animal-bite injury data) are useful to identify regions most affected by rabies and to ensure targeted actions.
Mobile phone technology could also enhance rabies surveillance by allowing real-time reporting/detection of cases and animal-bite injuries as well as providing timely information on availability of anti-rabies biologicals.
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