Toward Elimination of Dog-Mediated Human Rabies: Experiences from Implementing a Large-scale Demonstration Project in Southern Tanzania.
A Rabies Elimination Demonstration Project was implemented in Tanzania from 2010 through to 2015, bringing together government ministries from the health and veterinary sectors, the World Health Organization, and national and international research institutions. Detailed data on mass dog vaccination campaigns, bite exposures, use of post-exposure prophylaxis (PEP), and human rabies deaths were collected throughout the project duration and project areas. Despite no previous experience in dog vaccination within the project areas, district veterinary officers were able to implement district-wide vaccination campaigns that, for most part, progressively increased the numbers of dogs vaccinated with each phase of the project. Bite exposures declined, particularly in the southernmost districts with the smallest dog populations, and health workers successfully transitioned from primarily intramuscular administration of PEP to intradermal administration, resulting in major cost savings. However, even with improved PEP provision, vaccine shortages still occurred in some districts. In laboratory diagnosis, there were several logistical challenges in sample handling and submission but compared to the situation before the project started, there was a moderate increase in the number of laboratory samples submitted and tested for rabies in the project areas with a decrease in the proportion of rabies-positive samples over time. The project had a major impact on public health policy and practice with the formation of a One Health Coordination Unit at the Prime Minister's Office and development of the Tanzania National Rabies Control Strategy, which lays a roadmap for elimination of rabies in Tanzania by 2030 by following the Stepwise Approach towards Rabies Elimination (SARE). Overall, the project generated many important lessons relevant to rabies prevention and control in particular and disease surveillance in general. Lessons include the need for (1) a specific unit in the government for managing disease surveillance; (2) application of innovative data collection and management approaches such as the use of mobile phones; (3) close cooperation and effective communication among all key sectors and stakeholders; and (4) flexible and adaptive programs that can incorporate new information to improve their delivery, and overcome challenges of logistics and procurement.
Global Health and Biomedical Sciences, School of Life Sciences and Bioengineering, Nelson Mandela African Institution of Science and Technology, Arusha, Tanzania; Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, UK; Paul G. Allen School for Global Animal Health, Washington State University, Pullman, WA, USA.
Emmanuel Abraham
EA
Mpolya
Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow , Glasgow , UK.
Tiziana
T
Lembo
Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, UK; Ifakara Health Institute, Dar es Salaam, Tanzania.
Kennedy
K
Lushasi
Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow , Glasgow , UK.
Rebecca
R
Mancy
Department of Epidemiology, Ministry of Agriculture, Livestock and Fisheries , Dar es Salaam , Tanzania.
Eberhard M
EM
Mbunda
Department of Epidemiology, Ministry of Agriculture, Livestock and Fisheries , Dar es Salaam , Tanzania.
Selemani
S
Makungu
Department of Epidemiology, Ministry of Agriculture, Livestock and Fisheries , Dar es Salaam , Tanzania.
Matthew
M
Maziku
Ifakara Health Institute , Dar es Salaam , Tanzania.
Lwitiko
L
Sikana
Preventive Veterinary Medicine, Sokoine University of Agriculture (SUA) , Morogoro , Tanzania.
Gurdeep
G
Jaswant
Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow , Glasgow , UK.
Sunny
S
Townsend
Food Safety Zoonoses and Food-Borne Diseases, World Health Organization (former WO staff) , Geneva , Switzerland.
François-Xavier
FX
Meslin
Neglected Zoonotic Diseases, WHO , Geneva , Switzerland.
Bernadette
B
Abela-Ridder
Tanzania Veterinary Laboratory Agency (TVLA), Ministry of Agriculture, Livestock and Fisheries , Dar es Salaam , Tanzania.
Chanasa
C
Ngeleja
Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, UK; Ifakara Health Institute, Dar es Salaam, Tanzania.
Joel
J
Changalucha
Ifakara Health Institute , Dar es Salaam , Tanzania.
Zacharia
Z
Mtema
Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, UK; Ifakara Health Institute, Dar es Salaam, Tanzania.
Maganga
M
Sambo
Department of Epidemiology, Ministry of Health, Community Development, Gender, Elderly and Children (MoHCDGEC) , Dar es Salaam , Tanzania.
Geofrey
G
Mchau
Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow , Glasgow , UK.
Kristyna
K
Rysava
Department of Neglected Tropical Diseases, World Health Organization - Country Office of Tanzania , Dar es Salaam , Tanzania.
Alphoncina
A
Nanai
Preventive Veterinary Medicine, Sokoine University of Agriculture (SUA) , Morogoro , Tanzania.
Rudovick
R
Kazwala
Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow , Glasgow , UK.
Sarah
S
Cleaveland
Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow , Glasgow , UK.
Katie
K
Hampson
One Health; Rabies Elimination Demonstration Project; SARE; Southeastern Tanzania; mass dog vaccination