title: Surveillance of Canine Rabies in the Central African Republic: Impact on Human Health and Molecular Epidemiology.
abstract: BACKGROUND
  Although rabies represents an important public health threat, it is still a neglected disease in Asia and Africa where it causes tens of thousands of deaths annually despite available human and animal vaccines. In the Central African Republic (CAR), an endemic country for rabies, this disease remains poorly investigated.
  
  
  METHODS
  To evaluate the extent of the threat that rabies poses in the CAR, we analyzed data for 2012 from the National Reference Laboratory for Rabies, where laboratory confirmation was performed by immunofluorescence and PCR for both animal and human suspected cases, and data from the only anti-rabies dispensary of the country and only place where post-exposure prophylaxis (PEP) is available. Both are located in Bangui, the capital of the CAR. For positive samples, a portion of the N gene was amplified and sequenced to determine the molecular epidemiology of circulating strains.
  
  
  RESULTS
  In 2012, 966 exposed persons visited the anti-rabies dispensary and 632 received a post-exposure rabies vaccination. More than 90% of the exposed persons were from Bangui and its suburbs and almost 60% of them were under 15-years of age. No rabies-related human death was confirmed. Of the 82 samples from suspected rabid dogs tested, 69 were confirmed positive. Most of the rabid dogs were owned although unvaccinated. There was a strong spatiotemporal correlation within Bangui and within the country between reported human exposures and detection of rabid dogs (P<0.001). Phylogenetic analysis indicated that three variants belonging to Africa I and II lineages actively circulated in 2012.
  
  
  CONCLUSIONS
  These data indicate that canine rabies was endemic in the CAR in 2012 and had a detrimental impact on human health as shown by the hundreds of exposed persons who received PEP. Implementation of effective public health interventions including mass dog vaccination and improvement of the surveillance and the access to PEP are urgently needed in this country.
authors: Laboratoire de Virologie, Institut Pasteur de Bangui, Bangui, Central African Republic.
authors: Vianney
authors: V
authors: Tricou
authors: Médecins du Monde France, Paris, France.
authors: Julie
authors: J
authors: Bouscaillou
authors: Laboratoire de Virologie, Institut Pasteur de Bangui, Bangui, Central African Republic.
authors: Emmanuel
authors: E
authors: Kamba Mebourou
authors: Service de Santé Publique Vétérinaire, Agence Nationale du Développement de l'Elevage, Bangui, Central African Republic.
authors: Fidèle Dieudonné
authors: FD
authors: Koyanongo
authors: Laboratoire de Virologie, Institut Pasteur de Bangui, Bangui, Central African Republic.|Laboratoire National de Référence pour la Rage, Institut Pasteur de Bangui, Bangui, Central African Republic.
authors: Emmanuel
authors: E
authors: Nakouné
authors: Laboratoire de Virologie, Institut Pasteur de Bangui, Bangui, Central African Republic.
authors: Mirdad
authors: M
authors: Kazanji
mesh_terms: D000293:Adolescent; D000328:Adult; D000818:Animals; D002488:Central African Republic / Q000453:epidemiology; D002648:Child; D004283:Dog Diseases / Q000453:epidemiology / Q000821:virology*; D004285:Dogs; D005260:Female; D006801:Humans; D008297:Male; D017720:Molecular Epidemiology; D010802:Phylogeny; D056990:Post-Exposure Prophylaxis; D011818:Rabies / Q000453:epidemiology* / Q000517:prevention & control / Q000662:veterinary* / Q000821:virology; D011820:Rabies virus / Q000145:classification / Q000235:genetics* / Q000302:isolation & purification / Q000502:physiology; D018571:Sentinel Surveillance; D055815:Young Adult