Lessons learned from Latin America’s near rabies-free status
Cases of rabies within Latin American and Caribbean (LAC) countries have declined dramatically in the last few decades.
Laboratory confirmed dog rabies cases decreased from 25,000 in 1980 to less than 300 in 2010 . It’s an incredible achievement which has been possible as a result of strong political and technical commitment to take control of the disease, coordinated by the Pan American Health Organization (PAHO).
Despite these consistent efforts, achieving a rabies-free region has remained elusive. The region has set and committed to four elimination targets (1990, 2000, 2012 and 2015). And although several countries have been declared rabies-free, there are still pockets where it exists .
A 2017 review by the Pan American Health Organisation summarized many of the lessons learned from their push to elimination and we’ve captured a few of these below:
1. Robust surveillance
Tracking a disease is the foundation of eradication. Unless we know where rabies exists, it cannot be treated. It’s why Latin American countries worked together to create SIRVERA. This database enables each country to track every rabies case, enabling them to better understand the scale and movement of the disease.
SIRVERA has demonstrated a clear link between those countries who use it and are successfully reducing the impact of rabies. It means that improving reporting in countries where rabies remains endemic could help clarify where they need to focus their efforts.
The regional program has also identified that monitoring cases does not offer the full picture. It’s supporting a shift towards monitoring capacities and vulnerabilities, in addition to incidences.
As part of this, it’s essential to track awareness among the population in risk areas to identify any areas that might be at risk of a rise in cases. This is because as incidences drop, so does awareness, which is often followed by a reduced uptake of preventative measures.
2. Plan vaccination stocks
All countries, aside from those who have been free from rabies for a while, include plans to purchase both human and dog vaccines in their annual budgets. But it is those that plan well in advance, have a clear timeline for usage and properly manage of batches that have reached elimination or are coming close.
The PAHO supplies quality vaccines at competitive prices to the region by utilizing its purchasing power. This has helped to promote regular budgeting practices in the countries. The PAHO’s incorporation of the dog rabies vaccine alongside the human rabies vaccine, as part of its regular purchase of treatments, has had a beneficial impact.
3. Persistently prioritize disease eradication
Rabies is a victim of its own success; as incidences drop, it can be perceived to be a lesser priority. But with more than 30 years of outstanding effort, falling at the last hurdle isn’t an option. Until we have eradicated the disease, it remains at risk of re-emergence.
To help keep the pressure on, system improvements are being rolled out. The regional program has developed a framework to evaluate rabies capacities, commissioned research to help provide guidance on dog surveillance and it has launched a new SIRVERA platform to manage evidence requirements in the elimination phase. It is also formalizing the process around maintaining elimination status.
And the end is in sight – the regional LAC program is now working towards eradication by 2022. Just four years from now, we could be celebrating a big step towards global elimination.
Read our interview with Professor Louis Nel, CEO of the Global Alliance for Rabies Control