5.4.2. Why is epidemiological surveillance important and what can we do to enhance it?

- 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) to monitor and evaluate the progress and impact of intervention, (3) to manage potential human exposures adequately (4) to calculate the cost-effectiveness of control efforts and (5) to demonstrate absence and freedom of disease in a given area. (See Section 1 of the Rabies Surveillance Blueprint for further details on the importance of surveillance.)

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. An example list of basic indicators that can be used to assess the burden of canine rabies and the impact of control measures can be found here

- 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 programme must have the minimum infrastructure for laboratory-based diagnosis, as described here, using the gold standard, the 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, prior thorough validation and comparison to standard rabies diagnostic test is essential and confirmation of results at central laboratories using the fluorescent antibody test may only be required for negative samples. For an overview of the minimum requirements needed for an effective surveillance system, read Section 3 of the Rabies Surveillance Blueprint.

- Simple sample collection techniques for implementation by a range of operators, including veterinary, livestock/extension officers, and game wardens, may be introduced to facilitate field collection and transport of samples in remote rural locations and to improve sample submission rates. Click here for the list of supplies that 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. See the Rabies Surveillance Blueprint Section 3.3 for further information on personnel and infrastructure needed for sample collection.

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Photo courtesy of the Serengeti Carnivore Disease Project

- Recognition of rabies cases by communities living in rabies-endemic areas can be relatively accurate. Under these circumstances, information on (unconfirmed) cases of human and animal rabies and animal-bite injuries can be obtained from questionnaire surveys or may be part of syndromic surveillance. 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.

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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. Surveillance systems that take animal bite patient data and then follow up in the patients’ communities can lead to better data on cases of rabid animals and also reveal additional victims bitten by those dogs. If biting dogs are located and remain healthy after 10 days of observation, the patient can stop the course of PEP, leading to cost savings. This form of surveillance has been very effectively applied in Haiti (see CASE STUDY HAITI).

- Hospitals can also provide information on post-exposure prophylaxis doses administered which can be used to evaluate the cost-effectiveness of canine rabies control programmes 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. For more information, see here.

For further details on what types of data should be collected and how to establish a database for conducting epidemiological analysis is available in the Rabies Surveillance Blueprint, Section 5.

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