Rabies Epidemiological Bulletin (REB)

The Rabies Epidemiological Bulletin (REB) is a free-to-use, comprehensive, One Health rabies surveillance system that has been built by GARC for use by national governments. It helps countries to ensure that relevant rabies data can be collected easily and analysed automatically, resulting in system-generated visuals such as graphs, maps and tables.

REB levels
REB overview, depicting each of the levels in which the system facilitates the collection and analysis of country surveillance data

Sub-National REB components:  

While the primary function of the REB is to collect, collate, analyse and disseminate national-level data, various additional components, each designed to improve data resolution and quality for the country, have been developed. These components address challenges faced at each of the administrative levels and are summarised below. The data from each of the components can be automatically  aggregated to the national level, supplementing and improving the quality and resolution of the data at the national level.
 

Rabies Vaccination Tracker (RVT) component
RVT map
Map output of number of vaccinations tracked in an area

Used by: Animal vaccinators

The Rabies Vaccination Tracker (RVT) component of the REB facilitates tracking and planning of strategic mass dog vaccination campaigns. It enables the direct integration of the data collected on GARC Data Logger (GDL) devices into the bulletin, by allowing the automatic import of data that had been logged using a GDL directly onto the system within a few seconds. The REB automatically generates maps, graphs and other visuals based on the imported data, removing the need for timely analysis and costly GIS experts to process and analyse vaccination data.

End users who do not utilize the GDL in their vaccination campaigns, but still collect the coordinates for each vaccinated animal, are able to manually upload their data on to the RVT component of the REB. In so doing, countries still have access to the automatically generated maps, graphs and other visuals that are based on the manually imported data. 

Rabies Case Surveillance (RCS) component

Used by: Laboratories

RCS map F
Interactive map showcasing rabies-positive cases as red dots and vaccinated animals as black dots

The Rabies Case Surveillance (RCS) component of the REB analyses and creates outputs for rabies laboratory-diagnosed cases. It helps to plot both rabies-positive and -negative cases on maps to identify rabies hotspots and high-risk areas to direct targeted vaccination. In addition to the maps that are automatically generated, the data entered using the RCS component results in graphs and other visuals that showcase the effectiveness of the routine surveillance system across a pre-defined time period.

The RCS component has been designed to work hand-in-hand with the GDL component, enabling map overlays (rabies cases and vaccinated animals displayed on one map) to guide vaccination programs and monitor the effects of vaccination on reducing cases in a particular area. 

Community-Based Rabies Surveillance (CBRS) component

Used by: Health facilities, animal health professionals, Community Health Workers (CHWs).

The Community-based Rabies Surveillance (CBRS) component is a comprehensive, real-time, digital, integrated bite-case management system that not only incorporates the identification of human bite victims, but also the identification and processing of suspect rabid animals and dead animals in the community.

CBRS
Conceptualisation of the CBRS system (In this instance, the initiation of the system is triggered by the identification of a suspect animal in the community)

The CBRS is able to directly link suspect human cases with the responsible biting animal, meaning that authorities can track the outcome of the animal and correlate this to the treatment required for the human. For example, PEP can be stopped if the laboratory diagnosis of the suspect animal is negative. This outcome would result in direct cost-savings for the exposed person as well as the government. Alternatively, if the animal is confirmed positive, the patient can be reminded and encouraged to attend the clinic to complete their full course of PEP.
In brief, the CBRS focuses on the following aspects of surveillance:

  • Rapid identification of new suspect rabies cases (both human and animal cases)
  • Ensuring exposed individuals receive adequate PEP
  • Ensuring that more cases are detected and reported
  • Improving suspect sample submission (including roadkill)
  • Facilitating timely investigations and rapid follow-up
  • Can result in reduced PEP usage
  • Ensuring data quality and enabling identification of breaks in the communication chain
Rabies Treatment Tracker (RTT) component

Used by: Health facilities

The Rabies Treatment Tracker (RTT) component of the REB improves PEP compliance and patient record-keeping. It has been specifically designed to address the needs of tracking individual bite victims and people who have been potentially exposed to rabies. The RTT replaces the need for cumbersome paper-based record keeping, whilst also enabling health personnel to determine the location of high-risk bite patients, vaccine needs and requirements – with a focus on ensuring that stock can meet demand – and automatically reminding patients of their next required clinic visit.

The RTT focuses on patient PEP compliance through automated SMS and/or email reminders to help patients to complete their full course of PEP within the recommended timeframe. A referral system is also included to cater for patients who visit different clinics over their PEP course and to help health staff understand what treatments, vaccines and preventative measures have already been provided to the patient. Warnings and alerts based on adverse effects following vaccination, allergies and other challenges are created for health personnel, to ensure that each patient receives optimal treatment in a safe manner.
In summary, the RTT facilitates the following:

  • Improved PEP compliance with rabies-exposed individuals through automated messaging reminders
  • Automated patient risk-assessments based on exposure, wound category and other criteria
  • Streamlined and easily accessible patient records
  • Effective referral system to cater for patients attending multiple clinics
  • Alerts to health personnel relating to adverse effects, allergies and other specialised patient requirements
  • Vaccine stock tracking, reminders and alerts to ensure adequate stock in facilities
  • Tracking of bite incidence locations to plot and facilitate future interventions 

Lastly, by using the RTT in multiple health facilities, the collected data from each healthcare facility can be automatically aggregated up to the municipality, district, province/region, national level -  resulting in improved burden estimates within pre-defined geographical areas.

BPT data aggregation
BPT data aggregation from the healthcare facility level to the national level

Regional data collection and national reporting

The REB has been specifically designed for those countries that simply do not have the capacity or resources to develop, build and implement their own dedicated, One Health, rabies  surveillance systems. GARC provides human and technological resources to develop a customised section for each country on the REB. Data is entered in a secure area by government representatives from relevant departments (usually the Ministry of Agriculture - MoA, and the Ministry of Health - MoA). Although all of the countries share one data platform, each country has full access to only their own data at any point in time. 

Importantly, the data stored on the REB belongs to the country. GARC shares certain aggregated data on its website once permission is granted by the human and animal health sectors from each country. If a country does not provide GARC with permission, the data will not be publicly available. The REB is currently being used extensively throughout all the rabies-specific regional networks – PARACON, ARACON and MERACON

International reporting

The REB facilitates data reporting by countries to international organisations such as the WHO and FAO. GARC has been working closely with these, and other international organisations, to standardise indicators and facilitate the reporting process to these international platforms.