Model development for targeted rabies control and management in Asia

Lead Research Organisation: University of Warwick
Department Name: School of Life Sciences

Abstract

Rabies circulating in domestic dogs has been eliminated from the industrialised world, but remains a major public health concern throughout low and middle-income countries, imposing an enormous toll in human lives and economic costs. Following the global targets of zero human deaths from dog-mediated rabies by 2030, elimination of the disease has become the ultimate goal for many control managers around the world. Scientific guidance for managing elimination programmes to ensure continued progress is, however, often limited and lacking in specific recommendations.

The most effective strategies should be deployed accordingly to the local epidemiological dynamics. Uncertainty in the pattern of disease spread, however, hinders decision-making given limited surveillance data of variable quality and substantial spatial and temporal heterogeneity characteristics of the disease. In this work, we will use Bayesian Monte Carlo Markov Chain (MCMC) methodology to utilize partially observed rabies incidence data from endemic settings across Southeast Asia. The resulting parameter estimates will subsequently inform development of spatially tailored mathematical and statistical models to address the question on how to optimize rollout and impact of control strategies.
Combining extensive understanding of rabies dynamics with sophisticated quantitative tools will allow us to explore and evaluate the effectiveness of potential intervention options for disease management, ensuring that the resulting recommendations are practical and implementable for rabies stake-holders and practitioners in Southeast Asia. Our findings will, therefore, translate directly into global policy development, delivering context-specific guidelines for elimination efforts and sustained freedom.

Publications

10 25 50
publication icon
Purwo Suseno P (2019) Lessons for rabies control and elimination programmes: a decade of One Health experience from Bali, Indonesia. in Revue scientifique et technique (International Office of Epizootics)

Studentship Projects

Project Reference Relationship Related To Start End Student Name
BB/M01116X/1 01/10/2015 30/09/2023
1786910 Studentship BB/M01116X/1 03/10/2016 31/01/2021 Kristyna Rysava
 
Description Our research has addressed questions round rabies control and surveillance in low-income settings in Southeast Asia. the preliminary results are summarised below.
1) Routine surveillance of rabies in dogs is insufficient with epidemiological investigations conducted only in the case of human death from rabies. We identified a pressing need for enhanced surveillance to provide insights into the local epidemiological situation, to evaluate control measures and identify individuals at risk of rabies.
2) Mass vaccination of dogs is the key measure to sustainably control rabies and achieve elimination, but the competing priorities for other diseases of more industrial importance mean that very little resources are allocated to rabies control in dogs. On the other hand, substantial budget is allocated to provision of post-exposure vaccine for humans even in the case of non-rabies cases with bite incidence increasing every year. We provide a One Health surveillance framework to guide epidemiological investigations at anti-rabies clinics and in field to rapidly identify truly rabid individuals and facilitate relevant healthcare for those in need. This approach would result in necessary savings on the human side that could be redirected to funding the fundamental veterinary intervention programmes.
Exploitation Route We are continuously communicating our results (and recommendations based on these outputs) with the Departments of Health and Agriculture in the Philippines, as well as with the provincial veterinary office and non-governmental organisations.
Sectors Environment,Healthcare

 
Description Through our pilot project in Albay Province, Philippines we provided local capacity training in epidemiological investigations, contact tracing and data management. In addition, our presence in the region facilitated a wide-spread awareness of rabies in domestic dogs and the risk of rabies transmission from dogs to humans.
First Year Of Impact 2018
Sector Digital/Communication/Information Technologies (including Software),Education,Healthcare
Impact Types Societal,Policy & public services

 
Description National Rabies Prevention and Control Committee Meeting - Progressive zoning to guide and accelerate rabies elimination programmes
Geographic Reach National 
Policy Influence Type Participation in a national consultation
 
Description Technical Consultant, UN Food and Agriculture Organisation office Jakarta, Indonesia - Guidelines for rabies control and management in Bali
Geographic Reach Local/Municipal/Regional 
Policy Influence Type Gave evidence to a government review
Impact I have undertaken a work placement with The Food and Agriculture Organization of the United Nations in Indonesia between January and March 2017, assigned to their regional rabies programme. The lager objective of my internship at FAO was to to develop management recommendations to inform their Technical Cooperation Project and contribute to a management workshop in Bali planned for early May 2017. My main duties included compilation and evaluation of existing rabies control and surveillance practices and dog management in Bali and their epidemiological impacts through review of existing reports and documentation and field assessment of technical operations on the ground. By direct liaising with the FAO personnel and local government authorities I was able to validate existing documentation on rabies management and control strategies as well as to obtain missing data and internal governmental reports. By the end of my internship, FAO was provided with a written report collating insights into strengths and weaknesses of the current rabies management in Bali. This report was then used to support new recommendation guidelines and changes in the local legislation on the context of rabies control and public health in Bali. I have maintained my working relationship with the FAO, providing scientific support and updated recommendations for annual mass dog vaccination campaigns.
 
Description Travelling Fellowships to support attendance of the VSRC programme at the EEB Department, Princeton
Amount £2,500 (GBP)
Funding ID DMMTF181154 
Organisation Company of Biologists 
Sector Charity/Non Profit
Country United Kingdom
Start 01/2019 
End 06/2019
 
Title Surveillance design and data collection for enhanced detection rabies cases 
Description As part of my PhD research, I am leading a project to develop new approaches for enhanced One Health surveillance and timely communication of canine rabies in the Philippines, aiming to facilitate faster progress of rabies control and elimination efforts. To this date, I have established a longitudinal study of dog bite-injury patients starting in March 2018 in Albay province, in central Bicol peninsula (Region V, Philippines), and designed detailed surveillance questionnaires for active case-finding by tracing of dog-bite patients attending anti-rabies clinics. Nurse personnel at clinics record patient background information and share the information with our team of study data collectors who conduct a short interview (following the above mentioned questionnaires) with patients after post-exposure prophylaxis is administered. Interviews inspect bite incident background, history and health condition of the biting dog and details on the exposure and treatment. When telephone numbers are provided, bite victims are called after 14 days and an additional questionnaire is completed over the phone to identify whether an incident involved a potentially rabid animal. If a bite is suspected to be due to a rabid animal, a field investigation is carried out to obtain a sample from a suspicious animal for confirmatory testing using the Fluorescent Antibody Test (FAT). Clinic registry data, patient interviews and phone follow up information as well as laboratory results are recorded using a tailor-made mobile phone-based application (BITERS; please, see Software & Technical Products). 
Type Of Material Improvements to research infrastructure 
Year Produced 2018 
Provided To Others? Yes  
Impact Since the establishment of our integrated surveillance scheme in Albay province in early 2018, we have overseen a six-fold increase in the number of detected, laboratory confirmed dog cases, directly yielding positive public health implications. I have also begun to establish communication with the Department of Health (DoH) and Bureau of Animal Industry (BAI) and our my has been presented at the National Rabies Prevention and Control Committee (NRPCC). Therefore I believe that there is significant potential for our integrated surveillance protocol to be taken up at the national level and potentially expand the impact at larger (national) scale. More over, the data collected are used to generate better insights in disease dynamics through increased detection of rabies, as well as information on health-seeking behavior of bite victims and potential to diagnose rabid dogs clinically. 
 
Description An Investigation of the Epidemiological Characteristics of Teratogenic Viruses and the Potential Positive Implications of Teratogenicity on Pathogen Fitness and Disease Persistence 
Organisation Princeton University
Country United States 
Sector Academic/University 
PI Contribution During my stay at Princeton, I will be working with Professor Jessica Metcalf and her final year undergraduate student Vivian Ufongene upon model development of teratogenic disease dynamics with the aim to push forward our understanding of the evolutionary context acting on transmission of teratogenic infections that are likely to yield both evolutionary insight and public health information.
Collaborator Contribution Combining expertise in mathematical modelling and computational methods with strong ecological underpinning will both build my research skills as well further the Metcalf lab's agenda on evolutionary drivers of disease persistence.
Impact A manuscript submitted.
Start Year 2019
 
Description Deciphering the spatial scale of rabies transmission: understanding principles governing effective control strategies 
Organisation Princeton University
Department Princeton Plasma Physics Laboratory
Country United States 
Sector Academic/University 
PI Contribution During my stay at Princeton, I aim to work closely with Professor Jessica Metcalf (the Metcalf lab), an expert in infectious disease ecology, with a particular interest in spatiotemporal dynamics of disease systems in the context of control interventions. Additionally, I aspire to build upon the mutual interest in spatial ecology I share with Malavika Rajeev, a Princeton graduate student at the Metcalf lab, and further explore spatiotemporal dynamics of rabies transmission. Bringing detailed epidemiological datasets from different rabies-endemic settings as well as diverse technical skills, both Malavika and I will greatly benefit from the collaborative efforts, developing novel analytical approaches for capturing the spatial scale of rabies risk. Interacting with Professor Metcalf as well as other academics in the wider group at the Department of Ecology and Evolutionary Biology will give me an opportunity to obtain research experience at an institute renowned for its excellence in addressing enigmatic questions applying cutting-edge tools and approaches. Undertaking the Visiting Student Research Collaboration scheme at Princeton University will be an incredible asset to my scientific portfolio, especially at the beginning of my career, expanding the methodologies I could draw from during my future research.
Collaborator Contribution With Prof Metcalf lab, I will be working on themes around rabies surveillance, control and elimination that echoes some of the core themes addressed in her lab. My unique perspective will be a welcome addition to their community, helping the group to break new ground in this important area. Over the course of my visit, we will both develop statistical methods to probe the pattern of rabies incidence, but also deepen our conceptual map of what limits rabies outbreaks. With my background in wildlife disease ecology, and increasing interest in surveillance, I will be a suitable addition to the community in Princeton.
Impact The goal of the visit is to drive forward research on rabies dynamics. This will be achieved through the development of novel statistical methodology that can be used to investigate spatial drivers of rabies transmission. Using a set of canonical systems for illustration, we aim to develop a tractable approach to capturing the spatial scale of rabies risk whilst deepening the conceptual understanding of factors limiting rabies spread. In addition to answering fundamental scientific questions in rabies ecology, the approaches we employ have the potential to influence both policy and practice based on immediate needs of stakeholders and the level of variability in the local system. For example, identifying areas of elevated risk as well as missing zones/hotspots of case reporting can directly inform the design of locally tailored surveillance strategies. Similarly, understanding the impact of interventions on spatiotemporal correlation has the potential to advise rabies vaccination programmes, particularly on logistical issues regarding the scale of spatial and temporal synchronicity. Our results are anticipated to ultimately provide applicable guidelines for decision making in the context of vaccination planning and rabies surveillance.
Start Year 2019
 
Title Mobile phone based application - Bite Incidence Tool for Enhanced Rabies Surveillance (BITERS) 
Description BITERS is a surveillance tool that assists the Philippines public health sector with recording and interpretation of surveillance data collected on rabies prevalence within the country. This framework includes a mobile-based application used by animal health workers at ABTCs to record follow up investigations of dog-bite patients. The resultant information will be linked to a web-based platform for visualisation and interpretation of monitoring data. This platform serves as a secure repository for rabies surveillance programmes and to generate and disseminate analytical output to relevant stakeholders, policymakers and rabies practitioners in "real-time". 
Type Of Technology Webtool/Application 
Year Produced 2017 
Impact The BITERS application has been piloted since March 2018 in Albay province, Philippines. During this pilot study, dog-bite victims are interviewed by animal health workers and all relevant information is uploaded and stored at a server hosted by the University of Warwick. Therefore, we provide a virtual database of animal bite cases in the province that allows for detailed investigation and follow up of suspect incidents. The database is directly used to generate insights in disease dynamics through increased detection of rabies, as well as information on health-seeking behavior of bite victims and potential to diagnose rabid dogs clinically. The outcome of this project is a mobile- and web-based tool that will not only be utilized to monitor progress towards rabies elimination in the Philippines, but that will be directly transferable to other endemic countries in Southeast Asia where rabies remains a significant public health threat and economic burden. 
URL http://nero.wsbc.warwick.ac.uk/biters/
 
Description OIE Stop Transboundary Animal Diseases and Zoonoses Initiative (STANDZ) Closing Ceremony 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Policymakers/politicians
Results and Impact Invited speaker to deliver a talk on rabies epidemiology in the Bicol Region, Philippines with particular focus on modeling work to support rabies control and management. The Ceremony was organised by the World Organization for Animal Health (OIE) in Legaspi, Philippines, June 2017.
Year(s) Of Engagement Activity 2017
 
Description The ASEAN-Tripartite Rabies Meeting 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Policymakers/politicians
Results and Impact At the ASEAN-Tripartite (WHO, FAO, OIE) Rabies Meeting held in Ha Noi, Viet Nam, in December 2018 I delivered a talk titled "Scientific platform to inform rabies control and management strategies in South East Asia", presented a series of scientific posters on rabies control and cost-effectiveness of One Health approaches in rabies management and surveillance as well as participated in workshops and debates discussing prospective improvements in rabies programmes implemented across Southeast Asia.
Year(s) Of Engagement Activity 2018
URL http://www.rr-asia.oie.int/regional-representations-activities/read/article/the-asean-tripartite-rab...